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1.
Can J Diabetes ; 38(2): 79-84, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24690501

ABSTRACT

OBJECTIVE: Many people with dysglycemia are unaware that they have the condition. We conducted a study to determine whether a screening program for hospitalized patients could identify new cases of unrecognized dysglycemia and affect the actions of attending care providers during hospitalization. METHODS: We measured A1C in 466 participants with no history of diabetes who had been admitted to hospital for coronary heart disease or elective joint replacement surgery. Participants with A1C <6.0% were considered normoglycemic and those with A1C ≥6.0% were considered dysglycemic. Notifications to care providers were placed on the charts of participants who had dysglycemia, along with recommendations for in-hospital monitoring and care. Oral glucose tolerance tests were completed 6 weeks post-hospitalization for participants with dysglycemia and a subsample of participants who were normoglycemic. Sensitivity and specificity of in-hospital dysglycemia criteria were calculated. Provider practices were determined by chart review. RESULTS: In-hospital dysglycemia was present in 10.4% of patients with coronary heart disease and 11.4% of participants with elective joint replacement surgery. Attending care providers took few of the recommended actions, despite the chart notification of dysglycemia; glucose monitoring occurred <30% of the time. The in-hospital dysglycemia criterion of ≥6% demonstrated moderate sensitivity (47.5%) and high specificity (96.2%) in detecting dysglycemia based on oral glucose tolerance tests. CONCLUSIONS: Dysglycemia was a relatively common finding in patients with no history of diabetes who had been admitted for coronary heart disease or elective joint replacement surgery. The in-hospital A1C screening criteria generated a high level of false-negative tests, and a chart notification had limited effects on the practices of attending care providers. Future studies examining lower A1C thresholds and the barriers to and facilitators of attending care providers' behaviours are warranted.


Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus, Type 2/prevention & control , Inpatients/statistics & numerical data , Mass Screening , Monitoring, Physiologic/methods , Prediabetic State/diagnosis , Aged , Arthroplasty, Replacement/statistics & numerical data , Canada/epidemiology , Coronary Artery Disease/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Early Diagnosis , Elective Surgical Procedures/statistics & numerical data , Female , Glucose Tolerance Test , Glycated Hemoglobin/metabolism , Humans , Male , Mass Screening/methods , Prediabetic State/epidemiology , Program Evaluation , Sensitivity and Specificity
2.
Eur J Prev Cardiol ; 19(6): 1357-64, 2012 Dec.
Article in English | MEDLINE | ID: mdl-21903744

ABSTRACT

BACKGROUND: The CardioFit Internet-based expert system was designed to promote physical activity in patients with coronary heart disease (CHD) who were not participating in cardiac rehabilitation. DESIGN: This randomized controlled trial compared CardioFit to usual care to assess its effects on physical activity following hospitalization for acute coronary syndromes. METHODS: A total of 223 participants were recruited at the University of Ottawa Heart Institute or London Health Sciences Centre and randomly assigned to either CardioFit (n = 115) or usual care (n = 108). The CardioFit group received a personally tailored physical-activity plan upon discharge from the hospital and access to a secure website for activity planning and tracking. They completed five online tutorials over a 6-month period and were in email contact with an exercise specialist. Usual care consisted of physical activity guidance from an attending cardiologist. Physical activity was measured by pedometer and self-reported over a 7-day period, 6 and 12 months after randomization. RESULTS: The CardioFit Internet-based physical activity expert system significantly increased objectively measured (p = 0.023) and self-reported physical activity (p = 0.047) compared to usual care. Emotional (p = 0.038) and physical (p = 0.031) dimensions of heart disease health-related quality of life were also higher with CardioFit compared to usual care. CONCLUSIONS: Patients with CHD using an Internet-based activity prescription with online coaching were more physically active at follow up than those receiving usual care. Use of the CardioFit program could extend the reach of rehabilitation and secondary-prevention services.


Subject(s)
Acute Coronary Syndrome/rehabilitation , Exercise Therapy/methods , Expert Systems , Internet , Motor Activity , Secondary Prevention/methods , Therapy, Computer-Assisted , Actigraphy/instrumentation , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/psychology , Aged , Emotions , Exercise Therapy/adverse effects , Female , Health Behavior , Health Knowledge, Attitudes, Practice , Health Status , Humans , Male , Mental Health , Middle Aged , Ontario , Patient Compliance , Patient Discharge , Quality of Life , Self Report , Time Factors , Treatment Outcome
3.
Can J Physiol Pharmacol ; 85(1): 17-23, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17487242

ABSTRACT

We describe transitions between exercise stages of change in people with coronary artery disease (CAD) over a 6-month period following a CAD-related hospitalization and evaluate constructs from Protection Motivation Theory, Theory of Planned Behavior, Social Cognitive Theory, the Ecological Model, and participation in cardiac rehabilitation as correlates of stage transition. Seven hundred eighty-two adults hospitalized with CAD were recruited and administered a baseline survey including assessments of theory-based constructs and exercise stage of change. Mailed surveys were used to gather information concerning exercise stage of change and participation in cardiac rehabilitation 6 months later. Progression from pre-action stages between baseline and 6 month follow-up was associated with greater perceived efficacy of exercise to reduce risk of future disease, fewer barriers to exercise, more access to home exercise equipment, and participation in cardiac rehabilitation. Regression from already active stages between baseline and 6 month follow-up was associated with increased perceived susceptibility to a future CAD-related event, fewer intentions to exercise, lower self-efficacy, and more barriers to exercise.


Subject(s)
Coronary Artery Disease/rehabilitation , Exercise , Hospitalization/statistics & numerical data , Surveys and Questionnaires , Adult , Aged , Aged, 80 and over , Coronary Artery Disease/mortality , Coronary Artery Disease/psychology , Female , Follow-Up Studies , Health Behavior , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Ontario/epidemiology , Predictive Value of Tests , Prospective Studies , Severity of Illness Index , Time Factors
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