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Journey to facility birth in Zanzibar: a questionnaire-based cohort study of patients perspectives on preparedness, access and quality of care

Por: Herklots · T. · D'haene · L. · Mbarouk · K. S. · Rajhy · M. · Couperus · S. · Meguid · T. · Franx · A. · Koster · M. P. H. · Jacod · B.
Introduction

Tackling substandard maternity care in health facilities requires engaging women’s perspectives in strategies to improve outcomes. This study aims to provide insights in the perspectives of women with severe maternal morbidity on preparedness, access and quality of care in Zanzibar’s referral hospital.

Methods

In a prospective cohort from April 2017 to December 2018, we performed semistructured interviews with women who experienced maternal near-miss complications and matched controls. These focused on sociodemographic and obstetric characteristics, perceived accessibility to and quality of facility care with 15 domains, scored on a one-to-five scale. Participants’ comments and answers to open questions were employed to illustrate quantitative outcomes. Zanzibar’s Medical Research and Ethics Committee approved the study (ZAMREC/0002/JUN/17).

Results

We included 174 cases and 151 controls. Compared with controls, patients with a near-miss had less formal education (p=0.049), perceived their wealth as poor (p=0.002) and had a stillbirth more often (p

Conclusion

Most patients promptly sought, accessed and received maternity care in Zanzibar’s referral hospital. A minority experienced barriers, mostly financial, in reaching care and more so among patients with near-miss complications. Quality of facility care was generally highly rated. However, some reported insightful critical perceptions. This study highlights the impact of sociodemographic differences on health, the value of involving patients in decisions regarding maternity care and the need to ensure availability of medical supplies, all which will contribute to improved maternal well-being.

Family perspectives need considering as part of the assisted dying process

Por: Bravo · P. H.

Commentary on: Gamondi C, Fusi-Schmidhauser T, Oriani A, et al. Family members’ experiences of assisted dying: a systematic literature review with thematic synthesis. Palliat Med 2019;33:1091–105. doi: 10.1177/0269216319857630.

Implications for practice and research

  • Family support positively influences patient engagement in assisted dying.

  • Future research is needed to identify and incorporate family needs into evidenced-based assisted dying guidelines.

  • Context

    Though assisted dying is a growing practice, it is not legally permissible throughout the world. Currently, only 176 million people worldwide have legal access to this practice.1 It encompasses two practices: assisted suicide and active euthanasia.2 While rates of assisted dying have increased in countries legally allowing the practice, family requirements differ geographically based on the model of assisted dying used.1 This variability in family responsibility can result in differing family experiences. This study focussed on identifying and understanding these experiences...

    The GALANT trial: study protocol of a randomised placebo-controlled trial in patients with a 68Ga-DOTATATE PET-positive, clinically non-functioning pituitary macroadenoma on the effect of lanreotide on tumour size

    Por: Boertien · T. M. · Drent · M. L. · Booij · J. · Majoie · C. B. L. M. · Stokkel · M. P. M. · Hoogmoed · J. · Pereira · A. · Biermasz · N. R. · Simsek · S. · Groote Veldman · R. · Tanck · M. W. T. · Fliers · E. · Bisschop · P. H.
    Introduction

    At present, there is no approved medical treatment option for patients with non-functioning pituitary adenoma. A number of open-label studies suggest that treatment with somatostatin analogues may prevent tumour progression. In vivo somatostatin receptor imaging using 68Ga-DOTATATE PET (PET, positron emission tomography) could help in preselecting patients potentially responsive to treatment. Our aim is to investigate the effect of the somatostatin analogue lanreotide as compared with placebo on tumour size in patients with a 68Ga-DOTATATE PET-positive non-functioning pituitary macroadenoma (NFMA).

    Methods and analysis

    The GALANT study is a multicentre, randomised, double-blind, placebo-controlled trial in adult patients with a suprasellar extending NFMA. Included patients undergo a 68Ga-DOTATATE PET/CT of the head and tracer uptake is assessed after coregistration with pituitary MRI. Forty-four patients with a 68Ga-DOTATATE PET-positive NFMA are randomised in a 1:1 ratio between lanreotide 120 mg or placebo, both administered as subcutaneous injections every 28 days for 72 weeks. The primary outcome is the change in cranio-caudal tumour diameter on pituitary MRI after treatment. Secondary outcomes are change in tumour volume, time to tumour progression, change in quality of life and number of adverse events. Final results are expected in the second half of 2021.

    Ethics and dissemination

    The study protocol has been approved by the Medical Research Ethics Committee of the Academic Medical Centre (AMC) of the Amsterdam University Medical Centres and by the Dutch competent authority. It is an investigator-initiated study with financial support by Ipsen Farmaceutica BV. The AMC, as sponsor, remains owner of all data. Results will be submitted for publication in a peer-reviewed journal.

    Trial registration number

    NL5136 (Netherlands Trial Register); pre-recruitment.

    Involuntary treatment in dementia care at home: Results from the Netherlands and Belgium

    Abstract

    Aims and objectives

    To gain insight into the request, use and associated factors of involuntary treatment in people with dementia (PwD) receiving professional home care in the Netherlands and Belgium.

    Background

    Most of the PwD remain living at home as long as possible. Due to complex care needs, this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment.

    Design

    Secondary data analyses of two cross‐sectional surveys.

    Methods

    Dementia case managers and district nurses filled in a questionnaire for each PwD in their caseload. This study included data of 627 PwD receiving professional home care in the Netherlands and 217 in Belgium. The same methodology (questionnaire and variables) was used in both samples. Descriptive statistics and multi‐level logistic regression analyses were used to analyse the data. The study adhered to the STROBE checklist.

    Results

    More than half of the PwD (50.7%) living at home received involuntary treatment (Belgium 68.2% and the Netherlands 44.7%). Nonconsensual care (82.7%) was the most common, followed by psychotropic medication (40.7%) and physical restraints (18.5%). Involuntary treatment use was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. Involuntary treatment was most often requested by family caregivers.

    Conclusions

    Involuntary treatment is often used in PwD, which is in line with previous findings indicating dementia as a risk factor for involuntary treatment use. More research is needed to gain insight into variations in prevalence across other countries, which factors influence these differences and what countries can learn from each other regarding prevention of involuntary treatment.

    Relevance to clinical practice

    To provide person‐centred care, it is important to study ways to prevent involuntary treatment in PwD and to stimulate dialogue between professional and family caregivers for alternative interventions.

    Breast cancer application protocol: a randomised controlled trial to evaluate a self-management app for breast cancer survivors

    Por: Cheng · A. S. K. · Liu · X. · Ng · P. H. F. · Kwok · C. T. T. · Zeng · Y. · Feuerstein · M.
    Introduction

    The eHealth technologies that are being designed for chronic disease constitute a global trend towards health assessment and self-management. However, most of these approaches tend to focus on a single symptom or problem rather than on the multiple problems that are characteristic of many of these chronic illnesses. The aim of this study is to examine the effectiveness of and adherence to a self-management application (app) that identifies multiple problem areas related to surviving breast cancer as the targeted chronic illness.

    Methods and analysis

    This is a randomised controlled study. Eligible participants will be allocated randomly into either an intervention group or a control group at a 1:1 ratio. The intervention group will be assigned to the self-management app (‘Be-with-You’), while the control group will use a general health app (‘Sham’ app). The primary outcomes will include the differences between the two groups in their health literacy, problem-solving skills and self-management skills. The secondary outcomes will include group differences in self-efficacy, readiness for change and health-related quality of life. All of these outcomes will be measured at baseline and at 4 weeks and 12 weeks after intervention. In addition, usability of these two mobile apps will be measured at 4 weeks and 12 weeks after intervention. The planned sample size is 476.

    Ethics and dissemination

    The Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University approved the study (HSEARS20190922001, 24 September 2019). Dissemination of findings will occur at the local, national and international levels.

    Trial registration number

    ChiCTR1900026244.

    Community-based weight loss programme targeting overweight Chinese adults with pre-diabetes: study protocol of a randomised controlled trial

    Por: Ho · M. · Chau · P. H. · Yu · E. Y. T. · Ying · M. T.-c. · Lam · C. L. K.
    Introduction

    Type 2 diabetes mellitus (T2DM) is one of the world’s fastest growing health problems. Asians have a strong ethnic predisposition for T2DM, developing T2DM at a lower degree of obesity and at younger ages than other ethnic groups. T2DM has a gradual onset, with most individuals progressing through a pre-diabetic state, providing an opportunity to prevent T2DM and its complications. This study aims to evaluate the effectiveness of a community-based lifestyle intervention programme on weight loss and improvements in insulin sensitivity and cardiometabolic profiles in Chinese adults with pre-diabetes.

    Methods and analysis

    This study is a 12-month, assessor-blinded randomised controlled trial. Adults with pre-diabetes (aged 40–64 years, n=180) with pre-diabetes are randomised into either an intervention group (receiving group-based lifestyle interventions) or a control group (receiving text messages containing health information). The intervention programme targets a weight loss of 5% during the first 6 months by restricting caloric intake and increasing physical activity. Participants in the intervention group will attend six group sessions and two individual face-to-face diet counselling sessions during the first 6 months, followed by monthly telephone support during the 6-month maintenance phase. Participants in the control group will receive monthly text messages containing general health information only. The primary outcome is weight loss (%). Secondary outcomes include insulin sensitivity (assessed using fasting insulin level and homeostatic model assessment of insulin resistance), glycaemic control (assessed using glycated haemoglobin level), lipid profile, blood pressure, carotid artery thickness, dietary intake and level of physical activity. Intention-to-treat analysis will be conducted using a generalised linear mixed effects model with a logit link and linear mixed models.

    Ethics and dissemination

    This study has been approved by the relevant research ethics committee. The results will be disseminated through peer-reviewed journals and scientific presentations.

    Trial registration number

    NCT03609697.

    Cognitive-behavioural group therapy for adolescents with ADHD: study protocol for a randomised controlled trial

    Por: Novik · T. S. · Haugan · A.-L. J. · Lydersen · S. · Thomsen · P. H. · Young · S. · Sund · A. M.
    Introduction

    Persistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive–behavioural therapy (CBT) programme for adolescents with ADHD aged 14–18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD.

    Methods and analysis

    We conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV.

    Ethics and dissemination

    The Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere.

    Trial registration number

    NCT02937142

    Study finds medication errors common after Intensive Care Unit transfer

    Por: Bravo · P. H.

    Commentary on: Tully AP, Hammond DA, Li C, et al. Evaluation of medication errors at the transition of care from an ICU to non-ICU location. Crit Care Med 2019;47:543–9. Doi: 10.1097/CCM.0000000000003633

    Implications for practice and research

  • Nearly half of patients transferred from Intensive Care Unit to non-Intensive Care Unit (ICU) settings experience medication error.1

  • Renal replacement therapy, anti-infective medications, haematological agents, intravenous fluids, electrolytes and diuretics prescribed during ICU stay place patients at highest risk for error.

  • Future research must identify innovative interdisciplinary and technological interventions to decrease medical errors among high-risk transfers.

  • Context

    Medication errors at time of hospital discharge to outpatient settings have been thoroughly studied, showing 60% or greater of patients discharged experience medication errors.2–5 Though information exists on medication errors in individual units, little information exists on medication errors...

    Screening Of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA): rationale and design of a multicentre, cross-sectional study

    Por: Cheng · Y. · Tung · C.-K. · Chung · A. K. K. · Liu · W.-W. · Huang · D. · Chan · P. H. · Lam · M. · Chan · W.-C. · Siu · C.-W. · Hai · J. J.
    Introduction

    Methamphetamine misuse is classified as a ‘likely’ risk factor for pulmonary arterial hypertension (PAH). Nevertheless, the actual prevalence of and a screening strategy for PAH in methamphetamine users have not been established. We plan to study the prevalence of PAH and identify its independent risk factors among methamphetamine users.

    Methods and analysis

    The Screening Of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA) study will be a multicentre, cross-sectional screening study that will involve substance abuse clinics, hospitals and rehabilitation facilities in Hong Kong that cater to more than 20 methamphetamine users. A total of 400 patients who (1) are ≥18 years at enrolment; (2) report methamphetamine use in the last 2 years; (3) are diagnosed with methamphetamine use disorder; and (4) voluntarily agree to participate by providing written informed consent will be included. Patients will undergo standard echocardiography-based PAH screening procedures recommended for those with systemic sclerosis. Right heart catheterisation will be offered to participants with intermediate or high echocardiographic probability of PAH. For participants with a low echocardiographic probability of PAH, rescreening will be performed within 1 year. The primary measure will be the prevalence of PAH in methamphetamine users. The secondary measures will be the risk factors and a prediction model for PAH in methamphetamine users.

    Ethics and dissemination

    The SOPHMA study has been approved by the institutional review board. The findings of this study will provide the necessary evidence to establish universal guidelines for screening of PAH in methamphetamine users. Our results will be disseminated through immediate feedback to study participants, press release to the general public, as well as presentation in medical conferences and publications in peer-reviewed journals to healthcare providers and academia worldwide.

    The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

    Por: Plate · J. D. J. · Peelen · L. M. · Leenen · L. P. H. · Hietbrink · F.
    Objectives

    To determine whether and to what extent the surgical intermediate care unit (IMCU) reduces healthcare costs.

    Design

    Retrospective cohort study.

    Setting

    The mixed-surgical IMCU of a tertiary academic referral hospital.

    Participants

    All admissions (n=2577) from 2012 to 2015.

    Primary and secondary outcome measures

    The outcome measure was the hypothetical cost savings due to the presence of the IMCU. For this, each admission day was classified as either low-acuity or high-acuity, based on the Therapeutic Intervention Scoring System-28, the required specific nursing interventions and the indication for admission at the IMCU. Costs (2018) used were 463 per hospital ward, 1307 per IMCU and 2224 per intensive care unit (ICU) admission day. Savings were calculated by subtracting the actual IMCU costs from the hypothetical costs in the absence of the IMCU.

    Results

    There were 9037 admission days (n=2577 admissions) at the IMCU. The proportion of high-acuity admissions was 87.6%. Total costs at the IMCU were 11.808 888. Total hypothetical costs in absence of the IMCU were 18.115 284. Total cost savings were thus 6.306 395, or 1.576 599, per year.

    Conclusions

    The surgical IMCU may substantially reduce societal healthcare costs, making it a cost saving alternative to ICU care. Constant adequate triage is essential to optimise its potential.

    Patient satisfaction in treatment of non-complex fractures and dislocations in general practice in the Netherlands: prospective cohort study protocol

    Por: Verbeek · T. · Arentsen · H. · Breet · E. J. · Kuipers · M. M. · Lubbert · P. H. W. · Burger · H.
    Introduction

    Diagnosis and treatment of fractures and dislocations are mostly performed in hospital settings. However, equal care for patients with non-­complex fractures or dislocations (‘minor trauma care’) may be provided in general practice. While substitution of care from secondary to primary care settings is stimulated by governments and insurers, it is unknown what the effects are on patient satisfaction level. Therefore, our primary objective is to determine the effect of minor trauma care delivered in a general practice as compared with a hospital on patient satisfaction. Secondary objectives are to assess the effects on treatment outcomes, cost-effectiveness and time consumption.

    Methods and analysis

    In a prospective cohort study, we will include 200 patients aged 12 and over with an X-ray confirmed diagnosis of a non­-complex fracture or dislocation out of whom 100 treated in a general practice and 100 in a secondary care hospital, both located in the Netherlands. All treatment procedures and follow-up will be done in accordance to the hospital’s standards of trauma care. Study assessments will be performed pre-treatment, and 1, 6 and 12 weeks after treatment. Data collected include demographics, patient satisfaction and patient-reported outcomes including physical functioning, complications, pain scores and treatment-related costs. The primary outcome patient satisfaction measured at 12 weeks will be compared between the settings and additionally multivariable regression will be performed to assess potential confounding effects of unbalanced prognostic factors. Treatment outcomes and time consumption will be analysed following the same approach while cost-effectiveness will be assessed using an incremental cost-effectiveness ratio. Subsequently, results will be discussed using focus groups consisting of patients (n=15) and healthcare providers.

    Ethics and dissemination

    The Medical Ethics Committee from the University Medical Center Groningen reviewed this study protocol and granted exemption from ethical approval (METc UMCG 2017/277). Study results will be presented at (inter)national conferences and published in peer-reviewed journals.

    Trial registration number

    NCT03506958; Pre-results.

    Associations between physical activity and asthma, eczema and obesity in children aged 12-16: an observational cohort study

    Por: Jago · R. · Salway · R. E. · Ness · A. R. · Shield · J. P. H. · Ridd · M. J. · Henderson · A. J.
    Objectives

    To compare the physical activity of adolescents with three common long-term conditions (asthma, eczema and obesity) with adolescents without these conditions.

    Design

    Cross-sectional and longitudinal analyses of adolescents at ages 12, 14 and 16 in a large UK cohort study.

    Setting

    The Avon Longitudinal Study of Parents and Children.

    Participants

    6473 adolescents with complete accelerometer data at at least one time point.

    Methods

    Mean minutes of moderate to vigorous intensity physical activity (MVPA) and sedentary time per day were derived from accelerometer-based measurements at ages 12, 14 and 16. Obesity was defined at each time point from height and weight measurements. Parents reported doctor-assessed asthma or eczema. Cross-sectional and longitudinal regression models examined any differences in MVPA or sedentary time for adolescents with asthma, eczema or obesity compared with those without.

    Results

    In longitudinal models, boys engaged in an average of 69.7 (95% CI 67.6 to 71.7) min MVPA at age 12, declining by 3.1 (95% CI 2.6 to 3.6) min/year while girls’ average MVPA was 47.5 (95% CI 46.1 to 48.9) min at age 12, declining by 1.8 (95% CI 1.5 to 2.1) min/year. There was no strong evidence of differences in physical activity patterns of those with and without asthma or eczema. Obese boys engaged in 11.1 (95% CI 8.7 to 13.6) fewer minutes of MVPA, and obese girls in 5.0 (95% CI 3.3 to 6.8) fewer minutes than their non-obese counterparts. Cross-sectional models showed comparable findings.

    Conclusions

    Mean minutes of MVPA per day did not differ between adolescents with asthma or eczema and those without, but obese adolescents engaged in fewer minutes of MVPA. Findings reinforce the need for strategies to help obese adolescents be more active but suggest no need to develop bespoke physical activity strategies for adolescents with mild asthma or eczema.

    Smoking behaviours of Hong Kong Chinese hospitalised patients and predictors of smoking abstinence after discharge: a cross-sectional study

    Por: Ho · K. Y. · Li · W. H. C. · Lam · K. K. W. · Wang · M. P. · Xia · W. · Ho · L. Y. · Tan · K. C. B. · Sin · H. K. M. · Cheung · E. · Mok · M. P. H. · Lam · T. H.
    Objectives

    Patients admitted to hospitals represent an excellent teachable moment for smoking cessation, as they are required to abstain from tobacco use during hospitalisation. Nevertheless, smoking behaviours of hospitalised patients, and factors that lead to smoking abstinence thereafter, remain relatively underexplored, particularly in a Hong Kong Chinese context. This study aimed to examine the smoking behaviours of hospitalised patients and explore factors leading to their abstaining from cigarette use after being hospitalised.

    Design

    A cross-sectional design was employed.

    Setting

    This study was conducted in three outpatient clinics in different regions in Hong Kong.

    Participants

    A total of 382 recruited Chinese patients.

    Primary and secondary outcome measures

    The patients were asked to complete a structured questionnaire that assessed their smoking behaviours before, during and after hospitalisation.

    Results

    The results indicated 23.6% of smokers smoked secretly during their hospital stay, and about 76.1% of smokers resumed smoking after discharge. Multivariate logistic regression analysis found that number of days of hospitalisation admission in the preceding year (OR 1.02; 95% CI 1.01 to 1.27; p=0.036), patients’ perceived correlation between smoking and their illness (OR 1.08; 95% CI 1.01 to 1.17; p=0.032), withdrawal symptoms experienced during hospitalisation (OR 0.75; 95% CI 0.58 to 0.97; p=0.027) and smoking cessation support from healthcare professionals (OR 1.18; 95% CI 1.07 to 1.36; p=0.014) were significant predictors of smoking abstinence after discharge.

    Conclusions

    The results of this study will aid development of appropriate and innovative smoking cessation interventions that can help patients achieve more successful smoking abstinence and less relapse.

    Trial registration number

    NCT02866760.

    Influence of family history on prognosis of spinal pain and the role of leisure time physical activity and body mass index: a prospective study using family-linkage data from the Norwegian HUNT study

    Por: Amorim · A. B. · Ferreira · P. H. · Ferreira · M. L. · Lier · R. · Simic · M. · Pappas · E. · Zadro · J. R. · Mork · P. J. · Nilsen · T. I.
    Objectives

    To investigate the influence of parental chronic spinal pain on prognosis of chronic spinal pain in adult offspring, and whether offspring physical activity level and body mass index (BMI) modified this association.

    Design

    Prospective cohort study.

    Setting

    We used family-linked longitudinal data from the Norwegian HUNT study collected in HUNT2 (1995–1997) and HUNT3 (2006–2008).

    Participants

    A total of 1529 offspring who reported spinal pain in HUNT2 were linked with parental data and followed up in HUNT3.

    Outcomes

    We estimated relative risk (RR) with 95% CI for recovery from chronic spinal pain, and also from activity limiting spinal pain, in offspring related to chronic spinal pain in parents. We also investigated whether offspring leisure time physical activity and BMI modified these intergenerational associations in spinal pain.

    Results

    A total of 540 (35%) offspring were defined as recovered after approximately 11 years of follow-up. Offspring with both parents reporting chronic spinal pain were less likely to recover from chronic spinal pain (RR 0.83, 95% CI 0.69 to 0.99) and activity limiting spinal pain (RR 0.71, 95% CI 0.54 to 0.94), compared with offspring of parents without chronic spinal pain. Analyses stratified by BMI and physical activity showed no strong evidence of effect modification on these associations. However, offspring who were overweight/obese and with both parents reporting chronic spinal pain had particularly low probability of recovery from activity limiting spinal pain, compared with those who were normal weight and had parents without chronic spinal pain (RR 0.57, 95% CI 0.39 to 0.84).

    Conclusion

    Offspring with chronic spinal pain are less likely to recover if they have parents with chronic spinal pain, particularly if offspring are overweight/obese.

    Short-term and long-term cost-effectiveness of a pedometer-based exercise intervention in primary care: a within-trial analysis and beyond-trial modelling

    Por: Anokye · N. · Fox-Rushby · J. · Sanghera · S. · Cook · D. G. · Limb · E. · Furness · C. · Kerry · S. M. · Victor · C. R. · Iliffe · S. · Ussher · M. · Whincup · P. H. · Ekelund · U. · deWilde · S. · Harris · T.
    Objectives

    A short-term and long-term cost-effectiveness analysis (CEA) of two pedometer-based walking interventions compared with usual care.

    Design

    (A) Short-term CEA: parallel three-arm cluster randomised trial randomised by household. (B) Long-term CEA: Markov decision model.

    Setting

    Seven primary care practices in South London, UK.

    Participants

    (A) Short-term CEA: 1023 people (922 households) aged 45–75 years without physical activity (PA) contraindications. (b) Long-term CEA: a cohort of 100 000 people aged 59–88 years.

    Interventions

    Pedometers, 12-week walking programmes and PA diaries delivered by post or through three PA consultations with practice nurses.

    Primary and secondary outcome measures

    Accelerometer-measured change (baseline to 12 months) in average daily step count and time in 10 min bouts of moderate to vigorous PA (MVPA), and EQ-5D-5L quality-adjusted life-years (QALY).

    Methods

    Resource use costs (£2013/2014) from a National Health Service perspective, presented as incremental cost-effectiveness ratios for each outcome over a 1-year and lifetime horizon, with cost-effectiveness acceptability curves and willingness to pay per QALY. Deterministic and probabilistic sensitivity analyses evaluate uncertainty.

    Results

    (A) Short-term CEA: At 12 months, incremental cost was £3.61 (£109)/min in ≥10 min MVPA bouts for nurse support compared with control (postal group). At £20 000/QALY, the postal group had a 50% chance of being cost saving compared with control. (B) Long-term CEA: The postal group had more QALYs (+759 QALYs, 95% CI 400 to 1247) and lower costs (–£11 million, 95% CI –12 to –10) than control and nurse groups, resulting in an incremental net monetary benefit of £26 million per 100 000 population. Results were sensitive to reporting serious adverse events, excluding health service use, and including all participant costs.

    Conclusions

    Postal delivery of a pedometer intervention in primary care is cost-effective long term and has a 50% chance of being cost-effective, through resource savings, within 1 year. Further research should ascertain maintenance of the higher levels of PA, and its impact on quality of life and health service use.

    Trial registration number

    ISRCTN98538934; Pre-results.

    Professional and family caregivers’ attitudes towards involuntary treatment in community‐dwelling people with dementia 职业护理人员和家庭护理人员对社区痴呆患者非自愿治疗的态度

    Abstract

    Aims

    The aim of this study was to gain insight into professional and family caregivers’ attitudes towards involuntary treatment in community‐dwelling people with dementia (PwD).

    Background

    The number of PwD with complex care needs living at home is increasing rapidly. In some situations, caregivers provide care against the will of PwD, referred to as involuntary treatment, which includes non‐consensual care, psychotropic medication and physical restraints.

    Design

    A cross‐sectional study.

    Methods

    A total of 228 professional (nursing staff, general practitioners (GPs) and other healthcare professionals such as physical therapists and psychologists) and 77 family caregivers of PwD completed the Maastricht Attitude Questionnaire—Home Care. This questionnaire measures attitudes towards involuntary treatment and perceived restrictiveness of and experienced discomfort in using involuntary treatment. Data were collected in the Netherlands between June and November 2016.

    Results

    Family caregivers and GPs had more positive attitudes towards involuntary treatment than nursing staff and other healthcare professionals, indicating that they are more accepting of involuntary treatment. A more positive attitude was associated with higher perceived caregiver burden and being a family caregiver. Family caregivers and GPs found the use of involuntary treatment less restrictive and indicated feeling more comfortable when using these measures.

    Conclusion

    It is important to account for the differences in attitudes and foster dialogue among professional and family caregivers to find common ground about alternatives to involuntary treatment. These results will inform the development of an intervention that aims to prevent involuntary treatment in home care.

    目的

    本研究旨在了解职业护理人员和家庭护理人员对社区痴呆(PwD)患者非自愿治疗的态度。

    背景

    居住在家中的具有复杂护理需求的痴呆患者人数迅速增加。在某些情况下,护理人员违背痴呆患者的意愿提供护理,即非自愿治疗,包括非自愿护理、精神药物治疗和身体约束。

    设计

    横断面研究。

    方法

    对228名痴呆患者专业护理人员(护理人员、全科医生(GP)、理疗学家和心理学家等其他护理专业人员)和77名痴呆患者家庭护理人员进行Maastricht态度问卷调查——家庭护理。此问卷旨在判断对非自愿治疗的态度以及进行非自愿治疗时患者所感受到的限制性和所经历的不适。2016年6月至11月期间在荷兰收集数据。

    结果

    家庭护理人员和全科医生对非自愿治疗的态度比护理人员和其他医护人员更积极,表明他们对非自愿治疗的接受程度更高。积极态度与较重的护理人员负担及家庭护理人员有关。家庭护理人员和全科医生认为,非自愿治疗的使用限制性较小,并表示进行非自愿治疗时感觉更舒适。

    结论

    重要的是要说明态度的差异,并促进专业护理人员和家庭护理人员之间的对话,找到非自愿治疗的替代方案的共同点。本研究结果有助于制定旨在防止家庭护理中非自愿治疗的干预措施。

    Effectiveness of therapeutic clowning on handwashing habits remains unknown

    Por: Lee · P. H.

    Commentary on: Arıkan D, Gürarslan Bas N, Kurudirek F, Bastopcu A, Uslu H. The effect of therapeutic clowning on handwashing technique and microbial colonization in preschool children. J Nurs Scholarsh; article in press.

    Implications for practice and research

  • Further interventions targeting preschool children can consider delivery methods involving clowns and other entertaining methods.

  • The effectiveness of the therapeutic clowning approach should be compared with existing teaching methods.

  • Context

    Handwashing is an effective and convenient practice to prevent many infectious diseases.1 Children, especially preschoolers, will benefit the most from proper handwashing as they are vulnerable to infectious diseases. Traditional educations on handwashing may not effectively engage preschool children. Arıkan and colleagues proposed an entertaining method, that is, using therapeutic clowning, to teach handwashing technique among preschool children.2 They evaluated their proposed therapeutic clowning by their subjects’ handwashing habit and hand cleanliness.

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