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Liu Y, Su M, Lei Y, Tian J, Xue L, Zhang L. Patient Preferences for Cardiac Rehabilitation - A Systematic Review. Patient Prefer Adherence 2023; 17:75-88. [PMID: 36636288 PMCID: PMC9831083 DOI: 10.2147/ppa.s392417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although a large number of studies have demonstrated the effectiveness of cardiac rehabilitation(CR), patient preferences for CR remain unclear. Knowing patient preferences may contribute to increasing patient participation and adherence, thus improving patient prognosis. METHODS A systematic search was carried out using electronic databases and manual reference checks from inception until 15th June 2022. Quantitative studies, qualitative studies and mixed methods studies assessing patient preferences for CR were included. Two researchers independently conducted study selectionand data extraction. CR preferences were divided into three categories: CR settings, CR components, and CR contents. A narrative synthesis was applied to integrate the results of the included studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. RESULTS Ultimately, 17 publications were included in this study. Regarding CR settings, most patients preferred the hospital to home, some considered both, and a few were willing to accept the local CR club as an alternative setting to the hospital. For CR components, regardless of age and gender, patients considered exercise training and nutrition counseling to be the most important and smoking cessation to be the least important. In exercise intervention of CR contents, progress discussion and encouragement were rated as most critical, and non-conflicting with other activities was rated as least critical. In psychological intervention of CR contents, most patients were willing to accept psychological intervention, and a few patients wanted to heal the trauma with the passage of time. CONCLUSION This systematic review provides important insights into patient preferences for CR, clarifying patient preferences for CR settings, components, and contents, along with possible influencing factors. Patient preferences may change due to the COVID-19 epidemic, and there is still a need to focus on patient preferences for CR and conduct more relevant primary research to validate the findings of this paper in the future.
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Affiliation(s)
- Yunyue Liu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Mengyu Su
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yang Lei
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
- Correspondence: Yang Lei, School of Nursing, Nanjing Medical University, No. 101, Longmian Avenue, Jiangning District, Nanjing, Jiangsu Province, People’s Republic of China, Tel +86 19955062997, Fax +86 258 6869 555, Email
| | - Jinping Tian
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
- Department of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
- Jinping Tian, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, People’s Republic of China, Tel +86 13851550156, Fax +86 519 6809 1881, Email
| | - Leng Xue
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Lin Zhang
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
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Optimal Gender-Specific Strategies for the Secondary Prevention of Heart Disease in Women: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2018; 38:279-285. [PMID: 30074521 DOI: 10.1097/hcr.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of evidence on gender-specific, individually tailored secondary prevention (cardiac rehabilitation [CR]) services for women with heart disease. Women participate less in CR programs, thus increasing their risk of further cardiac events. This review aims to (1) determine the effectiveness of gender-specific interventions specifically designed for women with heart disease, delivered in outpatient CR settings; and (2) classify key elements of effective CR strategies/models for women with heart disease. METHODS Using the PRISMA guidelines, this is a systematic review of CR models tailored to women to improve cardiovascular risk. Four databases were searched for randomized controlled trials (RCTs) between January 1974 and July 2017 published in peer-reviewed English language journals. RESULTS Three RCTs comprising 725 women of gender-specific CR strategies were identified. Significant improvements were found in one-third (1 study) of the included multicomponent CR strategies for outcomes including general health, social functioning, vitality, mental health, depression, and quality of life. CONCLUSION Further large-scale RCTs are required to replicate positive findings and accurately assess the capacity for gender-specific multicomponent CR programs that incorporate participant-driven collaborative models to moderate psychological risk and improve functional capacity and quality of life for women with heart disease.
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Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation. Int J Cardiol 2017; 232:33-39. [PMID: 28159358 DOI: 10.1016/j.ijcard.2017.01.126] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/18/2016] [Accepted: 01/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess patient preference for exercise setting and examine if choice of setting influences the long-term health benefit of exercise-based cardiac rehabilitation. METHODS Patients participating in a randomised controlled trial following either heart valve surgery, or radiofrequency ablation for atrial fibrillation were given the choice to perform a 12-week exercise programme in either a supervised centre-based, or a self-management home-based setting. Exercise capacity and physical and mental health outcomes were assessed for up to 24months after hospital discharge. Outcomes between settings were compared using a time×setting interaction using a mixed effects regression model. RESULTS Across the 158 included patients, an equivalent proportion preferred to undertake exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to 63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p=0.233). At baseline, those who preferred a home-based setting reported better physical health (mean difference in physical component score: 5.0, 95% CI 2.3 to 7.4; p=0.001) and higher exercise capacity (mean between group difference 15.9watts, 95% CI 3.7 to 28.1; p=0.011). With the exception of the depression score in the Hospital Anxiety and Depression Score (F(3.65), p=0.004), there was no evidence of a significant difference in outcomes between settings. CONCLUSION The preference of patients to participate in home-based and centre-based exercise programmes appears to be equivalent and provides similar health benefits. Whilst these findings support that patients should be given the choice between exercise-settings when initiating cardiac rehabilitation, further confirmatory evidence is needed.
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Dollard J, Smith J, R Thompson D, Stewart S. Broadening the Reach of Cardiac Rehabilitation to Rural and Remote Australia. Eur J Cardiovasc Nurs 2017; 3:27-42. [PMID: 15053886 DOI: 10.1016/j.ejcnurse.2003.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Accepted: 10/27/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) has an evidence base but traditional models may not readily apply to people living in rural and remote regions. AIM : To outline published comprehensive and non-hospital based CR models used for people discharged from hospital after a cardiac event that have potential relevance to those living in rural and remote areas in Australia. METHODS The PubMed database was searched using Medical subject headings (MeSH) terms and the key word 'cardiac rehabilitation' limited to clinical trials. Articles were retrieved if they included at least two components of CR and were not based in an outpatient setting. RESULTS No CR models specifically developed for rural and remote areas were identified. However, 14 studies were found that outlined 11 non-conventional comprehensive CR models. All provided CR in a home-based setting. Health professionals provided support via telephone contact or home visits, and via resources such as the Heart Manual. Reported outcomes from these CR programs varied: ranging from an increase in knowledge of risk factors, to improvements in physical activity, decreased risk factor profile, improved psychological and social functioning and reductions in health service costs and mortality. CONCLUSION Home-based, CR models have the most substantive evidence base and, therefore the greatest potential to be developed and made accessible to eligible people living in rural and remote areas.
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Affiliation(s)
- Joanne Dollard
- Spencer Gulf Rural Health School, University of South Autralia - Whyalla Campus, Nicolson Avenue, Whyalla Norrie, SA 5608, Australia.
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Bjarnason-Wehrens B, Grande G, Loewel H, Völler H, Mittag O. Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes? ACTA ACUST UNITED AC 2016; 14:163-71. [PMID: 17446793 DOI: 10.1097/hjr.0b013e3280128bce] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ischaemic heart disease (IHD) has changed from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s. Most clinical studies during the past three decades have been conducted with men. Cardiac rehabilitation programmes were also developed with special regard to improving the rate of return to work in middle-aged men. The rehabilitation needs of older patients and women in particular have been largely neglected. The aim of this review is briefly to outline our present knowledge on gender issues in cardiac rehabilitation, and to specify barriers with regard to physical activities especially in (older) women. Coping with a cardiac event, women tend to minimize or play down the impact of their health situation and avoid burdening their social contacts. After a first cardiac event, women report greater psychological distress and lower self-efficacy and self-esteem. In addition, older age, lower exercise levels and reduced functional capacity or co-morbid conditions such as osteoporosis and urinary incontinence are barriers to physical activities in women with IHD. Recent studies on psychosocial intervention revealed less favourable results in women compared with men. These findings have not yet been well explained. This emphasizes our current lack of knowledge about the processes and determinants of successful psychosocial interventions in men and women with IHD. A large (European) trial on gender-specific coping styles, needs, and preferences of older women, and the effects of psychosocial intervention is proposed.
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Affiliation(s)
- Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, German Sport University Cologne, 50933 Cologne, Germany.
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Reime B, Ratner PA, Seidenstücker S, Janssen PA, Novak P. Motives for Smoking Cessation are Associated with Stage of Readiness to Quit Smoking and Sociodemographics among German Industrial Employees. Am J Health Promot 2016; 20:259-66. [PMID: 16555799 DOI: 10.4278/0890-1171-20.4.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics. Design. A cross-sectional study to examine attitudes toward and use of health promotion at the worksite, using a self-administered questionnaire. Setting. Two German metal companies. Subjects. Of 1641 responding employees (response rate 65% in company A and 44% in company B), 360 smokers who intended to quit immediately (n = 105) or in the near future (n = 255) were analyzed. Measures. The questionnaire comprised of sociodemographic characteristics, smoking behavior, smoking history, readiness to quit smoking, motives to quit, such as coworkers' complaints and health-related or financial concerns. Chi-squared tests and multiple logistic regression analyses were performed. Results. Health-related reasons (94%) predominated financial (27%) or image-related (14%) reasons for smoking cessation. Participants in the cessation preparation group were more likely to report an awareness of being addicted (79.6% vs. 58.2%; p < .001) and the negative public image (22.5% vs. 11.6%; p < .01) as reasons for quitting compared with those in the contemplation group. In multivariable regression models, the motives for smoking cessation, including reduced performance, family's and coworkers' complaints, pregnancy/children, and negative public image, but not health-related and financial concerns, differed significantly by gender, age, marital status, education, and occupational status. Conclusions. Motives for smoking cessation vary according to the individual's level of readiness to quit and sociodemographic background.
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Affiliation(s)
- Birgit Reime
- NEXUS: Social Contexts of Health Behaviour Research, University of British Columbia, 302-6190 Agronomy Road, Vancouver BC V6T 1Z3, Canada.
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Abstract
Cardiac rehabilitation has assumed more prominence over the past decade, due largely to an increase in user demand, an improvement in the evidence base and an enhancement of its status. This paper presents a view from the United Kingdom and suggests some ways in which cardiac rehabilitation can be improved by focusing on a number of key issues: service organisation and delivery, process and outcome measurement, performance management, and education, training and continuing professional development. The paper concludes that there is a need to make cardiac rehabilitation more widely available using creative and flexible approaches to enhance access, participation and adherence.
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Affiliation(s)
- David R. Thompson
- Department of Health Sciences, University of York, York YO10 5DQ, UK
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Henriksen E, Rosenqvist U. Understanding Cardiac Follow-Up Services—A Qualitative Study of Patients, Healthcare Professionals, and Managers. Eur J Cardiovasc Nurs 2016; 2:95-104. [PMID: 14622634 DOI: 10.1016/s1474-5151(03)00003-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The study explores the experience and understanding of stakeholders involved in follow-up services after a cardiovascular event. A multimethod approach was used consisting of questionnaires, telephone surveys, and in-depth, face-to-face interviews. Five themes were identified: patients wished to be seen in their total context, patients should do as told; healthcare professionals perform check-ups and control cardiac risk factors; healthcare professionals are in charge of the care processes; and the structure and processes of the healthcare organization. Results indicate that healthcare professionals have considerable difficulty in understanding the patient's situation and to collaborate between different levels of care. Furthermore, the total healthcare organization lacked comprehensive and practical structures in the follow-up process, rehabilitation, and secondary preventive services.
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Affiliation(s)
- E Henriksen
- Department of Public Health and Caring Sciences, Section of Health Services Research, Uppsala University, North-West Stockholm County, Uppsala, Sweden.
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Zrinyi M, Horvath T. Impact of Satisfaction, Nurse–Patient Interactions and Perceived Benefits on Health Behaviors Following a Cardiac Event. Eur J Cardiovasc Nurs 2016; 2:159-66. [PMID: 14622641 DOI: 10.1016/s1474-5151(03)00032-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims: To describe patient perceptions of quality and satisfaction with nursing care, nurse–patient interactions and barriers to and benefits of implementing a healthy lifestyle. Methods: A pretest–posttest cross-sectional correlational research design was used. Subjects were randomly selected between November 2001 and January 2002 from patients admitted to the National Institute of Cardiology in Budapest, Hungary. Participants completed 3 self-reported measures and a demographic survey, which assessed individual lifestyle behaviors (e.g. frequency of smoking, physical activity, stress and unhealthy dieting). Results: Satisfaction with nursing care and nurse–patient interactions influenced both perceived benefits and barriers. Patient satisfaction and perceived benefits at discharge were associated with more frequent exercising and less smoking. Among other factors, perceived benefits at discharge were predicted by attentive nurse behaviors toward patients and by patients’ ability to initiate discussion with nurses. Conclusions: Findings support effects of patient satisfaction and nurse–patient relationships on perceived benefits/barriers. Compared to barriers, perceived benefits more importantly determined health behaviors. Attentive nursing care and the patient's ability to discuss health concerns with nurses appear more influential in modifying patient perceptions. Exploring nursing interventions to maximize perceived benefits during hospitalization is suggested.
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Abstract
There is a wide variety of literature available about coronary heart disease (CHD). However much of the research related to CHD has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. It is apparent that more researchers are focusing on research that examines women's responses to CHD and the care and treatment they receive. The following literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience of cardiac rehabilitation may be different to that of men. There is a need for nurses working within this area of practice to have an understanding of women's experience of recovery from a heart attack in order to better meet their needs.
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Affiliation(s)
- Wendy Day
- Faculty of Health, Science and Technology, Universal College of Learning, Palmerston North, New Zealand
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Sutton EJ, Rolfe DE, Landry M, Sternberg L, Price JAD. Cardiac rehabilitation and the therapeutic environment: the importance of physical, social, and symbolic safety for programme participation among women. J Adv Nurs 2012; 68:1834-46. [PMID: 22697385 DOI: 10.1111/j.1365-2648.2012.06041.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To report an exploration of the multidimensionality of safety in cardiac rehabilitation programmes as perceived by women who were enrolled in the Women's Cardiovascular Health Initiative in Toronto, Canada. BACKGROUND Cardiovascular disease is the leading cause of death among women. Although cardiac rehabilitation is clinically effective, significantly fewer women than men participate in available programmes. The literature identifies factors affecting women's cardiac rehabilitation participation, and provides possible explanations for this gender disparity. Although safety is mentioned among the barriers to women's cardiac rehabilitation participation, the extent to which safety contributes to programme participation, completion, and maintenance remains under-explored in the cardiac rehabilitation literature. DESIGN We conducted an exploratory qualitative study to examine the role safety and place play for women engaged in cardiac prevention and rehabilitation at the Women's Cardiovascular Health Initiative. Methods. From 2005-2006, 14 participants engaged in semi-structured, qualitative interviews lasting 30-90 minutes. Discussions addressed women's experiences at the Women's Cardiovascular Health Initiative. Interview transcripts were analysed using thematic analysis. FINDINGS Three themes were developed: 'Safety', which was sub-categorized according to physical, social, and symbolic interpretations of safety, 'searching for a sense of place', and 'confidence and empowerment'. CONCLUSION Feeling physically, socially, and symbolically safe in one's cardiac rehabilitation environment may contribute to programme adherence and exercise maintenance for women. Focusing on comprehensive notions of safety in future cardiac rehabilitation research could offer insight into why many women do not maintain an exercise regimen in currently structured cardiac rehabilitation and community programmes.
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Affiliation(s)
- Erica J Sutton
- Dalla Lana School of Public Health & the Joint Centre for Bioethics, University of Toronto, Ontario, Canada.
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Scane K, Alter D, Oh P, Brooks D. Adherence to a cardiac rehabilitation home program model of care: a comparison to a well-established traditional on-site supervised program. Appl Physiol Nutr Metab 2012; 37:206-13. [PMID: 22360343 DOI: 10.1139/h11-151] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the proven benefits of cardiac rehabilitation (CR), adherence to programs remains suboptimal. To improve adherence, alternative models of care, such as using home programs (HP), have been recommended. Little information exists, however, about its effect on adherence in real-world settings. Therefore, this study's primary objective was to compare adherence of patients in an HP and traditional on-site program (TP) model of CR. The secondary objective was to compare their clinical and demographic profiles and changes in cardiovascular fitness. We implemented a retrospective review of 200 consecutively enrolled patients who chose either a TP or HP model. Profile data was collected at intake assessment. Adherence, defined as attendance to prescheduled contacts or on-site visits in each respective cohort, served as a primary outcome measure. Secondary outcomes included completion of program and cardiopulmonary fitness levels at 6 months. We found that the HP cohort had patients who were significantly younger, male (significantly moreso than female), were more geographically removed from the on-site centre, were employed, and (or) had greater cardiopulmonary fitness at initiation. Similar mean attendance (p = 0.21) and completion rates (p = 0.22) were seen between models. Both groups attained similar gains in cardiovascular fitness (p = 0.79). Analysis of adherence shows the HP to be a suitable option for patients who face barriers for TP-CR participation.
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Affiliation(s)
- Kerseri Scane
- Department of Rehabilitation Science, University of Toronto, Toronto, ON M5T 1W5, Canada
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Abstract
PURPOSE : While cardiac rehabilitation has been established as an essential part of comprehensive cardiac care, participation rates for female patients are substantially lower than for male patients. Lower referral rates and higher ages of female patients partly explain this underutilization. Gender differences in recovery goals of cardiac patients have not been examined. METHODS : Five hundred ninety patients (22.2% women) admitted to the hospital because of an acute myocardial infarction answered a questionnaire regarding 24 goals in 5 domains of recovery (physical functioning, risk-factor modification, psychological well-being, independence in daily life, and return to work). In addition, psychological symptoms and medical data were assessed. Gender differences were tested by using χ and Student t tests, as well as multivariate logistic and linear regression models. RESULTS : Gender differences were found in 7 of the 24 recovery goals. After adjustment for psychosocial and clinical characteristics, women still reported a higher importance of "performance of household duties" (odds ratio [OR] = 8.62; 95% confidence interval [CI], 5.43-13.66), "independence in activities of daily living" (OR = 2.38; CI, 1.58-3.59), and "emotional equilibrium" (OR = 1.58, CI, 1.01-2.46). Men rated "physical endurance" and "reducing strain at workplace" as more important goals (OR = 0.64; CI, 0.42-0.97 and OR = 0.39; CI, 0.17-0.93). Except for psychological distress, gender differences in health status were not related to differences in goals. CONCLUSIONS : Gender roles and differences in social-life conditions may have an important influence on the recovery goals of patients after an acute myocardial infarction. Recovery goals should be explored when planning intervention programs for individual patients.
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Grace SL, Racco C, Chessex C, Rivera T, Oh P. A narrative review on women and cardiac rehabilitation: Program adherence and preferences for alternative models of care. Maturitas 2010; 67:203-8. [DOI: 10.1016/j.maturitas.2010.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 07/01/2010] [Accepted: 07/03/2010] [Indexed: 12/18/2022]
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Examining the challenges of recruiting women into a cardiac rehabilitation clinical trial. J Cardiopulm Rehabil Prev 2009; 29:13-21; quiz 22-3. [PMID: 19158582 DOI: 10.1097/hcr.0b013e31819276cb] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the challenges of recruiting women for a 5-year cardiac rehabilitation randomized clinical trial; the aims of the study were to describe the range of recruitment sources, examine the myriad of factors contributing to ineligibility and nonparticipation of women during protocol screening, and discuss the challenges of enrolling women in the trial. METHODS The Women's-Only Phase II Cardiac Rehabilitation program used an experimental design with 2 treatment groups. Eligible participants included women who were (1) diagnosed with a myocardial infarction or stable angina or had undergone coronary revascularization within the last 12 months; (2) able to read, write, and speak English; and (3) older than 21 years. Responses to multiple recruitment strategies including automatic hospital referrals, physician office referrals, mass mailings, media advertisements, and community outreach are described. Reasons for ineligibility and nonparticipation in the trial are explored. RESULTS Automatic hospital order was the largest source of referral (n = 1,367, 81%) accounting for the highest enrollment rate of women (n = 184, 73%). The barriers to enrollment into the cardiac rehabilitation clinical trial included patient-oriented, provider-oriented, and programmatic factors. Of the referral sources, 52% were screened ineligible for provider-oriented reasons, 31% were ineligible due to patient-oriented factors, and 17.4% were linked to the study protocol. Study nonparticipation of those eligible (73.8%) was largely associated with patient-oriented factors (65.2%), with far less due to provider-related factors (4%) or study-related factors (3.4%). CONCLUSION Standing hospital orders facilitated enrollment to the cardiac rehabilitation clinical trial, yet women failed to participate predominantly due to significant patient-oriented biopsychosocial barriers.
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Gender differences in motivations and perceived effects of Mind–Body Therapy (MBT) practice and views on integrative cardiac rehabilitation among acute coronary syndrome patients: Why do women use MBT? Complement Ther Med 2008; 16:311-7. [DOI: 10.1016/j.ctim.2008.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 04/17/2008] [Accepted: 04/30/2008] [Indexed: 11/17/2022] Open
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Grande G. Genderspezifische Aspekte der Gesundheitsversorgung und Rehabilitation nach Herzinfarkt. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:36-45. [DOI: 10.1007/s00103-008-0417-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Parkosewich JA. Cardiac Rehabilitation Barriers and Opportunities Among Women With Cardiovascular Disease. Cardiol Rev 2008; 16:36-52. [DOI: 10.1097/crd.0b013e31815aff8b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yates BC, Heeren BM, Keller SM, Agrawal S, Stoner JA, Ott C. Comparing two methods of rehabilitation for risk factor modification after a cardiac event. Rehabil Nurs 2007; 32:15-22. [PMID: 17225370 DOI: 10.1002/j.2048-7940.2007.tb00144.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Because fewer than half of cardiac patients in the United States enroll in cardiac rehabilitation (CR) programs, there is a critical need to test alternative strategies of delivering CR services. This study tested whether a home-based CR (home-CR) program was at least as effective as traditional-CR (trad-CR) in the modification of coronary heart disease risk factors from the beginning of CR (baseline) to 2 and 4 months later. A repeated measures non-inferiority quasi-experimental design was used to examine changes in risk factors. Participants selected which CR program, traditional versus home-based, in which to participate: 37 patients chose trad-CR and 24 patients chose home-CR. The following indicators of risk factors were measured: smoking, blood pressure, frequency of aerobic exercise, cholesterol, amount of dietary fat, frequency of anger, body mass index (BMI), and waist circumference. Home-CR was found to be as effective as trad-CR in modification of cardiac risk factors including BMI, waist circumference, blood pressure, frequency of aerobic exercise, total cholesterol, and a low fat diet. Home-CR was not as effective as trad-CR in reducing the frequency of anger. These findings provide support for an alternative method of delivering cardiac rehabilitation services.
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Affiliation(s)
- Bernice C Yates
- University of Nebraska Medical Center, College of Nursing, Omaha 68198, USA.
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Kjaer T, Gyrd-Hansen D, Willaing I. Investigating patients' preferences for cardiac rehabilitation in Denmark. Int J Technol Assess Health Care 2006; 22:211-8. [PMID: 16571197 DOI: 10.1017/s0266462306051038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study was to analyze preferences for activities comprised in comprehensive cardiac rehabilitation programs among former cardiac patients from three different hospitals in Copenhagen County, Denmark. METHODS A discrete choice experiment was applied to elicit the preferences for the offer of participation in various cardiac rehabilitation program activities: smoking cessation course, physical exercise program, personal meetings with cardiac nurse, group meetings managed by cardiac nurses, and nutritional counseling guidance. The questionnaire was sent to 742 former cardiac patients. We had a response rate of 69 percent. RESULTS We found that preferences differed with respect to gender and age and that the offer of participation in cardiac rehabilitation activities was not highly valued by older patients, in particular among older men. CONCLUSIONS The discrete choice experiment proved a valuable instrument for the measurement of preferences for cardiac rehabilitation. The study provides important information on patients' preferences for cardiac rehabilitation for healthcare professionals and decision makers.
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Affiliation(s)
- Trine Kjaer
- Department of Health Economics/Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense C, Denmark.
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Vallance JKH, Courneya KS, Jones LW, Reiman T. Exercise preferences among a population-based sample of non-Hodgkin's lymphoma survivors. Eur J Cancer Care (Engl) 2006; 15:34-43. [PMID: 16441675 DOI: 10.1111/j.1365-2354.2005.00617.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the present study, we examined the exercise preferences of a population-based sample of non-Hodgkin's lymphoma (NHL) survivors. A secondary purpose was to explore the association between various demographic, medical, and exercise behaviour variables and elicited exercise preferences. Using a retrospective survey design, 431 NHL survivors residing in Alberta, Canada completed a mailed questionnaire designed to assess exercise preferences, past exercise behaviour, and various demographic variables. Overall, 77% of participants preferred or maybe preferred to receive exercise counselling at some point after their NHL diagnosis. An overwhelming majority indicated that they would possibly be interested (81%) and able (85%) to participate in an exercise programme designed for NHL survivors. The majority of participants (55%) listed walking as their preferred choice of exercise. Logistic regression analyses indicated that NHL survivors' exercise preferences were influenced by body mass index (BMI), exercise behaviour, and gender. Eliciting exercise preferences from the population in question yields important information for cancer care professionals designing exercise programmes for NHL survivors. Furthermore, tailoring exercise programmes to the preferences of NHL survivors may be one method to potentially enhance exercise adherence in this population both inside and outside of clinical trials.
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Affiliation(s)
- J K H Vallance
- Faculty of Physical Education, University of Alberta, Edmonton, AB, Canada
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22
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Expressed preferences for health education of patients after percutaneous coronary intervention. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/00149831-200512000-00010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Grace SL, McDonald J, Fishman D, Caruso V. Patient preferences for home-based versus hospital-based cardiac rehabilitation. ACTA ACUST UNITED AC 2005; 25:24-9. [PMID: 15714108 DOI: 10.1097/00008483-200501000-00006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sherry L Grace
- University Health Network Women's Health Program and Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada.
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Jackson L, Leclerc J, Erskine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart 2005; 91:10-4. [PMID: 15604322 PMCID: PMC1768637 DOI: 10.1136/hrt.2004.045559] [Citation(s) in RCA: 262] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2004] [Indexed: 11/04/2022] Open
Abstract
Comprehensive cardiac rehabilitation reduces mortality and morbidity but is utilised by only a fraction of eligible cardiac patients, with the participation rate of women being only about half that of men. This quantitative review assesses 32 studies meeting inclusion criteria, describing 16,804 patients, 5882 of whom were female. It was found that the main predictor of referral to a cardiac rehabilitation programme was the physician's endorsement of the effectiveness of such a programme. Patients were more likely to participate in rehabilitation programmes when they were actively referred, educated, married, possessed high self efficacy, and when the programmes were easily accessible. Patients were less likely to participate when they had to travel long distances to participate in a cardiac rehabilitation programme, or experienced guilt over family obligations. Women were less often referred and participated less often even after referral. In conclusion, many of the observed predictors, including those particular to women, are potentially modifiable with the help of health professionals.
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Affiliation(s)
- L Jackson
- University of British Columbia, Vancouver, British Columbia, Canada
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Jolly K, Greenfield SM, Hare R. Attendance of Ethnic Minority Patients in Cardiac Rehabilitation. ACTA ACUST UNITED AC 2004; 24:308-12. [PMID: 15602149 DOI: 10.1097/00008483-200409000-00004] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kate Jolly
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Jennings S, Carey D. Capacity and equity in cardiac rehabilitation in the eastern region: good and bad news. Ir J Med Sci 2004; 173:151-4. [PMID: 15693385 DOI: 10.1007/bf03167930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To document current baseline eligibility for Phase 3 cardiac rehabilitation (CR) and the capacity to meet this need in hospitals in the Eastern Regional Health Authority. METHODS Information on the eligible population and the capacity for CR was collected in all nine hospitals retrospectively (February-March 2001). RESULTS Forty-seven per cent of eligible patients were invited to participate with only two-thirds attending. Completion rates were very high (89%) in attenders. Age and health board area were significant independent predictors of being invited to CR. Gender was not independent of age. Fifty-three per cent of the need for this service was met by capacity in the region's nine hospitals in 2000 rising to 59% in 2002. CONCLUSIONS Many eligible patients are not invited to CR. Lack of capacity is a problem. Among the invited, non-participation is a factor. Inequity in age and inter-hospital variation in invitation is noted.
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Affiliation(s)
- S Jennings
- Department of Public Health, Eastern Regional Health Authority, Dublin, Ireland.
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Roblin D, Diseker RA, Orenstein D, Wilder M, Eley M. Delivery of Outpatient Cardiac Rehabilitation in a Managed Care Organization. ACTA ACUST UNITED AC 2004; 24:157-64. [PMID: 15235295 DOI: 10.1097/00008483-200405000-00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess referral and enrollment rates for postdischarge outpatient cardiac rehabilitation in a managed care organization. METHODS A prospective cohort study investigated Atlanta area managed care members, age 30 years or older, hospitalized for acute myocardial infarction or coronary revascularization during 1997-1999. Postdischarge cardiology medical records were abstracted for evidence of postdischarge visits; counseling on diet, weight, or exercise; and referral to outpatient cardiac rehabilitation. Enrollment in outpatient cardiac rehabilitation was confirmed by chart abstraction. Referral and enrollment rates were estimated using logistic regression models. RESULTS Of the 945 hospitalized patients, 783 remained alive and enrolled in the managed care organization 12 months after discharge. Of these 783 patients, 73.8% had at least one postdischarge cardiologist visit. Among these, 24.4% were referred by a cardiologist to outpatient cardiac rehabilitation, and 7.1% enrolled. Enrollment was significantly higher among patients with a documented referral than among patients not referred (P <.05). Patients 65 years of age or older were significantly less likely than younger patients to be referred to cardiac rehabilitation and enroll (P<.05). Of the patients with a postdischarge cardiologist visit, 31.5% received counseling on diet, weight, or exercise. The men and the patients with a body mass index of at least 30 were more likely to receive this counseling than women and those with body mass index less than 30 (P <.05). CONCLUSIONS The low rates of referral and enrollment for postdischarge outpatient cardiac rehabilitation in this managed care population are consistent with rates observed at academic medical centers. Despite demonstrated benefits after acute coronary events, outpatient cardiac rehabilitation remains underused.
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Scott IA, Lindsay KA, Harden HE. Utilisation of outpatient cardiac rehabilitation in Queensland. Med J Aust 2003; 179:341-5. [PMID: 14503895 DOI: 10.5694/j.1326-5377.2003.tb05588.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2003] [Accepted: 06/12/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs. DESIGN AND SETTING Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs. PARTICIPANTS Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private). MAIN OUTCOME MEASURES Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance. RESULTS 15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality. CONCLUSION There is significant underutilisation of facility-based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.
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Affiliation(s)
- Ian A Scott
- Department of Internal Medicine, Level 5, Medical Specialties, Princess Alexandra Hospital, Mail Drop Bag 69, Woolloongabba, QLD 4102, Australia.
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Harris DE, Record NB, Gilbert-Arcari J, Bunnell S, Record SS, Norton K. Cardiac rehabilitation with nurse care management and telephonic interactions at a community hospital: program evaluation of participation and lipid outcomes. LIPPINCOTT'S CASE MANAGEMENT : MANAGING THE PROCESS OF PATIENT CARE 2003; 8:141-57; quiz 158-9. [PMID: 12897627 DOI: 10.1097/00129234-200307000-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiac rehabilitation (CR) can help patients with heart disease control some risk factors, limit new coronary artery lesions, and decrease death rates. However, participation rates in CR are low. Using a descriptive design, we evaluated a modified CR program in which nurse care managers used telephonic communication with patients in their homes by comparing it to a traditional CR program in a hospital setting. Using multivariate analysis we compared the patient cohorts eligible for each of the programs, and program participants to the nonparticipants for each program. Compared to traditional CR, the modified CR program with nurse care management was associated with significantly improved participation rates (11% vs. 22%) and the apparent overcoming of several well-described barriers to CR participation (distance from the hospital and domestic isolation). Risk factor management, including testing of serum lipids and achieving goals for lipid reduction, for participants in both CR programs was superior to risk factor management for nonparticipants.
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Affiliation(s)
- David E Harris
- Lewiston-Auburn College, University of Southern Maine, 51 Westminister Street, Lewiston, ME 04240, USA.
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Harris DE, Record NB. Cardiac rehabilitation in community settings. JOURNAL OF CARDIOPULMONARY REHABILITATION 2003; 23:250-9. [PMID: 12893998 DOI: 10.1097/00008483-200307000-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David E Harris
- Lewiston-Auburn College, University of Southern Maine, Lewiston, ME 04240, USA.
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Scott LAB, Ben-Or K, Allen JK. Why are women missing from outpatient cardiac rehabilitation programs? A review of multilevel factors affecting referral, enrollment, and completion. J Womens Health (Larchmt) 2002; 11:773-91. [PMID: 12632591 DOI: 10.1089/15409990260430927] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objectives of this paper are to (1) systematically review the evidence for patient, provider, and programmatic factors that may influence women's referral to, enrollment in, and completion of outpatient cardiac rehabilitation and (2) make empirically based recommendations for future women's health research. METHODS Using a defined inclusion/exclusion criteria, this review involved a systematic review and description analysis of the published peer-review literature. RESULTS The review yielded 23 studies described in 25 publications. Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention. CONCLUSIONS Practitioners engaged in the care of eligible cardiac patients should be aware of the evidence for the effectiveness of cardiac rehabilitation, and researchers should examine programmatic and provider factors that affect women's participation.
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Affiliation(s)
- Lisa A Benz Scott
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
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