Patient-reported outcome measures for cancer caregivers: a systematic review

Purpose Informal caregivers provide invaluable help and support to people with cancer. As treatments extend survival and the potential burdens on carers increase, there is a need to assess the impact of the role. This systematic review identified instruments that measure the impact of caregiving, evaluated their psychometric performance specifically in cancer and appraised the content. Methods A 2-stage search strategy was employed to: 1. identify instruments that measure the impact of caregiving, 2. run individual searches on each measure to identify publications evaluating psychometric performance in the target population. Searches were conducted in Medline, Embase, CINAHL and Psychinfo and restricted to English for instrument used and article language. Psychometric performance was evaluated for content and construct validity, internal consistency, test-retest reliability, precision, responsiveness and acceptability. Individual scale items were extracted and systematically categorised into conceptual domains. Results 10 papers were included reporting on the psychometric properties of 8 measures. Although construct validity and internal consistency were most frequently evaluated, no study comprehensively evaluated all relevant properties. Few studies met our inclusion criteria so it was not possible to consider the psychometric performance of the measures across a group of studies. Content analysis resulted in 16 domains with 5 overarching themes: lifestyle disruption; wellbeing; health of the caregiver; managing the situation and relationships. Conclusions Few measures of caregiver impact have been subject to psychometric evaluation in cancer caregivers. Those that have do not capture well changes in roles and responsibilities within the family and career, indicating the need for a new instrument

Reconciling theories of a mechanically driven meridional overturning circulation with thermohaline forcing and multiple equilibria

It has recently been suggested that the structure and strength of the meridional overturning circulation in the global ocean is governed by the input of mechanical energy to the system by winds and tides. However, it is not clear how this suggestion relates to the existence of multiple equilibria of the meridional overturning circulation, which depends on thermohaline feedbacks and is more consistent with a buoyancy-driven view of the circulation. Both theories have been illustrated by box models in the past (Stommel in Tellus 13:224-230, 1961 Gnanadesikan in Science 283:2077-2079, 1999. Here we incorporate these two theories into a single box model in an attempt to reconcile the roles of mechanical and buoyancy forcing in driving the meridional overturning circulation. The box model has two equilibrium solutions, one with sinking at high northern latitudes as in the present-day Atlantic, and one without. The circulation is mechanically driven, but the northern sinking can be thought of as a release valve which acts as a sink of potential energy when the surface water at high northern latitudes is dense enough to convect. While the source of energy comes from mechanical forcing, the presence or otherwise of multiple equilibria is therefore determined by thermohaline feedbacks. In some areas of parameter space an oscillation between the model's two circulation regimes occurs, reminiscent of a bipolar seesaw. © Springer-Verlag 2007