Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial

BackgroundReturning to work is often a primary rehabilitation goal after traumatic brain injury (TBI). However, the evidence base for treatment options regarding return to work (RTW) and stable work maintenance remains scarce.ObjectiveThis study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI.MethodsIn this study, we compared 6 months of a combined compensatory cognitive training and supported employment (CCT-SE) intervention with 6 months of treatment as usual (TAU) in a randomised controlled trial to examine the effect on time to RTW, work percentage, hours worked per week and work stability. Eligible patients were those with mild-to-moderate TBI who were employed ≥ 50% at the time of injury, 18 to 60 years old and sick-listed ≥ 50% at 8 to 12 weeks after injury due to post-concussion symptoms, assessed by the Rivermead Post Concussion Symptoms Questionnaire. Both treatments were provided at the outpatient TBI department at Oslo University Hospital, and follow-ups were conducted at 3, 6 and 12 months after inclusion.ResultsWe included 116 individuals, 60 randomised to CCT-SE and 56 to TAU. The groups did not differ in characteristics at the 12-month follow-up. Overall, a high proportion had returned to work at 12 months (CCT-SE, 90%; TAU, 84%, P = 0.40), and all except 3 were stably employed after the RTW. However, a significantly higher proportion of participants in the CCT-SE than TAU group had returned to stable employment at 3 months (81% vs. 60%, P = 0.02).ConclusionThese results suggest that the CCT-SE intervention might help patients with mild-to-moderate TBI who are still sick-listed 8 to 12 weeks after injury in an earlier return to stable employment. However, the results should be replicated and a cost-benefit analysis performed before concluding.     

Workplace support after breast cancer treatment: recognition of vulnerability

Abstract

Background: Support from the workplace seems to be a key element in addressing the poor return-to-work (RTW) rate of employees with breast cancer. We aim to acquire an in-depth understanding of how Flemish employees experience their RTW after breast cancer and the support from the workplace. Method: Fourteen in-depth interviews of women who experienced breast cancer and returned to work (high school graduates, age range 42–55 years, mean age 48 at time of surgery) were analysed using the Qualitative Analysis Guide of Leuven (QUAGOL), based on a Grounded Theory approach. Results: The key experiences were feeling vulnerable, feeling able to work and need for support. Although little diversity in RTW experiences was found, the background of the vulnerability varied. Women experienced support (which could be emotional or practical) only as adequate if it addressed their specific vulnerability. Conclusions: Employees felt particularly vulnerable. Vulnerability is not the same as low-work ability and as such it should be added as theoretical concept in RTW research. Adequate workplace support addresses the specific vulnerability of an individual woman. Our study offers a nuanced insight into the RTW process of breast cancer survivors.

• Implications for Rehabilitation

• Upon actual return-to-work (RTW) after breast cancer treatment, women feel vulnerable but able to work and, hence, have a high need for workplace support.

• Support from the workplace during RTW after breast cancer treatment is experienced as adequate when it expresses genuine recognition of the individual woman’s vulnerability.

     

Development of work readiness in graduate nurses during a Transition to Practice Program: A survey study

BackgroundTransition to Practice Programs (TPPs) support graduate nurses and midwives during their first year of clinical practice. ‘Work readiness’ theory proposes specific skills, knowledge, and attributes are needed to successfully transition into the workplace.AimsTo measure development of self-perceived work readiness among graduates undertaking a 12-month TPP.MethodsRepeated measure, cross-sectional survey. Participants were a cohort of 160 graduate nurses and midwives (response rate 56.7%) commencing at a large tertiary hospital in Melbourne, Australia. Work readiness was measured using the Work Readiness Scale-graduate nurses at three timepoints: on commencement (T1), at 6 months (T2), and on completion (T3) of a 12-month TPP. Data were collected between 2018 and 2019.ResultsGraduate’s Social Intelligence (p = 0.007) and Work Competence (WC) (p < 0.001) subscales had a significant increase from T1 to T3. On completion of the TPP (T3), participants reported significantly higher Personal Work Characteristics (p = 0.017) and WC (p < 0.001) scores compared with baseline (T1). Scores for the organisational acumen (OA) subscale were high across all three timepoints (p = 0.898).DiscussionSignificant improvement in three of the four domains of work readiness was observed at timepoints across the TPP.OA was consistently high at all timepoints, which may reflect the comprehensive orientation provided before commencement of the program.ConclusionUnderstanding graduate development of work readiness can inform cost-effective TPPs that deliver desired graduate outcomes.     

Interrelationships among workload,illness severity,and function on return to work following acute respiratory distress syndrome

BackgroundInability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS).ObjectivesThe aim of this study is to examine interrelationships among pre-ARDS workload, illness severity, and post-ARDS cognitive, psychological, interpersonal, and physical function with RTW at 6 and 12 months after ARDS.MethodsWe conducted a secondary analysis using the US multicentre ARDS Network Long-Term Outcomes Study. The US Occupational Information Network was used to determine pre-ARDS workload. The Mini-Mental State Examination and SF-36 were used to measure four domains of post-ARDS function. Analyses used structural equation modeling and mediation analyses.ResultsAmong 329 previously employed ARDS survivors, 6- and 12-month RTW rates were 52% and 56%, respectively. Illness severity (standardised coefficients range: ?0.51 to ?0.54, p < 0.001) had a negative effect on RTW at 6 months, whereas function at 6 months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a positive effect. Working at 6 months (0.79 to 0.72, P < 0.001) had a positive effect on RTW at 12 months, whereas illness severity (?0.32 to ?0.33, p = 0.001) and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p = 0.002], interpersonal [0.44, p < 0.001; 0.22, p = 0.03], and physical abilities [0.47, p < 0.001; 0.33, p = 0.007]) only had an indirect effect on RTW at 12 months mediated through work at 6 months.ConclusionsRTW at 12 months was associated with patients' illness severity; post-ARDS cognitive, psychological, interpersonal, and physical function; and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving ARDS survivors' RTW may include optimisation of workload after RTW, along with interventions across the healthcare spectrum to improve patients’ physical, psychological, and interpersonal function.     

Psychometric properties assessment of Chinese version of work readiness scale for graduate nurses (WRS-GN) and associated factors of work readiness: Two cross-sectional studies

BackgroundLower work readiness is tied to anxiety, high turnover and nurse transition failure. An assessment of work readiness is necessary. To date, no relative scale exists in China. Thus, a work readiness related scale is urgently needed.ObjectivesTo assess the psychometric properties of the scale, and look into the status of Chinese graduate nurse work readiness and factors associated with work readiness.Design, settings, and participants.Both psychometric assessment and associated factors are designed with cross-sectional studies. 832 and 435 graduate nurses were recruited in the above two studies, respectively.MethodsBrislin's transition model was utilized for the transition process, and a six-expert panel and preliminary survey were conducted for face validity and testing the transition version respectively. Exploratory factor analysis, confirmatory factor analysis, internal consistency reliability and test-retest reliability were applied for reliability and validity testing. Additionally, a linear regression method was carried out for analyzing influencing factors of work readiness of graduate nurses across China.ResultsA 37-item Chinese version scale was proven to have great psychometric qualities. Five factors were extracted by exploratory factor analysis, which can explain 68.637% of the total variance. Furthermore, the confirmatory factor analysis demonstrates the fit indices of a five factors mode: X²/df = 1.769, RMSEA = 0.067, NFI = 0.859, RFI = 0.839, IFI = 0.934, CFI = 0.933, TLI = 0.923. Intra-class correlation coefficient, Cronbach's α and Guttman Split-half were 0.805, 0.960 and 0.903, respectively. Interpersonal relationships, leadership experience, scholarship, work experience and willingness to be nurses were associated with the potential to achieve higher work readiness.ConclusionThe Chinese version of WRS-GN with good validity and reliability can be utilized for assessment of work readiness. Besides, improving work readiness of graduate nurses based on above five associated factors, educators and hospital managers could help graduate nurses having a smooth transition for a stable nursing workforce.     

Integrative medicine in multiple myeloma and plasma cell disorders

IntroductionIntegrative Medicine (IM) use and efficacy is poorly defined in those with plasma cell disorders (PCD). A 69-question survey on the subject was hosted on HealthTree.org for 3 months.MethodThe survey included questions about complementary practice use, PHQ-2 score, quality of life, and more. Mean outcome values were compared between IM users and non-users. Proportions of supplement users and IM patients were compared between patients currently on myeloma specific treatment and patients not currently on treatment.ResultsThe top 10 IM modalities reported among 178 participants were aerobic exercise (83 %), nutrition (67 %), natural products (60 %), strength exercise (52 %), support groups (48 %), breathing exercises (44 %), meditation (42 %), yoga (40 %), mindfulness-based stress reduction (38 %), and massage (38 %). The survey showed most patients participated in IM modalities, though they felt uncomfortable discussing them with their oncologist. Participant characteristics were compared between groups (users and non-users) using two-sample t-tests and chi-square tests. Use of vitamin C (3.6 vs. 2.7; p = 0.01), medical marijuana (4.0 vs. 2.9; p = 0.03), support groups (3.4 vs. 2.7; p = 0.04), and massage (3.5 vs. 2.7; p = 0.03) were associated with a higher quality of life scores on MDA-SI MM. There were no other significant associations between supplement use or IM practices and the MDA-SI MM, brief fatigue inventory, or PHQ-2.ConclusionThis study provides a foundation in the understanding of IM use in PCD, but more research is needed to evaluate individual IM interventions and their efficacy.     

LONG-TERM EMPLOYMENT STATUS AND THE ASSOCIATION WITH FATIGUE IN PATIENTS WITH GRADE II GLIOMAS

ObjectiveTo investigate employment status and return to work in relation to fatigue in patients with World Health Organization (WHO) grade II glioma.DesignExploratory cross-sectional study.SubjectsPatients with grade II glioma, who underwent surgery between 2005 and 2016.MethodsA postal survey was sent in 2019, which included the Short Form-Health and Labour Questionnaire and the Multi-dimensional Fatigue Index. Outcomes of fatigue in subgroups of (not-) return to work were compared using independent t-tests and x² tests. The association between fatigue and return to work was analysed using multivariable logistic regression.ResultsIn total, 73 patients were included in the study (age at diagnosis 41.0 years (standard deviation (SD) 9.2 years), time post-diagnosis 8.0 years (interquartile range (IQR) 6-11 years). At diagnosis, 61 patients were employed and 32 returned to work during follow-up. The return to work group was significantly younger than the not-return to work group (p = 0.007). The proportion of patients who indicated that the consequences of glioma had affected return to work, in terms of demotion or reduced working hours, was 68.7%. The not-return to work group reported significantly more fatigue in all domains than the return to work group (p < 0.05). Mental fatigue (p = 0.023) and physical fatigue (p = 0.065) were independently associated with return to work, adjusted for age, sex and the use of anti-epileptic drugs.ConclusionLong-term fatigue is associated with return to work in patients with grade II glioma. Patients who were able to work in the long term were less fatigued, younger, more often male, and used less anti-epileptic drugs than the patients who did not return to work.LAY ABSTRACTPatients with glioma have adult brain cancer. These patients are relatively young and are of working age when they develop this disease. Treatment options for glioma have improved over recent years, and patients will survive approximately 5-15 years. Almost all patients are of working age. Because of the increased survival time, patients find it important to continue to participate in society, especially in work. This study examined working patterns in patients with glioma several years after the start of their disease. Fifty-two percent of patients were working 8 years after the diagnosis of glioma. Many patients with brain tumours felt tired (fatigued), both mentally and physically. Patients who were able to work in the long term were less fatigued, younger, more often male, and used less anti-epileptic drugs than the patients who did not return to work.Key words: employment, glioma, return to work, fatigue

Engagement in work is very important from a societal perspective and from an individual perspective, in preventing financial stress, social isolation and loss of self-esteem (1–3).In the general cancer population, improvements in diagnosis and treatment have increased the prognosis of patients, and an increasing number of patients return to work (RTW) following treatment or continue to work during therapy (4). A focus on RTW is part of the societal reintegration of cancer survivors (5).Rates of RTW in the overall cancer population range widely, from 30% to 93% (5–7). A metaanalysis reported that cancer survivors overall were 1.37 times more likely to be unemployed than healthy control participants, but patients with a central nervous system cancer were 1.78 times more likely to be unemployed (7).Patients diagnosed with grade II glioma are usually early in their working age and have a favourable midterm prognosis, with a survival time between 5 and 15 years (8, 9). RTW has long been an understudied aspect. Recently, Yoshida et al. (10) and Senft et al. (11) studied rates of RTW for patients with grade II and III glioma. They reported a RTW rate of 54.0% one year after surgery and after a median follow-up of 43.8 months (range 11–82 months) 70.7% of patients were able to resume a working life.Fatigue is a highly prevalent and debilitating symptom in cancer survivors, including patients with glioma (12). Cancer-related fatigue is defined as a “persistent, subjective sense of tiredness related to cancer and cancer treatment that interferes with usual functioning” It is described as a multidimensional phenomenon. In all types of cancer, fatigue is common during treatment and follow-up (13, 14).Fatigue is a negative predictor of RTW in patients who survive cancer (1, 15, 16). Fatigue and treatment-related symptoms are important reasons for not returning to work in diffuse glioma of all grades (11, 17). Since many patients with low-grade glioma have a relatively favourable prognosis, RTW is an important element of survival. The present study therefore investigated employment status and RTW in patients who underwent surgery for a grade II glioma after diagnosis, and the association between fatigue and employment status.     

Social support and quality of life among Chinese breast cancer survivors: Findings from a mixed methods study

BackgroundSocial support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory.AimTo explore social support and its relationship with QOL in breast cancer survivors in China.MethodsThis was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis.ResultsSurvivors reported a median support network size of 2.2 persons (interquartile range = 1.2–3.8) and a median support satisfaction score of 5.5 (interquartile range = 5–6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors' support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors.ConclusionsThis study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors' QOL through the underlying different types of situation-specific support.     

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak

BackgroundDuring the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses.MethodsA cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress.ResultsThe mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (β = 0.829, p < 0.001).ConclusionsPsychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.     

The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study

BackgroundDue to projected nurse shortages, it is necessary that undergraduate programs optimise work readiness outcomes in new graduate nurses. Research that quantitatively evaluates characteristics of clinical nursing programs that predict increased work readiness is required.ObjectivesTo explore the relationship between the undergraduate clinical learning environment and nurse perceptions of work readiness prior to and following, commencement as a new graduate nurse.DesignA pre-post follow-up study. Undergraduates were surveyed at the end of their Bachelor's degree (baseline) and at 8–10 weeks after commencement as a graduate nurse (Time 1).SettingA multi-site, metropolitan private hospital in Victoria, Australia.ParticipantsNursing graduates who completed a university fellowship program (n = 26), or were undertaking their graduate year and had completed placement blocks within (n = 18) or outside (n = 31) the healthcare organisation.MethodsParticipants self-completed the Clinical Learning Environment Inventory (CLEI) and Work Readiness Scale for Graduate Nurses (WRS-GN) at baseline and Time 1. Multiple regression analyses were performed.ResultsCLEI scores significantly predicted work readiness outcomes (all p-values<.05), accounting for 16–36% and 17–28% of the variance of WRS-GN scores at baseline and Time 1, respectively. After adjusting for clustering due to clinical placement groups, CLEI Individualisation (p = .023) and Valuing Nurses Work (p = .01) predicted improved Time 1 WRS-GN Organisational Acumen. CLEI Innovative and Adaptive Culture scores predicted poorer Time 1 Organisational Acumen (p = .001).ConclusionsLearning environments that offered high levels of individualised attention and valued nurses' work appeared to facilitate post-graduation engagement and identification with nursing practice. However, highly innovative and adaptive education may detract from optimal work readiness. Findings revealed that while important, the clinical learning environment only accounted for a small-to-moderate degree of nursing graduates' work readiness. To facilitate robust evidence-based improvement of clinical nursing education, future research should attempt to empirically establish the value of additional facilitators of work readiness.     

Association Between Loneliness and the Frequency of Using Online Peer Support Groups Among Cancer Patients With Minor Children: A Cross-Sectional Web-Based Study

ContextCancer patients with minor children are increasing; however, they do not receive sufficient support.ObjectiveThis study aimed to investigate the association between loneliness and the frequency of using online peer support groups among cancer patients with minor children.MethodsA cross-sectional web-based survey was conducted from April to May 2019. Cancer patients with minor children were recruited from an online peer support group called “Cancer Parents.” Individuals diagnosed with cancer and whose youngest children were younger than 18 years were enrolled. Materials included: the UCLA Loneliness Scale version 3 (UCLA-LS), K6 scale, abbreviated Lubben Social Network Scale, and the sociodemographic/clinical characteristics questionnaire. Multivariate logistics regression analysis was performed to determine the factors associated with the high loneliness group (defined as those above the median score on the UCLA-LS).ResultsA total of 334 patients participated (79.9% female; mean age 43.1 years, standard deviation 5.8). The most common primary cancer type was breast (34.1%). The median score of the UCLA-LS was 45 (interquartile range 37–53). The multivariate logistics regression analysis revealed that the high loneliness group was significantly associated with the frequent use of online peer support group less than once a week (odds ratio [OR] = 0.47; 95% CI = 0.26–0.85; P = 0.012), with a smaller social network (OR = 0.78; 95% CI = 0.73–0.83; P < 0.001), and higher psychological distress (OR = 1.16; 95% CI = 1.09–1.23; P < 0.001).ConclusionsFrequent use of online peer support groups was associated with less loneliness among cancer patients with minor children.     

A Web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial

BackgroundRegular exercise and dietary practices have been shown to affect the health-related quality of life (HRQOL) and survival of breast cancer patients.ObjectiveThe current study aimed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients.DesignA 12-week randomized, controlled trial.SettingOncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea.ParticipantsFifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0–III cancers within 2 years prior to the study were recruited.MethodsParticipants were randomly assigned to either the intervention group, which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies (n = 29), or to the control group, which used a 50-page educational booklet on exercise and diet (n = 28). The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables (F&V) per day, dietary quality, HRQOL, anxiety, depression, fatigue, motivational readiness, and self-efficacy.ResultsThe proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week; ate 5 servings of F&V per day; and had overall improvements in dietary quality, physical functioning and appetite loss (HRQOL), fatigue, and motivational readiness was greater in the intervention group than in the control group. The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group. A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy, although further research with a larger sample size is required to enable definitive conclusions.     

Systematic Review and Meta-Analysis of Predictors of Return to Work After Spinal Surgery for Chronic Low Back and Leg Pain

Spinal surgeries to treat chronic low back pain (CLBP) have variable success rates, and despite the significant personal and socioeconomic implications, we lack consensus for prognostic factors. This systematic review and meta-analysis evaluated the evidence for preoperative predictors of return to work (RTW) after spinal surgery for CLBP. We searched electronic databases and references (January 1984 to March 2021), screened 2,622 unique citations, and included 8 reports (5 low and 3 high risk-of-bias) which involved adults with ≥3 months duration of CLBP with/without leg pain undergoing first elective lumbar surgery with RTW assessed ≥3 months later. Narrative synthesis and meta-analysis where possible found that individuals less likely to RTW were older (odds ratio [OR] = .58; 95% confidence interval [CI]: 0.46–0.72), not working before surgery, had longer sick leave (OR = .95; 95% CI: 0.93–0.97), higher physical workload, legal representation (OR = .61; 95% CI: 0.53–0.71), psychiatric comorbidities and depression (moderate quality-of-evidence, QoE), and longer CLBP duration and opioid use (low QoE), independent of potential confounders. Low quality and small number of studies limit our confidence in other associations. In conclusion, RTW after spinal surgery for CLBP likely depends on sociodemographic and affective psychological factors, and potentially also on symptom duration and opioid use.PerspectiveThis systematic review and meta-analysis synthesizes and evaluates existing evidence for preoperative predictors of return to work after spinal surgery for chronic low back pain. Demonstrated associations between return to work and sociodemographic, health-related, and psychological factors can inform clinical decision-making and guide further research.     

Unplanned postdischarge healthcare utilisation,discharge readiness,and perceived quality of teaching in mothers of neonates hospitalized in a neonatal intensive care unit: A descriptive and correlational study

BackgroundDischarge teaching has been positively associated with discharge readiness in various care settings and patient types. Association of discharge readiness with unplanned use of health services has not received as much attention in the neonatal intensive care unit (NICU) population, but has been negatively associated in parents of older children.ObjectivesThe objective of the study was to describe and assess relationships between maternal readiness for neonates' discharge, discharge teaching, and unplanned use of health services after discharge from an NICU.MethodsMothers from an NICU of a tertiary referral hospital in Switzerland completed the “Readiness for Hospital Discharge Scale” and the “Quality of Discharge Teaching Scale parental forms” in the 24 h preceding discharge. Telephone interviews evaluating the unplanned use of health services were conducted 28 days after discharge. Simple linear regressions and multiple regressions were used to explore the links between the readiness, perceived quality of discharge, and unplanned use of health services.ResultsOf the 71 participants, 75% (n = 53%) felt ready for discharge when asked directly, and for 60% (n = 42) of them, the amount of discharge teaching received was equal to or higher than that needed, but with high heterogeneity in scores. For 38% of mothers (n = 27), the expected support from the medical care of their child after discharge was deemed insufficient. In the month after discharge, unplanned use of health services occurred in 46% of the participants (n = 32). Perceived quality of teaching positively predicted readiness for discharge (R² = 0.24, p = 0.0004). Unplanned use of health services correlated neither with readiness nor with perceived teaching quality.ConclusionsAt discharge, mothers felt mostly ready and well prepared to go home. In the month after discharge, almost half used health services in an unplanned manner. Further exploration of reasons leading to this high rate of postdischarge healthcare utilisation is warranted.     

Cancer-Related Fatigue: Central or Peripheral?

To evaluate cancer-related fatigue (CRF) by objective measurements to determine if CRF is a more centrally or peripherally mediated disorder, cancer patients and matched noncancer controls completed a Brief Fatigue Inventory (BFI) and underwent neuromuscular testing. Cancer patients had fatigue measured by the BFI, were off chemotherapy and radiation (for more than four weeks), had a hemoglobin level higher than 10 g/dL, and were neither receiving antidepressants nor were depressed on a screening question. The controls were screened for depression and matched by age, gender, and body mass index. Neuromuscular testing involved a sustained submaximal elbow flexion contraction (SC) at 30% maximal level (30% maximum elbow flexion force). Endurance time (ET) was measured from the beginning of the SC to the time when participants could not maintain the SC. Evoked twitch force (TF), a measure of muscle fatigue, and compound action potential (M-wave), an assessment of neuromuscular-junction transmission were performed during the SC. Compared with controls, the CRF group had a higher BFI score (P < 0.001), a shorter ET (P < 0.001), and a greater TF with the SC (CRF > controls, P < 0.05). This indicated less muscle fatigue. There was a greater TF (P < 0.05) at the end of the SC, indicating greater central fatigue, in the CRF group, which failed to recruit muscle (to continue the SC), as well as the controls. M-Wave amplitude was lower in the CRF group than in the controls (P < 0.01), indicating impaired neuromuscular junction conduction with CRF unrelated to central fatigue (M-wave amplitude did not change with SC). These data demonstrate that CRF patients exhibited greater central fatigue, indicated by shorter ET and less voluntary muscle recruitment during an SC relative to controls.