1
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Farrell MM, Jiang C, Moss G, Daly B, Weinstein E, Kemmann M, Gupta M, Lee RT. Associations between symptoms with healthcare utilization and death in advanced cancer patients. Support Care Cancer 2023; 31:183. [PMID: 36821057 PMCID: PMC9950186 DOI: 10.1007/s00520-023-07618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION There is limited data about assessments that are associated with increased utilization of medical services among advanced oncology patients (AOPs). We aimed to identify factors related to healthcare utilization and death in AOP. METHODS AOPs at a comprehensive cancer center were enrolled in a Center for Medicare and Medicaid Innovation program. Participants completed the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy-General (FACT-G) scale. We examined factors associated with palliative care (PC), acute care (AC), emergency room (ER), hospital admissions (HA), and death. RESULTS In all, 817 AOPs were included in these analyses with a median age of 69. They were generally female (58.7%), white (61.4%), stage IV (51.6%), and represented common cancers (31.5% GI, 25.2% thoracic, 14.3% gynecologic). ESAS pain, anxiety, and total score were related to more PC visits (B=0.31, 95% CI [0.21, 0.40], p<0.001; B=0.24 [0.12, 0.36], p<0.001; and B=0.038 [0.02, 0.06], p=0.001, respectively). Total FACT-G score and physical subscale were related to total PC visits (B=-0.021 [-0.037, -0.006], p=0.008 and B=-0.181 [-0.246, -0.117], p<0.001, respectively). Lower FACT-G social subscale scores were related to more ER visits (B=-0.03 [-0.53, -0.004], p=0.024), while increased tiredness was associated with fewer AC visits (B=-0.039 [-0.073, -0.006], p=0.023). Higher total ESAS scores were related to death within 30 days (OR=0.87 [0.76, 0.98], p=0.027). CONCLUSIONS The ESAS and FACT-G assessments were linked to PC and AC visits and death. These assessments may be useful for identifying AOPs that would benefit from routine PC.
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Affiliation(s)
- Megan M Farrell
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Cherry Jiang
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Gabriel Moss
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Barbara Daly
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA
| | - Elizabeth Weinstein
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA.,University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Matthew Kemmann
- University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Mona Gupta
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA.,University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Richard T Lee
- Case Western Reserve University School of Medicine, 21300 Cornell Rd, Cleveland, OH, 44106, USA. .,University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106, USA. .,City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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2
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Schreiner N, Scherer B, Al Battashi H, Harwell C, Topalsky V, Burant C, Daly B, Douglas S, Woods S. Examining the Association between Emotional Dysregulation and Treatment Burden. West J Nurs Res 2022; 44:992-1005. [PMID: 34166141 DOI: 10.1177/01939459211027655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Treatment burden contributes to suboptimal adherence and lower health-related quality of life among people diagnosed with chronic conditions, but little is known about how the psychological process of emotional dysregulation influences treatment burden. To explore this relationship, we conducted a descriptive, cross-sectional study comprised of 149 men and women diagnosed with one or more Centers for Medicare and Medicaid Systems defined chronic conditions recruited from a single primary care setting. Multivariate analyses demonstrated emotional dysregulation as an independent factor contributing to total (p < .001), medication (p = .007), and dietary (p < .001) treatment burden, with model effect sizes ranging from large (.43) to moderate (.21), controlling for other known antecedent factors of treatment burden. Emotional dysregulation was not a factor contributing to exercise related treatment burden. Our findings indicated emotional dysregulation as an important factor contributing to higher levels of total, medication, and dietary treatment burden associated with daily self-management regimens.
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Affiliation(s)
- Nathanial Schreiner
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Brooklynn Scherer
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Hamed Al Battashi
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Carla Harwell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals, Cleveland, OH, USA
| | | | - Christopher Burant
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Barbara Daly
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Sara Douglas
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
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3
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Akhtar A, Lawlor R, Cahalane J, Gillman C, Cronin F, Daly B, Hennessy J, Naughton C. 77 EXPERIENCES OF OLDER PEOPLE AND CARERS REFERRED TO AMBULATORY OUTREACH TEAM WITHIN INTEGRATED CARE PROGRAMME FOR OLDER PERSONS (ICPOP) SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ambulatory outreach services are part of new pathways to reduce reliance on secondary care as outlined in the Integrated Care Programme for Older Persons. Multidisciplinary outreach teams provide urgent medical and rehabilitation services in the person’s home to stabilise a health crisis.
Methods
The study aimed to explore the experiences of older people accessing a ambulatory outreach service and identify development opportunities. Interpretive description, an inductive analytic approach, was used to seek an understanding of clinical phenomena that illuminate their characteristics, patterns and structure. Data collection used qualitative telephone interviews. A purposeful sample of older people and carers were recruited following discharge from the outreach service over a three-month period.
Results
Sixteen participants (patients n=9 and carers n=7) were interviewed, 77% were female with a mean age of 83 years. Three major themes and seven sub-themes were identified:
Theme 1: Gratitude for specialised care: a) Moment of crisis “It was absolutely brilliant”; b) Care in my home: physical and psychological benefits
Theme 2: Living with and managing complexity: c) Resilience and resignation: living in the moment “Well she’s doing good at the moment, God forbids if there is more injuries”, d) Work of patients: maintain motivation & control; task and service boundaries e) Work of Families “We’re doing it so far”.
Theme 3:Scope for pro-active planning & Integration: f) What happens next? an unpredictable future; h) Integration with GP & community, g) Unspoken plan- sub-conscious advanced care planning “Nobody makes the decision on their own they call someone else”
Conclusion
The Outreach Team was highly valued by participants and was seen as vital in regaining functional capability and confidence to cope. Future developments need to examine task and service boundaries that undermine resilience, post outreach follow-up, integration with primary care, and opportunities for advanced care conversations.
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Affiliation(s)
- A Akhtar
- University College Cork , Cork, Ireland
| | - R Lawlor
- HSE Cork Kerry Community Healthcare , Cork, Ireland
| | - J Cahalane
- HSE Cork Kerry Community Healthcare , Cork, Ireland
| | - C Gillman
- HSE Cork Kerry Community Healthcare , Cork, Ireland
| | - F Cronin
- HSE Cork Kerry Community Healthcare , Cork, Ireland
| | - B Daly
- HSE Cork Kerry Community Healthcare , Cork, Ireland
| | - J Hennessy
- HSE Cork Kerry Community Healthcare , Cork, Ireland
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Cloney TM, Gannon E, Nor NM, Daly B, Ahern E, Pillary I. 94 WORKING TOWARDS AN AGE-FRIENDLY HEALTH SYSTEM IN AN IRISH MODEL FOUR TERTIARY REFERRAL HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Traditional consult services represent an area where the evidence-based 4Ms framework might be applied. A 4M framework Comprehensive Geriatric Assessment (CGA) consult form may help standardise the assessment of older persons outside of geriatric medicine. We aimed to incorporate a concise CGA tool based on the 4Ms within a geriatric medicine consult form.
Methods
Data from 100 geriatric medicine consult forms was entered onto an excel database. Each component was analysed, using descriptive statistics, for accuracy in completion, ability to contribute to referrers knowledge and a modified Delphi consensus model was used to inform the creation of a 4M framework-based concise CGA within the consult referral form. Time to completion was monitored.
Results
The median age of referred patients was 79 with a male:female ratio of 1:1. The average number of co-morbidities was 6, with 75% of patients having a significant vascular history, 30% a history of falls, and 16% diagnosed with delirium. 72% were on 5 or more medications. 53% had a complete Barthel index, with a median score of 12/20. What matters to the patient, clinical frailty score, mood and mental health were not well captured by the existing consult. These were incorporated, following consensus, into a ‘little g’, which takes between 4 and 15 minutes depending on user experience and patient complexity.
Conclusion
An evidence-based consult form, based on 4Ms, has been developed. Next steps are to introduce it to the next cohort of interns and assess efficiency and outcomes.
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Affiliation(s)
- TM Cloney
- Cork University Hospital , Cork, Ireland
| | - E Gannon
- Cork University Hospital , Cork, Ireland
| | - NM Nor
- Cork University Hospital , Cork, Ireland
| | - B Daly
- Cork University Hospital , Cork, Ireland
| | - E Ahern
- Cork University Hospital , Cork, Ireland
| | - I Pillary
- Cork University Hospital , Cork, Ireland
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5
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Thor M, Yorke E, Moran J, Daly B, Gomez D, Deasy J. PO-1250 Exploring published acute esophagitis models to support improved clinical management in thoracic RT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Mac Giolla Phadraig C, van Harten MT, Diniz-Freitas M, Limeres Posse J, Faulks D, Dougall A, Diz Dios P, Daly B. The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown. Med Oral Patol Oral Cir Bucal 2021; 26:e770-e777. [PMID: 34414999 PMCID: PMC8601643 DOI: 10.4317/medoral.24742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide. AIM To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020). MATERIAL AND METHODS Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown. RESULTS Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed. CONCLUSIONS During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.
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Affiliation(s)
- C Mac Giolla Phadraig
- Department of Child and Public Dental Health Dublin Dental University Hospital Trinity College Dublin, Dublin 2, Ireland
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7
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Talbot A, McCabe M, Daly B, Gallagher D. Heart Rate Variability-Guided Exercise During Chemotherapy in Triathlete with Stage 1 BRCA1-Mutated Breast Cancer. Ir Med J 2021; 114:420. [PMID: 35476380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- A Talbot
- Royal College of Surgeons in Ireland, Dublin
| | - M McCabe
- Sports Med Ireland, 32 Kildare St, Dublin
| | - B Daly
- Sports Med Ireland, 32 Kildare St, Dublin
| | - D Gallagher
- Mater Private Hospital, Eccles Street, Dublin
- St. James' Hospital, James' Street, Dublin
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8
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Hsiao CP, Daly B, Chen MK, Veigl M, Dorth J, Ponsky LE, Hoppel C. Possible Bioenergetic Biomarker for Chronic Cancer-Related Fatigue. Nurs Res 2021; 70:475-480. [PMID: 34380980 DOI: 10.1097/nnr.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer-related fatigue is a highly prevalent, debilitating, and persistent symptom experienced by patients receiving cancer treatments. Up to 71% of men with prostate cancer receiving radiation therapy experience acute and persistent CRF. There is neither an effective therapy nor a diagnostic biomarker for cancer-related fatigue. This pilot study aimed to discover potential biomarkers associated with chronic cancer-related fatigue in men with prostate cancer receiving radiation therapy. METHODS We used a longitudinal repeated-measures research design. Twenty men with prostate cancer undergoing radiation therapy completed all study visits. Cancer-related fatigue was evaluated by a well-established and validated questionnaire, the Patient-Reported Outcomes Measurement Information System-Fatigue (PROMIS-F) Short Form. In addition, peripheral blood mononuclear cells (PBMC) were harvested to quantify ribonucleic acid (RNA) gene expression of mitochondria-related genes. Data were collected before, during, on completion, and 24 months postradiation therapy and analyzed using paired t-tests and repeated measures analysis of variance. RESULTS The mean of the PROMIS-F T-score was significantly increased over time in patients with prostate cancer, remaining elevated at 24 months post-radiation therapy compared to baseline. A significant downregulated BC1 ubiquinol-cytochrome c reductase synthesis-like (BCS1L) was observed over time during radiation therapy and at 24 months postradiation therapy. An increased PROMIS-F score was trended with downregulated BCS1L in patients 24 months after completing radiation therapy. DISCUSSION This is the first evidence to describe altered messenger RNA for BCS1L in chronic cancer-related fatigue using the PROMIS-F measure with men receiving radiation therapy for prostate cancer. CONCLUSION Our results suggest that PBMC messenger RNA for BCS1L is a potential biomarker and therapeutic target for radiation therapy-induced chronic cancer-related fatigue in this clinical population.
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Affiliation(s)
- Chao-Pin Hsiao
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH The University of Arizona Department of Psychology, Tucson, AZ Case Western Reserve University Comprehensive Cancer Center, Cleveland, OH Case Western Reserve University School of Medicine, Cleveland, OH
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9
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Margevicius S, Daly B, Schluchter M, Flocke S, Manne S, Surdam J, Fulton S, Meropol NJ. Randomized trial of a web-based nurse education intervention to increase discussion of clinical trials. Contemp Clin Trials Commun 2021; 22:100789. [PMID: 34169174 PMCID: PMC8209078 DOI: 10.1016/j.conctc.2021.100789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/29/2021] [Accepted: 05/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Clinical trials are a critical source of evidence for oncology care, yet very few patients participate. Among healthcare providers, nurses spend the most time with cancer patients and are the most highly trusted professionals. We developed and evaluated an educational program for oncology nurses targeting knowledge, attitudes, self-efficacy and perceived norms to facilitate discussion about clinical trials and support patient decision making. Methods A nationwide sample of oncology nurses were randomly assigned to receive general clinical trials education delivered as text (attention control) vs. tailored video vignettes (intervention) in a web-based continuing education program. Participants completed a baseline assessment and follow up assessments immediately after the educational program and three months later. The primary outcome was intention to discuss clinical trials with patients. Secondary outcomes were knowledge and attitudes about clinical trials, self-efficacy, and perceived norms. Results 1393 nurses enrolled and completed the educational program and post-intervention assessment (720 control, 673 video). Both text education and tailored video education increased intention to discuss clinical trials with patients, with a greater effect in the video group (p < .0001). Likewise, knowledge, attitudes, perceived behavioral control, and perceived norms were all improved with education in both groups, and the magnitude of benefit was greater (p < .001) for the video group in all outcomes except knowledge. Conclusion A one-time online educational program for oncology nurses improves knowledge, attitudes, self-efficacy and intention to engage patients in discussions about clinical trials. A tailored video format was associated with a greater effect than standard text only material.
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Affiliation(s)
- Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.,Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mark Schluchter
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Flocke
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Jessica Surdam
- University Hospitals Connor Integrative Health Network, Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah Fulton
- Begun Center for Violence Prevention Research and Education, Case Western Reserve University, Cleveland, OH, USA
| | - Neal J Meropol
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.,Flatiron Health, New York, NY, USA
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10
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Treasure M, Daly B, Cao S, Fu P, Hong A, Weinstein E, Surdam J, Meropol NJ, Dowlati A. A randomized controlled trial of structured palliative care versus standard supportive care for patients enrolled in phase 1 clinical trials. Cancer Med 2021; 10:4312-4321. [PMID: 34033228 PMCID: PMC8267138 DOI: 10.1002/cam4.3971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Patients enrolled in Phase 1 clinical trials have typically exhausted standard therapies and often are choosing between a clinical trial and hospice care. Significant symptom burden can result in early trial discontinuation and confound trial outcomes. This study aimed to examine differences in study duration, symptom burden, adverse events (AE), and quality of life (QOL) between those receiving structured palliative care versus usual supportive care. Patients and methods Sixty‐eight patients enrolled in phase 1 clinical trials and 39 of their CGs were randomly assigned to receive structured palliative care or usual supportive care. Patient QOL was measured monthly using the Functional Assessment of Cancer Therapy and Memorial Symptom Assessment Scale. The Quality of Life in Life‐Threatening Illness–Family Care Version and Caregiver Reaction Assessment were used for CGs. AEs and use of palliative care resources were compared between arms. Results Mean duration of the phase 1 study was 142 days in the palliative care arm versus 116 days in the usual care arm (p = 0.55). Although not statistically significant, patients in the palliative care arm experienced fewer AEs and better QOL, as did their CGs, compared to those receiving usual care. Conclusions Phase 1 patients and their CGs have physical and psychosocial needs warranting palliative care services. Results suggest that structured palliative care is associated with the increased duration of the study and improved patient and CG QOL. Phase 1 patients and their caregivers have physical and psychosocial needs warranting palliative care services. Providing structured palliative care servies to this population was associated with increased duration on phase 1 study and improved patient and caregiver QOL.
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Affiliation(s)
- Michelle Treasure
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Frances Payne School of Nursing, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Shufen Cao
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Augustine Hong
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth Weinstein
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Jessica Surdam
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Neal J Meropol
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Afshin Dowlati
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
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11
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Larbi OM, Jiang C, McLane B, Wang GM, Daunov K, Hobson SM, Daly B, Mazanec SR, Feyes D, Rodgers-Melnick S, Li M, Momotaz H, Lee RT. Interest and Willingness to Pay for Integrative Therapies of Patients With Cancer and Caregivers. JCO Oncol Pract 2021; 17:e1622-e1630. [PMID: 33492981 DOI: 10.1200/op.20.00471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Complementary and integrative medicine (CIM) services are more prevalent in cancer centers but continue to be underutilized by patients. This study examines perspectives from patients and caregivers about these services being offered at a comprehensive cancer center. METHODS Patients and caregivers were surveyed about their familiarity, interest, and experience with five CIM therapies: acupuncture, massage, meditation, music therapy, and yoga. Respondents were also asked about their interest when recommended by their medical team and when offered in a clinical trial as well as their willingness to pay for these services. Respondents were also asked about perceived barriers to accessing these services. Chi-squared tests were performed to explore associations between past experience, interest levels, and willingness to pay. RESULTS A total of 576 surveys were obtained (464 patients and 112 caregivers). Most respondents identified as White or Caucasian (65.6%), female (57.2%), had been a patient for < 3 years (74.2%), had some college education (73.8%), and made > $40,000 in US dollars as their annual household income (69.1%). Respondents were most familiar with therapeutic massage (34.2%) and least familiar with acupuncture (20.0%). The average interest in these services increased from 53.3% to 64.1% when recommended by a medical professional. Respondents were most willing to pay $1-60 for therapeutic massage (62.3%) and least willing to pay for meditation (43.7%). The main barriers to accessing CIM services were cost (56.0%) and lack of knowledge (52.1%). CONCLUSION Overall, a significant proportion of patients and caregivers were unfamiliar with these five integrative therapies. Increasing education, decreasing cost, and a recommendation by medical professionals would improve CIM usage.
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Affiliation(s)
| | | | | | | | | | - Sean M Hobson
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | | | - Denise Feyes
- Case Western Reserve University Comprehensive Cancer Center, Cleveland, OH
| | | | - Ming Li
- Case Western Reserve University, Cleveland, OH
| | | | - Richard T Lee
- University Hospitals Seidman Cancer Center, Cleveland, OH.,Case Western Reserve University Comprehensive Cancer Center, Cleveland, OH
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12
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Daly B, Arroll B, Nirantharakumar K, Scragg RKR. Improved foot management of people with diabetes by primary healthcare nurses in Auckland, New Zealand. N Z Med J 2020; 133:39-50. [PMID: 33332327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIMS Evaluate trends in foot examinations for people with diabetes by primary healthcare nurses between 2006-2008 and 2016 in Auckland, New Zealand. METHODS All primary care nurses in 2006-2008 and 2016 were identified and 26% and 24% were randomly sampled and surveyed, respectively. Nurse participants completed a self-administered questionnaire and telephone interview about the care provided for people with diabetes. RESULTS Significantly more patients consulted by practice nurses received foot examinations in 2016 (58%) compared with 2006-2008 (36%), and foot-care education (66% versus 26%). Of the 43% of patients who had no foot examination in 2016, 23% had no previous examination documented. Significantly more nurses in 2016 than in 2006-2008 self-reported routinely examining patients' feet (45% versus 31%) and giving foot-care education (28% versus 13%). These practices were associated with nurses undertaking >5 hours of diabetes education within the past five years. CONCLUSIONS Practice nurses have significantly expanded their role in managing people with diabetes over the last decade by increasing the number of foot examinations and providing recommended foot-care education. Improved management was associated with nurses attending diabetes education in the past five years. Gaps were identified in conducting the recommended number of foot examinations, categorising patients' risk of foot disease and recording previous examinations.
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Affiliation(s)
- Barbara Daly
- PhD, MHSc, BSc, RN, Senior Lecturer, School of Nursing, Faculty of Medical and Health Sciences, University of Auckland
| | - Bruce Arroll
- PhD, MBChB, FRNZCGP, Professor of General Practice & Primary Health Care, School of Population Health, University of Auckland
| | - Krishnarajah Nirantharakumar
- MBBS, MPH, MD, MRCP, Senior Clinical Lecturer, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Robert Keith Rhodes Scragg
- PhD, MBBS, FNZCPHM, Professor of Epidemiology and Biostatistics, School of Population Health, University of Auckland
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13
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Schreiner N, Perazzo J, Digennaro S, Burant C, Daly B, Webel A. Associations between symptom severity and treatment burden in people living with HIV. J Adv Nurs 2020; 76:2348-2358. [PMID: 32643309 DOI: 10.1111/jan.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
AIM To examine the association between symptoms severity and treatment burden in people living with HIV. DESIGN Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross-sectional study examining physical activity patterns. METHODS We analysed data from 103 men and women using self-report data collected between March 2016 - February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS-29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire-13. RESULTS Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task-specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task-specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms. CONCLUSION Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression. IMPACT People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self-management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self-management of HIV and other co-morbid conditions.
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Affiliation(s)
- Nathanial Schreiner
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | | | - Sarah Digennaro
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Christopher Burant
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Barbara Daly
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Allison Webel
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
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Barbato E, Daly B, Douglas S, Kerr M, Litman P, Darrah R. Genetic Variation Near chrXq22-q23 Is Linked to Emotional Functioning in Cystic Fibrosis. Biol Res Nurs 2020; 22:319-325. [PMID: 32390518 DOI: 10.1177/1099800420924125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) is an autosomal recessive disease that affects many organ systems, most notably the pulmonary and gastrointestinal systems. Through genome-wide association studies, multiple genetic regions modifying CF-related pulmonary and gastrointestinal symptoms have been identified, but translation of these findings to clinical benefit remains elusive. Symptom variation in CF patients has been associated with changes in health-related quality of life (HRQOL), but the relationship between CF symptom-modifying genetic loci and HRQOL has not been explored. The purpose of this study was to determine whether two previously identified genetic modifiers of CF-related pathology also modify the subscales of HRQOL. METHODS HRQOL and genotype data were obtained and analyzed. Linear regressions were used to examine the amount of variance in HRQOL subscales that could be explained by genotype for each modifier locus. RESULTS A significant regression equation was found between genotype for rs5952223, a variant near chrXq22-q23, and emotional functioning in a sample of 129 CF patients. DISCUSSION These data suggest that genotype for this single-nucleotide polymorphism is associated with emotional functioning in CF patients and highlight this genetic region as a potential therapeutic target, irrespective of CF transmembrane conductance regulator genotype.
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Affiliation(s)
- Eric Barbato
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Sara Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Kerr
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Paul Litman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca Darrah
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA.,Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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15
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Baer LK, Weinstein E, Daly B, McQuigg B, Otegbeye F, de Lima M. Stem Cell Transplant and Palliative Care: Joining Forces to Improve Survivor Quality of Life. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Abstract
BACKGROUND Caring for an adult with chronic critical illness is a difficult undertaking. Family surrogates are tasked with decision-making on behalf of their loved one, particularly during acute-on-chronic illness episodes. Critical care nurses are well positioned and well qualified to facilitate this process. OBJECTIVES To explore family surrogate decision-making for people with chronic critical illness. METHODS In this qualitative study, interviews were conducted with family surrogates (n = 7) as part of a larger descriptive, longitudinal study (N = 264). Content analyses were guided by Miles and colleagues' methods of data analysis. RESULTS Family surrogates serving as decision makers for a spouse or another adult loved one were mostly female. Although decision-making was often described as "frustrating," most surrogates reported that they were "comfortable" with this role. Major decision-making themes were "communication as key in decision-making," "impact of past experiences," and "difficulties and coping." Advice from family and friends, health care providers (such as nurses), and faith or spirituality were significant resources for coping with decision-making challenges. CONCLUSIONS Results support recent recommendations of the National Academy of Medicine that endorsed shared decision-making. Data also support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity. Critical care nurses can use their expertise to positively influence these outcomes.
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Affiliation(s)
- Karen O Moss
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center.
| | - Sara L Douglas
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center
| | - Eric Baum
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center
| | - Barbara Daly
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center
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Watt R, Daly B, Allison P, Macpherson L, Venturelli R, Listl S, Weyant R, Mathur M, Guarnizo-Herreño C, Celeste R, Peres M, Kearns C, Benzian H. The Lancet Oral Health Series: Implications for Oral and Dental Research. J Dent Res 2019; 99:8-10. [DOI: 10.1177/0022034519889050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- R.G. Watt
- Department of Epidemiology and Public Health, UCL, London, UK
| | - B. Daly
- Division of Child and Public Dental Health, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - P. Allison
- Faculty of Dentistry, McGill University, Montreal, Canada
| | - L.M.D. Macpherson
- Department of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - R. Venturelli
- Department of Epidemiology and Public Health, UCL, London, UK
| | - S. Listl
- Department of Dentistry–Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
- Section for Translational Health Economics, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - R.J. Weyant
- Department of Dental Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M.R. Mathur
- Public Health Foundation of India, Institutional Area Gurgaon, Haryana, India
| | - C.C. Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - R.K. Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - M.A. Peres
- Menzies Health Institute Queensland, School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - C. Kearns
- Department of Preventive and Restorative Dental Sciences, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - H. Benzian
- WHO Collaborating Center Evidence-based Dentistry and Quality Improvement, College of Global Public Health and College of Dentistry, New York University, New York, NY, USA
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Schreiner N, Perazzo J, Digenarro S, Currie J, Daly B, Webel A. Examining the Association between Item Specific Treatment Burden and Adherence in People Living with HIV. West J Nurs Res 2019; 42:495-502. [PMID: 31585518 DOI: 10.1177/0193945919880317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For the 1.1 million people with HIV (PWH) in the United States, adherence to a HIV anti-retroviral medication regimen, engagement in regular physical activity, and eating a healthy diet are essential for maintaining optimal health. However, treatment burden can increase the risk for self-management non-adherence. We analyzed data of 103 men and women diagnosed with HIV to examine the relationship between medication, physical activity, and diet-related treatment burden to corresponding measures of self-management adherence. Multivariate analysis demonstrated that one medication treatment burden item explained 11% (p=.01) of self-reported 30-day HIV anti-retroviral medication adherence; physical activity treatment burden, along with physical functioning, explained 25% (p<.001) of physical activity, measured by daily average steps; and diet-specific treatment burden was non-significant in maintaining a healthy diet, measured by a total Healthy Eating Index-2010 score. Findings demonstrate that specific treatment burden items can predict specific self-management outcome behavior in PWH.
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Affiliation(s)
- Nathanial Schreiner
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Joseph Perazzo
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Sarah Digenarro
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Jackson Currie
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Barbara Daly
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Allison Webel
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
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Lavrentaki A, Thomas T, Subramanian A, Valsamakis G, Thomas N, Toulis KA, Wang J, Daly B, Saravanan P, Sumilo D, Mastorakos G, Tahrani AA, Nirantharakumar K. Increased risk of non-alcoholic fatty liver disease in women with gestational diabetes mellitus: A population-based cohort study, systematic review and meta-analysis. J Diabetes Complications 2019; 33:107401. [PMID: 31326267 DOI: 10.1016/j.jdiacomp.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/21/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Abstract
AIMS Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the leading causes of liver transplantation in the West. This study seeks to examine whether women with gestational diabetes mellitus (GDM) are at increased risk of developing NAFLD compared to women without GDM. METHODS We conducted a population-based retrospective matched-controlled cohort study utilising The Health Improvement Network (THIN), a large primary care database representative of the United Kingdom population, between 01/01/1990 to 31/05/2016 followed by systematic review of available literature. The study population included 9640 women with GDM and 31,296 controls without GDM, matched for age, body mass index (BMI) and time of pregnancy. All study participants were free from NAFLD diagnosis at study entry. Patients with GDM and patients developing NAFLD were identified by clinical codes. RESULTS The median (range) follow-up duration was similar in women with and without GDM (2.95 (1.21-6.01) vs 2.85 (1.14-5.75) years respectively). Unadjusted incidence rate ratio (IRR) for NAFLD development in women with vs without GDM was 3.28 (95% CI 2.14-5.02), which remained significant after adjustment for wide range of potential confounders (IRR 2.70; 95% CI 1.744-4.19). The risk of NAFLD in GDM remained high (IRR 2.46: 95% CI 1.51-4.00) despite women being censored after they developed type 2 diabetes. The meta-analysis of 3 studies (including the current study) showed increased NAFLD risk in women with vs without GDM (OR 2.60; 95% CI 1.90-3.57, I2 = 0%). As our study is based on routine clinical diagnosis of NAFLD, this study could potentially have underestimated the risk of NAFLD development. CONCLUSIONS Women with GDM are at increased risk of developing NAFLD in their later life compared to women without GDM regardless of the development of type 2 diabetes. Clinicians should have a low threshold to investigate women with history of GDM for the presence of NAFLD. Further studies to identify screening strategies are needed.
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Affiliation(s)
- Aikaterini Lavrentaki
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Endocrine Unit, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tom Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK.
| | | | - George Valsamakis
- Department of Endocrinology and Metabolic Diseases, University Hospital of Larissa, Medical School of Larissa, University of Thessaly, Larissa, Greece
| | - Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Konstantinos A Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ponnusamy Saravanan
- Diabetes, Endocrinology & Metabolism, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Dana Sumilo
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - George Mastorakos
- Endocrine Unit, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
| | - Krishnarajah Nirantharakumar
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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20
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Hsiao CP, Chen MK, Veigl ML, Ellis R, Cooney M, Daly B, Hoppel C. Relationships between expression of BCS1L, mitochondrial bioenergetics, and fatigue among patients with prostate cancer. Cancer Manag Res 2019; 11:6703-6717. [PMID: 31410061 PMCID: PMC6645361 DOI: 10.2147/cmar.s203317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Cancer-related fatigue (CRF) is the most debilitating symptom with the greatest adverse side effect on quality of life. The etiology of this symptom is still not understood. The purpose of this study was to examine the relationship between mitochondrial gene expression, mitochondrial oxidative phosphorylation, electron transport chain complex activity, and fatigue in prostate cancer patients undergoing radiotherapy (XRT), compared to patients on active surveillance (AS). Methods: The study used a matched case–control and repeated-measures research design. Fatigue was measured using the revised Piper Fatigue Scale from 52 patients with prostate cancer. Mitochondrial oxidative phosphorylation, electron-transport chain enzymatic activity, and BCS1L gene expression were determined using patients’ peripheral mononuclear cells. Data were collected at three time points and analyzed using repeated measures ANOVA. Results: The fatigue score was significantly different over time between patients undergoing XRT and AS (P<0.05). Patients undergoing XRT experienced significantly increased fatigue at day 21 and day 42 of XRT (P<0.01). Downregulated mitochondrial gene (BC1, ubiquinol-cytochrome c reductase, synthesis-like, BCS1L, P<0.05) expression, decreased OXPHOS-complex III oxidation (P<0.05), and reduced activity of complex III were observed over time in patients with XRT. Moreover, increased fatigue was significantly associated with downregulated BCS1L and decreased complex III oxidation in patients undergoing XRT. Conclusion: Our results suggest that BCS1L and complex III in mitochondrial mononuclear cells are potential biomarkers and feasible therapeutic targets for acute XRT-induced fatigue in this clinical population.
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Affiliation(s)
- Chao-Pin Hsiao
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.,School of Nursing, Taipei Medical University, Taipei , Taiwan
| | - Mei-Kuang Chen
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Martina L Veigl
- Gene Expression & Genotyping Facility, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rodney Ellis
- Department of Radiation Oncology and Urology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Cooney
- Department of Medical Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Charles Hoppel
- Center for Mitochondrial Disease, Department of Pharmacology and Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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21
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Schreiner N, Schreiner S, Daly B. The Association Between Chronic Condition Symptoms and Treatment Burden in a Skilled Nursing Population. J Gerontol Nurs 2018; 44:45-52. [PMID: 30484847 PMCID: PMC6747057 DOI: 10.3928/00989134-20181019-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/24/2018] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to determine the relationship between chronic condition symptoms and treatment burden in older adults transitioning from skilled nursing facilities to home. Treatment burden is defined as the burden associated with adhering to a prescribed chronic condition self-management regimen. Analysis of correlations between chronic condition symptoms and treatment burden revealed that symptoms and treatment burden are positively correlated (p < 0.05). Multivariate analysis (adjusted R2 = 0.40, F[10, 63] = 5.96, p < 0.001), controlling for other known antecedents of treatment burden, demonstrated that fatigue (standardized beta coefficient = 0.47, p < 0.001) predicted higher levels of treatment burden. Post hoc analysis revealed caregiver presence partially mediated the effect of fatigue on treatment burden, decreasing treatment burden during transition. Findings support existing transitional care literature suggesting that clinical assessment, including symptom screening, treatment of symptoms, and/or intervention reducing the impact of symptoms on patients' health and well-being, may lower treatment burden, thus improving self-management adherence. [Journal of Gerontological Nursing, 44(12), 45-52.].
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Hsiao CP, Chen MK, Daly B, Hoppel C. Integrated mitochondrial function and cancer-related fatigue in men with prostate cancer undergoing radiation therapy. Cancer Manag Res 2018; 10:6367-6377. [PMID: 30568498 PMCID: PMC6267769 DOI: 10.2147/cmar.s185706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction Fatigue experienced by cancer patients is one of the most common symptoms with the greatest adverse effect on quality of life, but arguably the least understood. The purpose of this study was to explore changes in integrated mitochondrial function and fatigue in non-metastatic prostate cancer patients receiving localized radiation therapy (XRT). Materials and methods We proposed a mitochondrial bioenergetics mechanism of radiation-induced fatigue linking impaired oxidative phosphorylation (OXPHOS) through complex III and decreased adenosine triphosphate (ATP) production as consequences of XRT. Integrated mitochondrial function was measured as mitochondrial OXPHOS from patients’ peripheral blood mononuclear cells. Fatigue was measured using the revised Piper Fatigue Scale. Data were collected before (day 0) and at day 21 of XRT. Results At day 21 of XRT, fatigue symptom intensified in 15 prostate cancer patients (P<0.05). Mitochondrial OXPHOS complex III-linked and uncoupled complex III rates were significantly decreased in mononuclear cells at day 21 during XRT compared to that before XRT (P<0.05). Additionally, increased fatigue appeared to be associated with decreased OXPHOS complex III-linked respiration in patients undergoing XRT. Conclusion Fatigue was associated with OXPHOS complex III-linked oxidation and a defect in oxidation starting at complex III in mononuclear cell mitochondria was revealed at day 21 of XRT in 15 prostate cancer patients. Complex III is a potential target for pharmacological and, in particular, nutraceutical interventions, eg, Q10, for design of interventions for CRF.
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Affiliation(s)
- Chao-Pin Hsiao
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA,
| | - Mei-Kuang Chen
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Barbara Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA,
| | - Charles Hoppel
- Center for Mitochondrial Disease, Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Webel A, Prince-Paul M, Ganocy S, DiFranco E, Wellman C, Avery A, Daly B, Slomka J. Randomized clinical trial of a community navigation intervention to improve well-being in persons living with HIV and other co-morbidities. AIDS Care 2018; 31:529-535. [PMID: 30442033 DOI: 10.1080/09540121.2018.1546819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Long-term survival of people living with HIV (PLWH) is associated with the development of co-morbid conditions and need for symptom management and other efforts to enhance quality of life. We conducted a longitudinal, randomized trial over 36 months to evaluate the effect of a community-based navigator intervention to provide early palliative care to 179 PLWH and other chronic conditions. Outcomes included quality of life, symptom management, coping ability, social support, self-management, and completion of advance directives. Data were analyzed using SAS mixed effects model repeat measurement. Our navigator program showed variable improvement over time of three outcome variables, self-blame, symptom distress, and HIV self-management. However, the program did not improve overall quality of life, social support, or completion of advance directives.
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Affiliation(s)
- Allison Webel
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | - Maryjo Prince-Paul
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | - Stephen Ganocy
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | - Evelina DiFranco
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | | | - Ann Avery
- c CWRU School of Medicine , Cleveland , OH , USA.,d MetroHealth Medical Center , Cleveland , OH , USA
| | - Barbara Daly
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
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Moss K, Douglas S, Daly B, Lipson A, Blackstone E. END OF LIFE AND QUALITY OF LIFE IN OLDER ADULTS WITH ADVANCED CANCER: A QUALITATIVE ANALYSIS WITH CAREGIVERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Moss
- Case Western Reserve University
| | | | - B Daly
- Case Western Reserve University
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Abstract
In the following article, we illustrate an interview between a living donor advocate and a potential living organ donor in which the donor faced a hard choice: the reasons to donate and the reasons not to donate were equally persuasive. In the discussion that follows, we analyze the act of willing, what differentiates coercion and willing, and how the case study highlights a different, but by no means rare, instance in which donors feel paralyzed by the choice at hand. In such cases, we suspect that donor advocates either do not approve the potential donor for transplantation or simply remain neutral. But we think that this approach benefits neither the donor nor the recipient. We conclude this study with recommendations for living donor advocates, providing questions that might solicit donors' deeper values and suggesting that in these situations donors may benefit from additional time for reflection.
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Clough S, Burke M, Daly B, Scambler S. The impact of pre-radiotherapy dental extractions on head and neck cancer patients: a qualitative study. Br Dent J 2018; 225:28-32. [DOI: 10.1038/sj.bdj.2018.442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/09/2022]
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Lavrentaki A, Subramanian A, Thomas GN, Valsamakis G, Toulis K, Daly B, Mastorakos G, Tahrani A, Nirantharakumar K. Gestational Diabetes Mellitus is associated with increased risk of Non-Alcoholic Fatty Liver Disease: A population-based cohort study. EJEA 2018. [DOI: 10.1530/endoabs.56.gp92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Faulks D, Dougall A, Ting G, Ari T, Nunn J, Friedman C, John J, Daly B, Roger-Leroi V, Newton JT. Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups. Eur J Dent Educ 2018; 22:e278-e290. [PMID: 28940883 DOI: 10.1111/eje.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION These results are positive, and the scales now need to be validated in the field. CONCLUSIONS It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.
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Affiliation(s)
- D Faulks
- Université Clermont Auvergne, EA4847 CROC, and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - A Dougall
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - G Ting
- Dental Institute, King's College Hospital NHS Foundation Trust, London, UK
| | - T Ari
- Division of Paediatric dentistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - J Nunn
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - C Friedman
- Paediatric Oral Health & Dentistry, London, ON, Canada
| | - J John
- Faculty of Dentistry, Department of Restorative Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - B Daly
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - V Roger-Leroi
- Université Clermont Auvergne, EA4847 CROC, and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| | - J T Newton
- Department of population and Patient Health, King's College London Dental Institute, London, UK
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Abstract
Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work-flow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.
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Affiliation(s)
- Breanna Hetland
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Ronald Hickman
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Natalie McAndrew
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Barbara Daly
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Keohane DM, McGillivary NA, Daly B. Physical activity levels and perceived barriers to exercise participation in Irish General Practitioners and General Practice trainees. Ir Med J 2018; 111:690. [PMID: 29952439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physical activity is a pillar stone of health promotion and primary care is perfectly poised to disseminate this message. Primary care however, often fails in this regard, missing an opportunity to promote a simple intervention that is effective, free and easily accessible. This study aimed to determine physical activity levels in Irish General Practitioners and General Practice Trainees in addition to describing the barriers to exercise that exist amongst this cohort. This cross-sectional study of Irish General Practice trainers and trainees captured a categorical record of physical activity as well as a qualitative measure of the perceived barriers to exercise. Only 49% (n=107) of those studied engaged in health enhancing physical activity while 20% (n=44) were completely inactive. Sixty percent (n=131) demonstrated excessively sedentary behaviour. The greatest barriers to exercise were time expenditure and exhaustion. General practitioners and trainees are more likely to engage with promoting physical activity as a health intervention if its benefits are clearly demonstrable in their own lives. This established trend of inactivity needs to be reversed if physicians wish to realise significant health benefits in their own lives and achieve substantial change in the health behaviours of their patients.
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Affiliation(s)
- D M Keohane
- South West Specialist Training Programme in General Practice, S�las Building, ITT North Campus, Tralee, Co. Kerry, Ireland
| | - N A McGillivary
- South West Specialist Training Programme in General Practice, S�las Building, ITT North Campus, Tralee, Co. Kerry, Ireland
| | - B Daly
- South West Specialist Training Programme in General Practice, S�las Building, ITT North Campus, Tralee, Co. Kerry, Ireland
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Daly B, Toulis KA, Thomas N, Gokhale K, Martin J, Webber J, Keerthy D, Jolly K, Saravanan P, Nirantharakumar K. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study. PLoS Med 2018; 15:e1002488. [PMID: 29337985 PMCID: PMC5770032 DOI: 10.1371/journal.pmed.1002488] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/11/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with developing type 2 diabetes, but very few studies have examined its effect on developing cardiovascular disease. METHODS AND FINDINGS We conducted a retrospective cohort study utilizing a large primary care database in the United Kingdom. From 1 February 1990 to 15 May 2016, 9,118 women diagnosed with GDM were identified and randomly matched with 37,281 control women by age and timing of pregnancy (up to 3 months). Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for cardiovascular risk factors and cardiovascular disease. Women with GDM were more likely to develop type 2 diabetes (IRR = 21.96; 95% CI 18.31-26.34) and hypertension (IRR = 1.85; 95% CI 1.59-2.16) after adjusting for age, Townsend (deprivation) quintile, body mass index, and smoking. For ischemic heart disease (IHD), the IRR was 2.78 (95% CI 1.37-5.66), and for cerebrovascular disease 0.95 (95% CI 0.51-1.77; p-value = 0.87), after adjusting for the above covariates and lipid-lowering medication and hypertension at baseline. Follow-up screening for type 2 diabetes and cardiovascular risk factors was poor. Limitations include potential selective documentation of severe GDM for women in primary care, higher surveillance for outcomes in women diagnosed with GDM than control women, and a short median follow-up postpartum period, with a small number of outcomes for IHD and cerebrovascular disease. CONCLUSIONS Women diagnosed with GDM were at very high risk of developing type 2 diabetes and had a significantly increased incidence of hypertension and IHD. Identifying this group of women in general practice and targeting cardiovascular risk factors could improve long-term outcomes.
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Konstantinos A. Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Webber
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Deepi Keerthy
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ponnusamy Saravanan
- Diabetes, Endocrinology & Metabolism, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Daly B, Thompsell A, Sharpling J, Rooney YM, Hillman L, Wanyonyi KL, White S, Gallagher JE. Evidence summary: the relationship between oral health and dementia. Br Dent J 2017; 223:846-853. [DOI: 10.1038/sj.bdj.2017.992] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/29/2022]
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Bolster F, Ali Z, Daly B. The “pseudo-CT myelogram sign”: an aid to the diagnosis of underlying brain stem and spinal cord trauma in the presence of major craniocervical region injury on post-mortem CT. Clin Radiol 2017; 72:1085.e11-1085.e15. [DOI: 10.1016/j.crad.2017.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/01/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
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Munoz-Largacha J, Rao S, Daly B, Litle V, Suzuki K. P1.05-013 Induction Chemoradiation Is Associated with Improved Survival in Resected Non-Pancoast Lung Cancer with Chest Wall Invasion. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dougall A, Hayes M, Daly B. A systematic review of the use of local analgesia in medically compromised children and adolescents. Eur Arch Paediatr Dent 2017; 18:331-343. [DOI: 10.1007/s40368-017-0304-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022]
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Daly B, Tian CJL, Scragg RKR. Effect of nurse-led randomised control trials on cardiovascular risk factors and HbA1c in diabetes patients: A meta-analysis. Diabetes Res Clin Pract 2017; 131:187-199. [PMID: 28756133 DOI: 10.1016/j.diabres.2017.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/23/2017] [Accepted: 07/07/2017] [Indexed: 12/31/2022]
Abstract
A systematic review and meta-analysis identified 42 randomised control trials comparing a nurse-led intervention with 'usual care' to quantify their effect on glycated haemoglobin (HbA1c) and major cardiovascular risk factors in diabetes patients. All relevant databases were systematically searched for publications to February 2016: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE and Cumulative Index to Nursing & Allied Health Literature (CINAHL). The 42 trials recruited 9955 diabetes patients (5022 randomised to intervention and 4933 to 'usual care'). For patients receiving the nurse-led intervention, compared with 'usual care', there were small but significant mean reductions for HbA1c [-0.28%; 95% CI -0.38%, -0.18%; p-value<0.0001, n=6920] and serum triglyceride levels [-0.27mmol/L; 95% CI -0.49, -0.06; p=0.01, n=1169], and a greater proportion of patients stopped smoking [risk ratio=2.70; 95% CI 1.35, 5.43; p=0.005, n=1890 patients]. Mean reductions for systolic [-1.84mmHg; 95% CI -3.97, -0.10; p=0.06, 4241 patients] and diastolic [-0.95mmHg; 95% CI -2.15, -0.25; p=0.12, 3811 patients] blood pressures trended towards significance. There were no significant mean reductions for body mass index or serum cholesterol. Nurse-led interventions produced greater improvements than 'usual care' for HbA1c, serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management.
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Private Bag, Auckland, New Zealand.
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Abstract
The communication of risk in dental settings is a routine task that most clinicians are familiar with in their clinical encounters. However, work from medical settings has suggested that using this process in order to support health behaviour change in people may well be undermined by difficulties in understanding risk information, in presenting the information in a way that is clearly understood by the recipient and in the effects that such information may have for supporting further health behaviours by patients. This paper synthesises literature in the area that addresses these issues and explores approaches dental care professionals might consider when communicating risks in the dental surgery.
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Affiliation(s)
- K Asimakopoulou
- King's College London, Dental Institute, Division of Population and Patient Health, Social and Behavioural Sciences Group, Floor 18, Guy's Tower, Great Maze Pond, London, SE1 9RW
| | - G Rhodes
- King's College London, Dental Institute, Division of Population and Patient Health, Social and Behavioural Sciences Group, Floor 18, Guy's Tower, Great Maze Pond, London, SE1 9RW
| | - B Daly
- King's College London, Dental Institute, Division of Population and Patient Health, Social and Behavioural Sciences Group, Floor 18, Guy's Tower, Great Maze Pond, London, SE1 9RW
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Daly B, Raiman I, Goodson J. Screening for diabetes in pregnancy in a regional area with a high Māori population. N Z Med J 2017; 130:25-31. [PMID: 28207722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIMS To identify and document factors associated with screening for diabetes in pregnancy in a regional area with a high Māori population in New Zealand. METHODS An audit was undertaken of routine hospital data collected from all 656 women who gave birth, between June and December in 2013 and 2014, in two Mid-North Island hospitals in the Bay of Plenty region. RESULTS Of the 656 woman who gave birth during these periods, only 416 (63%) were screened for diabetes in pregnancy, including 390 (60%) for gestational diabetes mellitus later in pregnancy. After controlling for age, screening was less common in Māori (56%) compared with European women (76%). After adjusting for ethnicity, women aged 35-40 years were more likely to be screened compared with women aged 25-29 years (77% versus 61%; p=0.02). Screening was associated with longer hospital stays following birth, with screened women more likely to stay >5 days than <1 day, compared with unscreened women (84% versus 56%; p<0.0001). Screening was significantly higher in 2014 than 2013 (68% versus 58%; p=0.008). CONCLUSIONS Greater effort is required to increase screening, especially for Māori women who have increased risk of type 2 diabetes and gestational diabetes mellitus and of poorer outcomes.
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Affiliation(s)
- Barbara Daly
- Senior Lecturer in Nursing, School of Nursing, University of Auckland, Auckland
| | - Isabel Raiman
- Medical Service, Nurse Practitioner (Diabetes), Bay of Plenty, District Health Board, Tauranga
| | - Jennifer Goodson
- Clinical Study Coordinator, Medical Service, Bay of Plenty, District Health Board, Tauranga
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Daly B, Young S, Marla R, Riddell L, Junkin R, Weidenhammer N, Dolan J, Kinsella J, Zhang R. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background. Int J Obstet Anesth 2017; 29:57-63. [DOI: 10.1016/j.ijoa.2016.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/24/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
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Abstract
Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women’s understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists’ purported incorrect beliefs about providing dental treatment to pregnant women and the women’s lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women. Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.
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Affiliation(s)
- S. Al Khamis
- Department of Oral and Dental Health, College of Health Sciences, Public Authority for Applied Education and Training, Shuwaikh, Kuwait
| | - K. Asimakopoulou
- Social and Behavioural Sciences Group, Division of Population and Patient Health, King’s College London Dental Institute, London, UK
| | - J.T. Newton
- Social and Behavioural Sciences Group, Division of Population and Patient Health, King’s College London Dental Institute, London, UK
| | - B. Daly
- Division of Population and Patient Health, King’s College London Dental Institute, London, UK
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Abstract
Fatigue is one of the most common side-effects accompanying radiotherapy, but arguably the least understood. Radiotherapy-induced fatigue (RIF) is a clinical subtype of cancer treatment-related fatigue. It is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living, and is not relieved by adequate rest or sleep. RIF is one of the early side-effects and long-lasting for cancer patients treated with localized radiation. Although the underlying mechanisms of fatigue have been studied in several disease conditions, the etiology, mechanisms, and risk factors of RIF remain elusive, and this symptom remains poorly managed. The purpose of this paper is to review and discuss recent articles that defined, proposed biologic underpinnings and mechanisms to explain the pathobiology of RIF, as well as articles that proposed interventions to manage RIF. Understanding the mechanisms of RIF can describe promising pathways to identify at-risk individuals and identify potential therapeutic targets to alleviate and prevent RIF using a multimodal, multidisciplinary approach.
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Affiliation(s)
- Chao-Pin Hsiao
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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Moore S, Shiers D, Daly B, Mitchell AJ, Gaughran F. Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatr Scand 2015; 132:109-21. [PMID: 25958971 DOI: 10.1111/acps.12431] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Acquiring a diagnosis of schizophrenia reduces life expectancy for many reasons including poverty, difficulties in communication, side-effects of medication and access to care. This mortality gap is driven by natural deaths; cardiovascular disease is a major cause, but outcomes for people with severe mental illness are worse for many physical health conditions, including cancer, fractures and complications of surgery. We set out to examine the literature on disparities in medical and dental care experienced by people with schizophrenia and suggest possible approaches to improving health. METHOD This narrative review used a targeted literature search to identify the literature on physical health disparities in schizophrenia. RESULTS There is evidence of inequitable access to and/or uptake of physical and dental health care by those with schizophrenia. CONCLUSION The goal was to reduce the mortality gap through equity of access to all levels of health care, including acute care, long-term condition management, preventative medicine and health promotion. We suggest solutions to promote health, wellbeing and longevity in this population, prioritising identification of and intervention for risk factors for premature morbidity and mortality. Shared approaches are vital, while joint education of clinicians will help break down the artificial mind-body divide.
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Affiliation(s)
- S Moore
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - D Shiers
- Royal College of Psychiatrists, Centre for Quality Improvement, London, UK
| | - B Daly
- King's College Hospital, Dental Public Health, London, UK
| | - A J Mitchell
- Department of Psycho-oncology, Leicestershire Partnership Trust and Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - F Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, London and South London and Maudsley NHS Foundation Trust, National Psychosis Service, London, UK
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Ciro RE, Gokhale S, Daly B. Author response. Neurology 2015; 84:1910-1911. [PMID: 26131460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Pullicino PM, Ramos-Estebanez C, Gokhale S, Daly B, Schor NF. Clinical and ethical judgment: A profound dilemma. Neurology 2015; 84:1910. [DOI: 10.1212/01.wnl.0000465425.64165.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Daly B, Arroll B, Kenealy T, Sheridan N, Scragg R. Management of diabetes by primary health care nurses in Auckland, New Zealand. J Prim Health Care 2015; 7:42-49. [PMID: 25770715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes.
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Bruce Arroll
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Timothy Kenealy
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicolette Sheridan
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Robert Scragg
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Daly B, Arroll B, Kenealy T, Sheridan N, Scragg R. Management of diabetes by primary health care nurses in Auckland, New Zealand. J Prim Health Care 2015. [DOI: 10.1071/hc15042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION: The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM: To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS: Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS: Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION: Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes. KEYWORDS: Blood glucose; diabetes mellitus type 1; diabetes mellitus type 2; nurses; primary health care; risk management
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Douglas S, Daly B, Rowbottom J, Hejal R, O’Toole E. 394. Crit Care Med 2014. [DOI: 10.1097/01.ccm.0000457891.66845.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daly B, Kenealy T, Arroll B, Sheridan N, Scragg R. Do primary health care nurses address cardiovascular risk in diabetes patients? Diabetes Res Clin Pract 2014; 106:212-20. [PMID: 25271111 DOI: 10.1016/j.diabres.2014.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 08/15/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
Abstract
AIMS To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. METHODS Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. RESULTS The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p < 0.0001). CONCLUSIONS Measurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Timothy Kenealy
- General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Bruce Arroll
- General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Nicolette Sheridan
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robert Scragg
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
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Affiliation(s)
- Barbara Daly
- From the Department of Neurology, Neurocritical Care & Stroke Divisions (C.R.-E.), Case Western Reserve University (B.D.), Cleveland, OH; and the Department of Neurology (S.G.), Neurocritical Care Division, University of Texas Southwestern, Dallas
| | - Sankalp Gokhale
- From the Department of Neurology, Neurocritical Care & Stroke Divisions (C.R.-E.), Case Western Reserve University (B.D.), Cleveland, OH; and the Department of Neurology (S.G.), Neurocritical Care Division, University of Texas Southwestern, Dallas
| | - Ciro Ramos-Estebanez
- From the Department of Neurology, Neurocritical Care & Stroke Divisions (C.R.-E.), Case Western Reserve University (B.D.), Cleveland, OH; and the Department of Neurology (S.G.), Neurocritical Care Division, University of Texas Southwestern, Dallas.
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Daly B, Arroll B, Sheridan N, Kenealy T, Scragg R. Diabetes knowledge of nurses providing community care for diabetes patients in Auckland, New Zealand. Prim Care Diabetes 2014; 8:215-223. [PMID: 24485171 DOI: 10.1016/j.pcd.2014.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/14/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
Abstract
AIMS To quantify and compare knowledge of diabetes including risk factors for diabetes-related complications among the three main groups of primary health care nurses. METHODS In a cross-sectional survey of practice, district and specialist nurses (n=1091) in Auckland, New Zealand, 31% were randomly sampled to complete a self-administered questionnaire and telephone interview, designed to ascertain nurses' knowledge of diabetes and best practice, in 2006-2008. RESULTS All 287 nurses (response rate 86%) completed the telephone interview and 284 the self-administered questionnaire. Major risk factors identified by nurses were excess body weight for type 2 diabetes (96%) and elevated plasma glucose levels or glycosylated haemoglobin (86%) for diabetes-related complications. In contrast, major cardiovascular risk factors were less well identified, particularly smoking, although by more specialist nurses (43%) than practice (14%) and district (12%) nurses (p=0.0005). Cardiovascular complications, particularly stroke, were less well known than microvascular complications, and by significantly fewer practice (13%) and district (8%) nurses than specialist nurses (36%, p=0.002). CONCLUSIONS In general, nurses had better knowledge of overweight as a risk factor for type 2 diabetes mellitus and elevated plasma glucose levels as a risk factor for diabetes-related complications compared with knowledge of cardiovascular risk factors, particularly smoking.
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MESH Headings
- Adult
- Attitude of Health Personnel
- Clinical Competence
- Community Health Services
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/nursing
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/nursing
- Female
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Humans
- Interviews as Topic
- Male
- New Zealand/epidemiology
- Nurse's Role
- Nurses, Community Health/psychology
- Practice Patterns, Nurses'
- Primary Care Nursing
- Risk Factors
- Surveys and Questionnaires
- Telephone
- Workforce
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Bruce Arroll
- School of Population Health, University of Auckland, New Zealand
| | - Nicolette Sheridan
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Timothy Kenealy
- School of Population Health, University of Auckland, New Zealand
| | - Robert Scragg
- School of Population Health, University of Auckland, New Zealand
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