Can mobile technology improve weight loss in overweight and obese patients?

Q: Can mobile technology improve weight loss in overweight and obese patients? Evidence-based answer: Yes, this technology can help in the short term. Mobile technology compared with minimal or no intervention increases short-term (<6 months) weight loss (1.4 to 2.7 kg) in overweight and obese patients (strength of recommendation [SOR]: A, meta-analysis of good quality studies and randomized controlled trials [RCTs]). Interventions that combine nonelectronic measures with mobile technology increase weight loss more effectively (3.7 kg) than no intervention (SOR: A,  metaanalysis of good-quality studies and RCTs). Using mobile technology shows no significant benefits for weight loss after 12 months (SOR: A, multiple good-quality RCTs)

I’ve Changed, I’m Smarter: Empowering Youth to Thrive Neurosequential Approach to Employment, Education and Training Outcomes for Youth

This paper explores the impact of a neurosequential brain development approach on employment, education and training outcomes of vulnerable long-term unemployed youth, aged 15-24 years. The Empowering Youth to Thrive (EYTT) program utilises neuroscience research, which underpin varied creative and sensory and regulatory experiences used to engage youth in social and emotional learning. The aim is to enhance brain pathways to increase youth’s higher order thinking functions such as problem solving, communication and critical thinking skills. These are considered necessary attributes for positive engagement in the current and future workforce. A bricolage methodology was used to evaluate the impact of the program, with findings determining the EYTT program had benefits for participants in gaining successful training, education and/or employment opportunities

Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research

Purpose: To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. Methods: Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. Results: Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. Conclusion: This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development

Lung cancer screening: what do long-term smokers know and believe?

Objective To explore knowledge and beliefs of long-term smokers about lung cancer, associated risk factors and lung cancer screening. Design Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long-term smokers' who had and had not been screened for lung cancer. Methods Twenty-six long-term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened. Results While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long-term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma. Conclusions Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health-care system distrust may impact successful implementation of screening programmes. Perceived smoking-related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision-making process between health-care providers and their high-risk patients

Understanding the decision to screen for lung cancer or not: A qualitative analysis

Background Although new screening programmes with low‐dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening‐eligible persons' decisions to screen or not remain poorly understood. Objective To describe how current and former long‐term smokers explain their decisions regarding participation in lung cancer screening. Design Phone interviews using a semi‐structured interview guide were conducted to ask screening‐eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques. Setting and participants A subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements. Results The sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening‐eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x‐ray. A physician recommendation was a key influence on decisions to screen. Discussion and conclusions Education initiatives aimed at providers and long‐term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates

Development and Psychometric Evaluation of the Lung Cancer Screening Health Belief Scales

Background: Lung cancer screening is a recent recommendation for long-term smokers. Understanding individual health beliefs about screening is a critical component in future efforts to facilitate patient-provider conversations about screening participation. Objective: The aim of this study was to describe the development and psychometric testing of 4 new scales to measure lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). Methods: In phase I, 4 scales were developed from extensive literature review, item modification from existing Breast and Colorectal Cancer Screening Health Belief Scales, focus groups with long-term smokers, and evaluation/feedback from a panel of 10 content experts. In phase II, we conducted a survey of 497 long-term smokers to assess the final scales’ reliability and validity. Results: Phase I: content validity was established with the content expert panel. Phase II: internal consistency reliability of the scales was supported with Cronbach’s α’s ranging from .88 to .92. Construct validity was established with confirmatory factor analysis and testing for differences between screeners and nonscreeners in theoretically proposed directions. Conclusions: Initial testing supports the scales are valid and reliable. These new scales can help investigators identify long-term smokers more likely to screen for lung cancer and are useful for the development and testing of behavioral interventions regarding lung cancer screening. Implications for Practice: Development of effective interventions to enhance shared decision making about lung cancer screening between patients and providers must first identify factors influencing the individual’s screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision

A Qualitative Study Exploring Why Individuals Opt Out of Lung Cancer Screening

Background. Lung cancer screening with annual low-dose computed tomography is relatively new for long-term smokers in the USA supported by a US Preventive Services Task Force Grade B recommendation. As screening programs are more widely implemented nationally and providers engage patients about lung cancer screening, it is critical to understand behaviour among high-risk smokers who opt out to improve shared decision-making processes for lung cancer screening. Objective. The purpose of this study was to explore the reasons for screening-eligible patients’ decisions to opt out of screening after receiving a provider recommendation. Methods. Semi-structured qualitative telephone interviews were performed with 18 participants who met lung cancer screening criteria for age, smoking and pack-year history in Washington State from November 2015 to January 2016. Two researchers with cancer screening and qualitative methodology expertise conducted data analysis using thematic content analytic procedures from audio-recorded interviews. Results. Five primary themes emerged for reasons of opting out of lung cancer screening: (i) Knowledge Avoidance; (ii) Perceived Low Value; (iii) False-Positive Worry; (iv) Practical Barriers; and (v) Patient Misunderstanding. Conclusion. The participants in our study provided insight into why some patients make the decision to opt out of low-dose computed tomography screening, which provides knowledge that can inform intervention development to enhance shared decision-making processes between long-term smokers and their providers and decrease decisional conflict about screening

Is there a correlation between infection control performance and other hospital quality measures?

Quality measures are increasingly reported by hospitals to the Centers for Medicare and Medicaid Services (CMS), yet there may be tradeoffs in performance between infection control (IC) and other quality measures. Hospitals that performed best on IC measures did not perform well on most CMS non–IC quality measures