https://www.onlinecjc.ca/article/S0828-282X(16)30004-6/pdf

Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy

Background Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone–based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone–based monitoring and videoconferencing, require further investigation.

https://espace.library.uq.edu.au/view/UQ:171e2d3/SFT15_P25.pdf

Remote monitoring of patients with heart failure: a review of systematic reviews

The “Bicycle Process” is a systematic approach that requires health care providers to establish their own minimal standards of patient care. Any performance below their minimally accepted level is called a performance deficit. Educational programs are instituted for each performance deficit after which their performance is remeasured. To be successful the process requires at least the cooperation of physicians, administrators, boards of trustees and medical record analysts. At one children's hospital attempting to institute the “Bicycle Process”, the staff created 54 standards of care for 3 commonly encountered conditions (meningitis, asthma and pneumonitis). Performance deficits were shown for 34 standards before and 29 standards after the educational programs. Of the 29 remaining deficits, 20 showed improvement, 6 worsened and 3 remained unchanged. Thus, the “Bicycle Process” can lead to significant improvements in patient care and warrants close inspection by all who render patient care.

/pdf/improving-patient-care-51sikvplu8.pdf

Improving patient care

Objectives: Chronic health conditions are a major challenge to the health care system Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical se

Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review.

The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides present evidence on symptom management in user-friendly formats and using plain language. The aim of this work is to summarize changes to the practice guides based on new evidence including management specific to immune checkpoint inhibitors (ICIs). A systematic review of literature was conducted to identify clinical practice guidelines and systematic reviews. For version 2020, there is new evidence from 86 sources (range 2–16; mean 9 per guide), including 14 specific to ICIs, and we removed 21 outdated sources. The 15 COSTaRS practice guides were updated and 2 new guides created for mouth dryness and skin rash. The National Cancer Institute's common terminology criteria for adverse events (NCI-CTCAE) grading was added to the assessment results. “Review self-care strategies” was changed to “Review 3 or more self-care strategies”. There were changes based on new evidence and ensuring consistency across practice guides. The 2020 update was validated by oncology nurses from across Canada.

/pdf/pan-canadian-oncology-symptom-triage-and-remote-support-j1if29osnq.pdf

Pan-Canadian oncology symptom triage and remote support (COSTaRS) practice guides: What’s changed in version 2020?

ObjectivesShared medical appointments are group appointments, with an optional individual consultation, for patients diagnosed with chronic illnesses. Shared medical appointments improve diabetes m...

https://journals.sagepub.com/doi/pdf/10.1177/1742395317731608

Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review.

Patients with cancer treatment-related cardiotoxicity, which may manifest as heart failure (HF), can present with dyspnea. Nurses frequently assess, triage and offer self-care strategies to patients experiencing dyspnea in both the cardiology and oncology settings. However, there are no known tools available for nurses to manage patients in the setting of cancer treatment-related cardiotoxicity. The objective of this study was to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses over the telephone for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity. The CAN-IMPLEMENT© methodology guided this descriptive study. A systematic search was conducted in four databases to identify cardio-oncology and HF guidelines and systematic reviews. Screening was conducted by two reviewers, with data extracted into a recommendation matrix from eligible guidelines and systematic reviews on: assessment criteria, medications, and/or self-care strategies to manage dyspnea. Healthcare professionals with an expertise in oncology and/or cardiology were recruited using purposeful and snowball sampling. Evaluation of acceptability of the adapted SPG was gathered through semi-structured interviews and a survey with open- and closed-ended questions. Quantitative findings and participant feedback from the interviews and the open-ended survey questions were analyzed descriptively. Of 490 citations, seven HF guidelines were identified. Evidence from these guidelines was added to the original SPG. Eleven healthcare professionals completed the interview and acceptability survey. The adapted SPG was iteratively revised three times during the interviews. The original SPG was adaptable, and participants indicated the adapted SPG was comprehensive, easy to follow, and would be useful in clinical practice. This study highlights the lack of knowledge tools and available clinical practice guidelines to guide healthcare professionals to assess, triage and/or offer self-care strategies to patients with cancer treatment-related cardiotoxic dyspnea. Moreover, most nurses require assistance to differentiate among the various causes of dyspnea from oncology treatment in order to triage severity appropriately. Further research should focus on evaluating the validity of the adapted SPG in clinical practice.

/pdf/symptom-practice-guide-for-telephone-assessment-of-patients-43e6a7v9bc.pdf

Symptom practice guide for telephone assessment of patients with cancer treatment-related cardiotoxic dyspnea: Adaptation and evaluation of acceptability

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Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review.

Symptom practice guide for telephone assessment of patients with cancer treatment-related cardiotoxic dyspnea: Adaptation and evaluation of acceptability