10 research outputs found
Towards tailoring of self-management for patients with chronic heart failure or chronic obstructive pulmonary disease: a protocol for an individual patient data meta-analysis
Introduction Self-management interventions in patients with chronic conditions have received increasing attention over the past few years, yet the meta-analyses encountered considerable heterogeneity in results. This suggests that the effectiveness of self-management interventions must be assessed in the context of which components are responsible for eliciting the effect and in which subgroups of patients the intervention works best. The aim of the present study is to identify condition-transcending determinants of success of self-management interventions in two parallel individual patient data meta-analyses of self-management trials in patients with congestive heart failure (CHF) and in patients with chronic obstructive pulmonary disease (COPD).
Methods and analysis Investigators of 53 randomised trials (32 in CHF and 21 in COPD) will be requested to share their de-identified individual patient data. Data will be analysed using random effects models, taking clustering within studies into account. Effect modification by age, sex, disease severity, symptom status, comorbid conditions and level of education will be assessed. Sensitivity analyses will be conducted to assess the robustness of the findings.
Ethics and dissemination The de-identified individual patient data are used only for the purpose for which they were originally collected and for which ethical approval has been obtained by the original investigators. Knowledge on the effective ingredients of self-management programmes and identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised self-management interventions for patients with CHF and COPD as well as with other chronic diseases
What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis
To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations
Self-management behaviors to reduce exacerbation impact in COPD patients: A delphi study
Little is known about which self-management behaviors have the highest potential to influence exacerbation impact in COPD patients. We aimed to reach expert consensus on the most relevant set of self-management behaviors that can be targeted and influenced to maximize reduction of exacerbation impact.
A 2-round Delphi study was performed using online surveys to rate the relevance and feasibility of predetermined self-management behaviors identified by literature and expert opinion. Descriptive statistics and qualitative analyses were used
Self-management behaviors to reduce exacerbation impact in COPD patients : a Delphi study
BACKGROUND: Little is known about which self-management behaviors have the highest potential to influence exacerbation impact in COPD patients. We aimed to reach expert consensus on the most relevant set of self-management behaviors that can be targeted and influenced to maximize reduction of exacerbation impact. MATERIALS AND METHODS: A 2-round Delphi study was performed using online surveys to rate the relevance and feasibility of predetermined self-management behaviors identified by literature and expert opinion. Descriptive statistics and qualitative analyses were used. RESULTS: An international expert panel reached consensus on 17 self-management behaviors focusing on: stable phase (n=5): pharmacotherapy, vaccination, physical activity, avoiding stimuli and smoking cessation; periods of symptom deterioration (n=1): early detection; during an exacerbation (n=5): early detection, health care contact, self-treatment, managing stress/anxiety and physical activity; during recovery (n=4): completing treatment, managing stress/anxiety, physical activity and exercise training; and after recovery (n=2): awareness for recurrent exacerbations and restart of pulmonary rehabilitation. CONCLUSION: This study has provided insight into expert opinion on the most relevant and feasible self-management behaviors that can be targeted and influenced before, during and after an exacerbation to exert the highest magnitude of influence on the impact of exacerbations. Future research should focus at developing more comprehensive patient-tailored interventions supporting patients in these exacerbation-related self-management behaviors
Nurses' perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study
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Nurses' perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care : A qualitative study
Background: Self-management support is widely accepted for the management of chronic conditions. Self-management often requires behaviour change in patients, in which primary care nurses play a pivotal role. To support patients in changing their behaviour, the structured behaviour change Activate intervention was developed. This intervention aims to enhance physical activity in patients at risk for cardiovascular disease in primary care as well as to enhance nurses' role in supporting these patients. This study aimed to evaluate nurses' perceptions towards the delivery and feasibility of the Activate intervention. Methods: A qualitative study nested within a cluster-randomised controlled trial using semistructured interviews was conducted and thematically analysed. Fourteen nurses who delivered the Activate intervention participated. Results: Three key themes emerged concerning nurses' perceptions of delivering the intervention: nurses' engagement towards delivering the intervention; acquiring knowledge and skills; and dealing with adherence to the consultation structure. Three key themes were identified concerning the feasibility of the intervention: expectations towards the use of the intervention in routine practice; perceptions towards the feasibility of the training programme; and enabling personal development. Conclusions: Delivering a behaviour change intervention is challenged by the complexity of changing nurses' consultation style, including acquiring corresponding knowledge and skills. The findings have increased the understanding of the effectiveness of the Activate trial and will guide the development and evaluation of future behaviour change interventions delivered by nurses in primary care. Trial registration: ClinicalTrials.gov NCT02725203
Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery
Background/Aims: This study examines the feasibility of a preoperative exercise program to improve the physical fitness of a patient before gastrointestinal surgery. Methods: An outpatient exercise program was developed to increase preoperative aerobic capacity, peripheral muscle endurance and respiratory scheduled within 2 weeks. Results: The 115 participants followed on average 5.7 (3.5) training sessions. Adherence to the exercise program was high: 82% of muscle function in patients with pancreatic, liver, intestinal, gastric or esophageal cancer. During a consult at the outpatient clinic, patients were invited to participate in the exercise program when their surgery was not the planned training sessions were attended, and no adverse events occurred. Mixed model analyses showed a significant increase of maximal inspiratory muscle strength (84.1-104.7 cm H2O; p = 0.00) and inspiratory muscle endurance (35.0-39.5 cm H2O; p = 0.00). No significant changes were found in aerobic capacity and peripheral muscle strength. Conclusion: This exercise program in patients awaiting oncological surgery is feasible in terms of participation and adherence. Inspiratory muscle function improved significantly as a result of inspiratory muscle training. The exercise program however failed to result in improved aerobic capacity and peripheral muscle strength, probably due to the limited number of training sessions as a result of the restricted time interval between screening and surgery.</p
How can we build and maintain the resilience of our health care professionals during COVID-19?: Recommendations based on a scoping review
Objective To explore how to build and maintain the
resilience of frontline healthcare professionals exposed to
COVID-19 outbreak working conditions.
Design Scoping review supplemented with expert
interviews to validate the findings.
Setting Hospitals.
Methods We searched PubMed, Embase, PsycINFO,
CINAHL, bioRxiv and medRxiv systematically and grey
literature for articles focusing on the impact of COVID-
19-like
working conditions on the physical and/or mental
health of healthcare professionals in a hospital setting.
Articles using an empirical design about determinants
or causes of physical and/or mental health and about
interventions, measures and policies to preserve physical
and/or mental health were included. Four experts were
interviewed to reflect on the results from the scoping
review.
Results In total, 4471 records were screened leading
to an inclusion of 73 articles. Recommendations prior
to the outbreak fostering resilience included optimal
provision of education and training, resilience training
and interventions to create a feeling of being prepared.
Recommendations during the outbreak consisted of (1)
enhancing resilience by proper provision of information,
psychosocial support and treatment (eg, create enabling
conditions such as forming a psychosocial support
team), monitoring the health status of professionals and
using various forms and content of psychosocial support
(eg, encouraging peer support, sharing and celebrating
successes), (2) tasks and responsibilities, in which
attention should be paid to kind of tasks, task mix and
responsibilities as well as the intensity and weight of
these tasks and (3) work patterns and working conditions.
Findings of the review were validated by experts.
Conclusions Recommendations were developed on how
to build and maintain resilience of frontline healthcare
professionals exposed to COVID-19 outbreak working
conditions. These practical and easy to implement
recommendations can be used by hospitals and other
healthcare organisations to foster and preserve short-term
and long-term
physical and mental health and
employability of their professionals