Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93528/1/gps2830.pd

TALK score: Development and validation of a prognostic model for predicting larynx preservation outcome

Objectives/Hypothesis: To develop and validate a simple prognostic tool that would help predict larynx preservation outcome. Study Design: A retrospective review of 3 prospective studies. Methods: We reviewed consecutive chemotherapy/radiation protocols for patients (n = 170) with advanced, resectable, squamous cell, larynx, or pharynx cancer treated at Memorial Sloan‐Kettering Cancer Center from 1988 to 1995 with larynx preservation intent. The outcome was successful larynx preservation. Model validation used data from U. S. Department of Veterans Affairs larynx preservation study. Results: The developed model added one point for each poor prognostic covariate present (show in parentheses) and was given the acronym TALK: T stage (T4), albumin (<4 g/dL), maximum alcohol/liquor use (≥6 drinks/day or heavy drinking), and Karnofsky performance status (<80%). The 3‐year larynx preservation rates by TALK score were 65% (0), 41% (1–2), and 6% (3–4), P < .0001; on validation, the TALK 3–4 group was particularly well demarcated. Conclusions: The TALK score is an easily applied and valid tool that should assist treatment selection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91127/1/23220_ftp.pd

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

Background Dementia has an enormous impact on the lives of individuals and families, and on health and social services, and this will increase as the population ages. The needs of people with dementia and their carers for information and support are inadequately addressed at all key points in the illness trajectory. Methods The Unit is working specifically on an evaluation of the impact of the Mental Capacity Act 2005, and will develop practice guidance to enhance concordance with the Act. Phase One of the study has involved baseline interviews with practitioners across a wide range of services to establish knowledge and expectations of the Act, and to consider change processes when new policy and legislation are implemented. Findings Phase 1, involving baseline interviews with 115 practitioners, identified variable knowledge and understanding about the principles of the Act. Phase 2 is exploring everyday decision-making by people with memory problems and their carers

Effects and feasibility of a multi-disciplinary orientation program for newly registered cancer patients: design of a randomised controlled trial

Background Diagnosis and treatment of cancer can contribute to psychological distress and anxiety amongst patients. Evidence indicates that information giving can be beneficial in reducing patient anxiety, so oncology specific information may have a major impact on this patient group. This study investigates the effects of an orientation program on levels of anxiety and self-efficacy amongst newly registered cancer patients who are about to undergo chemotherapy and/or radiation therapy in the cancer care centre of a large tertiary Australian hospital. Methods The concept of interventions for orienting new cancer patients needs revisiting due to the dynamic health care system. Historically, most orientation programs at this cancer centre were conducted by one nurse. A randomised controlled trial has been designed to test the effectiveness of an orientation program with bundled interventions; a face-to-face program which includes introduction to the hospital facilities, introduction to the multi-disciplinary team and an overview of treatment side effects and self care strategies. The aim is to orientate patients to the cancer centre and to meet the health care team. We hypothesize that patients who receive this orientation will experience lower levels of anxiety and distress, and a higher level of self-efficacy. Discussion An orientation program is a common health care service provided by cancer care centres for new cancer patients. Such programs aim to give information to patients at the beginning of their encounter at a cancer care centre. It is clear in the literature that interventions that aim to improve self-efficacy in patients may demonstrate potential improvement in health outcomes. Yet, evidence on the effects of orientation programs for cancer patients on self-efficacy remains scarce, particularly with respect to the use of multidisciplinary team members. This paper presents the design of a randomised controlled trial that will evaluate the effects and feasibility of a multidisciplinary orientation program for new cancer patients

Systematic review: Effective Home Support in Dementia Care, components and impacts – Stage 2, effectiveness of home support interventions.

Aim: To explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research. Background: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored. Design: Systematic review with narrative summary. Data sources: Electronic searches of published studies in English using PubMed, Cochrane Central Register of Controlled Trials, PsychINFO, CINAHL, Applied Social Science Index and CSA Social Services Abstracts. Databases and sources were searched from inception to April 2014 with no date restrictions to locate studies. Review methods: The PRISMA statement was followed and established systematic review methods used. Using 14 components of care for people with dementia and their carers, identified previously, data across studies were synthesized. Interventions were grouped and described and effectiveness ratings applied. Qualitative studies were synthesized using key themes. Results: Seventy studies (four qualitative) were included. Most were directed to carers and of high quality. Seven interventions for carers and two for people with dementia were identified, covering 81% of studies. Those relating to daily living, cognitive training and physical activity for people with dementia were absent. Measures of effectiveness were influenced mainly by the intensity (duration and frequency) of interventions. Those containing education, social support and behaviour management appeared most effective. Conclusion: These interventions reflect emergent patterns of home support. Research is required to identify effective interventions linked to the stage of dementia, which can be applied as part of routine clinical care

The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

Abstract Background Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants. Methods and design Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues) intervention or to an attention control (Care) condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infant's hospitalization, and the sixth contact occurs after discharge, in the participant mother's home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age. Discussion The Cues and Care trial will provide important information on the efficacy of a brief, skills-based intervention to reduce anxiety and increase sensitivity in mothers of very low birthweight infants. A brief intervention of this nature may be more readily implemented as part of standard neonatal intensive care than broad-based, multi-component interventions. By intervening early, we aim to optimize developmental outcomes in these high risk infants. Trial Registration Current Controlled Trials ISRCTN00918472 The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infant

Carer social care-related quality of life outcomes: estimating English preference weights for the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer)

Objective: To estimate preference-based index values for the English version of the ASCOT-Carer, a measure assessing social care-related quality of life (SCRQoL) in informal carers, from the general population in England. Methods: The ASCOT-Carer consists of seven domains, each reflecting aspects of SCRQoL in informal carers. Preferences for the ASCOT-Carer SCRQoL states were estimated using a Best-Worst Scaling exercise (BWS) in an online survey. The survey was administered to a sample of the general adult population in England (n=1,000). Participants were asked to put themselves into the hypothetical state of being an informal carer and indicate which attribute they thought was the best (first and second) and worst (first and second) from a profile list of seven attributes reflecting the seven domains, each ranging at a different level (1-4). Multinomial logistic regression was used to analyse the data and estimate preference weights for the ASCOT-Carer measure. Results: The most valued aspect by English participants was the ‘occupation’ attribute at its highest level. Results further showed participants rated having ‘no control over their daily life’ as the lowest attribute-level of all those presented. The position of the seven attributes influenced participants’ best and worst choices, and there was evidence of both scale and taste heterogeneity on preferences. Conclusions: This study has established a set of preference-based index values for the ASCOT-Carer in England derived from the BWS exercise that can be used for economic evaluation of interventions on older individuals and their informal carers