The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

BACKGROUND: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. METHODS: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz\u27s constructivist grounded theory approach. RESULTS: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of Navigating Unknown Waters . This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. CONCLUSION: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population

Mental Practice : some observations and speculations

The use of words such as mental practice, imagery, and rehearsal have great meaning in the psychological, motor learning and sport psycology literature. There exists logic and precedence to simplifyterminology and research that utilizes the paradigm where any kind of mental rehearsal is takin place. In fact, there is some justification that such a mechanism is and always have been an integral part of the learning process. A rubric incorporating mental practice into the mainstream of learning is presented. The importance of these mental processes in learning and performing motor skills become evident when characteristics of the cognitive, associative and autonomous learning continuum are considered in conjuntion with task novelty. Under the authors' rubric, it is suggested that a mental practice can have a signifficant effect on learning and performance not only for elite performers, but also, from the very onset learningEl uso de términos tales como práctica imaginada, visualización, y repetición imaginada poseen una gran significación en la literatura psicológica, del aprendizaje motor y de la psicología del deporte. La lógica y los antecedentes imponen simpoificar la terminología y la investigación que utiliza el paradigma allí donde se produce cualquier tipo de repetición imaginada. De hecho, está justificado que este mecanismo es y ha sido siempre parte integral del proceso de aprendizaje. Se presenta una sección donde se incorpora la práctica imaginada dentro de la tendencia principal del aprendizaje. La importancia de estos procesos mentales en el aprendizaje y ejecución de acciones motoras se hace evidente cuando las características del continuum del aprendizaje cognitivo, asociativo y autónomo se consideran en unión con la novedad de la tarea. Los autores sugieren que la práctica imaginada puede tener un efecto significativo en el aprendizaje y en la ejecución, no sólo para los practicantes de élite, sino, además desde muy al principio del aprendizaj

Mental Practice : some observations and speculations

The use of words such as mental practice, imagery, and rehearsal have great meaning in the psychological, motor learning and sport psycology literature. There exists logic and precedence to simplifyterminology and research that utilizes the paradigm where any kind of mental rehearsal is takin place. In fact, there is some justification that such a mechanism is and always have been an integral part of the learning process. A rubric incorporating mental practice into the mainstream of learning is presented. The importance of these mental processes in learning and performing motor skills become evident when characteristics of the cognitive, associative and autonomous learning continuum are considered in conjuntion with task novelty. Under the authors' rubric, it is suggested that a mental practice can have a signifficant effect on learning and performance not only for elite performers, but also, from the very onset learningEl uso de términos tales como práctica imaginada, visualización, y repetición imaginada poseen una gran significación en la literatura psicológica, del aprendizaje motor y de la psicología del deporte. La lógica y los antecedentes imponen simpoificar la terminología y la investigación que utiliza el paradigma allí donde se produce cualquier tipo de repetición imaginada. De hecho, está justificado que este mecanismo es y ha sido siempre parte integral del proceso de aprendizaje. Se presenta una sección donde se incorpora la práctica imaginada dentro de la tendencia principal del aprendizaje. La importancia de estos procesos mentales en el aprendizaje y ejecución de acciones motoras se hace evidente cuando las características del continuum del aprendizaje cognitivo, asociativo y autónomo se consideran en unión con la novedad de la tarea. Los autores sugieren que la práctica imaginada puede tener un efecto significativo en el aprendizaje y en la ejecución, no sólo para los practicantes de élite, sino, además desde muy al principio del aprendizaj

The acute effect of intra-aortic balloon counterpulsation during extracorporeal life support: An experimental study

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P < 0.05/-8%, P < 0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P < 0.03). Coronary perfusion was increased by additional IABP: CC, Qcor, +9%, and DPTI, +18% (P < 0.02); PC, Qcor,+6%, and DPTI, +11% (P < 0.05). IABP augmented the myocardial oxygen supply/demand ratios (CC/PC): Qcor/(PVA.heart rate) (+21%/+22%, P < 0.02) and DPTI/TTI (+27%/+24%, P < 0.03). In case of low arterial pressure (< 50 mm Hg) and reduced ECLS flow, the overall hemodynamic profile improved only with central cannulation. We conclude that in both central and peripheral ECLS cannulation settings, adjunctive IABP improves the myocardial oxygen supply demand balance. In case of low cardiac output and insufficient extracorporeal flow with PC, adjunctive IABP may be contraindicated

eHealth to improve patient outcome in rehabilitating myocardial infarction patients

Introduction: Cardiac rehabilitation is aimed at risk factor modification and improving quality of life. eHealth has a couple of potential benefits to improve this aim. The primary purpose of this review is to summarize available literature for eHealth strategies that have been investigated in randomized controlled trials in post-myocardial infarction (MI) patients. The second purpose of this review is to investigate the clinical effectiveness in post-MI patients. Areas covered: The literature was searched using PubMed. Randomized controlled trials (RCTs) describing interventions in patients that had experienced an ST-elevation myocardial infarction or non-ST acute coronary syndrome were eligible for inclusion. Fifteen full-texts were included and their results are described in this review. These RCTs described interventions that used remote coaching or remote monitoring in post-MI patients. Most interventions resulted in an improved cardiovascular risk profile. Remote coaching had a positive effect on activity and dietary intake. Expert opinion: eHealth might be clinically beneficial in post-MI patients, particularly for risk estimation. Moreover, eHealth as a tool for remote coaching on activity is a good addition to traditional cardiac rehabilitation programs. Further research needs to corroborate these findings

The acute effect of intra-aortic balloon counterpulsation during extracorporeal life support: an experimental study

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P < 0.05/-8%, P < 0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P < 0.03). Coronary perfusion was increased by additional IABP: CC, Qcor, +9%, and DPTI, +18% (P < 0.02); PC, Qcor,+6%, and DPTI, +11% (P < 0.05). IABP augmented the myocardial oxygen supply/demand ratios (CC/PC): Qcor/(PVA.heart rate) (+21%/+22%, P < 0.02) and DPTI/TTI (+27%/+24%, P < 0.03). In case of low arterial pressure (< 50 mm Hg) and reduced ECLS flow, the overall hemodynamic profile improved only with central cannulation. We conclude that in both central and peripheral ECLS cannulation settings, adjunctive IABP improves the myocardial oxygen supply demand balance. In case of low cardiac output and insufficient extracorporeal flow with PC, adjunctive IABP may be contraindicated

A mobile one-lead ECG device incorporated in a symptom-driven remote arrhythmia monitoring program. The first 5,982 Hartwacht ECGs

Background: In recent years many mobile devices able to record health-related data in ambulatory patients have emerged. However, well-organised programs to incorporate these devices are sparse. Hartwacht Arrhythmia (HA) is such a program, focusing on remote arrhythmia detection using the AliveCor Kardia Mobile (KM) and its algorithm. Objectives: The aim of this study was to assess the benefit of the KM device and its algorithm in detecting cardiac arrhythmias in a real-world cohort of ambulatory patients. Methods: All KM ECGs recorded in the HA program between January 2017 and March 2018 were included. Classification by the KM algorithm was compared with that of the Hartwacht team led by a cardiologist. Statistical analyses were performed with respect to detection of sinus rhythm (SR), atrial fibrillation (AF) and other arrhythmias. Results: 5,982 KM ECGs were received from 233 patients (mean age 58 years, 52% male). The KM algorithm categorised 59% as SR, 22% as possible AF, 17% as unclassified and 2% as unreadable. According to the Hartwacht team, 498 (8%) ECGs were uninterpretable. Negative predictive value for detection of AF was 98%. However, positive predictive value as well as detection of other arrhythmias was poor. In 81% of the unclassified ECGs, the Hartwacht team was able to provide a diagnosis. Conclusions: This study reports on the first symptom-driven remote arrhythmia monitoring program in the Netherlands. Less than 10% of the ECGs were uninterpretable. However, the current performance of the KM algorithm makes the device inadequate as a stand-alone application, supporting the need for manual ECG analysis in HA and similar programs

Bewertung einer Leitlinie zur Datenqualität durch Vertreter epidemiologischer Kohortenstudien in Deutschland

High data quality is a precondition for valid scientific conclusions. Indicators should therefore routinely be used to evaluate data quality within the life cycle of health studies. In this project, 15 representatives of seven German population-based cohort studies assessed 51 quality indicators that were proposed in a guideline for networked medical research. The applicability of the indicators to primary data collections was assessed. In addition, their importance was evaluated using a scale ranging from 1 (essential) to 4 (not important). Moreover, their implementation in data quality assessments in the participating studies was evaluated. Comments on potential improvements could be made. Forty-three indicators were rated as applicable. Of these, 29 received a mean importance score of 2 (important) or better, nine received a mean importance score of 1.5 or better. The latter represent a potential core set of data quality indicators for cohort studies. Most indicators that were rated as highly important were used in data quality assessments of the participating studies. Points of criticism regarding the guideline related to its structure and the understandability of some indicators. It was concluded that further improvement of the data quality indicator set will increase its usefulness and applicability in primary data collections. In practice, a small subset of data quality indicators may suffice to capture the most important aspects of data quality in cohort studies.Eine hohe Datenqualität ist wesentlich für valide wissenschaftliche Schlussfolgerungen. Indikatoren sollten daher routinemäßig angewendet werden, um die Datenqualität innerhalb des Lebenszyklus von Gesundheitsstudien zu beurteilen. In dem hier beschriebenen Projekt haben 15 Vertreter von sieben bevölkerungsbezogenen Kohortenstudien in Deutschland 51 Qualitätsindikatoren bewertet, die im Rahmen einer deutschen Leitlinie für die vernetzte medizinische Forschung vorgeschlagen wurden. Die Evaluation betraf die Anwendbarkeit der Indikatoren für primäre Datenerhebungen, deren Wichtigkeit auf einer Skala von 1 (essentiell) bis 4 (nicht wichtig) sowie deren Implementation in den teilnehmenden Kohorten. Verbesserungsvorschläge konnten gemacht werden. 43 Indikatoren wurden als anwendbar angesehen. Davon erhielten 29 eine durchschnittliche Wichtigkeit von mindestens 2 (wichtig), neun eine durchschnittliche Wichtigkeit von mindestens 1,5. Die als am wichtigsten bewerteten Indikatoren geben Hinweise auf einen für Kohortenstudien relevanten Kernsatz von Indikatoren zur Erfassung der Datenqualität. Die Mehrzahl der hoch bewerteten Indikatoren wurde in den teilnehmenden Kohorten im Rahmen der Datenqualitätssicherung betrachtet. Als Schwächen der Leitlinie wurden die Verständlichkeit einzelner Indikatoren sowie die Struktur der Leitlinie identifiziert. Das Konzept von Indikatoren zur Datenqualität sollte weiter verbessert werden, um den Nutzwert und die Anwendbarkeit im Rahmen primärer Datenerhebungen zu erhöhen. In der praktischen Anwendung reicht eine Teilmenge der Indikatoren aus, um wesentliche Aspekte der Datenqualität in Kohortenstudien zu beschreiben