Effects of a tailor-made exercise program on exercise adherence and health outcomes in patients with knee osteoarthritis: a mixed-methods pilot study

Fung-Kam Iris Lee, Tze-Fan Diana Lee, Winnie Kwok-Wei So The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR China Introduction: Previous studies showed that exercise intervention was effective in symptoms control of knee osteoarthritis (OA) but poor intervention adherence reduced the exercise effect. It has been suspected that the design of exercise intervention mainly from the health care professionals’ perspective could not address the patients’ barriers to exercise. Therefore, a tailor-made exercise program which incorporated the patient’s perspective in the design was developed and ready for evaluation.Objectives: This pilot study estimated the effects of a tailor-made exercise program on exercise adherence and health outcomes, and explored the participants’ perception and experience of the program.Methods: The intervention of this study was a 4-week community-based group exercise program, which required the participants to attend a 1-hour session each week. Thirty-four older people with knee OA were recruited to the program. Mixed-methods study design was used to estimate the effects of this program and explore the participants’ perception and experience of the program. Exercise adherence and performance in return-demonstration of the exercise were assessed at 12 weeks after the program. Disease-specific health status (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (12-item Short Form of the Medical Outcome Study Questionnaire), knee range of motion, muscle strength, and endurance of the lower extremities (Timed-Stands Test) were measured at the beginning of the program and 12 weeks after. Six participants were interviewed individually on the 12th week.Results: Thirty-three participants (75.0±7.3 years) completed the one-group pretest and posttest study. The participants’ exercise adherence was 91.4%±14.54%, and their correct performance in return-demonstration was 76.7%±21.75%. Most of the participants’ health outcomes significantly improved at posttests except the 12-item Short Form of the Medical Outcome Study Questionnaire physical health summary score. The qualitative findings provided rich information to explain and support the quantitative results.Conclusion: The results of this study showed that a tailor-made exercise program could improve exercise adherence and health outcomes in older people with knee OA. Keywords: Hong Kong, exercise intervention, Chinese, community-based program, older peopl

Dignity in the care of older people: a review of the theoretical and empirical literature

BACKGROUND: Dignity has become a central concern in UK health policy in relation to older and vulnerable people. The empirical and theoretical literature relating to dignity is extensive and as likely to confound and confuse as to clarify the meaning of dignity for nurses in practice. The aim of this paper is critically to examine the literature and to address the following questions: What does dignity mean? What promotes and diminishes dignity? And how might dignity be operationalised in the care of older people?This paper critically reviews the theoretical and empirical literature relating to dignity and clarifies the meaning and implications of dignity in relation to the care of older people. If nurses are to provide dignified care clarification is an essential first step. METHODS: This is a review article, critically examining papers reporting theoretical perspectives and empirical studies relating to dignity. The following databases were searched: Assia, BHI, CINAHL, Social Services Abstracts, IBSS, Web of Knowledge Social Sciences Citation Index and Arts & Humanities Citation Index and location of books a chapters in philosophy literature. An analytical approach was adopted to the publications reviewed, focusing on the objectives of the review. RESULTS AND DISCUSSION: We review a range of theoretical and empirical accounts of dignity and identify key dignity promoting factors evident in the literature, including staff attitudes and behaviour; environment; culture of care; and the performance of specific care activities. Although there is scope to learn more about cultural aspects of dignity we know a good deal about dignity in care in general terms. CONCLUSION: We argue that what is required is to provide sufficient support and education to help nurses understand dignity and adequate resources to operationalise dignity in their everyday practice. Using the themes identified from our review we offer proposals for the direction of future research

Further Evidence for the Impact of a Genome-Wide-Supported Psychosis Risk Variant in ZNF804A on the Theory of Mind Network

The single-nucleotide polymorphism (SNP) rs1344706 in ZNF804A is one of the best supported risk variants for psychosis. We hypothesized that this SNP contributes to the development of schizophrenia by affecting the ability to understand other people's mental states. This skill, commonly referred to as Theory of Mind (ToM), has consistently been found to be impaired in schizophrenia. Using functional magnetic resonance imaging, we previously showed that in healthy individuals rs1344706 impacted on activity and connectivity of key areas of the ToM network including the dorsomedial prefrontal cortex, temporo-parietal junction as well as the posterior cingulate cortex, which show aberrant activity in schizophrenia patients, too. We aimed to replicate these results in an independent sample of 188 healthy German volunteers. In order to assess reliability of brain activity elicited by the ToM task, 25 participants performed the task twice with an interval of 14 days showing excellent accordance in recruitment of key ToM areas. Confirming our previous results, we observed decreasing activity of the left temporo-parietal junction, dorsomedial prefrontal cortex and the posterior cingulate cortex with increasing number of risk alleles during ToM. Complementing our replication sample with the discovery sample, analyzed in a previous report (total N=297), revealed further negative genotype effects in the left dorsomedial prefrontal cortex as well as temporal and parietal regions. In addition, as shown previously, rs1344706 risk allele dose positively predicted increased frontal-temporo-parietal connectivity. These findings confirm effects of the psychosis risk variant in ZNF804A on dysfunction of the ToM network.Neuropsychopharmacology accepted article preview online, 19 November 2013. doi:10.1038/npp.2013.321

Empathy Regulation in Crisis Scenario

Empathic communication represents the first step of the “END” Communication procedure, which is followed by normalization and de-escalation communication. In this chapter, our view of empathy is conceived not only as an ability of inferring and representing the other one’s mental state but also all the interpersonal procedures and expressions given in a reciprocal and mutual communication. First, we focus on the theoretical aspects of empathic communication and even on practical aspects of this skill; that is not innate but can be learned. Then we present the neural basis of empathy, which are important for having a “neural guide” to address our communication procedures. In this chapter, we provide a number of case vignettes to better explain the difference between a “good/bad” communication and empathic communication and the different results in terms of compliance, therapeutic alliance and outcomes in crisis scenario. Furthermore, the chapter provides practical examples of “empathic” phrases that can be used by clinicians in emergency situations with psychiatric patients but even in other medical settings: the common fields of application of empathic communication basically involve all those contexts in which a healthcare professional-patient relationship is involved. Empathic communication has a cost for the clinician because if in several cases it is easy to represent the mental state of the other and tune in to it, in some cases it can be very difficult and constitute a considerable effort: that’s why we recommend a training and a careful supervision for clinicians and healthcare professionals

Long- and short-range correlations and their event-scale dependence in high-multiplicity pp collisions at <mml:msqrt>s</mml:msqrt>=13 TeV

Two-particle angular correlations are measured in high-multiplicity proton-proton collisions at s√ = 13 TeV by the ALICE Collaboration. The yields of particle pairs at short-(∆η ∼ 0) and long-range (1.6 < |∆η| < 1.8) in pseudorapidity are extracted on the near-side (∆φ ∼ 0). They are reported as a function of transverse momentum (pT) in the range 1 < pT < 4 GeV/c. Furthermore, the event-scale dependence is studied for the first time by requiring the presence of high-pT leading particles or jets for varying pT thresholds. The results demonstrate that the long-range “ridge” yield, possibly related to the collective behavior of the system, is present in events with high-pT processes as well. The magnitudes of the short- and long-range yields are found to grow with the event scale. The results are compared to EPOS LHC and PYTHIA 8 calculations, with and without string-shoving interactions. It is found that while both models describe the qualitative trends in the data, calculations from EPOS LHC show a better quantitative agreement for the pT dependency, while overestimating the event-scale dependency.publishedVersio