Geographic variation and evolutionary history of Dipodomys nitratoides (Rodentia: Heteromyidae), a species in severe decline

We examined geographic patterns of diversification in the highly impacted San Joaquin kangaroo rat, Dipodomys nitratoides, throughout its range in the San Joaquin Valley and adjacent basins in central California. The currently recognized subspecies were distinct by the original set of mensural and color variables used in their formal diagnoses, although the Fresno kangaroo rat (D. n. exilis) is the most strongly differentiated with sharp steps in character clines relative to the adjacent Tipton (D. n. nitratoides) and short-nosed (D. n. brevinasus) races. The latter two grade more smoothly into one another but still exhibit independent, and different, character clines within themselves. At the molecular level, as delineated by mtDNA cytochrome b sequences, most population samples retain high levels of diversity despite significant retraction in the species range and severe fragmentation of local populations in recent decades due primarily to landscape conversion for agriculture and secondarily to increased urbanization. Haplotype apportionment bears no relationship to morphologically defined subspecies boundaries. Rather, a haplotype network is shallow, most haplotypes are single-step variants, and the time to coalescence is substantially more recent than the time of species split between D. nitratoides and its sister taxon, D. merriami. The biogeographic history of the species within the San Joaquin Valley appears tied to mid-late Pleistocene expansion following significant drying of the valley resulting from the rain shadow produced by uplift of the Central Coastal Ranges

Role of Hospice Care at the End of Life for People With Cancer.

Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer.Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient's death compared with people who did not have access to these services.Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient

Apps for Older People's Pain Self-Management: Perspectives of Primary Care and Allied Health Clinicians.

BACKGROUND: Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients' self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain. METHODS: Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia. RESULTS: The overarching theme underlying participants' views on integration of apps into older people's pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians' involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access. DISCUSSION: The predominant clinician perspective of integrating apps into their older patients/clients' pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients' self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients)

Quality and usability of arthritic pain self-management apps for older adults: A systematic review

© 2017 American Academy of Pain Medicine. Objective. To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to selfmanage their arthritic pain. Methods. A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Results. Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N =3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Conclusions. Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self- Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors

Feasibility evaluation of a pain self-management app-based intervention among older people living with arthritic pain: study protocol.

Background: Optimal management of chronic arthritic pain experienced by older adults involves applying active self-management strategies every day. Cost-effective and innovative strategies to help build older people's pain self-management capability are required. This study protocol is designed to evaluate the feasibility, acceptability, and preliminary outcomes of a pain self-management app among older people living in the community with arthritic pain. Methods/design: This is a phase I feasibility study. A pre-post test study design will be used to trial a freely available pain self-management app named Rheumatoid Arthritis Information Support and Education ("RAISE") for 14 days. Thirty community-dwelling older people living with arthritic pain who use a smartphone will be recruited from (1) various community-based social clubs/organizations/groups or (2) via Facebook groups with potentially high number of older members. In addition, snowballing sampling approach will also be utilized.These participants will trial the RAISE app, which was selected following a systematic evaluation of all available chronic pain apps by the investigator team. A face-to-face or telephone-based meeting will be organized with all consenting participants in order to seek their informed consent, download and set up the intervention app on their mobile device, be provided with app training, and complete the pre-test data (Time 1 (T1)). Participants will be asked to use the RAISE app as desired for 14 days. Post-test data collection (Time 2 (T2)) will occur on day 15. Data collected includes participant's demographic and clinical information, pain scores, pain self-efficacy, and online technology self-efficacy. Participants will be invited to take part in a semi-structured telephone interview at T2 to explore their experiences of using the app.An evaluation of patterns of app use, recruitment, retention, attrition rates, and analysis of the missing data will inform the study and intervention feasibility. Preliminary outcomes are participant's pain intensity and interference, pain self-efficacy, and online technology self-efficacy. Discussion: This study will help us better understand the feasibility and acceptability of using this novel intervention among community-dwelling older people living with arthritic pain. The results will also help inform future pain app studies. Trial registration: Australia New Zealand Clinical Trials Registry: ACTRN12617000921381

Prevalence and characteristics of Australian women who use prayer or spiritual healing: A nationally representative cross-sectional study

© 2016 Elsevier Ltd. Objectives: To determine the prevalence and characteristics of users of prayer or spiritual healing among Australian women aged 31-36 years. Design and setting: This cross-sectional study was conducted as a part of the Australian Longitudinal Study on Women's Health (ALSWH). The sample used in the current sub-study were participants from the 'young' cohort (1973-78) (n = 8180) aged between 31 and 36 years. Main outcome measure: Use of prayer or spiritual healing. Results: Prayer or spiritual healing was used on a regular basis by 20% of women aged between 31 and 36 years in 2009. Women who had symptoms of chronic illnesses (p = 0.001), women who had never smoked (p = 0.001) and women who used other forms of CAM (p < 0.001) were significantly more likely to use prayer or spiritual healing. Conclusion: A signifibasis. Further research is required to better understand their rationale for using prayer or spiritual healing and its perceived impact on health related outcomes and general well-being.cant proportion of women use prayer or spiritual healing on a regular basis. Further research is required to better understand their rationale for using prayer or spiritual healing and its perceived impact on health related outcomes and general well-being

Patients Receiving Palliative Care and Their Families' Experiences of Participating in a "Patient-Centered Family Meeting": A Qualitative Substudy of the Valuing Opinions, Individual Communication, and Experience Feasibility Trial.

Background: Family meetings are used in palliative care to facilitate discussion between palliative patients, their families, and the clinical team. However, few studies have undertaken qualitative assessment of the impact of family meetings on patients and their families. Objectives: To explore inpatients receiving palliative care and their families' experiences of participation in a patient-centered family meeting ("Meeting"), where the patient sets the Meeting agenda. Design: This qualitative study used the constant comparative method for thematic content analysis of the data. Setting/Participants: The setting was a specialist palliative care (SPC) inpatient unit in Australia. Nine palliative care inpatients and nine family members were interviewed. Measurements: Semistructured interviews were used evaluate the patients' and their families' experiences and perceptions of the Meeting. Results: Three overarching themes described the experiences of participating in a patient-focused family meeting, namely that the Meeting: (1) provides a forum for inpatients receiving SPC to speak openly about their end-of-life concerns, clarify issues, and is of comfort to patients; (2) provides the family members with a voice, and an opportunity to discuss their concerns and have their needs addressed; and (3) helps to ensure that everyone is "on the same page" and patient care plans can be discussed. Conclusions: These Meetings are a potentially effective means of supporting certain palliative care patients and their families to articulate, confront, and address end-of-life issues in the presence of the interdisciplinary team. It is important to undertake further research to further examine the evidence for this Meeting model and to identify the patients and families who would most benefit from this type of Meeting

Self-Perceived Pain Assessment Knowledge and Confidence (Self-PAC) Scale for Cancer and Palliative Care Nurses: A Preliminary Validation Study

© 2018 American Society for Pain Management Nursing Background: Pain is highly prevalent in all health care settings, and frequently poorly managed. Effective pain management is predicated on a continuous cycle of screening, assessing, intervening and evaluating. Identifying gaps in nurses’ self-perceived pain assessment competencies is an essential first step in the design of tailored interventions to embed effective pain assessment into routine clinical practice, and improve patient reported pain outcomes. Yet, few validated instruments focus on the competencies required for undertaking a comprehensive pain assessment, with most focusing on clinician's pain management competencies. Aim: To examine the validity of the ‘Self-Perceived Pain Assessment Knowledge and Confidence’ (Self-PAC) Scale. Design: Preliminary instrument validation. Setting: Two Australian cancer and palliative care services. Participants/Subjects: 186 cancer and palliative care nurses. Methods: The Self-PAC Scale was administered to participants online. Factor Analyses, including Exploratory and Confirmatory, were applied to examine the structural validity, Cronbach's alpha was calculated for internal consistency. Criterion validity was investigated by comparing responses from experienced and non-experienced nurses. Results: Two components resulted with a single factor structure for pain assessment confidence and a two-factor structure for the knowledge of pain assessment. The factor loading for the subscales ranged from 0.653 to 0.969, with large proportions of the variances explained by the factors. Cronbach's alpha of the subscales ranged from 0.87-0.92 and significant difference in responses were found between experienced and non-experienced nurses. Conclusion: Preliminary validation of the Self-PAC Scale suggests that it is a helpful instrument for assessing cancer and palliative care nurse’ pain assessment competencies