AbstractContextPhysical activity for women with early-stage breast cancer is well recognized for managing cancer-related symptoms and improving quality of life. While typically excluded from ...interventions, women with metastatic breast cancer may also benefit from physical activity. ObjectiveTo 1) determine the safety and feasibility of a physical activity program for women with metastatic breast cancer and 2) explore the efficacy of the program. MethodsFourteen women with metastatic breast cancer were randomized to either a control group or an 8-week home-based physical activity intervention comprising twice weekly supervised resistance training and an unsupervized walking program. ResultsThe recruitment rate was 93%. Adherence to the resistance and walking components of the program was 100% and 25%, respectively. No adverse events were reported. When mean change scores from baseline to postintervention were compared, trends in favor of the exercise group over the control group were observed for the Functional Assessment of Chronic Illness Therapy-Fatigue score (+5.6 ± 3.2 vs. −1.8 ± 3.9, respectively), VO 2max (+1.6 ml/kg/minute ±1.8 mL/kg/minute vs. −0.2 mL/kg/minute ±0.1 mL/kg/minute, respectively) and six-minute walk test (+40 m ± 23 m vs. −46 m ± 56 m, respectively). ConclusionA partially supervised home-based physical activity program for women with metastatic breast cancer is feasible and safe. The dose of the resistance training component was well tolerated and achievable in this population. In contrast, adherence and compliance to the walking program were poor. Preliminary data suggest a physical activity program, comprising predominantly resistance training, may lead to improvements in physical capacity and may help women to live well with their disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD.
Population-based ...cross-sectional survey.
Nursing homes (n = 31) in Wuhan, Mainland Southern China.
Cognitively intact nursing home residents (n = 467) older than 60 years.
Face-to-face questionnaire interviews were used to collect information on demographics, chronic diseases, life-sustaining treatment, AD, and other end-of-life care preferences.
Most (95.3%) had never heard of AD, and fewer than one-third (31.5%) preferred to make an AD. More than half (52.5%) would receive life-sustaining treatment if they sustained a life-threatening condition. Fewer than one-half (43.3%) chose doctors as the surrogate decision maker about life-sustaining treatment, whereas most (78.8%) nominated their eldest son or daughter as their proxy. More than half (58.2%) wanted to live and die in their present nursing homes. The significant independent predictors of AD preference included having heard of AD before (odds ratio OR 9.323), having definite answers of receiving (OR 3.433) or rejecting (OR 2.530) life-sustaining treatment, and higher Cumulative Illness Rating Scale score (OR 1.098).
Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.
Abstract Context Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is ...needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly. Objectives To establish whether community SPCSs offering home nursing increase rates of home death compared with other models. Methods We searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed. Results Of 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24–6.11; P < 0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97–2.02; P = 0.071). Bias was minimal. Conclusion A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background Debate about the appropriate means to assess the effects of complex public health interventions is very much ongoing, particularly the feasibility and value of randomised ...controlled trials. There has been little systematic investigation of complexity in studies of public health interventions, but an approach to evaluation that explicitly investigates the signs and sources of complexity in an intervention has the potential to increase understanding of why an intervention works or fails. We review the debate about how randomised controlled trials can accommodate complex interventions, how complexity can be investigated within the controlled trial framework, and what the added benefits of such an approach might be. We use the Well London cluster randomised trial as a case study. Case study Local adaptation is a commonly cited feature of complexity, as are complicated intervention delivery logistics and interactions between multiple intervention components. A key unresolved objection to the use of controlled trials for complex intervention evaluation is the reductionist conceptualisation of the intervention. The effectiveness component of the Well London trial necessarily treats this multiple-component, locally adapted, community engagement for health programme as simple, to allow valid causal inference. Although the trial includes quantitative community-level outcomes and examines interaction between the intervention and context, this analysis is in a subgroup model. Only the qualitative study nested within the trial directly addresses signs of complexity (synergies between intervention components, phase changes, unexpected outcomes). We propose that the notion of an intervention as simple or complex is dictated by the research question. From this view, although the effectiveness component of a trial treats the intervention as simple, and as such could be seen as overly reductionist, it is not theoretically inconsistent for an assessment to include some additional components investigating aspects of complexity. Additional methods could be easily accommodated, both quantitative and qualitative, including collection of outcome and exposure data continuously throughout the intervention period from a subcohort of study participants; diaries and other ongoing reflective documentation by community members and practitioners delivering the intervention; and social network analysis. Logic models play a central part in identification of potential unexpected outcomes and sources of complexity for investigation. However, methods for logic model development must accommodate non-linear aspects of community engagement interventions to be useful. Interpretation The benefit of a focus on complexity in the controlled trial framework is to provide rich data about how the intervention interacts with context to assess transferability and explain the findings of the effectiveness component, whether they are positive, null, or negative. The knowledge produced will expand the comparatively sparse basic science evidence base underpinning upstream, preventive public health interventions, which do not receive developmental funding akin to pharmaceutical interventions, to understand in detail how the intervention takes effect before an effectiveness trial. Complexity is important to consider in the process of development of research questions with relevant stakeholders. Consideration of complexity at that stage provides a less reductionist way of thinking about public health interventions and the social systems within which they exist, motivating selection of different research questions and, importantly, different outcomes for the study. Funding Wellcome Trust ( grant 083679/Z/07/Z ).
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Abstract Context Delirium is underrecognized by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or ...hinder palliative care nurses' delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients' delirium outcomes. Objectives The aim of the study was to identify nurses' perceptions of the barriers and enablers to recognizing and assessing delirium symptoms in palliative care inpatient settings. Methods A series of semistructured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants' recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyze the qualitative data. Results Thirty participants from nine palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting that were categorized as patient and family, health professional, and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: 1) value in listening to patients and engaging families, 2) assessment is integrated with care delivery, 3) respecting and integrating nurses' observations, 4) addressing nurses' delirium knowledge needs, and 5) integrating delirium recognition and assessment processes. Conclusion Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional, and system levels.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Context Despite limited clinical evidence, long term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not ...necessarily hypoxaemic. Objectives The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves. Methods The qualitative study used semi-structured interviews. The study was conducted in two states in Australia. Participants (n=20) were self-nominated caregivers of people receiving LTOT for refractory breathlessness in the palliative setting. Results Data analyses established one overarching theme titled: ‘Oxygen giveth (something to help caregivers relieve breathlessness) and oxygen taketh away (from patients who lose some autonomy)’. The theme captured caregivers’ feelings of extreme distress in response to witnessing refractory breathlessness, and oxygen fulfilling several critical and beneficial roles in this context. In parallel caregivers also explicitly and implicitly articulated several downsides to the use of LTOT. Conclusion Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often over-estimated while its potential harms are under-estimated. As significant stakeholders in care of people receiving LTOT caregivers should be provided with opportunities to collaborate with clinicians in evidence based decision making and efforts should be made to provide them with information and education about the most effective pharmacological and non-pharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Context The handheld fan is an inexpensive and safe way to provide facial airflow, which may reduce the sensation of chronic refractory breathlessness, a frequently encountered symptom. ...Objectives To test the feasibility of developing an adequately powered, multicenter, multinational randomized controlled trial comparing the efficacy of a handheld fan and exercise advice with advice alone in increasing activity in people with chronic refractory breathlessness from a variety of medical conditions, measuring recruitment rates; data quality; and potential primary outcome measures. Methods This was a Phase II, multisite, international, parallel, nonblinded, mixed-methods randomized controlled trial. Participants were centrally randomized to fan or control. All received breathlessness self-management/exercise advice and were followed up weekly for four weeks. Participants/carers were invited to participate in a semistructured interview at the study's conclusion. Results Ninety-seven people were screened, 49 randomized (mean age 68 years; 49% men), and 43 completed the study. Site recruitment varied from 0.25 to 3.3/month and screening:randomization from 1.1:1 to 8.5:1. There were few missing data except for the Chronic Obstructive Pulmonary Disease Self-Efficacy Scale (two-thirds of data missing). No harms were observed. Three interview themes included 1) a fan is a helpful self-management strategy, 2) a fan aids recovery, and 3) a symptom control trial was welcome. Conclusion A definitive, multisite trial to study the use of the handheld fan as part of self-management of chronic refractory breathlessness is feasible. Participants found the fan useful. However, the value of information for changing practice or policy is unlikely to justify the expense of such a trial, given perceived benefits, the minimal costs, and an absence of harms demonstrated in this study.
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Highlights • Few studies have tested digital health technology in older people’s pain management. • Integration of these technologies is feasible and acceptable among older people. • These ...technologies are not effective in improving older peoples’ pain outcomes. • Older people face adoption barriers in using these technologies for pain management. • User training can facilitate integration of such technologies in older population.
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9.
Physical Activity and Physical Fitness Haskell, William L., PhD; Troiano, Richard P., PhD; Hammond, Jane A., PhD ...
American journal of preventive medicine,
20/May , Volume:
42, Issue:
5
Journal Article
Peer reviewed
Open access
Abstract The focus of the PhenX (Phenotypes and eXposures) Toolkit is to provide researchers whose expertise lies outside a particular area with key measures identified by experts for uniform use in ...large-scale genetic studies and other extensive epidemiologic efforts going forward. The current paper specifically addresses the PhenX Toolkit research domain of physical activity and physical fitness (PA/PF), which are often associated with health outcomes. A Working Group (WG) of content experts completed a 6-month consensus process in which they identified a set of 14 high-priority, low-burden, and scientifically supported measures. During this process, the WG considered self-reported and objective measures that included the latest technology (e.g., accelerometers, pedometers, and heart-rate monitors). They also sought the input of measurement experts and other members of the research community during their deliberations. A majority of the measures include protocols for children (or adolescents), adults, and older adults or are applicable to all ages. Measures from the PA/PF domain and 20 other domains are publicly available and found at the PhenX Toolkit website, www.phenxtoolkit.org . The use of common measures and protocols across large studies enhances the capacity to combine or compare data across studies, benefiting both PA/PF experts and non-experts. Use of these common measures by the research community should increase statistical power and enhance the ability to answer scientific questions that previously might have gone unanswered.
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Abstract Context Mobility is linked to health status and quality of life. Life-Space Mobility Assessment (LSMA; range 0–120) measures the spatial extent of people's excursion and physical support ...needs over the preceding month. Objectives The aim of this study was to generate normative population data for an LSMA-Composite (LSMA-C) score, irrespective of age or health service contact and explore the LSM of people with diabetes, current asthma, arthritis, and osteoporosis. Methods LSMA questions were included in the 2011 South Australian Health Omnibus Survey, a multistage, systematic, and clustered sample of household face-to-face interviews. Sociodemographic and clinical variables were explored in relation to LSMA scores using descriptive, univariable, and multivariable analyses and receiver operator curves. Results For the 3032 respondents, the mean LSMA score was 98.3 (SD 20.3; median 100; interquartile range 34 86–120; range 6–120). Five percent of respondents scored <60, 11% scored between ≥60 and 79, 27% scored between ≥80 and 99, and the remainder scored between 100 and 120. After 55 years of age, LSMA-C scores declined, more so in females. In multivariable analysis, declining scores were associated with being female, being older, living in rural areas, lower educational attainment, not working, lower household income, and higher numbers of chronic conditions ( R2 = 0.35, P < 0.001). The receiver operator curve demonstrated a highly specific but relatively insensitive measure. Conclusion Having controlled for known confounders, the male/female difference cannot be easily explained. These data will help to contextualize studies in the future that use the LSMA-C score.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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