An intervention for multiethnic obese parents and overweight children.

The purpose of this pilot study was to determine the effects of the addition of coping skills training for obese multiethnic parents whose overweight children were attending a weight management program. At 6 months, parents in the experimental group had significantly lower body mass index (BMI) and body fat percentage (BFP) and higher numbers of pedometer steps compared with those in the control group. Parents in the experimental group also demonstrated significant improvement in interpersonal relationships, behavior control, and stress management compared with those in the control group. Children in the experimental group demonstrated trends toward decreased BMI and BFP and increased pedometer steps.     

A feasibility study of an educational intervention for children with daytime wetting

Daytime wetting in children is a common problem and though behavioural and educational interventions have been recommended, they have not been extensively evaluated. AIM: To evaluate the feasibility and usefulness of an educational intervention (home workbook) for daytime wetting in children aged six to ten years. METHODS: The workbook was piloted with two groups of children with daytime wetting. One group (n = 10) received verbal information only, while the other group (n = 10) received the same verbal information and the workbook supporting the verbal information. Telephone surveys were undertaken every two weeks to monitor the child's progress. RESULTS: The workbook was acceptable and usable by both children and parents, and was positively evaluated. Though the results do not show a clinically meaningful improvement in symptoms, they suggest a larger trial is worthwhile. CONCLUSION: A simple, paper-based educational intervention for children and parents on the management of daytime wetting is acceptable and usable.     

Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain

Purpose: To identify prognostic factors for perceived pain and function with focus at one-year follow-up in primary care patients treated for non-specific neck pain. Methods: A prospective study was performed including 193 neck pain patients. Before and after treatment period, and 12 months after the start date for treatment, patients completed a questionnaire including background data and aspects of pain, function and general health. Linear multiple regression analysis was used to identify prognostic factors with the dependent variables Oswestry score and pain intensity at 12-month follow-up. Response rate 81%. Results: At 12-month follow-up, Oswestry score identified four prognostic factors: pain intensity; well-being; expectations of treatment; and duration of current episode. Adjusted R² for the model was 0.32, and 20% of the patients had three of the four prognostic factors at entry, indicating risk of poor outcome. The dependent variable pain intensity revealed three prognostic factors: Oswestry score; duration of current episode; and similar problem during the previous five years. Adjusted R² was 0.24, and 60% of the patients had two of the three prognostic factors at entry, indicating risk of poor outcome. Conclusions: Different prognostic factors (with the exception of duration of current episode) were identified by the two outcome variables. Thus the results suggest that it should be taken into account whether an impairment or disability outcome is used.     

Needs for care among patients with schizophrenia in six European countries: a one-year follow-up study

Background

This article compares needs for care among patients with schizophrenia across six European countries and examines how this relates to the diversity of psychiatric systems in Europe.

Methods

A one-year prospective cohort study was set up. Inclusion criteria for patients were: a clinical lifetime diagnosis of schizophrenia according to ICD-10 (F20) diagnostic criteria for research, age between 18 and 65 years and at least one contact with mental health services in 1993. The patients were assessed for their clinical diagnosis and symptoms using the SCAN interview (Schedules for Clinical Assessment in Neuropsychiatry) and the interventions proposed to them were recorded through the systematic use of the NFCAS (Needs For Care Assessment Schedule).

Results

438 patients were included and 391 were followed up. The mean age was 38 years, the mean age at onset was 22 years, and 59% were out-patients, 24% in day care and 15% hospitalized. The populations in the different centres were significantly different for almost all the variables: sociodemographic, clinical and social, and the problems identified remained relatively stable over the year. Comparisons highlighted cultural differences concerning the interventions that were proposed. Centres in Italy, Spain and Portugal proposed many interventions even though they were relatively deprived in terms of resources, and the tendency seems to be the reverse for the Northern European countries. On average, one in four patients suffered from needs that were not adequately met by the mental health service in their region. These needs (on average 6 per patient) varied from psychotic symptoms to managing their own affairs. The number of interventions was not correlated to the need status. The availability of community-based treatment, rehabilitation and residential care seems to predict smaller proportions of patients with unmet needs.

Conclusion

There appeared to be a systematic relationship between the availability of community-based mental health care and the need status of schizophrenic patients: the fewer out-patient and rehabilitation services available, the more unmet needs there were.

     

Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain

Purpose: To identify prognostic factors for perceived pain and function with focus at one-year follow-up in primary care patients treated for non-specific neck pain. Methods: A prospective study was performed including 193 neck pain patients. Before and after treatment period, and 12 months after the start date for treatment, patients completed a questionnaire including background data and aspects of pain, function and general health. Linear multiple regression analysis was used to identify prognostic factors with the dependent variables Oswestry score and pain intensity at 12-month follow-up. Response rate 81%. Results: At 12-month follow-up, Oswestry score identified four prognostic factors: pain intensity; well-being; expectations of treatment; and duration of current episode. Adjusted R² for the model was 0.32, and 20% of the patients had three of the four prognostic factors at entry, indicating risk of poor outcome. The dependent variable pain intensity revealed three prognostic factors: Oswestry score; duration of current episode; and similar problem during the previous five years. Adjusted R² was 0.24, and 60% of the patients had two of the three prognostic factors at entry, indicating risk of poor outcome. Conclusions: Different prognostic factors (with the exception of duration of current episode) were identified by the two outcome variables. Thus the results suggest that it should be taken into account whether an impairment or disability outcome is used.     

Changes in exercise and musculoskeletal symptoms of novice nurses: A one-year follow-up study

BackgroundNursing is a high-risk occupation for work-related musculoskeletal disorders and many nursing students have a history of musculoskeletal symptoms.AimsTo quantify (1) changes in exercise and musculoskeletal symptoms from pre-registration to 12-month registered nurses, and (2) the best predictor of severity of musculoskeletal symptoms from measures of the five physical fitness components and exercise participation.MethodsIn this longitudinal study, August 2013 to April 2015, 62 (55.9%) of 111 nursing students fitness tested completed questionnaires measuring nursing work history, exercise, and musculoskeletal symptoms at baseline and 12 months post-registration.FindingsNurses’ exercise participation declined post-registration and 38.0% were overweight/obese. At 12 months post-registration, 76.0% experienced musculoskeletal symptoms, mainly affecting the low back, neck, and/or shoulders. Approximately 50% of symptoms were attributed partly/solely to work; yet few were reported to employers or prompted sick leave. For female nurses, increases in whole-body strength were positively associated with increases in whole-body musculoskeletal symptom severity; however, the multiple regression model contained unexplained variability.DiscussionMany nursing students entered nursing with modifiable risk factors for work-related musculoskeletal disorders: overweight/obese, earlier musculoskeletal symptoms, and poor exercise habits. As registered nurses, they showed high lifetime and 12-month prevalence of musculoskeletal symptoms and declining exercise. Reporting musculoskeletal symptoms were undervalued.Conclusion(s)Inadequate exercise and high prevalence of musculoskeletal symptoms among novice registered nurses may contribute to/aggravate musculoskeletal disorders. Nurse leaders should understand the exercise habits and fitness of pre-registration and novice registered nurses to develop interventions towards improving health behaviours to reduce musculoskeletal disorder risk.     

The impact of low back pain on work: A study in primary care consulters

Background: The cost of low back pain (LBP) to employers is high, with an estimated £9090 million lost in the United Kingdom in 1998. Economic analysis of LBP has focused on work absence among the employed. There is little research characterising individuals who report reduced duties or who are not in employment because of LBP. Aims: To compare the health related characteristics of primary care LBP consulters reporting usual employment, reduced duties, sick leave and non‐employment as a result of LBP. Methods: Prospective cohort study recruiting LBP consulters aged 30–59 years of age from five general practices in North Staffordshire. Results: Nine hundred and thirty‐five participants completed the baseline phase, 65% were in employment and 35% were not in employment. Of the employed participants over 1 in 10 (11%) were undertaking reduced duties and almost one‐fifth were reporting sick leave (22%). Furthermore, 37% of non‐employed consulters reported that LBP was the reason for non‐employment. Significant differences at baseline in socioeconomic status, self‐rated health, anxiety, depression and disability were found between those undertaking their usual job, those on reduced duties and those on sickness absence due to LBP, with those participants further removed from the work force reporting worse health across all measures. Significant differences were also found in self‐rated health between those not working due to LBP and those not working for other reasons, with participants not working due to LBP reporting worse self‐rated health. At follow‐up, work status was found to be relatively stable. Conclusion: These findings indicate that the economic impact of LBP may be higher than previously estimated when data on reduced duties is combined with work absence. The additional impact of unemployment due to LBP should also be included in future assessments of the impact of LBP on the workforce.     

Patient self-management of warfarin therapy: pragmatic feasibility study in Canadian primary care

Objective

To investigate the effectiveness of patient self-management (PSM) of anticoagulation using warfarin in a typical primary care site in Canada and to determine the feasibility of conducting a future large-scale trial in this setting.

Design

An 8-month pragmatic open-label randomized crossover trial.

Setting

A typical Canadian primary care practice in British Columbia.

Intervention

Patients were randomized to PSM or physician management for 4 months, after which allocation was reversed. The PSM group members were instructed to monitor their serum international normalized ratio (INR) at community laboratories and to adjust their warfarin doses independently using provided nomograms. Education on warfarin dose adjustment was limited to a single 15-minute office visit.

Main outcome measures

The primary outcome was the proportion of INR values in the therapeutic range among participants. Feasibility outcomes included proportion of eligible patients consenting, patients’ preference of management strategy, patients’ satisfaction, and visits or phone communication with physicians regarding dose adjustment. Safety outcomes included bleeding or thromboembolic events.

Results

Eleven patients completed the trial, contributing 99 patient-months of monitoring and providing 122 INR measures. The mean proportion of INR values in therapeutic range among subjects in the PSM and physician-management groups was 82% and 80%, respectively (P = .82). The improvement in patient satisfaction with PSM was not significant. Ten of the 11 patients preferred PSM to physician management and elected to continue with this strategy after study completion (P = .001). No calls or visits were made to the physician regarding dose adjustment during the PSM period. There were no episodes of major bleeding or thromboembolic events.

Conclusion

Patient self-management was not demonstrated to be superior to standard care, but was easily implemented and was the method preferred by patients. Our feasibility outcomes justify a larger trial and suggest that subject recruitment and protocol adherence would not pose barriers for such a study.

Trial registration number

{"type":"clinical-trial","attrs":{"text":"NCT00925028","term_id":"NCT00925028"}}NCT00925028 (ClinicalTrials.gov).     

Implementing a collaborative coaching intervention for professionals providing care to children and their families: An exploratory study

The growing complexity of healthcare requires family and interprofessional partnerships to deliver effective care. Interprofessional coaching can enhance family-centred practice and collaboration. The purpose of this study was to explore the acceptability and feasibility of collaborative coaching training to improve family centredness within acute paediatric rehabilitation. Using a participatory action design, service providers (SPs; n = 36) underwent a 6-month coaching programme involving coaching workshops, learning triads, and tailored sessions with a licensed coach. The feasibility and acceptability of coaching on SPs’ family interactions and care was explored. Measure of Processes of Care (MPOC) and MPOC-SP, a coaching skills questionnaire, and focus groups were used to evaluate the acceptability of coaching training. We found that structured coaching training was feasible and SPs reported significant improvements in their coaching skills; however, MPOC and MPOC-SP scores did not reveal significant differences. Qualitative themes indicated that clinicians are developing coaching competencies and applying these skills in clinical practice. Participants perceived that the coaching approach strengthened relationships amongst colleagues, and they valued the opportunity for interprofessional learning. Findings suggest that coaching offers promise as an approach to facilitate successful patient outcomes and improve processes of care. Preliminary findings indicate that interprofessional coaching training is acceptable, feasible, and can significantly improve SP coaching skills and improve team cohesion. Further research to study the effects of coaching on interprofessional care using validated outcome measures and to assess the impact on service delivery is recommended.     

School-based language screening among primary school children using telepractice: A feasibility study from India

Abstract

Purpose: This study explored the feasibility of conducting school-based language screening using telepractice to expand its scope for providing speech-language pathology services in India.

Method: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child-related factors influencing screening were documented using an inventory.

Result: Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. The trained facilitator played a crucial role in overcoming child related factors such as poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP and need for frequent breaks.

Conclusion: Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.     

The impact of specialist care for low back pain on health service utilization in primary care patients: A prospective cohort study

Guidelines portray low back pain (LBP) as a benign self‐limiting disease which should be managed mainly by primary care physicians. For the German health care system we analyze which factors are associated with receiving specialist care and how this affects treatment. This is a longitudinal prospective cohort study. General practitioners recruited consecutive adult patients presenting with LBP. Data on physical function, on depression, and on utilization of health services were collected at the first consultation and at follow‐up telephone interviews for a period of 12 months. Logistic regression models were calculated to investigate predictors for specialist consultations and use of specific health care services. Large proportions (57%) of the 1342 patients were seeking additional specialist care. Although patients receiving specialist care had more often chronic LBP and a positive depression score, the association was weak. A total of 623 (46%) patients received some form of imaging, 654 (49%) physiotherapy and 417 (31%) massage. Consulting a specialist remained the strongest predictor for imaging and therapeutic interventions while disease‐related and socio‐demographic factors were less important. Our results suggest that the high use of specialist care in Germany is due to the absence of a functioning primary care gate keeping system for patient selection. The high dependence of health care service utilization on providers rather than clinical factors indicates an unsystematic and probably inadequate management of LBP.     

饮食控制联合运动教育干预对肥胖儿童肾功能的影响

目的:探讨饮食控制联合运动教育干预对肥胖儿童肾功能的影响。方法:将72例肥胖儿童随机分为3组,对比观察治疗前后3组患儿的尿Alb、IgG、TRF等指标。结果:治疗后营养组、运动组和联合组均能使尿Alb、IgG、TRF明显降低,组间差异均有显着性(P0.01)。而治疗前后α1-MG、NAG、血BUN、血Cr组间差异无统计学意义(P0.05)。结论:运动组与联合组在调控肥胖儿童肾功能的改善效果较好,其中联合组效果更好,对患儿以后提高生活质量有积极作用。     

Effects of a programme for structured outpatient follow-up care after inpatient rehabilitation of obese children and adolescents--a multicentre, randomized study

INTRODUCTION: Inpatient rehabilitation is an important contributor to the treatment of child and adolescent obesity with comorbidity in Germany. Thus far outpatient follow-up care has not been subject to research. The main goal of this study is the development and longer-term evaluation of a programme for structured outpatient follow-up care by primary care physicians after inpatient rehabilitation of obese children and adolescents. METHODS: This multicentre, randomized, parallel controlled clinical trial enrolled 521 children and adolescents aged 9 - 16 (avg. 13.3) years in 7 cooperating specialized rehabilitation facilities. The patients were randomized at the end of their multimodal inpatient treatment that lasted for 5.9 (+/- 1.2) weeks. The intervention consisted of 12 half-hour outpatient consultations by the primary care physicians utilizing a modular consultation guideline and an internet-based training programme. The control group received standard care. Outcome variables included anthropometric measures, questionnaires on eating behaviour, physical activity, quality of life, self-efficacy and subjective rating of the intervention. Measurements were performed at the beginning (t1) and end (t2) of inpatient rehabilitation as well as 6 (t3) and 12 (t4) months after discharge. RESULTS: There was a highly significant improvement of BMI-z-score (standard deviation score of the Body Mass Index), relevant behaviour, quality of life and self-efficacy between t1 and t4. On intention to treat analysis no differences were detected between intervention and control groups. The intervention was utilized by only 50 % of entitled. The BMI-z-score reached a minimum at t3 (6-month follow-up). Predictors of longer-term BMI-z-score decline were psychological suffering, poor eating behaviour, low physical activity and high socio-economic status. In multivariate linear regression improvement of eating behaviour and physical activity correlated with the improvement of BMI-z-score. DISCUSSION: This low-level outpatient intervention did not improve the demonstrated longer-term effectiveness of inpatient rehabilitation. An interdisciplinary outpatient follow-up care in groups with inclusion of the parents is recommended.     

Prevention, detection and intervention with delirium in an acute care hospital: a feasibility study

Background. The prevalence of delirium in acute care hospitals ranges from 5–86%. Delirious patients are at greater risk of negative health outcomes and their care is often more costly. Aim. To determine the feasibility of a full‐scale trial to test the effectiveness of an intervention designed to improve delirium prevention, detection and intervention in an acute care hospital. Design. A delirium prevention protocol was designed by an interdisciplinary group of clinicians and implemented on intervention unit patients who passed a mental status screen, were at high risk for delirium according to the modified NEECHAM scale, and met other eligibility criteria. These patients were reviewed at daily interdisciplinary team meetings and team recommendations were placed in the patient’s chart. On the usual care unit, physicians were notified if their patients were at high risk, but the delirium protocol was not implemented. Methods. The delirium protocol was pilot tested with 35 high risk patients on an Acute Care for Elders (ACE) unit. Outcomes were compared to 35 high risk patients on a similar medical unit without the delirium protocol. Results. The main outcome examined whether there is a difference in average day 3 modified NEECHAM scores comparing the intervention and control groups. The mean modified NEECHAMs on day 3 were not statistically significantly different (intervention group 3.76 and control group 3.24) (P= 0.368). Baseline NEECHAM scores did not correlate well with development of delirium (P = 0.204). A history of confusion during a previous hospitalization was the strongest predictor of developing delirium during the current hospitalization. Conclusion. This pilot study was not powered to detect an effect of the intervention, however, feasibility for a fully powered trial was established. Relevance to clinical practice. Completion of the NEECHAM screen every shift was not considered burdensome for either nurses or patients and may help identify acute delirium.     

A study protocol to develop and test an e-health intervention in follow-up service for intensive care survivors' relatives

Background

The negative impact on long-term health-related outcomes among relatives of critically ill patients in the intensive care unit (ICU) has been well described. High-quality ICU specialized follow-up care, which is easily accessible with digital innovation and which is designed by and with relevant stakeholders (i.e., ICU patients' relatives and nurses), should be considered to reduce these impairments in the psychological and social domains.

Aim

The programme's aim is to develop and test an e-health intervention in a follow-up service to support ICU patients' relatives. Here, the protocol for the overall study programme will be described.

Study Design

The overall study comprises a mixed-methods, multicentre research design with qualitative and quantitative study parts. The study population is ICU patients' adult relatives and ICU nurses. The main outcomes are the experiences of these stakeholders with the newly developed e-health intervention. There will be no predefined selection based on age, gender, and level of education to maximize diversity throughout the study programme. After the participants provide informed consent, data will be gathered through focus groups (n = 5) among relatives and individual interviews (n = 20) among nurses exploring the needs and priorities of a digital follow-up service. The findings will be explored further for priority considerations among members of the patient/relative organization (aiming n = 150), which will serve as a basis for digital prototypes of the e-health intervention. Assessment of the intervention will be followed during an iterative process with investigator-developed questionnaires. Finally, symptoms of anxiety and depression will be measured with the 14-item Dutch version of the ‘Hospital Anxiety and Depression Scale’, and symptoms of posttraumatic stress will be measured with the 21-item Dutch version of the ‘Impact of Events Scale-Revised’ to indicate the effectiveness of digital support among ICU patients' relatives.

Relevance to Clinical Practice

The e-health intervention to be developed during this research programme can possibly bridge the gap in integrated ICU follow-up care by providing relevant information, self-monitoring and stimulating self-care among ICU patients' relatives.     

A feasibility study of a combined nurse/pharmacist-led chronic pain clinic in primary care

Chronic pain is common and management hampered by lack of resources in primary and secondary care. Nurse- or pharmacist-led clinics have been shown to lead to improvements in care for patients with chronic pain. This study showed that a combined nurse/pharmacist-led clinic for managing chronic pain in primary care can lead to improvements in management of pain, reduction in use of secondary care resources and high rates of satisfaction.     

A personalized behavioral intervention implementing mHealth technologies for older adults: A pilot feasibility study

Sedentary behavior has been associated with adverse health outcomes such as disturbed sleep in older adults. We conducted a single-group pretest and posttest study to evaluate the feasibility of a personalized behavioral intervention program using mobile health technology in improving physical activity and sleep in older adults. The four-week intervention included: personalized physical activity training, real-time physical activity self-monitoring, interactive prompts and feedback with a smartwatch, phone consultation with an exercise trainer and research team members, and weekly financial incentives for achieving weekly physical activity goals. Eight cognitively intact older adults were recruited and completed the study. Findings suggested that the intervention was feasible in this sample of older adults and provided favorable changes in levels of physical activity during the intervention and at post-intervention. Future studies will include a fully powered trial to evaluate the efficacy of this intervention in sedentary older adults.