A pilot study of therapeutic massage for people with Parkinson's disease: the added value of user involvement

OBJECTIVE: To carry out a pilot study, with particular attention to adequacy of outcome measures. DESIGN: Observational study and user participation. SETTING AND PARTICIPANTS: A local user group selected seven participants with a wide range of illness severity. INTERVENTION: A course of eight 1hr sessions of deep whole body (therapeutic) massage over 8 weeks. OUTCOME MEASURES: The Parkinson's Disease Questionnaire (PDQ-39), the Measure Yourself Medical Outcome Profile (MYMOP), and the Medication Change Questionnaire (MCQ). Semi-structured interviews, before and after the intervention. RESULTS: In addition to enjoying the massage, individuals showed improvement in self-confidence, well-being, walking and activities of daily living. There was good agreement between data from the outcome questionnaires, interviews and clinical notes. User involvement highlighted issues that would otherwise have been ignored. CONCLUSIONS: The study confirms the benefits of involving users in the research process and makes recommendations concerning the design of any future randomised trial.     

Positive touch, the implications for parents and their children with autism: an exploratory study

The aims of this study were (1) to explore the experience of touch between parents and children with autism before, during, and after a Training and Support Programme (TSP), and (2) to develop a model of the process of touch therapy for this group of parents and children. Fourteen parents and their children agreed to take part in the study. Five of these parents withdrew. Reasons for withdrawal included personal circumstances and ill health. Data were collected by semi-structured interviews with parents before attending the TSP and Home Record Sheets completed by parents during the TSP. Results indicate that before the TSP touch was experienced as out of parents' control. During the TSP, the experience of touch appeared to change. A key benefit gained by parents was the feeling of closeness to children. The key benefits gained by children were perceived by the parents as improved sleep patterns, children were more relaxed after receiving the massage and appeared more amenable to touch. Of interest was children's request for massage at home. At 16-week follow-up both parents and children continue to enjoy giving and receiving touch therapy, respectively.     

Educational preferences, psychological well-being and self-efficacy among people with rheumatoid arthritis.

As a basis for developing interventions to meet the psycho-educational needs of rheumatoid arthritis (RA) outpatients attending a regional hospital have been investigated. Specifically, patients' preferences for interventions addressing education (e.g. the disease and its treatment), self-management (e.g. pain-management, exercise) and the consequences (e.g. emotions, impact on work, family relationships) of RA were examined. In addition, psychological well-being and self-efficacy were examined. Results showed that patients preferred education about the disease and its treatment to be delivered on a one-to-one basis by health professionals. Similarly, emotional issues were believed to be best dealt with one-to-one although this could be with a similar other (i.e. a patient). Group interventions were the preferred format for self-management, exercise and relationship issues, whereas videos were thought to be useful for demonstrating use of aids and how other families cope. None of the participants would welcome computer-based interventions. Psychological well-being (e.g. depression, anxiety) remained stable over a 12-month period. Both physical and psychological health status were correlated with arthritis self-efficacy. The implications of these findings are discussed in relation to development of interventions to better meet the psycho-educational needs of outpatients with RA.     

Breast cancer screening in an era of personalized regimens: A conceptual model and National Cancer Institute initiative for risk‐based and preference‐based approaches at a population level

Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population‐based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for “overdiagnosis,” and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a “1‐size‐fits‐all” guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population‐based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk‐based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits‐to‐harms tradeoffs in population‐based screening, which is a timely goal in the era of health care reform. Cancer 2014;120:2955–2964. © 2014 American Cancer Society.     

Effect of obesity on aromatase inhibitor efficacy in postmenopausal,hormone receptor-positive breast cancer: a systematic review

Aromatase inhibitors (AIs) decrease the production of oestrogen, decreasing stimulation of hormone receptor-positive breast cancer. Theoretically, AIs may be less effective in obese women, due to the greater quantity of aromatase in peripheral fatty tissue. We performed a systematic review to assess the effect of obesity on AI efficacy in breast cancer treatment. The review followed PRISMA guidelines. Studies included were interventional or observational studies with comparison groups, of postmenopausal women with hormone receptor-positive breast cancer on treatment with an AI, alone or in combination with other drugs, in which body mass index or another measure of obesity was recorded. Studies in all languages were included; if published as an abstract only, authors were contacted for further information. Outcome measures included overall survival, disease-free survival or time to progressive disease, survival from the start of therapy, mortality measures, local or distant recurrence of primary cancer and time to recurrence. Of 2,344 citations identified from five databases, eight studies met the criteria for inclusion; three randomised controlled trials and five retrospective cohort studies. Due to variability in study factors, it was not possible to perform a quantitative meta-analysis. However, the systematic review showed a trend towards a negative effect of obesity on AI efficacy. There is evidence of a negative effect of obesity on AI efficacy in postmenopausal hormone receptor-positive breast cancer, but the size of the effect cannot be assessed. More information is needed before clinical recommendations are made.     

Readiness to change as a moderator of outcome in transdiagnostic treatment

Abstract Initial symptom severity is a client characteristic associated with psychotherapy outcome, although this relationship is not well-understood. Readiness to change is a factor that may influence this relationship. This study tested readiness as a moderator of the relationship between initial severity and symptom change. Data were derived from an RCT examining the efficacy of a transdiagnostic CBT treatment. Readiness was assessed with the URICA, and symptom and functioning outcomes were assessed. Multiple regression models indicated that severity was associated with less overall change, yet readiness moderated this relationship. At higher levels of readiness, the effect of initial severity on outcome was essentially reversed; for clients with higher initial readiness, higher levels of severity were associated with greater change.