Background
This study assessed the feasibility of a preoperative high‐intensity interval training (HIT) programme in patients awaiting elective abdominal aortic aneurysm repair.
Methods
In this ...feasibility trial, participants were allocated by minimization to preoperative HIT or usual care. Patients in the HIT group were offered three exercise sessions per week for 4 weeks, and weekly maintenance sessions if surgery was delayed. Feasibility and acceptability outcomes were: rates of screening, eligibility, recruitment, retention, outcome completion, adverse events and adherence to exercise. Data on exercise enjoyment (Physical Activity Enjoyment Scale, PACES), cardiorespiratory fitness (anaerobic threshold and peak oxygen uptake), quality of life, postoperative morbidity and mortality, duration of hospital stay and healthcare utilization were also collected.
Results
Twenty‐seven patients were allocated to HIT and 26 to usual care (controls). Screening, eligibility, recruitment, retention and outcome completion rates were 100 per cent (556 of 556), 43·2 per cent (240 of 556), 22·1 per cent (53 of 240), 91 per cent (48 of 53) and 79–92 per cent respectively. The overall exercise session attendance rate was 75·8 per cent (276 of 364), and the mean(s.d.) PACES score after the programme was 98(19) (‘enjoyable’); however, the intensity of exercise was generally lower than intended. The mean anaerobic threshold after exercise training (adjusted for baseline score and minimization variables) was 11·7 ml per kg per min in the exercise group and 11·4 ml per kg per min in controls (difference 0·3 (95 per cent c.i. –0·4 to 1·1) ml per kg per min). There were trivial‐to‐small differences in postoperative clinical and patient‐reported outcomes between the exercise and control groups.
Conclusion
Despite the intensity of exercise being generally lower than intended, the findings support the feasibility and acceptability of both preoperative HIT and the trial procedures. A definitive trial is warranted. Registration number: ISRCTN09433624 (
https://www.isrctn.com/).
Precursor to a bigger trial
Summary
Pre‐operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous ...alcohol consumption and an unhealthy weight can reduce the risk of peri‐operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short‐term peri‐operative health benefits in comparison with long‐term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent sample t‐tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired sample t‐tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri‐operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre‐operatively. Overall, confidence ratings were lower than motivation levels in both the short‐ and long‐term. This study identifies both substantial patient desire to modify behaviours for peri‐operative benefit and the need for structured pre‐operative support. These results provide objective evidence in support of a ‘pre‐operative teachable moment’, and of patients’ desire to change behaviours for health benefits in the short term.
Frailty refers to the reduction in homeostatic reserve resulting from an accumulation of physiological deficits over a lifetime. Frailty is common in older patients undergoing surgery and is an ...independent risk factor for post-operative mortality, morbidity and increased length of hospital stay. In frail individuals, stressors, such as surgery, can precipitate an acute deterioration in health, manifesting as delirium, falls, reduction in mobility or continence, rendering these individuals at an increased risk of adverse perioperative outcomes. However, little is known about how frailty affects the patient experience, functional ability and quality of life (QoL) after surgery. In addition, the distribution of frailty in this population is unknown.
We will conduct a multi-centre observational trial to investigate the relationship between patient reported outcome measures and preoperative frailty. We aim to recruit approximately two-hundred patients with operable, potentially curative colorectal cancer. Eligible patients will be identified at three hospital sites. QoL and functional ability (measured using EORTC QLQ-C30 and WHO-DAS 2.0 respectively) will be recorded at the pre-operative assessment clinic, and at 6 and 12 weeks postoperatively. Frailty scores including the Edmonton Frail Scale (EFS) and Rockwood clinical frailty scale (CFS) will be calculated both preoperatively, and at 12 weeks post-operatively. Secondary outcome measures including post-operative morbidity and mortality will be measured using Clavien Dindo classification and 90-day mortality.
This observational feasibility study seeks to define the prevalence of frailty in older (> 65 years) colorectal cancer patients and understand how frailty impacts on patient reported outcome measures. This information will help to inform larger studies relating to treatment decision algorithms and promote shared decision making in this population.
We examined the heave motion of a spherical buoy during a free-decay drop test. A comprehensive approach was adopted to study the oscillations of the buoy involving experimental measurements and ...complementary numerical simulations. The experiments were performed in a wave tank equipped with an array of high-speed motion-capture cameras and a set of high-precision wave gauges. The simulations included three sets of calculations with varying levels of sophistication. Specifically, in one set, the volume-of-fluid (VOF) method was used to solve the incompressible, two-phase, Navier–Stokes equations on an overset grid, whereas the calculations in other sets were based on Cummins and mass-spring-damper models that are both rooted in the linear potential flow theory. Excellent agreements were observed between the experimental data and the results of VOF simulations. Although less accurate, the predictions of the two reduced-order models were found to be quite credible, too. Regarding the motion of the buoy, the obtained results indicate that, after being released from a height approximately equal to its draft at static equilibrium (which is about 60% of its radius), the buoy underwent nearly harmonic damped oscillations. The conducted analysis reveals that the draft length of the buoy has a profound effect on the frequency and attenuation rate of the oscillations. For example, compared to a spherical buoy of the same size that is half submerged at equilibrium (i.e., the draft is equal to the radius), the tested buoy oscillated with a period that was roughly 20% shorter, and its amplitude of oscillations decayed almost twice faster per period. Overall, the presented study provides additional insights into the motion response of a floating sphere that can be used for optimal buoy design for energy extraction.
Introduction: Cardiovascular diseases are the main cause of death in Brazil and are related to the need for cardiac surgery using cardiopulmonary bypass (CPB), which can cause complications. ...Objectives: Analyze the influence of CPB time on the clinical outcomes of patients undergoing cardiac surgery at a hospital in Rio Grande do Sul, Brazil. Method: Retrospective study, by consulting the records of cardiovascular surgeries performed at the institution's operating room from 2013 to 2017. The sample was divided into two groups, the cutoff point used was the median CPB time (89 minutes). Statistical analysis was performed using version 26.0 of the SPSS (Statistical Package for the Social Sciences). The variables were described as mean, standard deviation, frequency and absolute number, comparisons between categorical variables were made using the Chi-square test and between numerical variables using Student's t test. An alpha less than or equal to 5% was considered as statistical significance. Results: The sample consisted of 236 patients, 66.1% male, mean age 60.52 ± 12.63 years, and patients with older age had a longer CPB time. The most frequent cardiac surgery was myocardial revascularization, followed by valve replacement and double correction surgery, most of the procedures occurred electively. Most of the procedures followed some complication in the immediate postoperative period, with the group with the longest CPB time showing greater statistical significance for complications and mortality. There was no significant difference when considering the length of stay and the cause of death. Conclusion: The procedures had a median CPB time of 89 minutes. Older patients, hemodynamically unstable at the beginning of surgery, and who underwent double surgical correction remain in cardiopulmonary bypass longer. CPB time greater than 89 minutes is related to a greater number of complications in the postoperative period and a higher mortality rate
Passive behavior (PB) in persons with Alzheimer's disease (PWAD) has been overlooked despite recognition that it occurs on a daily basis and is often resistant to interventions. The purpose of this ...study was to describe how the experience of passivity was for the caregiver and the PWAD, factors that precipitated PB, caregiver responses that promoted engagement, and caregiver responses that intensified PB, as well as activities initiated by caregivers over the past month that reduced passivity in the person with dementia (PWD). Fifty caregivers of community-dwelling persons with mild (n = 15), moderate (n = 16), and severe (n = 19) Alzheimer's disease participated in a semi-structured interview. Data were analyzed using Colaizzi's Phenomenological Thematic Extraction and descriptive statistics. Caregivers identified decreased levels of activity, decreased verbalization, withdrawal, less socialization, and decreased interest in activities as examples of PBs. For caregivers, the experience of coping with PBs engendered frustration with their loved ones' cognitive deterioration, difficulty in watching and accepting loss of function, fatigue, sadness, and using coping skills. Paradoxically, both being alone and increased environmental stimuli precipitated PB. Feelings of helplessness and loss of control by the person also caused PB. The most successful interventions to promote engagement were: giving cues and assistance, initiating the task, giving guidance, and providing enjoyable activities. Responses that hindered engagement included: 'correcting' or putting stress on the person, rushing activities, and repeating directions. Faith, humor, patience, and contact with friends and family were identified as positive approaches. Caregiver interventions demonstrated synchrony with selected background and proximal variables in the Need-driven Dementia-compromised Behavior (NDB) model.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
To construct a taxonomy of passive behaviors for understanding people with Alzheimer's disease. Passive behaviors are those associated with decreased motor movements, decreasing interactions with the ...environment, and feelings of apathy and listlessness. Little is known about behaviors associated with passivity, and these behaviors have not been categorized.
Taxonomy construction. Passive behaviors in people with Alzheimer's disease were conceptualized as disturbing behaviors, patterns of personality change, and negative symptoms.
The taxonomy was developed using critical reviews of 15 empirical studies published 1985 through 1998. Procedures included listing behaviors; clustering behaviors into inductively derived groupings; conducting an expert panel-review, making revisions, and conducting a second review; establishing global and category-by-category reliability using Cohen's Kappa.
The nonhierarchic, natural taxonomy indicated five categories of behaviors associated with passivity in Alzheimer's disease: diminutions of cognition, psychomotor activity, emotions, interactions with people, and interactions with the environment. Analysis indicated substantial agreement beyond chance and showed statistically significant agreement among the six nurse-expert rates. Areas of synchrony between the taxonomy and the Need-Driven Dementia Compromised Behavior Model were identified.
This taxonomy of passive behaviors in patients with Alzheimer's disease showed empirical rigor and compatibility with a middle-range theory and can be viewed as a sensitizing analytic scheme to guide future practice, research, and theory development.
Purpose: In an attempt to more thoroughly describe aggressive behavior in nursing home residents with dementia, we examined background and proximal factors as guided by the Need-Driven ...Dementia-Compromised Behavior model. Design and Methods: We used a multivariate cross-sectional survey with repeated measures; participants resided in nine randomly selected nursing homes within four midwestern counties. The Minimum Data Set (with verification by caregivers) identified participants. We used a disproportionate probability sample of 107 participants (51% with a history of aggressive behavior) to ensure variability. Videotaped care events included four of direct care (shower baths, meals, dressing, and undressing) and two of nondirect care (two randomly selected 20-minute time periods in the afternoon and evening). The majority of participants (75%) received three shower baths, for a total of 282 videotaped baths. Results: Because the shower bath was the only care event significantly related to aggressive behavior (F = 6.9, p <.001), only those data are presented. Multilevel statistical modeling identified background factors (gender, mental status score, and lifelong history of less agreeableness) and a proximal factor (amount of nighttime sleep) as significant predictors (p <.05) of aggressive behavior during the shower bath. We found significant correlations between aggressive behavior and negative subject affect (r =.27) during the bath, and aggressive behavior and lifetime agreeableness level (r = −.192). We also found significant correlations between mental status and the amount of education (r =.212), and between negative caregiver affect and negative participant affect (r =.321). Implications: We identified three background and one proximal factor as significant risk factors for aggressive behavior in dementia. Data identify not only those persons most at risk for aggressive behavior during care, but also the care event most associated with aggressive behavior. Together these data inform both caregiving for persons with dementia as well as the design of intervention studies for aggressive behavior in dementia.
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