Support group for cancer patients. Does it improve their physical and psychological wellbeing? A pilot study

In order to evaluate a structured support intervention programme, symptoms and quality of life (QOL) were studied in 61 consecutive cancer patients with different tumour diagnoses in relation to intervention and follow-up. The majority of the patients were female. The Edmonton symptom assessment scale (ESAS), the Norwegian fatigue questionnaire and the hospital anxiety and depression scale (HADS) were used. Data were analysed according to ANOVA and Tukeys honest significant difference (HSD) test. ESAS sickness score (P=0.0001), depression (P=0.0001), anxiety (P=0.0001) and QOL (P=0.0009) improved and the improvements in depression and anxiety were still significant after 3 months (P=0.02 respectively). Aspects of fatigue also improved significantly in 7 of 11 questions after the intervention (P0.04) but these improvements were not observed after 3 months. Anxiety according to the HADS questionnaire improved significantly after the intervention (P=0.0006). The majority of the patients highly appreciated the possibility of sharing thoughts and troubles with others with similar experiences (59%). The programme was therefore found to improve QOL, and physical and psychological functions. Randomized studies in relation to immunological changes and follow-up are in progress.     

Are your staff spreading disease to patients?

Patients are at risk for contracting flu from ED staff. Vaccinations are effective in reducing flu and severe respiratory disease in health care workers. All staff who come in contact with severely ill or debilitated patients should consider getting an influenza vaccine to protect themselves and their patients.     

Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?

BACKGROUND: Numerous practice guidelines have been developed for patients with low back pain in an attempt to reduce inappropriate variations and improve the cost-effectiveness of care. Guideline implementation has received more research attention than the impact of adherence to guideline recommendations on outcomes and costs of care. OBJECTIVE: Examine the association between adherence to the guideline recommendation to use active versus passive treatments with clinical outcomes and costs for patients with acute low back pain receiving physical therapy. RESEARCH DESIGN: Retrospective review of patients with acute low back pain receiving physical therapy in 2004-2005. Adherence to the recommendation for active treatment was determined from billing records. Clinical and financial outcomes were compared between patients receiving adherent or nonadherent care. SUBJECTS: A total of 1190 patients age 18-60 years old with low back pain of less than 90 days duration in 10 clinics in 1 geographic region. MEASURES: Clinical outcomes included the numeric pain rating and Oswestry disability questionnaire taken initially and at the completion of treatment. Financial outcomes included the number of sessions and charges for physical therapy care. RESULTS: Adherence rate was 40.4%. Adherence was greater for patients receiving workers' compensation (P < 0.05). Patients receiving adherent care had fewer visits and lower charges (P < 0.05), and showed more improvement in disability [adjusted mean difference for percentage improvement 25.8%, 95% confidence interval (CI): 21.3-30.4, P < 0.001] and pain (adjusted mean difference for percentage improvement 22.4%, 95% CI: 17.5-27.3, P < 0.001). Patients receiving adherent care were more likely to have a successful physical therapy outcome (64.7% vs. 36.5%, P < 0.001). CONCLUSIONS: Adherence to the guideline recommendation for active care was associated with better clinical outcomes and reduced cost.     

Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients?

The purpose of this randomized, controlled, home care intervention was to test the effectiveness of two nurse-targeted, e-mail-based interventions to increase home care nurses' adherence to pain assessment and management guidelines, and to improve patient outcomes. Nurses from a large urban non-profit home care organization were assigned to usual care or one of two interventions upon identification of an eligible cancer patient with pain. The basic intervention consisted of a patient-specific, one-time e-mail reminder highlighting six pain-specific clinical recommendations. The augmented intervention supplemented the initial e-mail reminder with provider prompts, patient education material, and clinical nurse specialist outreach. Over 300 nurses were randomized and outcomes of 673 of their patients were reviewed. Data collection involved clinical record abstraction of nurse care practices and patient interviews completed approximately 45 days after start of care. The intervention had limited effect on nurse-documented care practices but patient outcomes were positively influenced. Patients in the augmented group improved significantly over the control group in ratings of pain intensity at its worst, whereas patients in the basic group had better ratings of pain intensity on average. Other outcomes measures were also positively influenced but did not reach statistical significance. Our findings suggest that although reminders have some role in improving cancer pain management, a more intensive approach is needed for a generalized nursing workforce with limited recent exposure to state-of-the-art pain management practices.     

Does psychological stress improve physical performance?

The purpose of this study is to determine whether psychological stress enhances physical performance and how personality traits affect it. The annual physical test was chosen as the psychological stressor. Ninety three students ran 50 meters as part of the test and one week after that as a control. The pulse rate and time were measured and pulse rate was used as an indicator of psychological stress. All students took the anxiety-trait scale test of the State-Trait Anxiety Inventory. The pulse rate was higher and the time record was better in the annual physical test compared with that of control. When we categorized the subjects by the anxiety-trait scale test, only the high anxiety-trait students could run faster when faced with higher stress. In conclusion, psychological stress can enhance the physical performance of certain students. It is possible that psychological stress and personality traits interact and both of them affect physical performance.     

Do family interventions improve health?

The central aim of this article is to examine the evidence that family interventions improve health in persons with chronic illness and their family members, across the life span. The review focuses on recent meta-analyses of randomized controlled trials of family intervention research. In adults, evidence supports the salutary effects of family interventions versus usual medical care for patient health and mental health, and for family member health. In children, robust evidence supports family-based multimodal interventions for obesity treatment. Reasonable evidence supports family approaches to type 1 diabetes treatment in children. Nurses led the research or were members of interdisciplinary research teams in several of these literatures, representing one quarter to one third of the research cited, but were absent in other literatures, such as family treatment of childhood obesity.