Feasibility and value of a domiciliary spirometry programme in the assessment of severe asthma: a real-world evaluation.

Background: Domiciliary spirometry (DS) is a novel tool that is widely employed in the assessment of respiratory disease. We assessed real-world feasibility, effectiveness and value of a physiologist-led home spirometry programme in patients with treatment-refractory severe asthma. Methods: Patients were referred and provided with a hand-held DS device. Patients completed baseline measurements in a physiologist-led virtual clinic and were instructed to provide further values during any periods of respiratory symptoms. Outcome measures included prevalence of new obstructed events, DS adherence and uptake of this approach. Results: 112 patients were enrolled from November 2020 to January 2023. 102 individuals, mean±sd age 44±13 years (86% female) with median (IQR) forced expiratory volume in 1 s % predicted 88% (77-97%), successfully recorded baseline spirometry values. During follow-up (24 months), 11 (11%) were identified with new obstructive spirometry and were subsequently able to be commenced on biologic therapy. Patient engagement was poor with median (IQR) of 4 (2-6) attempts of contact made before baseline values were recorded, and 2 (1-3) attempts required to record technically acceptable values. Continued DS use was suboptimal; 34% failed to use their device after baseline and only 10% continued at the end of the study period. The cost of DS measurements was greater than a single hospital-based visit but enables multiple event capture. Conclusion: Overall, DS measurement uptake was poor, with a minority of patients continuing to use the device at the end of the study period. However, for those that engage, DS provides an alternative approach to traditional hospital-based spirometry measurements that can alter clinical management.

'Paper care not patient care': Nurse and patient experiences of comprehensive risk assessment and care plan documentation in hospital.

AIMS AND OBJECTIVES: To explore organisation-wide experiences of person-centred care and risk assessment practices using existing healthcare organisation documentation. BACKGROUND: There is increasing emphasis on multidimensional risk assessments during hospital admission. However, little is known about how nurses use multidimensional assessment documentation in clinical practice to address preventable harms and optimise person-centred care. DESIGN: A qualitative descriptive study reported according to COREQ. METHODS: Metropolitan tertiary hospital and rehabilitation hospital servicing a population of 550,000. A sample of 111 participants (12 patients, 4 family members/carers, 94 nurses and 1 allied health professional) from a range of wards/clinical locations. Semi-structured interviews and focus groups were conducted at two time points. The audio recording was transcribed, and an inductive thematic analysis was used to provide insight from multiple perspectives. RESULTS: Three main themes emerged: (1) 'What works well in practice' included: efficiency in the structure of the documentation; the Introduction, Situation, Background Assessment, Recommendation (ISBAR) framework and prompting for clinical decision-making were valued by nurses; and direct patient care is always prioritised. (2) 'What does not work well in practice': obtaining the patient's signature on daily care plans; multidisciplinary (MDT) involvement; duplication of paperwork and person-centred goals are not well-captured in care plan documentation. (3) 'Experience of care'; satisfaction of person-centred care; communication in the MDT was important, but sometimes insufficient; patients had variable involvement in their daily care plan; and inadequate integration of care between MDT team which negatively impacted patients. CONCLUSIONS: Efficient and streamlined documentation systems should herald feedback from nurses to address their clinical workflow needs and can support, and capture, their decision-making that enables partnership with patients to improve the individualisation of care provision. RELEVANCE TO CLINICAL PRACTICE: The integration of effective MDT involvement in clinical documentation was problematic and resulted in unmet supportive care from the patient's perspective.

What Are the Unmet Supportive Care Needs of People Affected by Cancer: An Umbrella Systematic Review.

OBJECTIVE: The aim of this umbrella systematic review was to critically synthesize unmet supportive care needs of people affected by cancer. DATA SOURCES: The Joanna Briggs Institute (JBI) umbrella review method provided an overall examination of the body of evidence that was available in relation to the unmet supportive care needs among people living with cancer. All qualitative, quantitative, and mixed methods reviews were included irrespective of review design. Electronic databases were searched using a wide range of search terms. All records were managed using the software package Endnote X21 and uploaded to Covidence systematic review software. Duplication of records were removed. A preselection eligibility criterion was applied to all records. Data extraction and methodological quality assessment was conducted independently by two reviewers, and a meta-level narrative synthesis conducted. CONCLUSION: A total 30 systematic reviews were included representing a total of 666 publications globally. Irrespective of the type of cancer there were many commonalities in relation to the reported experiences of unmet supportive care needs, which therefore enables the development of targeted future clinical trials, clinical guidelines, and policy contribution. In descending order of frequency, the highest unmet supportive care needs were related to psychological/emotional (30 out of 30), health system/information (29 out of 30), interpersonal/intimacy (21 out of 30), social (20 out of 30), physical (19 out of 30), family (18 out of 30), practical (16 out of 30), daily living (10 out of 30), spiritual needs (8 out of 30), patient-clinician communication (8 out of 30), and cognitive needs (5 out of 30). IMPLICATIONS FOR NURSING PRACTICE: This umbrella review has underscored fundamental shortcomings in care delivery irrespective of the patient population and the type of cancer. People with cancer are continually reporting that their needs are not being met across many supportive care domains. It is time for change within the health care system and to full leverage multidisciplinary person-centered models of care to optimize recovery and survivorship experiences. In the meantime, policy makers and cancer care clinicians are encouraged to reflect on these findings to address individualized care needs.

The Experiences and Unmet Supportive Care Needs of Partners of Men Diagnosed With Prostate Cancer: A Meta-aggregation Systematic Review.

BACKGROUND: Partners of men diagnosed with prostate cancer face their own emotional struggles as they navigate additional caregiver responsibilities while concurrently adjusting to the diagnosis and coping with greater illness uncertainty for their loved one. OBJECTIVE: This qualitative systematic review examined the unmet supportive care needs of partners affected by prostate cancer. INTERVENTIONS/METHODS: A meta-aggregation was conducted. Four electronic databases were searched using key words. The methodology followed the Joanna Briggs Institute for qualitative evidence synthesis. The review process followed a registered priori review protocol and was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Data extraction and quality assessment were conducted in parallel. RESULTS: Twenty-one publications were included. A total of 239 findings and 32 categories were synthesized into 7 domains of unmet needs as experienced by partners. The domains of needs expressed by the participants included interpersonal/intimacy, physical/daily living, healthcare service, family-related, psychological/emotional needs, and spiritual and social needs. CONCLUSIONS: There are gaps in clinical service support, despite routine clinical consultation with healthcare professionals. Partners may diminish their social networks to protect their husband at the cost to their own self-preservation and well-being. IMPLICATIONS FOR PRACTICE: Cancer organizations, policy makers, healthcare care professionals, and researchers are slowly making progress to acknowledge the unique support needs of partners affected by cancer. Healthcare professionals should encourage partners to be included in models of prehabilitation to access timely support to address informational, intimacy, spiritual, and daily living needs support.

The Effects of Multimodal Prehabilitation Interventions in Men Affected by Prostate Cancer on Physical, Clinical and Patient Reported Outcome Measures: A Systematic Review.

OBJECTIVES: To synthesize existing evidence on the effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical, and patient-reported outcome measures. DATA SOURCES: A systematic review was conducted according to the PRISMA 2020 Statement Guidelines. Electronic databases (ie, Medline, Embase, CINAHL and Cochrane CENTRAL, and clinicaltrials.gov) were searched using key search terms. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. The findings were integrated in a narrative synthesis. CONCLUSION: Of the 5863 publications screened, 118 articles were assessed in full text and 17 studies met the prescreening eligibility criteria. There were a range of study designs that included randomized controlled clinical trials (n = 11), quasi experimental (n = 4), cohort (n = 1), and case series (n = 1), covering a total of 1739 participants. The prehabilitation interventions included physical activity, peer support, pelvic floor muscle training, diet, nurse-led prehabilitation, psychological, and prehabilitation administration of phosphodiesterase-5 inhibitors. IMPLICATIONS FOR NURSING PRACTICE: Significant heterogeneity existed in the prehabilitation intervention programs for men affected by prostate cancer in terms of the composition, duration, method of administration, and the outcomes measured to quantify their impact. This systematic review has identified that multimodal prehabilitation interventions are an emerging area for practice and research among men affected by prostate cancer. Importantly, there has been a lack of focus on the inclusion of partners as critical companions during this distressing phase of the cancer care continuum. For the moment, all members of the multidisciplinary team caring for people affected by prostate cancer are encouraged to use the findings in this review to inform holistic models of care.

What are the long-term holistic health consequences of COVID-19 among survivors? An umbrella systematic review.

Many people who have survived COVID-19 have experienced negative persistent impacts on health. Impacts on health have included persistent respiratory symptoms, decreased quality of life, fatigue, impaired functional capacity, memory deficits, psychological impacts, and difficulties in returning to paid employment. Evidence is yet to be pooled to inform future directions in research and practice, to determine the physical, psychological, social, and spiritual impacts of the illness which extend beyond the acute phase of COVID-19 survivors. This umbrella review (review of systematic reviews) critically synthesized physical (including abnormal laboratory parameters), psychological, social, and spiritual impacts which extended beyond the acute phase of COVID-19 survivors. The search strategy was based on the sample, phenomena of interest, design, evaluation, research model and all publications were double screened independently by four review authors for the eligibility criteria. Data extraction and quality assessment were conducted in parallel independently. Eighteen systematic reviews were included, which represented a total of 493 publications. Sample sizes ranged from n = 15 to n = 44 799 with a total of n = 295 455 participants. There was incomplete reporting of several significant data points including the description of the severe acute respiratory syndrome coronavirus 2 variant, COVID-19 treatments, and key clinical and demographic data. A number of physical, psychological, and social impacts were identified for individuals grappling with post-COVID condition. The long term sequalae of acute COVID-19 and size of the problem is only beginning to emerge. Further investigation is needed to ensure that those affected by post-COVID condition have their informational, spiritual, psychological, social, and physical needs met in the future.

The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice.

OBJECTIVE: This literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team. DATA SOURCES: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and gray literature were searched using Google Scholar up until September 2020. CONCLUSION: Although the safe and effective delivery of cancer care via telehealth requires education and training for health care professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes. IMPLICATIONS FOR NURSING PRACTICE: Global public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the "hub of cancer care" safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.

5-Year Survival after Endobronchial Coil Implantation: Secondary Analysis of the First Randomised Controlled Trial, RESET.

BACKGROUND: Lung volume reduction surgery is a proven treatment for emphysematous patients with hyperinflation, but the precarious health of candidates has prompted development of less invasive approaches. Bronchoscopic implanted endobronchial coils, shape-memory nitinol filaments, shrink emphysematous lung tissue to restore elastic recoil and to tether airways to maintain patency. Studies have demonstrated an acceptable safety profile and improvements in lung function, exercise capacity, and quality of life out to 3 years. Volume reduction is key. However, data for longer-term survival are limited. OBJECTIVE: The aim of this study was to establish the 5-year overall and transplant-free survivals of subjects whose procedure in the first randomized controlled trial, RESET, achieved clinically meaningful reduction in residual volume (RV). METHODS: Patients and their primary care doctors were contacted to confirm vital status and history of additional interventions. Death certificates were acquired via the General Registry Office. Survival time was calculated for responders achieving a reduction of ≥10% in RV compared to non-responders. RESULTS: 39 patients completed the planned bilateral sequential treatments. Six patients received unilateral implants. At 5 years, 22 patients had died. The overall survivals at 1, 2, 3, 4 and 5 years were 88.9, 88.9, 77.8, 64.4 and 50.6%, respectively. Two patients underwent lung transplantation at 52 and 59 months and were alive at 5 years. The transplant-free (TF) survivals at 1, 2, 3, 4 and 5 years were 88.9, 88.9, 77.8, 64.4 and 46.7%, respectively. Volume reduction responders (n = 18) at 3 months had a 5-year TF survival of 66.7% compared to 36.4% for non-responders (n = 22; p = 0.07). Higher baseline inspiratory capacity (HR 0.13, 95% CI 0.02-0.73; p = 0.02) and partial pressure of oxygen (pO2) (HR 0.57, 95% CI 0.38-0.86; p < 0.01) values were predictive of survival for the entire cohort and were not influenced by age. CONCLUSIONS: Endobronchial coil implantation appears to confer a 5-year survival advantage for those who achieved a 10% reduction in RV at 3 months. Ongoing trials are designed to clarify the mechanisms of action of coils and to refine patient selection.

Evaluating the GHG mitigation-potential of alternate wetting and drying in rice through life cycle assessment.

Alternate wetting and drying (AWD), has gained increasing attention as a promising strategy for mitigating greenhouse gas emissions (GHG) in flooded rice systems. AWD involves periodic drainage of rice paddies in order to inhibit methane (CH4) emissions. To date, studies evaluating this practice have been limited in their scope and resolution. Our study evaluates the mitigation potential of AWD from a life cycle perspective using high-resolution CH4 modeling to more accurately estimate the mitigation potential of this practice. We simulated California rice production under continuous flooding and under five AWD schedules ranging in the severity and frequency of dry-downs. Production models were coupled with the Peatland Ecosystem Photosynthesis Respiration and Methane Transport (PEPRMT) model to simulate CH4 fluxes at daily intervals. We then evaluated the GHG mitigation potential of AWD using life cycle assessment models. Frequent or severe dry-downs reduced simulated grain yields, which negated some of the benefits of AWD when assessed on a yield-scaled basis. We also found AWD-induced mitigation of CH4 emissions modeled with PEPRMT to be roughly half the magnitude reported from up-scaling of chamber measurements, highlighting the importance of high resolution field data to better characterize GHGs in rice systems. Reduced yields and conservative CH4 mitigation in our model lessened the overall mitigation potential of AWD. When the entire rice life cycle was considered, mitigation of overall global warming potential (GWP) was further reduced by the presence of additional GHG sources, which comprised roughly half of life cycle GWP. Our simulations resulted in ≤12% reductions in GWP kg-1 across all AWD scenarios and saw an increase in GWP when yields were severely reduced. Our results highlight the importance of constraining uncertainties in CH4 emissions and considering a life cycle perspective expressed on a yield-scaled basis in characterizing the mitigation potential of AWD.

Safety of pulmonary function testing: data from 20 years.

BACKGROUND: Pulmonary function testing (PFT) is a key investigation in the evaluation of individuals with respiratory symptoms; however, the safety of routine and specialised PFT testing has not been reported in a large data set. Using patient safety incident (PSI) records, we aimed to assess risk of PFT and to characterise these events and any associated risk factors. METHODS: In this single-centre audit, demographics and PSI data were collected and categorised for PFT performed between 1996 and 2016 and subdivided into cardiopulmonary or non-cardiopulmonary events. The severity of each PSI was rated using the NHS National Patient Safety Agency and any hospital admission reported. RESULTS: There were 119 PSIs reported from 186 000 PFT; that is, 0.6 PSIs per 1000 tests. Cardiopulmonary PSIs were 3.3 times more likely to occur than non-cardiopulmonary (95% CI 2.17 to 5.12). Syncope was the most frequently occurring cardiopulmonary PSI. Cardiopulmonary exercise testing was associated with 2 PSIs per 1000 tests. PSIs necessitating hospital admission and/or emergency department attendance occurred approximately once every 10 000 tests and there was no PFT-associated mortality. CONCLUSION: Routine and specialised PFT is safe for patients, in the context of established screening preparticipation guidelines. In the event of a PSI, these are likely to be low risk of harm. Our findings highlight the most common PSIs encountered during PFT to facilitate risk reduction.