Changes over time in caregiving demand and difficulty in spousal caregivers of coronary artery bypass graft surgery patients

Patients who undergo coronary artery bypass graft (CABG) surgery are often dependent on spouses or family members for care during their recovery. The purpose of this study was to examine changes over time in spousal caregivers of coronary artery bypass graft (CABG) patients in caregiving demand and caregiving difficulty and to identify the key demands and difficulties at each time point. Spouses (n = 34) of CABG patients comprised the sample. Caregiving demand and caregiving difficulty were measured using the Caregiving Burden Scale at three time points (baseline [early hospital discharge] and 3 and 6 months later) and analyzed using repeated measures analysis of variance. Mean scores of each item were used to identify the top four caregiving demands and difficulties at each time point. There was a significant decrease over time in caregiving demands (F [1.696] = 13.62, p < 0.001) and caregiving difficulties (F [1.613] = 4.52, p = 0.02). The most demanding and/or difficult caregiving activities at all time points were providing social support, managing behavior problems, taking on additional household tasks, and monitoring symptoms. Early in recovery, providing transportation was a top ranked demand and difficulty. Later in recovery (3 and 6 months), managing finances became a top ranked demand and difficulty. In conclusion, caregiving demands and difficulties declined significantly over six months for the caregivers in this study. These results indicate that caregiving demands and difficulties change over time and ongoing assessments of spouses and family members are needed to help them manage the caregiving situation.     

Measuring the expressed emotion in Chinese family caregivers of persons with dementia: Validation of a Chinese version of the Family Attitude Scale

BackgroundExpressed emotion (EE) captures the affective quality of the relationship between family caregivers and their care recipients and is known to increase the risk of poor health outcomes for caregiving dyads. Little is known about expressed emotion in the context of caregiving for persons with dementia, especially in non-Western cultures. The Family Attitude Scale (FAS) is a psychometrically sound self-reporting measure for EE. Its use in the examination of caregiving for patients with dementia has not yet been explored.ObjectivesThis study was performed to examine the psychometric properties of the Chinese version of the FAS (FAS-C) in Chinese caregivers of relatives with dementia, and its validity in predicting severe depressive symptoms among the caregivers.MethodsThe FAS was translated into Chinese using Brislin's model. Two expert panels evaluated the semantic equivalence and content validity of this Chinese version (FAS-C), respectively. A total of 123 Chinese primary caregivers of relatives with dementia were recruited from three elderly community care centers in Hong Kong. The FAS-C was administered with the Chinese versions of the 5-item Mental Health Inventory (MHI-5), the Zarit Burden Interview (ZBI) and the Revised Memory and Behavioral Problem Checklist (RMBPC).ResultsThe FAS-C had excellent semantic equivalence with the original version and a content validity index of 0.92. Exploratory factor analysis identified a three-factor structure for the FAS-C (hostile acts, criticism and distancing). Cronbach's alpha of the FAS-C was 0.92. Pearson's correlation indicated that there were significant associations between a higher score on the FAS-C and greater caregiver burden (r = 0.66, p < 0.001), poorer mental health of the caregivers (r = −0.65, p < 0.001) and a higher level of dementia-related symptoms (frequency of symptoms: r = 0.45, p < 0.001; symptom disturbance: r = 0.51, p < 0.001), which serves to suggest its construct validity. For detecting severe depressive symptoms of the family caregivers, the receiving operating characteristics (ROC) curve had an area under curve of 0.78 (95% confidence interval (CI) = 0.69–0.87, p < 0.0001). The optimal cut-off score was >47 with a sensitivity of 0.720 (95% CI = 0.506–0.879) and specificity of 0.742 (95% CI = 0.643–0.826).ConclusionsThe FAS-C is a reliable and valid measure to assess the affective quality of the relationship between Chinese caregivers and their relatives with dementia. It also has acceptable predictability in identifying family caregivers with severe depressive symptoms.     

The effectiveness of manual-guided,problem-solving-based self-learning programme for family caregivers of people with recent-onset psychosis: A randomised controlled trial with 6-month follow-up

BackgroundFamily intervention for psychotic disorders is an integral part of psychiatric treatment with positive effects on patients’ mental state and relapse rate. However, the effect of such family-based intervention on caregivers’ psychological distress and well-being, especially in non-Western countries, has received comparatively much less attention.ObjectivesTo test the effects of guided problem-solving-based manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis over a 6-month period of follow-up, when compared with those in usual family support service.DesignA single-centre randomised controlled trial, which was registered at ClinicalTrials.gov (NCT02391649), with a repeated-measures, two-arm (parallel-group) design.SettingsOne main psychiatric outpatient clinic in the New Territories of Hong Kong.ParticipantsA random sample of 116 family caregiverss of adult outpatients with recent-onset psychosis.MethodsFollowing pre-test measurement, caregivers were assigned randomly to one of two study groups: a 5-month self-help, problem-solving-based manual-guided self-learning (or bibliotherapy) programme (in addition to usual care), or usual family support service only. Varieties of patient and caregiver health outcomes were assessed and compared at baseline and at 1-week and 6-month post-intervention.ResultsOne hundred and eleven (96%) caregivers completed the 6-month follow-up (two post-tests); 55 of them (95%) completed ≥4 modules and attended ≥2 review sessions (i.e., 75% of the intervention). The family participants’ mean age was about 38 years and over 64% of them were female and patient's parent or spouse. Multivariate analyses of variance indicated that the manual-guided self-learning group reported significantly greater improvements than the usual care group in family burden [F(1,110) = 6.21, p = 0.006] and caregiving experience [F(1,110) = 6.88, p = 0.0004], and patients’ psychotic symptoms [F(1,110) = 6.25, p = 0.0003], functioning [F(1,110) = 7.01, p = 0.0005] and number of hospitalisations [F(1,110) = 5.71, p = 0.005] over 6-month follow-up.ConclusionsProblem-solving-based, manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis can be an effective self-help programme and provide medium-term benefits to patients’ and caregivers’ mental health and duration of patients’ re-hospitalisations.     

Effect of integrated caregiver support on caregiver burden for people taking care of people with cancer at the end of life: A cohort and quasi-experimental clinical trial

BackgroundPrevious studies have shown small-to-medium effects of support on reducing the caregiver burden for advanced cancer patients. A dearth of studies utilized longitudinal design to examine and evaluate the effect of support for the caregiving burden till the patient's death.ObjectivesTo test the ability of an integrative intervention program for caregivers of advanced cancer patients to lower caregiving burden as death approaches.DesignA two-group comparative design with repeated measures.SettingTwo cancer wards of a single university hospital.ParticipantsAdvanced cancer patients (N = 81) and their caregivers were allocated into two groups: an experimental group (N = 40) receiving coping strategies, assistance, recourses, and education intervention and a control group (N = 41) receiving standard care.MethodsCaregivers received training in the caregiver support intervention at least 3 times every 2 weeks to help them reduce their caregiving burden. Subjective (Caregiver Reaction Assessment) and objective (Heart Rate Variability) measures of caregiver burden were evaluated for caregivers of patients approaching death. Only data within 3 months before the patients’ death were analyzed.ResultsCaregiver self-efficacy significantly increased and the subjective caregiving burden significantly decreased in the experimental group as patients’ death approached. Heart Rate Variability also indicated a calming effect of the intervention, helping caregivers face patients’ death.ConclusionsThe caregiver support intervention can increase caregiver self-efficacy and reduce the subjective caregiving burden. Heart Rate Variability parameters have the potential to be useful for monitoring caregiver burden in facing patients’ death.     

An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study)

BackgroundThe prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention.ObjectiveThe aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission.DesignA multi-site, block randomised controlled trial.SettingsThe study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon.ParticipantsAdult patients presenting for an exacerbation of heart failure to one of the study centres were included. Patients with limited life expectancy or physical functionality, planned cardiac bypass or valve replacement surgery, living alone or in nursing homes, or aged less than 18 years were excluded.MethodsPatients allocated to the intervention group and their family caregivers were provided with a comprehensive, culturally appropriate, educational session on self-care maintenance and symptom management along with self-care resources. The usual care group received the self-care resources only. Follow-up phone calls were conducted 30 days following discharge by a research assistant blinded to treatment assignment. The primary outcome was hospital readmission and the secondary outcomes were self-care, quality of life, major vascular events and healthcare utilization.ResultsThe final sample included 256 patients hospitalized for heart failure randomised into control (130 patients) and intervention (126 patients) groups. The mean age was 67 (SD = 8) years, and the majority (55%) were male. Readmission at 30 days was significantly lower in the intervention group compared to the control group (n = 10, 9% vs. n = 20, 19% respectively, OR = 0.40, 95% CI = 0.02, 0.10, p = 0.02). Self-care scores improved in both groups at 30 days, with a significantly larger improvement in the intervention group than the control group in the maintenance and confidence sub-scales, but not in the self-care management sub-scale. No differences were seen in quality of life scores or emergency department presentations between the groups. More patients in the control group than in the intervention group visited health care facilities (n = 24, 23% vs. n = 12, 11% respectively, OR = 0.39, 95% CI = 0.18, 0.83, p = 0.01).ConclusionThe trial results confirmed the potential of the family-centred self-care educational intervention under evaluation to reduce the risk of readmission in Lebanese patients suffering from exacerbated heart failure. Further research is needed to validate these findings with longer periods of follow-up and to identify the intervention components and intensity required to induce sustained benefits on patients' self-care management and quality of life.     

Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial

BackgroundHospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers’ self-identified support needs.ObjectivesThis study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program.DesignThis single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient’s discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports.Setting and participantsDyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver.MethodsThe primary outcome was the caregiver’s self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15–21 days after discharge; Time 3, six weeks after discharge. Other measures included caregivers’ ratings of: their health, patients’ symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone.ResultsComplete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements.Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size = 0.52; p = 0.006) and from Time 1 to Time 3 (effect size = 0.43; p = 0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain.ConclusionsThese unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program’s implementation in this and other similar settings. Further testing is required to determine the generalisability of results.     

Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students

BackgroundHigh-fidelity simulation (HFS) offers a strategy to facilitate cognitive, affective, and psychomotor outcomes and motivate the new generation of students.ObjectivesThe purpose of this study was to examine the impact of using high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students.DesignA post-test, quasi-experimental design was used.SettingsTwo private universities in Lebanon were targeted to implement the intervention.ParticipantsA convenience sample of 56 nursing students from two private universities in Lebanon were recruited.MethodsData were collected using the Lasater Clinical Judgment Rubric and the Motivated Strategies for Learning questionnaires.ResultsNursing students exhibited significant improvement in clinical judgment and motivation due to exposure to HFS. There was a significant difference post HFS between the intervention group and the control group in clinical judgment intervention (t = 5.23, p < 0.001) and motivation for academic achievement (t = − 6.71, p < 0.001). The intervention group had a higher mean score of clinical judgment (29.5, SD = 5.4) than the control group (22.1, SD = 5.7) and, similarly, students had higher mean scores of motivation (198.6, SD = 10.5) in the intervention group than in the control group (161.6, SD = 20). The analysis related to differences between the intervention and control groups in motivation and clinical judgment; controlling for previous experience in health care services, the analysis showed no significant difference (Wilk's lambda = 0.77, F = 1.09, p = 0.374).ConclusionThere is a need for nursing educators to implement HFS in nursing curricula, where its integration can bridge the gap between theoretical knowledge and nursing practice and enhance critical thinking and motivation among nursing students.     

Exploring the other side of cancer care: The informal caregiver

ObjectivesTo identify the caregiver outcomes among relatives caring for patients with cancer and to examine the patient and family caregiver variables that predicted for caregiver burden and depression.MethodsOne hundred and thirty caregivers completed the Greek versions of the Burden Interview (BI), the Center of Epidemiology – Depression Scale (CES-D) and the Ways of Coping Questionnaire. Principal component analysis was performed to examine the underlying dimensions of caregiver outcome measures. One-way ANOVA and independent sample t-tests were used to test for differences in burden and depression in relation to demographic variables of interest. One-way ANOVA was used for examining differences in coping strategies.FindingsOne-way ANOVA showed that there are significant differences among the various educational levels (p < 0.001) and the income (p < 0.005) of the caregiver in terms of overall burden. 66.4% of caregivers had a depression above the usual cutoff point for depression. An independent samples t-test for possible gender differences, showed that there is a significant difference between males and females (p = 0.29). In regression analysis it was found that only caregiver's income and patient's age are statistically significant in predicting burden and depression. When considering high-burdened caregivers results showed that there are significant differences in the use of coping strategies (p < 0.001).ConclusionsCaregivers reported high levels of burden and depression. These outcomes of caregiving are related to several variables, but the caregiver's income and patient's age are predictive. Intervention strategies are needed to the vulnerable caregivers to help reduce burden and depression associated with caregiving.     

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

ObjectiveCompare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.DesignRandomized controlled trial.SettingOne long-term care facility in Taiwan.Participants86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n = 30), or usual activity (n = 30).InterventionOne certified trainer provided the intervention group with 40 min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.Main outcome measuresQuality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF)ResultsParticipants in the Tai Chi group (M = 3.76, SD = 3.65) recorded significantly lower GDS-SF scores than participants in the control (M = 7.76, SD = 5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p = 0.03], general health [p = 0.04], and the associated domains: physical health [p = 0.00], psychological health [p = 0.02], social relations [p = 0.00], and environment [p = 0.00].ConclusionsThe findings highlight the importance of Tai Chi in improving QOL and depression in this population.     

Interprofessional training enhances collaboration between nursing and medical students: A pilot study

BackgroundEffective collaboration among healthcare providers is an essential component of high-quality patient care. Interprofessional education is foundational to ensuring that students are prepared to engage in optimal collaboration once they enter clinical practice particularly in the care of complex geriatric patients undergoing surgery.Study DesignTo enhance interprofessional education between nursing students and medical students in a clinical environment, we modeled the desired behavior and skills needed for interprofessional preoperative geriatric assessment for students, then provided an opportunity for students to practice skills in nurse/physician pairs on standardized patients. This experience culminated with students performing skills independently in a clinic setting.ResultsNine nursing students and six medical students completed the pilot project. At baseline and after the final clinic visit we administered a ten question geriatric assessment test. Post-test scores (M = 90.33, SD = 11.09) were significantly higher than pre-test scores (M = 72.33, SD = 12.66, t(14) = − 4.50, p < 0.001. Nursing student post-test scores improved a mean of 22.0 points and medical students a mean of 11.7 points over pre-test scores.Analysis of observational notes provided evidence of interprofessional education skills in the themes of shared problem solving, conflict resolution, recognition of patient needs, shared decision making, knowledge and development of one's professional role, communication, transfer of interprofessional learning, and identification of learning needs.ConclusionsHaving nursing and medical students “learn about, from and with each other” while conducting a preoperative geriatric assessment offered a unique collaborative educational experience for students that better prepares them to integrate into interdisciplinary clinic teams.     

Prevalencia de úlceras por presión en atención primaria en dos comarcas catalanas

ObjectiveTo determine the prevalence of and risk factors for skin breakdown due to pressure ulcers.MethodWe performed an observational, cross sectional study between April 1 and April 15, 2003 in all community nurses in the areas of Bages and Berguedà (Barcelona, Spain) and the head nurses of all nursing homes. Information (patient and caregiver characteristics and preventive measures) was gathered on all patients previously diagnosed with skin breakdown or risk of skin breakdown.ResultsA total of 810 patients were studied (209 with skin breakdown and 601 at risk for skin breakdown). The prevalence of patients with skin breakdown due to pressure ulcers was 0.11% among the adult population, 0.42% in individuals aged more than 64 years old, 7.3% in patients receiving home care, and 4.8% in nursing home residents. Each community nurse attended a mean of 3.7 patients (SD = 2.5) at risk of skin breakdown and a mean of 1.8 patients (SD = 1.1) with pressure ulcers.ConclusionsGiven the prevalence of pressure ulcers in patients receiving home care, detection of risk should be increased to prevent ulcer progression. When risk is detected, preventive measures should be increased. Health education should be improved in family caregivers, who play a major role in the process.     

The effects of a sensory stimulation intervention on psychosocial and clinical outcomes of critically ill patients and their families: A randomised controlled trial

ObjectivesTo explore the effectiveness of a sensory stimulation intervention on intensive care unit patients' psychosocial, clinical, and family outcomes.DesignA prospective, assessor-blind, parallel-group randomised controlled trial.SettingA surgical intensive care unit of one tertiary hospital in Guangzhou, mainland China.InterventionParticipants in the intervention group received a daily 30-minute auditory and visual stimulation session starting from recruitment and for a maximum of seven days while in the intensive care unit.Measurement and main resultsOne hundred fifty-two patients and family caregiver dyads were recruited. Patients in the intervention group showed lower total scores of post-traumatic stress disorder (21.92 ± 6.34 vs 27.62 ± 10.35, p = 0.001), depressive symptoms (3.76 ± 3.99 vs 6.78 ± 4.75, p = 0.001) and delusional memories (0.47 ± 0.92 vs 0.82 ± 1.23, p = 0.001) collected immediately post-intervention than those in the control group, while not on depressive symptoms at one-month post-intervention (3.32 ± 4.03 vs 3.28 ± 3.77, p = 0.800). Sensory stimulation did not significantly impact patients' unit length of stay and 30-day mortality (all p > 0.05). For family outcomes, family caregivers in the intervention group had greater satisfaction with care (127.12 ± 14.14 vs 114.38 ± 21.97, p = 0.001) and a lower level of anxiety (28.49 ± 6.48 vs 34.64 ± 7.68, p = 0.001) than family caregivers in the control group.ConclusionsSensory stimulation may benefit patients' and family caregivers' psychological well-being, and further well-designed multi-centre clustered randomized controlled trials could be considered to strengthen the evidence.     

Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico

AimTo analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS).MethodCross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis.ResultsA response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004).ConclusionsThe results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.     

A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: Randomised controlled trial

BackgroundNon-Hodgkin’s lymphoma is a heterogeneous group of lymphoproliferative malignancies. Chemotherapy can improve patient survival rates, yet it is also associated with many adverse physical and psychosocial effects. It is suggested that qigong practices may be used to reduce patient distress and side effects.ObjectivesTo evaluate the effects of Chan-Chuang qigong on fatigue, complete blood cells, sleep quality, and quality of life for patients with non-Hodgkin lymphoma who had undergone the first course of chemotherapy.DesignA randomized controlled study.SettingsAn oncology ward of medical centre in northern Taiwan.ParticipantsFifty participants in each of the two groups.MethodsParticipants were randomly assigned to either the qigong group (n = 50) that received a 21-day Chan-Chuang qigong programme, or the control group (n = 50). The primary outcome was fatigue measured by Brief Fatigue Inventory. The secondary outcomes were complete blood cell counts, sleep quality measured by Verran and Snyder-Halpern Sleep Scale, and quality of life measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.ResultsAfter 21 days of intervention, the results obtained from ninety six participants were analysed. Participants in the qigong group exhibited decreased fatigue intensity and fatigue interference from 5.49 (SD = 1.02) and 5.53 (SD = 1.27) to 0.37 (SD = 1.39) and 0.20 (SD = 1.93), respectively. Generalized estimating equations analyses revealed that the qigong group, when compared to the control group, had significant improvement in fatigue intensity and fatigue interference over time (β = −1.04, 95% confidence interval [CI] from −1.59 to −0.48, p < 0.001; and β = −1.22, 95% CI from −1.86 to −0.59, p < 0.001, respectively). There was a significant between-group difference in the improvement in white blood cell counts (t = 5.14, p < 0.001), hemoglobin levels (t = 3.17, p = 0.002), and sleep quality (t = 17.73, p < 0.001), but not in platelet counts (p = 0.05). With regard to quality of life, the scores of the qigong group improved in all subscales and all symptom items when compared to that of the control group. No adverse effects were observed in the qigong group.ConclusionsThe findings of this study indicate that the 21-day Chan- Chuang qigong can reduce fatigue intensity and fatigue interference, and improved white blood cell counts, haemoglobin levels, sleep quality, and quality of life for patients with non-Hodgkin lymphoma who had undergone the first course of chemotherapy. Further studies involving a prolonged extended intervention period and follow-up are necessary for determining the long-term effect of qigong exercise.     

A randomized trial of a small changes approach for weight loss in veterans: Design,rationale, and baseline characteristics of the ASPIRE-VA trial

BackgroundOverweight/obesity rates among veterans are higher than the national average. While weight management treatment has been implemented in the Veterans Health Administration (VHA), program data shows low enrollment, participation, and weight loss. This paper presents the design, rationale and baseline characteristics of a multisite, multi-modality, randomized clinical trial assessing an innovative Small Changes (SC) approach on weight loss compared to the current weight management program in the VHA.MethodOverweight/obese veterans were recruited from two VHA medical centers. Participants were randomized to either: 1) sc group, 2) SC phone, or 3) usual care. Participants in the SC arms met with health coaches weekly in months 1–3, bi-weekly in months 4–9, and monthly in months 10–12. Usual care participants met weekly for 12 weeks with limited options for follow-up care. The primary outcome is weight at 12 months. Secondary outcomes include physiological, behavioral, psychosocial outcomes along with participation and adherence.ResultsParticipants include 481 veterans who are middle-aged (M = 55.45, SD = 10.00), obese (BMI = 36.45, SD = 6.24), relatively sedentary (M = 4721 steps per day; SD = 3115), disabled (52%), men (85%) with a large minority of non-white race/ethnicity (43%) and high prevalence of physical co-morbidities (83%) (Charlson Co-morbidity Index M = 1.27, SD = 1.75) and mental health disorders (57%) at baseline.ConclusionThe present study seeks to determine if an SC approach, delivered either via phone or in-person, will result in greater weight loss and program participation and adherence at 12 months compared to usual care.     

Cuidados e implicaciones en los cuidadores de pacientes quirúrgicos en el domicilio

ObjectiveTo identify the care given by informal caregivers to patients who underwent abdominal surgery in the Consorci Hospitalari of Vic (Barcelona). To compare the responsibility burden for those caregivers in all the different stages of the surgical process. To determine the consequences of the care itself on the caregiver's health and to identify the factors that contribute to the need of providing care and the appearance of consequences for the caregivers in the home.MethodologyA longitudinal observational study with follow-up at admission, at discharge and 10 days, of 317 non-paid caregivers of patients who suffer underwent surgery. The characteristics of caregivers and surgical patients were studied. The validated questionnaire, ICUB97-R based on the model by Virginia Henderson, was used to measure the care provided by informal caregivers and its impact on patient quality of life.ResultsMost of the caregivers were women, with an average age of 52.9 ± 13.7 years without any previous experience as caregivers. The greater intensity of care and impact was observed in the time when they arrived home after hospital discharge (p < 0.05). The predictive variables of repercussions were being a dependent patient before the surgical intervention (β = 2.93, p = 0.007), having a cancer diagnosis (β = 2.87, p < .001) and time dedicated to the care process (β = 0.07, p = 0.018).ConclusionsCaregivers involved in the surgical process provide a great amount of care at home depending on the characteristics of patients they care for, and it affects their quality of life.