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Castle EM, Billany RE, Lightfoot CJ, Annema C, De Smet S, Graham-Brown MP, Greenwood SA. Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? Curr Opin Nephrol Hypertens 2023; 32:502-508. [PMID: 37622530 PMCID: PMC10552838 DOI: 10.1097/mnh.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW The opportunity to review the more recent evidence for prescribing exercise-based physical rehabilitation for people living with chronic kidney disease (CKD) is timely. There has been a recent global focus evaluating how physical activity interventions might improve health-related quality of life and outcomes for people living with chronic health conditions in a post-COVID era. There is finally a long overdue commitment from the kidney research and clinical community to deliver pragmatic interventions to help people living with CKD to be able to live well with their condition. RECENT FINDINGS This article reviews recent research, and discusses the challenges and potential solutions, for providing exercise-based therapeutic options for people living with CKD; including predialysis self-management interventions, options for both prehabilitation and posttransplant rehabilitation, pragmatic considerations for delivery of exercise therapy for people receiving haemodialysis treatment and the role of virtual kidney-specific rehabilitation. SUMMARY Whilst there remains a need for further research in this area of patient care, there is now a body of evidence and kidney-specific guidelines that firmly support a rollout of pragmatic and scalable exercise-based interventions for people living with CKD. We are indeed nearly there now.
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Affiliation(s)
- Ellen M. Castle
- Physiotherapy, Department of Health Sciences, College of Health, Medicine, and life Sciences, Brunel University, London, UK
| | - Roseanne E. Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Coby Annema
- Section of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan De Smet
- Group Rehabilitation for Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Nephrology and Renal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Sharlene A. Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
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Morrison J, Balega J, Buckley L, Clamp A, Crosbie E, Drew Y, Durrant L, Forrest J, Fotopoulou C, Gajjar K, Ganesan R, Gupta J, Hughes J, Miles T, Moss E, Nanthakumar M, Newton C, Ryan N, Walther A, Taylor A. British Gynaecological Cancer Society (BGCS) uterine cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2022; 270:50-89. [DOI: 10.1016/j.ejogrb.2021.11.423] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022]
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Kalsi T, Harari D. Assessment methods and services for older people with cancer in the United Kingdom. World J Clin Oncol 2020; 11:152-161. [PMID: 32257846 PMCID: PMC7103526 DOI: 10.5306/wjco.v11.i3.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/18/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.
AIM To identify current assessment methods and access to relevant supporting services for older people with cancer.
METHODS A web-based survey (SurveyMonkey) targeting health professionals (oncologists, cancer surgeons, geriatricians, nurses and allied health professionals) was distributed January-April 2016 via United Kingdom nationally recognised professional societies. Responses were analysed in frequencies and percentages. Chi Square was used to compare differences in responses between different groups.
RESULTS 640 health care professionals responded. Only 14.1% often/always involved geriatricians and 52.0% often/always involved general practitioners in assessments. When wider assessments were used, they always/often influenced decision-making (40.5%) or at least sometimes (34.1%). But 30.5%-44.3% did not use structured assessment methods. Most clinicians favoured clinical history taking. Few used scoring tools and few wished to use them in the future. Most had urgent access to palliative care but only a minority had urgent access to other key supporting professionals (e.g. geriatricians, social workers, psychiatry). 69.6% were interested in developing Geriatric Oncology services with geriatricians.
CONCLUSION There is variability in assessment methods for older people with cancer across the United Kingdom and variation in perceived access to supporting services. Clinical history taking was preferred to scoring systems. Fostering closer links with geriatricians appears supported.
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Affiliation(s)
- Tania Kalsi
- Department of Ageing and Health, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
- King’s College London, Capital House, London SE1 3QD, United Kingdom
| | - Danielle Harari
- Department of Ageing and Health, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
- King’s College London, Capital House, London SE1 3QD, United Kingdom
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Maxwell M, Hibberd C, Aitchison P, Calveley E, Pratt R, Dougall N, Hoy C, Mercer S, Cameron I. The Patient Centred Assessment Method for improving nurse-led biopsychosocial assessment of patients with long-term conditions: a feasibility RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Annual reviews of people living with long-term conditions (LTCs) are mostly conducted by practice nurses (PNs), who focus on the physical needs of patients. The broader mental well-being and social needs of patients are also important if they are to live well. The Patient Centred Assessment Method (PCAM) is a new tool to help PNs conduct biopsychosocial assessments of patients’ needs.
Research questions
Is it feasible and acceptable to use the PCAM in primary care nurse-led reviews for those with LTCs? Is it feasible and acceptable to run a cluster randomised trial of the PCAM in primary care?
Methods
Four practitioner and two patient focus groups explored the acceptability and implementation requirements of the PCAM, which was then tested in a feasibility cluster randomised controlled trial aiming to recruit eight general practitioner (GP) practices and 16 nurses. Baseline data collection was conducted with nurses prior to randomisation, with a cohort of 10 patients per nurse, including patient demographics, patient evaluation of consultation, patient-completed outcomes (measured via the Consultation and Relational Empathy, Patient Enablement Instrument, Warwick–Edinburgh Mental Well-Being Scale, General Health Questionnaire and the Short Form questionnaire-12 items) and nurse referrals/signposting to services. Patient follow-up questionnaires were completed at 8 weeks. Practices were then randomised to the PCAM intervention or care as usual (CAU). Data collection was repeated for a second cohort of patients. Fidelity was tested by comparing a sample of recorded consultations before and after PCAM training. Qualitative interviews were conducted with PCAM nurses and a sample of patients.
Results
Approaches to 159 eligible practices resulted in the recruitment of six practices (10 nurses), with five practices (seven nurses) completing both data collection phases. Nurses collected baseline data on 113 patients, 71 of whom (62.8%) completed follow-up questionnaires. Five practices were randomised: three practices (six nurses) to the PCAM arm and two practices (four nurses) to the CAU arm. In phase 2, seven nurses collected data on 77 patients, of whom 40 (52%) completed follow-up. Only four PCAM nurses agreed to recording consultations, with five pre- and four post-PCAM recordings obtained. Post PCAM training, there was evidence of more attention being given to patients’ mental well-being and social issues. The PCAM was fairly easily integrated into consultation, although some nurses reflected that this benefited from early support. Patients were not always aware of its use, but most were happy to have their needs assessed.
Limitations
Recruitment of GP practices, and nurse recruitment and retention.
Conclusions
The PCAM is feasible and acceptable for use by primary care nurses and may have potential for encouraging biopsychosocial assessment of patients. Efforts required to recruit and retain staff indicate that a full trial is not feasible or cost-effective at this time.
Future work
The PCAM intervention warrants further exploration as an effective mechanism for improving care for people with LTCs; this could be conducted within an implementation study.
Trial registration
Current Controlled Trials ISRCTN98973169.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carina Hibberd
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Patricia Aitchison
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Christine Hoy
- Health and Social Care Alliance Scotland (the ALLIANCE), Glasgow, UK
| | - Stewart Mercer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Isobel Cameron
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Gibson JAG, Spencer S, Rogers SN, Shokrollahi K. Formulating a Patient Concerns Inventory specific to adult burns patients: learning from the PCI concept in other specialties. Scars Burn Heal 2018; 4:2059513118763382. [PMID: 29873336 PMCID: PMC5987093 DOI: 10.1177/2059513118763382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- John A G Gibson
- Post Graduate Medical Institute, Edge Hill University, Ormskirk, UK
- Mersey Regional Burns Centre, Whiston Hospital, Merseyside, UK
| | - Sally Spencer
- Post Graduate Medical Institute, Edge Hill University, Ormskirk, UK
| | - Simon N Rogers
- Post Graduate Medical Institute, Edge Hill University, Ormskirk, UK
- Merseyside Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - Kayvan Shokrollahi
- Post Graduate Medical Institute, Edge Hill University, Ormskirk, UK
- Mersey Regional Burns Centre, Whiston Hospital, Merseyside, UK
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Snowden A, Fleming M. Validation of the electronic Holistic Needs Assessment. SPRINGERPLUS 2015; 4:623. [PMID: 26543758 PMCID: PMC4628027 DOI: 10.1186/s40064-015-1401-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022]
Abstract
Macmillan Cancer Support UK have developed an electronic Holistic Needs Assessment (eHNA) to: (1) help people living with cancer express all their needs, (2) help those helping them better target support. eHNA consists of 48 items each ranked from zero (no problem) to 10. There has been no psychometric analysis of this tool and so its validity and reliability are untested. The aim of this study was to evaluate the psychometric properties of the eHNA by examining its construct validity. Objectives were to (a) test whether the eHNA measured holistic concerns and (b) analyse the factor structure of the eHNA. Objectives were achieved through a secondary analysis of 5421 responses to eHNA using concurrent application of Rasch analysis and principal component analysis. All the items bar one fit with the Rasch rating model and were equivalently important to people. Differential item functioning was evident according to whether people were described as curative or not. A 12-factor solution explained 46 % variance. Of this the emotional/spiritual factor explained the most variance accounting for 15 %. The eHNA was internally consistent and conceptually coherent with the construct of holistic needs assessment. Clinical focus is best directed to the individual items highlighted by the patient except where patients check too many problems for the clinician to accurately prioritise. In these cases only, the emotional/spiritual factor may help identify appropriate clinical action. Strengths and weaknesses of the analyses are discussed, particularly in relation to ‘at risk’ subsamples such as those classified as non-curative.
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Affiliation(s)
- Austyn Snowden
- School of Nursing Midwifery and Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Mick Fleming
- School of Health Nursing and Midwifery, University of the West of Scotland, Paisley, Scotland, UK
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Turner A, Stephenson M. Documentation of chemotherapy administration by nursing staff in inpatient and outpatient oncology/hematology settings: a best practice implementation project. ACTA ACUST UNITED AC 2015; 13:316-34. [DOI: 10.11124/jbisrir-2015-2157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Young J, Cund A, Renshaw M, Quigley A, Snowden A. Improving the care of cancer patients: holistic needs assessment. ACTA ACUST UNITED AC 2015; 24:S17-20. [PMID: 25723367 DOI: 10.12968/bjon.2015.24.sup4.s17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jenny Young
- Research Assistant, Institute Health, Nursing & Midwifery, University of the West of Scotland
| | - Audrey Cund
- Lecturer, University of the West of Scotland
| | | | | | - Austyn Snowden
- Chair in Mental Health, University of the West of Scotland
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