The diabetes network internet-based physical activity intervention: a randomized pilot study

OBJECTIVE: Because of other competing priorities, physical activity (PA) is seldom addressed in a consistent way in either primary care or diabetes education. This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels. RESEARCH DESIGN AND METHODS: A total of 78 type 2 diabetic patients (53% female, average age 52.3 years) were randomized to the Diabetes Network (D-Net) Active Lives PA Intervention or an Internet information-only condition. The intervention condition received goal-setting and personalized feedback, identified and developed strategies to overcome barriers, received and could post messages to an on-line "personal coach," and were invited to participate in peer group support areas. Key outcomes included minutes of PA per week and depressive symptomatology. RESULTS: There was an overall moderate improvement in PA levels within both intervention and control conditions, but there was no significant improvement in regard to condition effects. There was substantial variability in both site use and outcomes within the intervention and control conditions. Internal analyses revealed that among intervention participants, those who used the site more regularly derived significantly greater benefits, whereas those in the control condition derived no similar benefits with increased program use. CONCLUSIONS: Internet-based self-management interventions for PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions. We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time.     

A randomised pilot of a self-help workbook intervention for breast cancer survivors

Purpose  

The aim of this study is to evaluate the efficacy of a self-help workbook for improving adjustment for breast cancer survivors.     

Cardiopulmonary function in long-term survivors of childhood Hodgkin's lymphoma: a pilot study

Twelve patients who had received mantle radiotherapy for Hodgkin's lymphoma during childhood underwent cardiopulmonary testing 7 years or more after the initial diagnosis and treatment. All but one patient had been asymptomatic. Results of echocardiography, pulmonary function tests, or exercise studies were abnormal in 9 of the 12 patients. Long-term follow-up of cardiopulmonary function will be important to determine the ultimate significance of these abnormalities. These potential complications must be considered in planning prospective therapeutic studies in children with Hodgkin's disease.     

The effectiveness of a rehabilitation programme for Chinese cancer survivors: A pilot study

Cancer survivors have experienced high stress which impairs psychological functioning and decreases quality of life (QOL). This study aims to assess the mediating effect of self‐efficacy on mood disturbance and QOL, and determine the effectiveness of a 12 week rehabilitation programme to improve self‐efficacy as well as improve mood disturbance and QOL in Chinese cancer survivors. A total of 47 cancer patients were randomly assigned into the experimental (n = 24) and control (n = 23) groups. The participants in the experimental group received cancer‐related education, progressive muscle relaxation and emotional support. Self‐reported questionnaires, including General Self‐efficacy Scale (GSES), Profile of Mood States Scale–Short Form (POMS‐SF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30) were collected in pre‐ and post‐intervention. Findings from this study indicated that self‐efficacy was a complete mediator between mood disturbance and QOL, and the 12 week rehabilitation programme had a positive effect on self‐efficacy, mood disturbance and QOL for Chinese cancer survivors.     

Phase 2 pilot study of Pathfinders: a psychosocial intervention for cancer patients

Purpose  

Pathfinders is a multi-faceted psychosocial care program for cancer patients; it was developed in community oncology and adapted to the academic oncology setting. This prospective, single-arm, phase 2 pilot study examined the acceptability and feasibility of Pathfinders for women with metastatic breast cancer.     

Fatigue in patients with advanced cancer: a pilot study of an intervention with infliximab

GOALS OF WORK: The objective of this study was to determine the effect of infliximab, an antitumor necrosis factor alpha (TNFalpha) antibody, on fatigue in patients with advanced cancer. MATERIALS AND METHODS: This was a pilot study undertaken in a specialist palliative care unit. Seventeen eligible outpatients were enrolled in this study. Infliximab 5 mg/kg was administered intravenously at baseline and if there was observable clinical benefit, every 4 weeks thereafter until clinical benefit was lost. The primary outcome measure assessing subjective functional improvement was the change in fatigue severity scale (FSS) score at 4 weeks following an infliximab infusion. Secondary outcome measures of subjective functional improvement that were assessed 4 weeks after each infliximab infusion included changes in Karnofsky performance status (KPS), hospital anxiety and depression scale (HADS) score, anxiety and depression subscores, and appetite visual analogue scale. Clinical laboratory assessments were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), TNFalpha, interleukin-6, and leptin concentrations. MAIN RESULTS: At week 4, 9 of 14 patients improved in FSS, 3 of 15 improved in KPS, 7 of 15 improved in total HADS and the majority had modest improvements in serum CRP, ESR, or leptin concentrations. Case studies of six patients with overall improvement are described in detail. Five serious adverse events occurred; two were serious infections possibly related to treatment. CONCLUSIONS: A subgroup of patients in this small pilot study demonstrated uniform subjective/clinical benefit. We were not able to identify any predictors of this response; a larger, controlled study may reveal more information.     

An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study

Fatigue is reported by advanced cancer patients to be their most prevalent and distressing symptom. Despite this, few interventions have been developed and tested to manage this debilitating symptom. This paper describes a pilot study undertaken to test the effects of a 28-day exercise intervention on levels of fatigue in advanced cancer patients. All participants were able to increase their activity levels with no increase in reported fatigue. Furthermore, a trend was noted in all patients toward increased quality of life scores and decreased anxiety scores. All participants described a sense of satisfaction in attaining increased activity levels. These preliminary pilot results suggest that patients who initially report the highest levels of fatigue may achieve the largest decrease in fatigue scores. These findings provide support for the suitability of this intervention for the palliative care population and justify the importance of further hypothesis testing.     

Development of an internet-based intervention for parents of infants

Title. Development of an internet‐based intervention for parents of infants. Aim. This paper reports on a study to describe the development of an internet‐based intervention for parents with infants and to compare the participants and hospitals at baseline. Background. There is a need for interventions to support parenting and for more research into the use of information technology as an intervention strategy. The design and development of healthcare interventions is a complex task, but these are rarely discussed in research reports. Methods. A quasi‐experimental study was conducted. The data (N = 1300 families) were collected using a structured questionnaire at the hospital or no later than 1 week after discharge during the winter of 2006. The results were used to develop the intervention and to compare the participants at baseline. Statistically significant differences were determined by chi‐squared or Fisher’s exact tests for percentages and one‐way anova for means. The internal consistency relialibility of the scales was analysed using Cronbach’s alpha coefficients. Findings. Participants in the intervention (n = 469 mothers, n = 307 fathers) and control (n = 394 mothers, n = 218 fathers) hospitals were comparable in respect of parent and infant attributes. There were statistically significant differences between the hospitals in fathers’ overnight stays and their access to social support from professionals on the maternity ward. Exclusive breastfeeding was more common in the intervention hospital. More support for infants’ cues and behaviour, and day‐rhythm and sleep were needed in the intervention hospital. Conclusion. More research is needed to gain a clearer understanding of the effect size of the differences for a reliable evaluation of the effectiveness of the proposed intervention.     

Validity and reliability of an internet-based temporal gait assessment tool with healthy adults: a pilot study

OBJECTIVES: To assess in healthy adults the validity and the inter- and intrarater reliability of the Internet-based Shaw Gait Assessment (SGA). DESIGN: Concurrent test-retest reliability and validity study with participants, 4 raters, and the Elite motion analysis system (used as the criterion standard). SETTING: Motion analysis laboratory in a university physical therapy department. PARTICIPANTS: Convenience sample of 16 healthy men and women (age range, 28-53y). INTERVENTION: Each subject performed 2 consecutive walks "at a comfortable pace" on a 6-m walkway. A video camera from the Elite motion analysis system filmed reflective markers, which were attached to subjects' shoes, and the reflective markers provided the criterion standard. Four raters simultaneously recorded each walk by using laptop computers and the SGA. MAIN OUTCOME MEASURES: Paired t test (5% level) for average differences between each test and retest for raters and the Elite; Pearson correlations, limits of agreement, and coefficients of variation (CVs) for validity of the tool; intraclass correlation coefficients (ICCs) for inter- and intrarater reliability. RESULTS: Pearson product moment correlation coefficients between each of the raters and the Elite ranged from .92 to .95 for speed, from .85 to .97 for cadence, from .87 to .92 for step length, from .61 to .84 for left advance limb time, and from .68 to .83 for right advance limb time. Pooled CVs for all variables were below 8% for all raters and the Elite. Pooled ICCs for intrarater reliability were .89 for speed, .99 for cadence, .84 for step length, .76 for left limb advance time, and .84 for right limb advance time. Interrater ICCs were .89 for speed, .82 for cadence, .76 for step length, .66 for left limb advance time, and .81 for right limb advance time. CONCLUSIONS: The SGA is a valid and reliable tool for several key temporal measures of gait in a healthy adult population.     

Results of a randomized controlled pilot study of a self-management intervention for cancer pain

Purpose of the researchThis paper reports findings from a randomized controlled pilot study evaluating the PRO-SELF^© Plus Pain Control Program, a U.S.-developed cancer pain self-management intervention, regarding feasibility and effect sizes in a German patient sample.Methods and sampleThirty-nine German oncology outpatients were randomized to intervention (n = 19) and control (n = 20) groups. The intervention group received the PRO-SELF^© Plus Pain Control Program in 6 visits and 4 phone calls a 10-week period. The control group received standard education and care. The intervention employed three key strategies: information provision, skills building, and nurse coaching. Primary outcomes were changes in average and worst pain intensity. Secondary outcomes included changes in pain-related knowledge, opioid intake, and self-efficacy. Data were collected at enrollment, then at 6, 10, 14, and 22 weeks.Key resultsThe group-by-time effect showed a statistically significant increase in knowledge (week 10: p = 0.04; week 22: p < 0.01). Despite slight reductions in average and worst pain, no statistically significant changes were found for pain, opioid intake, or self-efficacy.ConclusionsThis study is the first to evaluate and demonstrate the feasibility of a U.S.-developed cancer pain self-management intervention in a German patient population. Pain self-management related knowledge improved significantly and effect sizes for pain reduction were determined. Findings from this pilot RCT provide the basis for planning a larger RCT.Clinical trial registration number: NCT00920504.     

Hepatitis C virus infection and long-term survivors of childhood cancer: Issues for the pediatric oncology nurse

Infection with hepatitis C virus (HCV) represents a major public health concern today because of its prevalence in the United States. Acute HCV is commonly asymptomatic and often results in chronic disease. However, symptoms related to chronic disease may not appear for decades. Patients with HCV have a broad spectrum of symptoms, which vary from elevated liver function test results to cirrhosis, liver cancer and end stage liver disease. Past treatment therapies have not been highly effective; however, a new treatment is currently available. Today, many high-risk activities are associated with HCV infection. Blood transfusions are no longer a risk factor. However, 20% of individuals who received transfused blood products contracted hepatitis C nearly two decades ago. Therefore, cancer survivors who received blood products to combat chemotherapy induced anemia and thrombocytopenia before 1980 represent a population at risk. It is important that nurses caring for these patients understand the pathophysiology, etiology, transmission, and course of HCV. This knowledge will enable nurses to encourage serological testing to identify infected individuals. Once identified, patients with hepatitis C can receive social support and appropriate referrals to help them deal with the psychosocial issues related to long-term effects and secondary illnesses.     

Health status of ICU survivors: a pilot study.

This paper reports on a pilot study that focused on the feasibility of conducting longitudinal research on the health status of intensive care unit (ICU) survivors. Twenty patients completed a short ICU specific health status survey while in ICU and then were invited to complete the same survey--with the addition of the Medical Outcome Study Short Form-36 (SF-36) health status survey--at 6 and 12 months after their hospital discharge. While the patients were in the ICU, 20 family members completed the same survey on the patients' behalf as proxy respondents. Most patients were willing to be in the study for its duration. There was a wide variation in patients' responses to the ICU specific instrument at all data collection points. Patient and proxy responses were very similar for almost all of the physical items but there was a lack of agreement for the more subjective psychosocial items. The SF-36 was found to be more reliable and easier to score and analyse in this small study than the ICU specific health status instrument. The three SF-36 scales ranked lowest at 6 months were physical functioning, role-physical and role-emotional, while at 12 months the three lowest were role-physical, role-emotional and vitality. Total attrition at 12 months was 40 per cent. Using the results of the SF-36, sample size estimates were conducted in preparation for a larger study. It was concluded that it is feasible to conduct longitudinal research on ICU survivors but proxy responses should not be used indiscriminately.     

Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors

Title. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors Aim. This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue, mood and quality of life in breast cancer survivors. Background. Women who receive primary treatment for breast cancer often complain of insomnia. Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue, mood and quality of life. Method. Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post‐completion of primary treatment without current evidence of disease. Women were randomly assigned to either the cognitive behavioural therapy for insomnia group, which received stimulus control instructions, sleep restriction therapy and sleep education and hygiene, or the component control group which received sleep education and hygiene only. The 10‐week study consisted of 2 weeks of pre‐treatment, 6 weeks of treatment and 2 weeks of post‐treatment. Fatigue, mood and quality of life were measured at pre‐ and post‐treatment. Findings. Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue, trait anxiety, depression and quality of life. The component control group also had statistically significant increases in quality of life, with a trend suggestive of lower depression at post‐treatment. Conclusion. Globally, as the number of survivors in this population continues to grow, it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue, anxiety and depression.