Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 11 de 11
Filter
1.
BMC Cardiovasc Disord ; 22(1): 270, 2022 06 16.
Article in English | MEDLINE | ID: covidwho-1962737

ABSTRACT

BACKGROUND: Cardiac rehabilitation for heart failure continues to be greatly underused worldwide despite being a Class I recommendation in international clinical guidelines and uptake is low in women and patients with mental health comorbidities. METHODS: Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme was implemented in four UK National Health Service early adopter sites ('Beacon Sites') between June 2019 and June 2020. Implementation and patient-reported outcome data were collected across sites as part of the National Audit of Cardiac Rehabilitation. The change in key outcomes before and after the supervised period of REACH-HF intervention across the Beacon Sites was assessed and compared to those of the intervention arm of the REACH-HF multicentre trial. RESULTS: Compared to the REACH-HF multicentre trial, patients treated at the Beacon Site were more likely to be female (33.8% vs 22.9%), older (75.6 vs 70.1), had a more severe classification of heart failure (26.5% vs 17.7%), had poorer baseline health-related quality of life (MLHFQ score 36.1 vs 31.4), were more depressed (HADS score 6.4 vs 4.1) and anxious (HADS score 7.2 vs 4.7), and had lower exercise capacity (ISWT distance 190 m vs 274.7 m). There appeared to be a substantial heterogeneity in the implementation process across the four Beacon Sites as evidenced by the variation in levels of patient recruitment, operationalisation of the REACH-HF intervention and patient outcomes. Overall lower improvements in patient-reported outcomes at the Beacon Sites compared to the trial may reflect differences in the population studied (having higher morbidity at baseline) as well as the marked challenges in intervention delivery during the COVID-19 pandemic. CONCLUSION: The results of this study illustrate the challenges in consistently implementing an intervention (shown to be clinically effective and cost-effective in a multicentre trial) into real-world practice, especially in the midst of a global pandemic. Further research is needed to establish the real-world effectiveness of the REACH-HF intervention in different populations.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Heart Failure , Female , Heart Failure/rehabilitation , Heart Failure/therapy , Humans , Male , Pandemics , Quality of Life , State Medicine
2.
BMJ Open ; 12(7): e060221, 2022 07 13.
Article in English | MEDLINE | ID: covidwho-1932753

ABSTRACT

OBJECTIVES: This study aimed to identify barriers to, and facilitators of, implementation of the Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme within existing cardiac rehabilitation services, and develop and refine the REACH-HF Service Delivery Guide (an implementation guide cocreated with healthcare professionals). REACH-HF is an effective and cost-effective 12-week home-based cardiac rehabilitation programme for patients with heart failure. SETTING/PARTICIPANTS: In 2019, four early adopter 'Beacon Sites' were set up to deliver REACH-HF to 200 patients. In 2020, 5 online REACH-HF training events were attended by 85 healthcare professionals from 45 National Health Service (NHS) teams across the UK and Ireland. DESIGN: Our mixed-methods study used in-depth semi-structured interviews and an online survey. Interviews were conducted with staff trained specifically for the Beacon Site project, identified by opportunity and snowball sampling. The online survey was later offered to subsequent NHS staff who took part in the online REACH-HF training. Normalisation Process Theory was used as a theoretical framework to guide data collection/analysis. RESULTS: Seventeen healthcare professionals working at the Beacon Sites were interviewed and 17 survey responses were received (20% response rate). The identified barriers and enablers included, among many, a lack of resources/commissioning, having interest in heart failure and working closely with the clinical heart failure team. Different implementation contexts (urban/rural), timing (during the COVID-19 pandemic) and factors outside the healthcare team/system (quality of the REACH-HF training) were observed to negatively or positively impact the implementation process. CONCLUSIONS: The findings are highly relevant to healthcare professionals involved in planning, delivering and commissioning of cardiac rehabilitation for patients with heart failure. The study's main output, a refined version of the REACH-HF Service Delivery Guide, can guide the implementation process (eg, designing new care pathways) and provide practical solutions to overcoming common implementation barriers (eg, through early identification of implementation champions).


Subject(s)
Cardiac Rehabilitation , Heart Failure , COVID-19 , Heart Failure/rehabilitation , Humans , Pandemics , State Medicine
3.
Pakistan Journal of Medical Sciences Quarterly ; 37(3):890, 2021.
Article in English | ProQuest Central | ID: covidwho-1897844

ABSTRACT

Objectives: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on health-related quality of life (HRQoL), clinical and behavioural outcomes in post-ACS. Methods: A single-centre, single-blinded, two-arm randomised controlled trial is planned at Armed Forces Institute of Cardiology (AFIC), Pakistan. The duration was two years, that is from January 2019 till December 2020. A total of 160 participants were recruited and randomly allocated to the control group or the intervention group. Intervention is a mobile health augmented cardiac rehabilitation (MCard), a medically supervised cardiac rehabilitation program for 23-24 weeks. The phase one includes individual counselling during the hospital stay and in phase two includes communication of standardised messages related to healthy lifestyle modification through a specifically designed software. Results: This clinical trial results will give insight into the impact of MCard in improving the health outcomes (HRQoL, clinical and behavioural) of participants. If proven to be effective, this technology can be scaled up and implemented in other cardiac centres in the country. It utilises fewer human resources and can be delivered at a lower cost. Conclusion: The study protocol will be giving evidence either MCard can contribute to improving the HRQoL, clinical and behavioural outcomes of post-ACS patients following hospital discharge. Considering the COVID-9 situation, this is the perfect time to implement and evaluate the effectiveness of MCard on health outcomes among post-ACS patients.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-319907

ABSTRACT

Lifestyle interventions involving exercise training offset the adverse effects of androgen deprivation therapy in men with prostate cancer (PCa). Yet provision of integrated exercise pathways in cancer care is sparse. This study assessed the feasibility and acceptability of an embedded supervised exercise training intervention into standard PCa care in a single-arm, multicentre prospective cohort study. Feasibility included recruitment, retention, adherence, fidelity and safety. Acceptability of behaviourally informed healthcare and exercise professional training was assessed qualitatively. Despite the imposition of lockdown for the COVID-19 pandemic, referral rates into and adherence to, the intervention was high. Of the 45 men eligible for participation, 79% received the intervention. Patients completed a mean of 27 minutes of aerobic exercise per session (SD=3.48), at 77% heart rate maximum (92% of target dose), and 3 sets of 10 reps of 3 resistance exercises twice weekly for 12 weeks, without serious adverse event. The intervention was delivered by healthcare and exercise professionals with moderate to high fidelity and the intervention was deemed highly acceptable to patients. The impact of societal changes due to the pandemic on the delivery of this face-to-face intervention remain uncertain but positive impacts of embedding exercise provision into PCa care warrant long-term investigation.

5.
BMJ ; 376: o131, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1631764
6.
Sci Rep ; 11(1): 12470, 2021 06 14.
Article in English | MEDLINE | ID: covidwho-1268004

ABSTRACT

Lifestyle interventions involving exercise training offset the adverse effects of androgen deprivation therapy in men with prostate cancer. Yet provision of integrated exercise pathways in cancer care is sparse. This study assessed the feasibility and acceptability of an embedded supervised exercise training intervention into standard prostate cancer care in a single-arm, multicentre prospective cohort study. Feasibility included recruitment, retention, adherence, fidelity and safety. Acceptability of behaviourally informed healthcare and exercise professional training was assessed qualitatively. Despite the imposition of lockdown for the COVID-19 pandemic, referral rates into and adherence to, the intervention was high. Of the 45 men eligible for participation, 79% (n = 36) received the intervention and 47% (n = 21) completed the intervention before a government mandated national lockdown was enforced in the United Kingdom. Patients completed a mean of 27 min of aerobic exercise per session (SD = 3.48), at 77% heart rate maximum (92% of target dose), and 3 sets of 10 reps of 3 resistance exercises twice weekly for 12 weeks, without serious adverse event. The intervention was delivered by 26 healthcare professionals and 16 exercise trainers with moderate to high fidelity, and the intervention was deemed highly acceptable to patients. The impact of societal changes due to the pandemic on the delivery of this face-to-face intervention remain uncertain but positive impacts of embedding exercise provision into prostate cancer care warrant long-term investigation.


Subject(s)
Exercise , Prostatic Neoplasms/pathology , Aged , Androgen Antagonists/therapeutic use , Attitude , Cohort Studies , Feasibility Studies , Humans , Life Style , Male , Middle Aged , Outcome Assessment, Health Care , Prostatic Neoplasms/drug therapy , Resistance Training
8.
Front Public Health ; 9: 628333, 2021.
Article in English | MEDLINE | ID: covidwho-1247940

ABSTRACT

Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community. Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment. Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19. Trial Registration: Current Trials ISRCTN ISRCTN14707226 Web: http://www.isrctn.com/ISRCTN14707226.


Subject(s)
COVID-19 , Quality of Life , England/epidemiology , Humans , SARS-CoV-2 , Wales
9.
Pak J Med Sci ; 37(3): 890-896, 2021.
Article in English | MEDLINE | ID: covidwho-1159725

ABSTRACT

OBJECTIVES: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on health-related quality of life (HRQoL), clinical and behavioural outcomes in post-ACS. METHODS: A single-centre, single-blinded, two-arm randomised controlled trial is planned at Armed Forces Institute of Cardiology (AFIC), Pakistan. The duration was two years, that is from January 2019 till December 2020. A total of 160 participants were recruited and randomly allocated to the control group or the intervention group. Intervention is a mobile health augmented cardiac rehabilitation (MCard), a medically supervised cardiac rehabilitation program for 23-24 weeks. The phase one includes individual counselling during the hospital stay and in phase two includes communication of standardised messages related to healthy lifestyle modification through a specifically designed software. RESULTS: This clinical trial results will give insight into the impact of MCard in improving the health outcomes (HRQoL, clinical and behavioural) of participants. If proven to be effective, this technology can be scaled up and implemented in other cardiac centres in the country. It utilises fewer human resources and can be delivered at a lower cost. CONCLUSION: The study protocol will be giving evidence either MCard can contribute to improving the HRQoL, clinical and behavioural outcomes of post-ACS patients following hospital discharge. Considering the COVID-9 situation, this is the perfect time to implement and evaluate the effectiveness of MCard on health outcomes among post-ACS patients.

10.
Virus Res ; 290: 198176, 2020 12.
Article in English | MEDLINE | ID: covidwho-798334

ABSTRACT

We have utilised the transcriptional response of lung epithelial cells following infection by the original Severe Acute Respiratory Syndrome coronavirus (SARS) to identify repurposable drugs for COVID-19. Drugs best able to recapitulate the infection profile are highly enriched for antiviral activity. Nine of these have been tested against SARS-2 and found to potently antagonise SARS-2 infection/replication, with a number now being considered for clinical trials. It is hoped that this approach may serve to broaden the spectrum of approved drugs that should be further assessed as potential anti-COVID-19 agents and may help elucidate how this seemingly disparate collection of drugs are able to inhibit SARS-2 infection/replication.


Subject(s)
Antiviral Agents/pharmacology , COVID-19/drug therapy , Drug Repositioning , SARS-CoV-2/drug effects , Antiviral Agents/chemistry , Antiviral Agents/therapeutic use , COVID-19/virology , Epithelial Cells/drug effects , Epithelial Cells/pathology , Epithelial Cells/virology , Gene Expression Profiling , Humans , Lung/drug effects , Lung/pathology , Lung/virology , SARS Virus/drug effects , SARS Virus/physiology , SARS-CoV-2/physiology , Transcriptome/drug effects
SELECTION OF CITATIONS
SEARCH DETAIL