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Commentary on: Shields GE, Rowlandson A, Dalal G, Nickerson S, Cranmer H, Capobianco L, Doherty P. Cost-effectiveness of home-based cardiac rehabilitation: a systematic review. Heart. 2023 Feb 27:heartjnl-2021-320459. doi: 10.1136/heartjnl-2021-320459. Epub ahead of print.
Home-based cardiac rehabilitation (CR) is a cost-effective alternative/supplementary model to increase CR accessibility, improve health benefits and reduce health service use. More robust clinical trials are needed as the heterogeneity in design, particularly the intervention dosage, staffing models, telehealth features, hybrid approach and individual costs, challenges the evidence base. The psychological care component is missing in the current cost-effectiveness analysis of home-based CR.
Despite evidence that exercise-based cardiovascular rehabilitation (CR) is an effective intervention, patient uptake and adherence are uncertain. Recent research suggests that home-based CR interventions are as effective and safe as those supervised in a centre.
Commentary on: TEAM Study Investigators and the ANZICS Clinical Trials Group; Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early active mobilization during mechanical ventilation in the ICU. N Engl J Med 2022;387(19):1747–58. doi:10.1056/NEJMoa2209083. Epub 26 Oct 2022.
Early mobilisation may improve patient outcomes; however, starting with a higher dosage at the early stage of critical illness may not provide any added benefit. Future research should explore the intensity, timing, duration and level of activity required to optimise physical rehabilitation of critically ill patients.
Early mobilisation (EM) refers to the practice of initiating physical activity that is of sufficient intensity to elicit acute physiological effects...
Commentary on: Poncin W, Baudet L, Braem F, Reychler G, Duprez F, Liistro G, Belkhir L, Yombi JC, De Greef J. Systems on top of nasal cannula improve oxygen delivery in patients with COVID-19: a randomized controlled trial. J Gen Intern Med 2022;37(5):1226–32. doi: 10.1007/s11606-022-07419-2. Epub 8 Feb 2022.
The adverse consequences of continuous exposure to high concentrations of oxygen must be considered before instituting prolonged oxygen therapy in patients with COVID-19. Hypoxaemia is significant in patients with COVID-19, and isolated arterial oxygen pressure (PaO2) improvement may not necessarily translate into any significant survival benefit nor relieve the distress of breathlessness.
Oxygen therapy is important in COVID-19 management. The low-flow nasal cannula (NC) has some drawbacks. The patient’s peak inspiratory flow rate requirements are not met due to significant leakage around the source. A need to improve oxygen...
Commentary on: Cuzco C, Castro P, Marín Pérez R, Ruiz García S, Núñez Delgado AI, Romero García M, Martínez Momblan MA, Benito Aracil L, Carmona Delgado I, Canalias Reverter M, Nicolás JM, Martínez Estalella G, Delgado-Hito P. Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial. Crit Care Med. 2022 Dec 1;50(12):1757-1767. doi: 10.1097/CCM.0000000000005676. Epub 2022 Sep 30.
Critical care nurses are advised to implement a nurse-driven patient empowerment intervention (NEI) in their daily practice to aid discharged patients. The long-term effects of NEI on patients with varying diseases need further evaluation.
Several studies have indicated that a significant proportion of patients who have been admitted or discharged from an intensive care unit (ICU) experienced high levels of anxiety and depression.
Commentary on: Skorstad M, Vistad I, Fegran L, et al. Nurse-led consultation reinforced with eHealth technology: a qualitative study of the experiences of the patients with gynecological cancer. BMC Nurs 2022;21:326. doi: 10.1186/s12912-022-01104-9.
To improve continuity and quality of cancer care (QoCC) and patients’ adherence to the oncological treatments, it is necessary to develop innovative, digitalised, personalised and evidence-informed follow-up interventions that enhances patients’ quality of life (QoL). Future research should focus on developing clear guidance and efficient technology-based assessment measures that are necessary for providing individualised early palliative care and post-treatment interventions.
A surge in the ageing population and the rising incidence of cancer risk factors have resulted in the increase in the occurrence of cancer in women worldwide, which requires careful treatment planning and innovations in post-treatment follow-up interventions.
Commentary on: Murooka Y, Sasabuchi Y, Takazawa T, Matsui H, Yasunaga H, Saito S. Long-Term Prognosis Following Early Rehabilitation in the ICU: A Retrospective Cohort Study. Crit Care Med. 2023 Mar 29. doi: 10.1097/CCM.0000000000005862. Epub ahead of print.
Rehabilitation programmes if introduced early after admissions to intensive care unit could be beneficial to patients and healthcare systems. Prospective studies are needed to confirm the long-term impacts of early introduction of rehabilitation programmes on healthcare outcomes in terms of, quality of life and physical functions, the optimal timing, duration, and intensity of rehabilitation.
Early rehabilitation is a promising treatment for postintensive care syndrome. Studies have demonstrated the benefits of rehabilitation, such as early exercise and mobilisation, which improve short-term physical and functional outcomes and reduce intensive care unit (ICU) and hospital stay durations for critically ill patients.
Commentary on: Goeddel L, Murphy Z, Owodunni O, et al. Domains of Frailty Predict Loss of Independence in Older Adults after Non-Cardiac Surgery. Ann Surg. 2022 Sep 20. doi: 10.1097/SLA.0000000000005720. Epub ahead of print.
Frailty screening with the Edmonton Frailty Scale can be used to identify risk factors for loss of independence after surgery, including a patient’s functional performance, functional dependence, social support and urinary incontinence. Prospective studies are needed to test whether risk factors can be modified before surgery to prevent loss of independence among frail patients.
Frailty is a common syndrome of physiological decline among older adults characterised by vulnerability to adverse outcomes and loss of functional independence after major surgery.
Commentary on: Wechsler PM, Liberman AL, Restifo D, Abramson EL, Navi BB, Kamel H, Parikh NS. Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack. Stroke. 2023 Apr;54(4):992-1000. doi: 10.1161/STROKEAHA.122.040356. Epub 2023 Mar 3.
Measures to promote smoking cessation should go beyond brief counselling to include intensive counselling with pharmacotherapeutic support, such as varenicline, which are cost-effective. Future research is needed to study to what extent the results obtained here are reproducible in other healthcare settings.
Smoking cessation in stroke survivors is associated with a reduction in vascular events and death.
Commentary on: Son YJ, Jang I. One-year trajectories of self-care behaviours and unplanned hospital readmissions among patients with heart failure: A prospective longitudinal study. J Clin Nurs. 2023 Sep;32(17-18):6427-6440. doi: 10.1111/jocn.16658. Epub 2023 Feb 23.
Timely identifying selfcare behaviour patterns over time may reduce the risk of hospital readmissions in patients with heart failure (HF). Further research studies are required to examine the effects of every 3–6 months self-care intervention on hospital readmissions among patients with HF.
Unplanned readmissions within 30 days and 6 months postdischarge are notably common in patients with HF.
Commentary on: Dawson LP, Nehme E, Nehme Z, Zomer E, Bloom J, Cox S, Anderson D, Stephenson M, Ball J, Zhou J, Lefkovits J, Taylor AJ, Horrigan M, Chew DP, Kaye D, Cullen L, Mihalopoulos C, Smith K, Stub D. Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment. JAMA Intern Med. 2023 Mar 1;183(3):203-211. doi: 10.1001/jamainternmed.2022.6409.
In patients calling the emergency medical system for acute chest pain without ST-segment elevation, prehospital risk stratification using validated risk scores and point-of-care (POC) cardiac troponin measurement by emergency nurses or paramedics can result in substantial cost savings. The safety of this strategy needs confirmation by sufficiently powered prospective randomised clinical trials.
Acute chest pain is one of the most common reasons for emergency system activation and transfer to the emergency department (ED).
Commentary on: Zhang M, Zhang C, Chen C, et al. The experience of diabetic retinopathy patients during hospital-to-home full-cycle care: a qualitative study. BMC Nurs. 2023 Mar 3;22(1):58. doi: 10.1186/s12912-023-01206-y.
Consideration of patients' life experiences, which aids in examining their feelings and patient’ experiences. Future research should further investigate the phenomenological approach in diverse healthcare contexts.
The transition from hospital to home treatment for patients with diabetic retinopathy (DR) is the subject of a study by Zhang and colleagues. The authors attempt to comprehend the substance of this phenomenon a shift towards patient-centric healthcare research by using a phenomenological method.
The descriptive phenomenology method was used to implement this...
Commentary on: Ayers JW, Poliak A, Dredze M, Leas EC, Zhu Z, Kelley JB, Faix DJ, Goodman AM, Longhurst CA, Hogarth M, Smith DM. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Intern Med. 2023 Jun 1;183(6):589-596. doi: 10.1001/jamainternmed.2023.1838.
AI assistants could be used to draft responses for physicians and nurses, potentially addressing a key element of burn-out. Further research is needed to assess the impact of communication on healthcare outcomes and should incorporate patient evaluations and feedback.
In the setting of increasing adoption of virtual healthcare and the surge in electronic patient messages, there has been a higher workload for physicians and nurses, contributing to burnout and potentially terse, unanswered or unhelpful patient messages. Given these challenges, there is a need to explore innovative solutions...
Commentary on: Calderón-Larrañaga S, Greenhalgh T, Clinch M, Robson J, Dostal I, Eto F, Finer S. Unravelling the potential of social prescribing in individual-level type 2 diabetes prevention: a mixed-methods realist evaluation. BMC Med. 2023 Mar 13;21(1):91. doi: 10.1186/s12916-023-02796-9.
Integrating social prescribing (SP) in primary care increases opportunities to deliver holistic care and facilitate clinic-community partnerships. Research examining the effect of SP on prediabetes-related clinical outcomes is needed.
Recent data suggest that 464 million adults worldwide have pre-diabetes and are at increased risk for type 2 diabetes (T2D).
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