Optimising self-care support for people with heart failure and their caregivers: development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping.

ArticleBackground We aimed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life. Methods We used intervention mapping to guide the development of our intervention. We identified “targets for change” by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We then used behaviour change theory, expert opinion and a taxonomy of behaviour change techniques, to identify barriers to and facilitators of change and to match intervention strategies to each target. A patient and public involvement group helped to identify patient and caregiver needs, refine the intervention objectives and strategies and deliver training to the intervention facilitators. A feasibility study (ISRCTN25032672) involving 23 patients, 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention. Results The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention is a comprehensive self-care support programme comprising the “Heart Failure Manual”, a choice of two exercise programmes for patients, a “Family and Friends Resource” for caregivers, a “Progress Tracker” tool and a facilitator training course. The main targets for change are engaging in exercise training, monitoring for symptom deterioration, managing stress and anxiety, managing medications and understanding heart failure. Secondary targets include managing low mood and smoking cessation. The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks, via home and telephone contacts. The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators, patients and caregivers. Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas, especially in terms of addressing caregivers’ needs. The REACH-HF materials were revised accordingly. Conclusions We have developed a comprehensive, evidence-informed, theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers. A randomised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers.This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-1210-12004). CA, RT and CG are also supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust; KJ by CLAHRC West Midlands and SS by CLAHRC East-Midlands. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

Weight loss maintenance: An agenda for health psychology

This is the peer reviewed version of the editorial, which has been published in final form at doi:10.1111/bjhp.12107. This editorial may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving.n/a (Editorial)NIHR'Fuse' (British Heart Foundation, Cancer Research UK, ESRC, MRC

Group-Based Diet and Physical Activity Weight-Loss Interventions: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordBACKGROUND: Many weight-loss interventions are delivered in groups but evidence on their effectiveness, and characteristics associated with effectiveness, is limited. We synthesised evidence on (1) design and delivery of group-based weight-loss interventions; (2) effectiveness; and (3) associations between intervention characteristics, change techniques, and effectiveness. METHODS: Five online databases were searched to May 2017 for randomised controlled trials (RCTs) of group-based diet and/or physical activity interventions for overweight/obese adults (BMI ≥ 25). Intervention characteristics were synthesised narratively. Mean differences (MD) in weight loss were calculated using a random-effects meta-analysis, and sub-group analyses were conducted to identify moderators of effectiveness. RESULTS: Forty-seven RCTs reporting 60 evaluations of group-based interventions were included. MD in weight loss between intervention and control groups was -3.49 [95% CI -4.15, -2.84], -3.44 [-4.23, -2.85], and -2.56 kg [-3.79, -1.33] at follow-ups closest to 6, 12, and 24 months, respectively. Explicitly targeting weight loss, men-only groups providing feedback and dietary goals were significantly associated with greater effectiveness (p < .05). CONCLUSIONS: Diet and physical activity interventions delivered in groups are effective in promoting clinically meaningful weight loss at 12 months. Intervention design and effectiveness vary considerably between studies, and evidence on what optimises the effectiveness of group-based weight-loss interventions remains limited.This work presents independent research funded by the UK National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC), C. Greaves’ Career Development Fellowship (CDF‐2012‐05‐029), and A. Borek's PhD scholarship from the University of Exeter

Techniques for modifying impulsive processes associated with unhealthy eating: a systematic review

Objective: This systematic review aimed to; (i) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior, (ii) describe the mechanisms targeted by such techniques and (iii) summarize available evidence on the effectiveness of these techniques. Methods: Searches of 5 bibliographic databases identified studies, published in English since 1993, that evaluated at least one technique to modify impulsive processes affecting eating in adults. Data were systematically extracted on study characteristics, population, study quality, intervention techniques, proposed mechanisms of action and outcomes. Effectiveness evidence was systematically collated and described without meta-analysis. Results: Ninety-two studies evaluated 17 distinct impulse management techniques. They were categorized according to whether they aimed to (1) modify the strength of impulses, or (2) engage the reflective system or other resources in identifying, suppressing or otherwise managing impulses. Although higher quality evidence is needed to draw definitive conclusions, promising changes in unhealthy food consumption and food cravings were observed for visuospatial loading, physical activity, and if-then planning, typically for up to 1-day follow-up. Conclusions: A wide range of techniques have been evaluated and some show promise for use in weight management interventions. However, larger-scale, more methodologically-robust, community based studies with longer follow-up times are needed to establish whether such techniques can have a long-term impact on eating patterns

Effective Behavior Change Techniques in Asthma Self-Care Interventions: Systematic Review and Meta-Regression

This article may not exactly replicate the final version published in the APA journal. It is not the copy of record.APA Journals®Objectives: The purpose of this study is to update previous systematic reviews of interventions targeting asthma self-care in adults with asthma, and to use meta-regression to examine the association between the use of specific behavior change techniques and intervention effectiveness. Methods: Electronic bibliographies were searched systematically to identify randomized controlled trials of interventions targeting asthma self-care. Intervention content was coded using a published taxonomy of behavior change techniques. For trials with a low-to-moderate risk of bias, study outcomes were pooled using random effects meta-analysis. Associations between intervention content and effect size were explored using meta-regression. Results: Meta-analysis of 38 trials (7883 patients) showed that interventions targeting asthma self-care reduced symptoms (standardized mean difference [SMD] = -0.38 [-0.52, -0.24]) and unscheduled health care use (odds ratio [OR] = 0.71 [0.56 to 0.90]) and increased adherence to preventive medication (OR = 2.55 [2.11 to 3.10]). meta-regression analyses found that "active involvement of participants" was associated with a reduction in unscheduled health care use (OR = 0.50 vs. 0.79). Inclusion of "stress management" techniques was associated with an increase in asthma symptoms (SMD = 0.01 vs. -0.44). Existing recommendations about the "optimal" content of asthma self-care interventions were tested but were not supported by the data. Conclusions: Interventions targeting asthma self-care are effective. Active involvement of participants is associated with increased intervention effectiveness, but the use of stress management techniques may be counterproductive. Taxonomy-based systematic reviews using meta-regression have potential for identifying techniques associated with increased effectiveness in behavioral interventions. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

JC and BK virus sequences are not detectable in leukaemic samples from children with common acute lymphoblastic leukaemia

Epidemiological evidence suggests that childhood leukaemia, and possibly common acute lymphoblastic leukaemia in particular, may have an infectious aetiology. Smith (1997 J Immunother20: 89–100) recently suggested that the critical infectious event occurs during pregnancy, and identified the polyoma virus JC as a candidate agent. In the present study we investigated whether genomes from the JC virus, and closely related BK virus, could be detected in leukaemic cells. No positive results were obtained suggesting that JC virus is unlikely to play a direct role in leukaemogenesis. © 1999 Cancer Research Campaig

Single cell analysis identifies <em>CRLF2</em> rearrangements as both early and late events in Down syndrome and non-Down syndrome acute lymphoblastic leukaemia

Deregulated expression of the type I cytokine receptor, CRLF2, is observed in 5-15% of precursor B-cell acute lymphoblastic leukaemia (B-ALL). We have previously reported the genomic landscape of patients with CRLF2 rearrangements (CRLF2-r) using both whole genome and exome sequencing, which identified a number of potential clonal and sub-clonal genomic alterations. In this study, we aimed to assess when the CRLF2-r; IGH-CRLF2 or P2RY8-CRLF2, arose during the evolution of both Down syndrome-ALL (DS-ALL) and non-DS-ALL. Using fluorescence in situ hybridisation, we were able to track up to four structural variants in single cells from 47 CRLF2-r B-ALL patients, which in association with our multiplex single cell analysis of a further four patients, permitted simultaneous tracking of copy number alterations, structural and single nucleotide variants within individual cells. We observed CRLF2-r arising as both early and late events in DS and non-DS-ALL patients. Parallel evolution of discrete clones was observed in the development of CRLF2-r B-ALL, either involving the CRLF2-r or one of the other tracked abnormalities. In depth single cell analysis identified both linear and branching evolution with early clones harbouring a multitude of abnormalities, including the CRLF2-r in DS-ALL patients

Impact of Type 2 diabetes prevention programmes based on risk identification and lifestyle intervention intensity strategies: a cost-effectiveness analysis

Aim To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes that target different at-risk population subgroups through lifestyle interventions of varying intensity. Methods An individual patient simulation model simulated the development of diabetes in a representative sample of adults without diabetes from the UK population. The model incorporates trajectories for HbA1c, 2-h glucose, fasting plasma glucose, BMI, systolic blood pressure, total cholesterol and HDL cholesterol. In the model, patients can be diagnosed with diabetes, cardiovascular disease, microvascular complications of diabetes, cancer, osteoarthritis and depression, or can die. The model collects costs and utilities over a lifetime horizon. The perspective is the UK National Health Service and Personal Social Services. We used the model to evaluate the population-wide impact of targeting a lifestyle intervention of varying intensity to six population subgroups defined as at high risk for diabetes. Results The intervention produces 0.0020 to 0.0026 incremental quality-adjusted life-years and saves £15 to £23 per person in the general population, depending on the subgroup targeted. Cost-effectiveness increases with intervention intensity. The most cost-effective options were to target South-Asian people and those with HbA1c levels > 42 mmol/mol (6%). Conclusion The model indicates that diabetes prevention interventions are likely to be cost-saving. The criteria for selecting at-risk individuals differentially has an impact on diabetes and cardiovascular disease outcomes, and on the timing of costs and benefits. The model is not currently able to account for potential differential uptake or efficacy between subgroups. These findings have implications for deciding who should be targeted for diabetes prevention interventions.NIH

Preference for different relaxation techniques by COPD patients: comparison between six techniques.

BACKGROUND: A review of the effectiveness of relaxation techniques for chronic obstructive pulmonary disease patients has shown inconsistent results, but studies have varied in terms of technique and outcome measures. AIM: To determine patient preference for different relaxation techniques. METHODS: Chronic obstructive pulmonary disease patients were presented with six techniques via a DVD and asked to rate the techniques in terms of effectiveness, rank in order of likely use, and comment. RESULTS: Patients differed in the technique preferred and reason for that preference, but the most commonly preferred technique both for effectiveness and ease of use was "thinking of a nice place" followed by progressive relaxation and counting. Familiarity and ease of activity were commonly given reasons for preference. CONCLUSION: Rather than providing patients with a single technique that they might find difficult to implement, these results suggest that it would be better to give a choice. "Thinking of a nice place" is a popular but under-investigated technique