Relationship between health-related quality of life and, acute care readmissions and survival in older adults with chronic illness

BACKGROUND: Australia's ageing population means that there is increasing emphasis on developing innovative models of health care delivery for older adults. The assessment of the most appropriate mix of services and measurement of their impact on patient outcomes is challenging. The aim of this evaluation was to describe the health related quality of life (HRQoL) of older adults with complex needs and to explore the relationship between HRQoL, readmission to acute care and survival. METHODS: The study was conducted in metropolitan Melbourne, Australia; participants were recruited from a cohort of older adults enrolled in a multidisciplinary case management service. HRQoL was measured at enrolment into the case-management service using The Assessment of Quality of Life (AQoL) instrument. In 2007-2009, participating service clinicians approached their patients and asked for consent to study participation. Administrative databases were used to obtain data on comorbidities (Charlson Comorbidity Index) at enrolment, and follow-up data on acute care readmissions over 12 months and five year mortality. HRQoL was compared to aged-matched norms using Welch's approximate t-tests. Univariate and multivariate logistic regression models were used to explore which patient factors were predictive of readmissions and mortality. RESULTS: There were 210 study participants, mean age 78 years, 67% were female. Participants reported significantly worse HRQoL than age-matched population norms with a mean AQOL of 0.30 (SD 0.27). Seventy-eight (38%) participants were readmitted over 12-months and 5-year mortality was 65 (31%). Multivariate regression found that an AQOL utility score <0.37 (OR 1.95, 95%CI, 1.03 - 3.70), and a Charlson Comorbidity Index ≥6 (OR 4.89, 95%CI 2.37 - 10.09) were predictive of readmission. Multivariate analysis demonstrated that age ≥80 years (OR 7.15, 95%CI, 1.83 - 28.02), and Charlson Comorbidity Index ≥6 (OR 6.00, 95%CI, 2.82 - 12.79) were predictive of death. CONCLUSION: This study confirms that the AQoL instrument is a robust measure of HRQoL in older community-dwelling adults with chronic illness. Lower self-reported HRQoL was associated with an increased risk of readmission independently of comorbidity and kind of service provided, but was not an independent predictor of five-year mortality

Disseminating sleep education to graduate psychology programs online : a knowledge translation study to improve the management of insomnia

Study Objectives: Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. Methods: Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. Results: Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students’ sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. Conclusions: Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide. © The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society

Disseminating sleep education to graduate psychology programs online: a knowledge translation study to improve the management of insomnia

Study Objectives Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. Methods Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. Results Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students’ sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. Conclusions Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide

Towards better management of obstructive sleep apnoea in tetraplegia

© 2018 Dr.Marnie GracoObstructive sleep apnoea (OSA) is a highly prevalent complication of tetraplegia that worsens health and quality of life. There are effective treatments available yet access to OSA diagnosis and treatment is poor. The overall aim of this research was to document, understand and address some of the knowledge gaps and issues preventing the optimal management of OSA for people with tetraplegia. Four separate but related research projects have been conducted, using a variety of methods. The research questions were chosen because the findings will guide future interventions aiming to improve the clinical management of OSA in tetraplegia, with the ultimate goal of improving quality of life. The aims of the individual projects were: 1. To develop and validate a simple method for detecting OSA in tetraplegia that does not require full in-laboratory sleep study. 2. To describe CPAP use in acute tetraplegia, including adherence rates, factors associated with adherence, and average pressures and mask leak. 3. To estimate CPAP adherence in people with chronic tetraplegia and OSA, and to understand the experience of using CPAP. 4. To describe the variation in OSA management practices in tetraplegia, and to explore factors influencing clinical practice. In the first study, a highly feasible two-stage model designed to detect moderate to severe OSA was modified and validated for people with tetraplegia. The model, consisting of a four-item questionnaire followed by portable overnight oximetry, provides a translatable alternative to full in-laboratory sleep study for identifying moderate to severe OSA in people with chronic tetraplegia. As such, this screening model has the potential to substantially increase the detection of OSA and improve access to treatment. The second study involved secondary analysis of CPAP data from a multicentre trial investigating the effect of CPAP on neurocognitive outcomes in people with acute, traumatic tetraplegia and OSA. This study found that within the trial adherence to CPAP was low, but similar to that observed in other specialized population groups, such as stroke and aged care. The study confirmed findings of previous research that people with tetraplegia require less pressure to treat OSA than people without disability, and those with more severe OSA are more likely to adhere to CPAP. Both qualitative and quantitative research methodologies were used in the third project to estimate rates of CPAP adherence in people with chronic tetraplegia and to understand the experience of the treatment. The burden of using CPAP was found to be substantial, and the balance between the perceived benefit and perceived burden appeared to strongly influence ongoing use. CPAP adherence patterns took up to six months to establish in people with tetraplegia; substantially longer than reported in people without disability. Finally, the fourth study used qualitative methods to describe variations in the clinical management of OSA within the spinal unit environment and to identify factors influencing doctors’ ability to practice in accordance with evidence-based recommendations. The clinical management of OSA was highly variable. Many spinal physicians were not routinely screening for OSA because they lacked resources and reminder systems. Few spinal units were independently diagnosing and treating non-complicated OSA. Those that were tended to be well resourced, involved the multidisciplinary team, and had “clinical champions” to lead the program. This thesis has confirmed that people with tetraplegia are under-diagnosed and under-treated for OSA. Several modifiable contributors have been identified, generating opportunities for further research aiming to improve access to OSA screening, diagnosis and treatment. Shifting current practice has the potential to greatly improve the quality of life and participation outcomes of people with OSA and tetraplegia

Participation in physical activity : perception of women with a previous history of gestational diabetes

The aim was to explore the perceptions of physical activity among women with previous gestational diabetes mellitus, in the context of preventing Type 2 diabetes mellitus.<br /

Understanding the clinical management of obstructive sleep apnoea in tetraplegia:A qualitative study using the theoretical domains framework

BACKGROUND: Clinical practice guidelines recommend further testing for people with tetraplegia and signs and symptoms of obstructive sleep apnoea (OSA), followed by treatment with positive airway pressure therapy. Little is known about how clinicians manage OSA in tetraplegia. The theoretical domains framework (TDF) is commonly used to identify determinants of clinical behaviours. This study aimed to describe OSA management practices in tetraplegia, and to explore factors influencing clinical practice. METHODS: Semi-structured interviews were conducted with 20 specialist doctors managing people with tetraplegia from spinal units in Europe, UK, Canada, USA, Australia and New Zealand. Interviews were audiotaped for verbatim transcription. OSA management was divided into screening, diagnosis and treatment components for inpatient and outpatient services, allowing common practices to be categorised. Data were thematically coded to the 12 constructs of the TDF. Common beliefs were identified and comparisons were made between participants reporting different practices. RESULTS: Routine screening for OSA signs and symptoms was reported by 10 (50%) doctors in inpatient settings and eight (40%) in outpatient clinics. Doctors commonly referred to sleep specialists for OSA diagnosis (9/20 in inpatients; 16/20 in outpatients), and treatment (12/20, 17/20). Three doctors reported their three spinal units were managing non-complicated OSA internally, without referral to sleep specialists. Ten belief statements representing six domains of the TDF were generated about screening. Lack of time and support staff (Environmental context and resources) and no prompts to screen for OSA (Memory, attention and decision processes) were commonly identified barriers to routine screening. Ten belief statements representing six TDF domains were generated for diagnosis and treatment behaviours. Common barriers to independent management practices were lack of skills (Skills), low confidence (Beliefs about capabilities), and the belief that OSA management was outside their scope of practice (Social/Professional role and identity). The three units independently managing OSA were well resourced with multidisciplinary involvement (Environmental context and resources), had 'clinical champions' to lead the program (Social influences). CONCLUSION: Clinical management of OSA in tetraplegia is highly varied. Several influences on OSA management within spinal units have been identified, facilitating the development of future interventions aiming to improve clinical practice