A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma

Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group. This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma.This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression - Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only. Follow-up was for 16 weeks and end points were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS.51 patients were randomised: 36% (51 out of 140) consent rate and attrition at week 16 was 12. Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging, this was the preferred method of delivery for these participants.This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy to recruit and retain the sample. Options for a less demanding intervention schedule, such as less frequent face-to-face visits and the use of web-based interventions, require careful consideration

A randomised controlled feasibility study of group cognitive behavioural therapy for people with severe asthma

Objectives: Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group. This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma. Method: This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression – Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only. Follow-up was for 16 weeks and end points were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS. Results: 51 patients were randomised: 36% (51 out of 140) consent rate and 25% (13/51) attrition at week 16. Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging, this was the preferred method of delivery for these participants. Conclusions: This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy to recruit and retain the sample. Options for a less demanding intervention schedule, such as less frequent face-to-face visits and the use of web-based interventions, require careful consideration

The impact of TAVI on vascular complications incidence: a literature review

Aim: This article provides a literature review on the post-procedural outcomes of patients who have undergone transfemoral transcatheter aortic valve implantation (TAVI). Background: TAVI is a less invasive treatment option than surgical aortic valve replacement (SAVR) for aortic stenosis. Aortic stenosis in the UK has a prevalence rate of 5% in people aged 75 and over. Access sites used for TAVI procedures include trans-aortic, subclavian, carotid, apical (TA) and femoral (TF) ( National Institute for Health and Care Excellence (NICE), 2012 ). Transfemoral TAVI access sites were previously closed using an open surgical access technique (closure of the skin using sutures). However, over the years, the use of percutaneous access closure devices such as Perclose Proglide has increased. Nevertheless, there is a gap in the literature that assesses the postoperative vascular complications in patients who undergo TAVI. Conclusion: This review highlights the importance of measuring patients' post-procedural outcomes, as well as the need for increased confidence and competence in all health professionals in their provision of care to patients, and more evidence-based care. Relevance to clinical practice: Nurses can improve patient care by observing the patient and ensuring their safety following the TAVI procedure. They should therefore be competent in recognising any major or minor vascular complications after transfemoral TAVI and assessing their significance. </jats:sec

Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom populationAim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in the United Kingdom.Background. The European Heart Failure Self-care Behaviour Scale quantifies the measures patients take to manage their heart failure. Produced in the Netherlands and Sweden, it has been translated into English.Methods. A convenience sample of 183 patients (response rate 85%) with heart failure (New York Heart Association, Class I-IV) was recruited from an outpatient clinic between July 2004 and July 2005. Mainly men (n = 143), they had a mean age of 65.6 years (SD = 12.3). They completed the Minnesota Living with Heart Failure Questionnaire, the Self-Care of Heart Failure Index, and the European Heart Failure Self-care Behaviour Scale during their clinic visit. The latter questionnaire was repeated at home within 2 weeks.Results. The scale was reliable but internal consistency was only moderate (Cronbach's alpha = 0.69) and lower than in other European populations. It appears to be repeatable in the short-term. Comparison with the Self-Care of Heart Failure Index raised questions about whether the two questionnaires measured the same concept. Variance in self-care was not explained by gender, age or severity of heart failure.Conclusion. As self-care is an important component in the life of patients with heart failure, further exploration of the methods for measuring patients' self-care behaviours is warranted to enable healthcare staff to assess patients effectively. This would also help in understanding the applicability of tools in a range of patients, cultures and settings.</p

The relationship between nurse staffing and patient outcomes: A case study

Background Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes. Objectives To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis. Design A case study using retrospective hospital data, at ward level. Setting A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals. Participants All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months. Methods Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined. Results In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased. Conclusions The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work

Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-2015

Objectives: Schwartz Center Rounds (‘Rounds’) are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so. Setting: Public healthcare organisations in England. Participants: Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations. Results: The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors—a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being—initially led to Rounds being seen as ‘an idea whose time had come’. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of ‘mimetic pressure’. Conclusions: The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England.</p

The relationship between nurse staffing and patient outcomes: A case study

BACKGROUND: Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes. OBJECTIVES: To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis

Assessment of dyspnea in asthma: Validation of the dyspnea-12

BACKGROUND: Dyspnea is a prominent symptom in asthma. The Dyspnea-12 (D-12), an instrument that quantifies breathlessness using 12 descriptors that tap the physical and affective aspects, has shown promise for the measurement of dyspnea in cardiorespiratory disease. OBJECTIVE: We report the results of a study designed to test the validity and reliability of the D-12 in a population of patients with asthma. METHODS: This cross-sectional study included 102 patients with asthma. Subjects completed the D-12, Hospital Anxiety and Depression Scale (HAD), St George’s Respiratory Questionnaire (SGRQ), MRC scale. Confirmatory factor analysis confirmed the two-component structure of the D-12 (i.e. 7 items that tap the Physical aspects of breathlessness and 5 items that tap the Affective aspects). RESULTS: The D-12 subscales had excellent internal reliability (Cronbach’s alpha for the ‘Physical’ score was 0.94 and the Affective score was 0.95). The D-12 Physical component was more strongly correlated with SGRQ Symptoms (r = 0.648), SGRQ Activities (r = 0.635) and MRC grade (r = 0.636), while the Affective component was more strongly correlated with SGRQ Impacts (r = 0.765) and HAD scores (anxiety r = 0.641 and depression r = 0.602). CONCLUSION: This study supports validity of the D-12 for use in the assessment of dyspnea of patients with asthma. It assesses one of the most pertinent symptoms of asthma from two viewpoints -physical and affective

Psychological interventions for adults with asthma: A systematic review

Aim The purpose of this study was to conduct a systematic review of randomized controlled trials where the efficacy of psychological interventions in modifying health and behavioural outcomes for adults with asthma was investigated. Method A review of randomized controlled trials was designed. The literature search was conducted until May 2005. Results Fourteen studies, involving 617 adults, were included in the review. The use of ‘as needed’ medications was reduced by relaxation therapy (OR 4.47, CI 1.22–16.44), quality of life, measured using the Asthma Quality of Life Questionnaire, showed a positive effect following cognitive behavioural therapy (WMD 0.71, CI 0.23–1.19), and peak expiratory flow outcome data indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09–1.23). Conclusions Some promising results did emerge from meta-analyses performed. However, due to heterogeneity and the low quality of included studies, this review was unable to draw firm conclusions for the role of psychological interventions in asthma. We recommend that larger and well-conducted randomized trials use valid outcome measures to evaluate the effectiveness of psychological interventions for adults with asthma