Download or read book Self Measured Blood Pressure Monitoring Comparative Effectiveness written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-10 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt: High blood pressure (BP), or hypertension, is a common, long-term health condition, particularly among older adults. Untreated or ineffectively treated hypertension leads to increased cardiovascular morbidity and mortality, and increased consumption of health care resources, thus levying high human and financial costs to society. In adults, hypertension is defined as a persistently elevated BP equal to or greater than 140/90 mmHg. In children, the diagnosis is made from an average of three or more BP readings greater than the 95th percentile for age, sex, and height. The Seventh Joint National Committee (JNC 7) guideline recommends a BP goal of 140/90 mmHg or less in the general population and a lower threshold of 130/80 mmHg or less in patients with diabetes mellitus or chronic kidney disease. The World Health Report 2002 estimates that over 1 billion people have high BP and that hypertension is responsible for 4.5 percent of the global disease burden. Within the U.S., about 76.4 million adults are affected. Despite improvements in the quality of health care and life expectancy, it is expected that the prevalence of hypertension will continue to rise worldwide. The World Health Organization ranks high BP as the third highest risk factor for burden of disease, highlighting the contribution of hypertension directly and indirectly to the development of numerous diseases. Hypertension has been identified as a major risk factor for cardiovascular disease, and is an important modifiable risk factor for coronary artery disease, stroke, peripheral vascular disease, congestive heart failure, and chronic kidney disease. High BP directly results in 7 million deaths every year. Effective management of BP has been shown to dramatically decrease the incidence of stroke, heart attack, and heart failure. However, hypertension is usually a lifelong condition, and long-term adherence to lifestyle modification and medication treatment remains a challenge in the management of hypertension. Thus an increasing focus has been placed on developing strategies that can improve adherence and result in satisfactory BP control with the goal of improving health outcomes for hypertensive patients. One such proposed method is self-measured blood pressure (SMBP) monitoring. SMBP refers to the regular self-measurement of a patient's BP at home or elsewhere outside the office or clinic setting. However, while patient self-participation in chronic disease management appears promising, the sustainability and clinical impact of this strategy remain uncertain. The primary objective of this review is to evaluate whether the use of SMBP monitoring influences outcomes in adults and children with hypertension, and to what extent these changes in outcomes can be attributable to the use of self-monitoring devices alone or the use of SMBP plus additional support or attention. The intention of this report is to inform physicians' decisionmaking as to whether to encourage the use of SMBP monitoring alone or along with additional support, and to assist health care policymakers and payers with decisions regarding coverage and promotion of SMBP monitoring. Key Questions include: 1. In people with hypertension (adults and children), does self-measured blood pressure (SMBP) monitoring, compared with usual care or other interventions without SMBP, have an effect on clinically important outcomes? 2. In trials of SMBP monitoring, how do clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence) vary by the type of additional support provided? 3. How do different devices for SMBP monitoring compare with each other (specifically semiautomatic or automatic vs. manual) in their effects on clinical, surrogate, and intermediate outcomes (including SMBP monitoring adherence)? 4. In trials of SMBP monitoring, how does achieving BP control relate to clinical and surrogate outcomes? 5. How does adherence with SMBP monitoring vary by patient factors?

Download or read book Self Measured Blood Pressure Monitoring written by and published by . This book was released on with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Home Blood Pressure Monitoring written by George S. Stergiou and published by Springer Nature. This book was released on 2019-10-31 with total page 174 pages. Available in PDF, EPUB and Kindle. Book excerpt: Hypertension remains a leading cause of disability and death worldwide. Self-monitoring of blood pressure by patients at home is currently recommended as a valuable tool for the diagnosis and management of hypertension. Unfortunately, in clinical practice, home blood pressure monitoring is often inadequately implemented, mostly due to the use of inaccurate devices and inappropriate methodologies. Thus, the potential of the method to improve the management of hypertension and cardiovascular disease prevention has not yet been exhausted. This volume presents the available evidence on home blood pressure monitoring, discusses its strengths and limitations, and presents strategies for its optimal implementation in clinical practice. Written by distinguished international experts, it offers a complete source of information and guide for practitioners and researchers dealing with the management of hypertension.

Download or read book Self measured Blood Pressure written by Katrin Uhlig and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Hypertension is an important public health issue. Self Measured Blood Pressure Monitoring (SMBP), the self measurement of blood pressure (BP) outside of the health care setting may be an effective tool to facilitate BP control. PURPOSE: Generate prioritized topics for future research on SMBP, building on evidence gaps identified in a prior comparative effectiveness review and following an explicit a stakeholder-driven nomination and prioritization process. METHODS: Building on evidence gaps identified in a previous CER on SMBP, a preliminary list of future research needs (FRN) was supplemented and refined through input from stakeholders. Stakeholders were asked to indicate their top five priority topics considering the following dimensions in prioritization: (1) importance, (2) desirability of research/avoidance of unnecessary duplication, (3) feasibility, and (4) potential impact. The five topics with the highest number of stakeholder endorsements were identified as the prioritized FRN topics. FUTURE RESEARCH NEEDS TOPICS: Four priority topics pertain to interrelated evidence gaps such as the lack of longer term studies which show persistence of BP control or clinical benefit from SMBP, uncertainty regarding who is likely to benefit from SMBP, lack of standardization in prescription of SMBP, and uncertainty regarding the most effective additional support. The fifth topic relates to the inability to assess cost-effectiveness of SMBP, due to the deficiencies in evidence identified in the first four gaps. To address these gaps, longer term randomized controlled trials are needed to examine clinical outcomes; exploration of treatment heterogeneity may identify those groups more likely to benefit from SMPB. Different prescriptions of SMBP should be compared in trials examining SMBP adherence and BP control. Additional support that shows promise for future study should be further refined by expert panels. Filling these evidence gaps will inform future modeling of cost-effectiveness.

Download or read book Self Measured Blood Pressure Monitoring written by U.s. Department of Health and Human Services and published by CreateSpace. This book was released on 2014-04-25 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: This publication provides action steps and resources for public health practitioners on self-measured blood pressure monitoring and is not meant to represent clinical recommendations or guidelines. It includes: A description of the burden of hypertension; A summary of the scientific evidence establishing the significance and effectiveness of SMBP plus additional support; A definition and explanation of additional support strategies for SMBP; Types and costs of home blood pressure monitors used for SMBP; Available cost data for SMBP plus additional support interventions; Health insurance coverage for SMBP; Action steps for public health practitioners on the implementation of SMBP plus additional support. This publication provides action steps for public health practitioners to facilitate the implementation of SMBP plus additional support in five key areas: understanding the environment, working with payers and purchasers, working with health care providers, spreading the word to the public, and monitoring/assessment of SMBP plus additional support implementation. For each area, relevant actions are given that can facilitate the implementation of SMBP plus additional support. A subsequent list of related electronic resources is also provided to assist with these actions, along with appendices that describe state-specific Medicaid coverage for blood pressure monitors and additional support as well as the top five insurance plans by market share in each state.

Download or read book Developing a Protocol for Observational Comparative Effectiveness Research A User s Guide written by Agency for Health Care Research and Quality (U.S.) and published by Government Printing Office. This book was released on 2013-02-21 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)

Download or read book Self Measured Blood Pressure Future Research Needs written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-23 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: Hypertension is a common, long-term health condition, particularly prevalent among older adults. Untreated or undertreated hypertension leads to increased cardiovascular morbidity and mortality, as well as increased consumption of health care resources; however, long-term adherence to lifestyle modification and medication remains a challenge. Self-measured blood pressure monitoring (SMBP) has been suggested as one method that may improve adherence to blood pressure (BP) treatment and consequently improve outcomes. SMBP refers to the regular self-measurement of a patient's BP at home or otherwise outside the office or clinic, as a supplement or alternative to those obtained in a health care setting. While patient self participation in chronic disease management appears to be a promising means of improving adherence, the sustainability and clinical effect of this strategy, as well as its impact on health care utilization, remain uncertain. The current Future Research Needs (FRN) project was launched upon the completion of an Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review (CER) on SMBP, and builds on the evidence gaps identified in that review. The present report describes the development of a stakeholder-prioritized list of research needs for that topic, along with a measured consideration of the advantages and disadvantages of various potential research designs, in order to help researchers and funders develop future research proposals or solicitations. This report identifies five high-priority future research needs with regards to SMBP, as determined by a stakeholder panel. They are: 1. What are the effects of SMBP on BP, medication adherence rates, satisfaction, and clinical event outcomes, after longer followup periods of 2 to 5 years or longer? 2. Which patients may be more likely to benefit from using SMBP? 3. What is the best prescription or protocol for SMBP (when, how often, and how frequently)? How do different prescriptions for SMBP compare regarding acceptance by patients, adherence with SMBP, and effect on BP control? 4. What is the role of additional support? What particular components of additional support should be further evaluated? 5. What is the effect of SMBP on resource utilization? What is the cost-effectiveness of SMBP?

Download or read book A Population Based Policy and Systems Change Approach to Prevent and Control Hypertension written by Institute of Medicine and published by National Academies Press. This book was released on 2010-08-13 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: Hypertension is one of the leading causes of death in the United States, affecting nearly one in three Americans. It is prevalent in adults and endemic in the older adult population. Hypertension is a major contributor to cardiovascular morbidity and disability. Although there is a simple test to diagnose hypertension and relatively inexpensive drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines. The book is an important resource for federal public health officials and organizations, especially the Center for Disease Control and Prevention, as well as medical professionals and community health workers.

Download or read book Self Measured Blood Pressure written by Tufts Medical Center Tuft Evidence-based Practice Center, Tufts Medical Center and published by . This book was released on 2014-02-18 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public and private sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. An important part of evidence reports is to not only synthesize the evidence, but also to identify the gaps in evidence that limited the ability to answer the systematic review questions. AHRQ supports EPCs to work with various stakeholders to identify and prioritize the future research that are needed by decisionmakers. This information is provided for researchers and funders of research in these Future Research Needs papers. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality.

Download or read book Diabetes and Hypertension written by Samy I. McFarlane and published by Springer Science & Business Media. This book was released on 2012-10-19 with total page 196 pages. Available in PDF, EPUB and Kindle. Book excerpt: Diabetes and hypertension have evolved as two of the modern day epidemics affecting millions of people around the world. These two common co-morbidities lead to substantial increase in cardiovascular disease, the major cause of morbidity and mortality of adults around the world. In Diabetes and Hypertension: Evaluation and Management, a panel of renowned experts address a range of critical topics -- from basic concepts in evaluation and management of diabetes and hypertension, such as dietary interventions, to evaluation and management of secondary hypertension in clinical practice. Other chapters focus on high cardiovascular risk populations such as those with coronary heart disease, chronic kidney disease and minority patients. In addition, evolving concepts and new developments in the field are presented in other chapters, such as prevention of type 2 diabetes and the epidemic of sleep apnea and its implication for diabetes and hypertension evaluation and management. An important title covering two of the most troubling disorders of our time, Diabetes and Hypertension: Evaluation and Management will provide the busy practitioner with cutting edge knowledge in the field as well as practical information that can translate into better care provided to the high-risk population of diabetics and hypertensive patients.

Download or read book Stroke Medicine written by Hugh Markus and published by Oxford University Press. This book was released on 2017 with total page 609 pages. Available in PDF, EPUB and Kindle. Book excerpt: A practical handbook written for the practising physician, 'Stroke Medicine' provides an up-to-date, and easily accessible source of information on all aspects of stroke care from acute care, through to rehabilitation and secondary prevention.

Download or read book Finding What Works in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-20 with total page 267 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

Download or read book Prehypertension and Cardiometabolic Syndrome written by Reuven Zimlichman and published by Springer. This book was released on 2018-12-06 with total page 689 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book sheds new light on the management of patients with borderline cardiovascular risk factors in order to prevent their progression to end organ damage. The book stimulates discussion of this poorly understood condition and lays the groundwork for developing recommendations and guidelines. While the diagnostic and therapeutic approach to full-blown diabetes, hypertension, dyslipidemia and obesity is well defined, there is still a lack of clear understanding and guidelines as far as patients with borderline conditions – especially when multiple – are concerned. Moreover, end-organ damage depends on several factors, including genetic factors, making it difficult to predict its extent. As such, the gradual transition from a healthy subject to one with functional hemodynamic changes, and then one with structurally asymptomatic changes and lastly to overt disease needs further investigation. In order to address these knowledge gaps, the book covers a broad variety of topics, making it a valuable tool for identifying which asymptomatic subjects could profit from being appropriately screened and at what stage. Furthermore it offers insights into better treating these patients to prevent their progression to overt disease. The book appeals to cardiologists, primary care physicians and all those healthcare professional looking to optimize the management of these complex and often undiagnosed cases.

Download or read book Oxford Textbook of Critical Care written by Webb and published by Oxford University Press. This book was released on 2020-01-10 with total page 1961 pages. Available in PDF, EPUB and Kindle. Book excerpt: Now in paperback, the second edition of the Oxford Textbook of Critical Care is a comprehensive multi-disciplinary text covering all aspects of adult intensive care management. Uniquely this text takes a problem-orientated approach providing a key resource for daily clinical issues in the intensive care unit. The text is organized into short topics allowing readers to rapidly access authoritative information on specific clinical problems. Each topic refers to basic physiological principles and provides up-to-date treatment advice supported by references to the most vital literature. Where international differences exist in clinical practice, authors cover alternative views. Key messages summarise each topic in order to aid quick review and decision making. Edited and written by an international group of recognized experts from many disciplines, the second edition of the Oxford Textbook of Critical Careprovides an up-to-date reference that is relevant for intensive care units and emergency departments globally. This volume is the definitive text for all health care providers, including physicians, nurses, respiratory therapists, and other allied health professionals who take care of critically ill patients.

Download or read book Essential Manual of 24 Hour Blood Pressure Management written by Kazuomi Kario and published by John Wiley & Sons. This book was released on 2015-05-06 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt: It is well known that cardiovascular events occur more frequently in the morning as blood pressure (BP) levels have been shown to increase during the period from night to early morning. In recent years, clinical research using ambulatory blood pressure monitoring (ABPM) or home BP monitoring has clarified that morning BP and BP surge are more closely related to the cardiovascular risk than clinical BP. This practical manual from field leading expert, Dr. Kazuomi Kario, reviews recent evidence on morning and nocturnal hypertension and the IT technologies physicians can use to support patients in home monitoring BP. Guidance on management via antihypertensive drugs is also discussed and with the aim of promoting perfect 24 hour BP control.

Download or read book Model Rules of Professional Conduct written by American Bar Association. House of Delegates and published by American Bar Association. This book was released on 2007 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.

Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.