8 research outputs found
Non-compliance in lifestyle intervention studies: the instrumental variable method provides insight into the bias.
Objective: In lifestyle intervention trials, participants of the control group often change their behavior despite the request to maintain their usual lifestyle pattern. These changes in the control group and changes in addition to the intended in the intervention group can lead to undesirable confounding effects. Study Design and Setting: We address several considerations for study design to prevent noncompliance or minimize its effects. Furthermore, we demonstrate how the instrumental variable method can give insight into the extent of bias introduced by noncompliance in randomized trials, within the context of the Sex Hormones and Physical Exercise study. Results: Noncompliance can be prevented by measures taken in the design phase of a study, for example, limited duration of the study, clear recommendations, power calculation, intensity of the intervention, involvement of the control group, waiting-list control group, and single-consent design nested within an observational study. When nevertheless noncompliance does occur, the instrumental variable method estimates the intervention effect of treatment among the compliers. Conclusion: Noncompliance can seriously affect validity of lifestyle trial results. Its occurrence should be prevented by taking measures during the design phase of a study. The instrumental variable method can give insight into confounding by noncompliance in randomized trials. © 2010 Elsevier Inc. All rights reserved
The role of nursing staff regarding goal setting and achieving in geriatric rehabilitation:A focus group study
Purpose: The aim of this study was to explore and clarify the role of nursing staff in geriatric rehabilitation on supporting patients in goal setting and achieving, through reflecting on rehabilitation interventions.Design: A descriptive qualitative study was conducted.Methods: We conducted four online focus group interviews with 23 members of the nursing staff working in geriatric rehabilitation. They reflected on six interventions, preclassified into three types: setting goals in the admission phase, increasing patient participation in order to personalize the rehabilitation trajectory, and supporting patients in working on short-term goals. Data were analyzed using thematic content analysis.Results: Setting goals in the admission phase is primarily the task of the multidisciplinary team rather than the nursing staff. Interventions to increase patient participation align with the coordinating role of nursing staff in the rehabilitation team. Working on short-term goals is of great value to patients.Clinical Relevance to the Practice of Rehabilitation Nursing: The connection between the patient’s personal goals and professional treatment aimed at functional recovery can be enhanced by strengthening the position of nursing staff working ingeriatric rehabilitation.Conclusion: Members of nursing staff in geriatric rehabilitation see themselves playing a coordinating role in the multidisciplinaryteam, supporting the patient in goal work. Interventions aimed at advancing patient participation and providing support for short-term goals reinforce this role
Behavioral changes after a 1-year exercise program and predictors of maintenance.
Purpose: Public health strategies attempt to stimulate participation in physical activity, aiming at permanent behavior change. We assessed the sustained effect of participating in an exercise program on physical activity behavior 1 yr after completion of the program. Furthermore, we aimed to identify factors that predict sustained exercise participation. Methods: Previously low-active, postmenopausal women originally participating in an exercise intervention study (the Sex Hormones and Physical Exercise study) were recontacted 1 yr after finishing the study. Their current level of physical activity was assessed by the Modified Baecke Questionnaire. MET-hours per week spent on at least moderate-intensity activities were calculated and used to assess compliance to the international physical activity recommendation. Multivariable linear regression analysis was applied to investigate which factors predict a higher level of physical activity in the intervention group 1 yr after the study. Results: Participation in the Sex Hormones and Physical Exercise study resulted in an increased level of physical activity in both the intervention (median at baseline and at 12 months = 4.9 and 19.8 MET•h•w
Supporting older patients in working on rehabilitation goals:A scoping review of nursing interventions
BackgroundNurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal-centred care in the multidisciplinary team.ObjectivesThe aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features.MethodsWe performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, rehabilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention component analysis.ResultsThe study includes 13 articles, describing 11 interventions which were developed for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nursing profession: assessing self-care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advisable; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement.ConclusionsThe interventions show that in goal-centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support the nursing role. This may indicate a blind spot in the rehabilitation community to the additional value of its contribution
External Quality Assessment Identifies Training Needs to Determine the Neoplastic Cell Content for Biomarker Testing
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Effect of an 8-weeks aerobic training program in elderly on oxidative stress and HSP72 expression in leukocytes during antioxidant supplementation.
OBJECTIVE: To investigate the effect of aerobic training in the context of antioxidant supplementation on systemic oxidative stress and leukocytes heat shock protein (Hsp)72 expression in the elderly.
DESIGN: Sixteen septuagenarians (8 males and 8 females, mean age 74.6) were supplemented with Vitamin C and E (respectively 500 and 100mg per day) and randomly assigned either to sedentary (AS) or individualized aerobically trained (AT) group for 8 weeks.
METHODS: Plasma Vitamin C and E concentrations and aerobic fitness, as well as resting and post graded exercise (GXT) Hsp72 expression in leukocytes, plasma levels of thiobarbituric acid reactive substances (TBARS) and advanced oxidation protein product (AOPP) were measured pre and post training / supplementation.
RESULTS: At the end of the intervention, the two groups showed a significant increase in resting plasma vitamin C and E (approximately 50 and 20% increase respectively) and a significant decrease in both resting and post GXT plasma TBARS and AOPP (approximately 25 and 20% decrease respectively). These changes were of similar magnitude in the two groups. The reduced oxidative stress was concomitant with a 15% decreased expression of Hsp72 in monocytes and granulocytes in both groups.
CONCLUSION: This study provides evidence that in elderly, increased concentration of antioxidant vitamins C and E is associated with a reduction in oxidative stress and leukocytes Hsp72. In this context, 8 weeks of aerobic training has no impact on oxidative stress or leukocytes Hsp72 expression in elderly people