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OBJECTIVES: Hard-to-treat childhood cancers are those where standard treatment options do not exist and the prognosis is poor. Healthcare professionals (HCPs) are responsible for communicating with families about prognosis and complex experimental treatments. We aimed to identify HCPs' key challenges and skills required when communicating with families about hard-to-treat cancers and their perceptions of communication-related training. METHODS: We interviewed Australian HCPs who had direct responsibilities in managing children/adolescents with hard-to-treat cancer within the past 24 months. Interviews were analyzed using qualitative content analysis. RESULTS: We interviewed 10 oncologists, 7 nurses, and 3 social workers. HCPs identified several challenges for communication with families including: balancing information provision while maintaining realistic hope; managing their own uncertainty; and nurses and social workers being underutilized during conversations with families, despite widespread preferences for multidisciplinary teamwork. HCPs perceived that making themselves available to families, empowering them to ask questions, and repeating information helped to establish and maintain trusting relationships with families. Half the HCPs reported receiving no formal training for communicating prognosis and treatment options with families of children with hard-to-treat cancers. Nurses, social workers, and less experienced oncologists supported the development of communication training resources, more so than more experienced oncologists. SIGNIFICANCE OF RESULTS: Resources are needed which support HCPs to communicate with families of children with hard-to-treat cancers. Such resources may be particularly beneficial for junior oncologists and other HCPs during their training, and they should aim to prepare them for common challenges and foster greater multidisciplinary collaboration.
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Comunicação , Pessoal de Saúde , Neoplasias , Pesquisa Qualitativa , Humanos , Neoplasias/psicologia , Neoplasias/terapia , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Feminino , Masculino , Adulto , Austrália , Relações Profissional-Família , Pessoa de Meia-Idade , Adolescente , CriançaRESUMO
OBJECTIVE: Accessible interventions are needed to prevent coronary heart disease (CHD) and Type 2 diabetes (T2D). This prospective, randomized, controlled trial evaluated remote health coaching (HC), genetic risk testing (GRT), or both added to standardized risk assessment (SRA) in at-risk military primary care patients. METHOD: Using a 2 × 2 factorial longitudinal design, 200 Air Force at-risk participants provided primary outcomes at baseline, 3-, 6- (HC endpoint), and 12-months. Secondary measures were taken less often. Per protocol analyses used linear models and logistic regression; intent-to-treat (ITT) analyses used mixed models. RESULTS: Compared with those not receiving HC, the HC group was 3.6 times more likely to report moderate to intense physical activity at 6-months (p = .0009), and 2.9 times more likely to report such at 12-months (p = .0065). ITT longitudinal model did not reach significance (p = .0885). The HC group reported lower emotional representations of illness at 6-weeks and lower depression at 6 months. There were no other significant findings. HC and GRT interacted; higher T2D risk participants receiving HC were 4.7 times more likely to report higher stage of change for exercise at 6-months, and lost 2.2 kg more by 12-months. Lower T2D risk participants receiving HC perceived greater control over CHD risk at 6-weeks, and averaged lower 6-month depression. CONCLUSIONS: Remote HC after SRA increased physical activity, which was sustained 6-months later. Incorporating GRT into SRA warrants further exploration regarding the potential to leverage HC for weight loss in elevated T2D risk participants, and for depression in lower T2D risk participants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Diabetes Mellitus Tipo 2 , Tutoria , Diabetes Mellitus Tipo 2/genética , Humanos , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Fatores de RiscoRESUMO
PURPOSE: To examine the effectiveness of 3 lifestyle intervention programs in an active duty military population. DESIGN: Experimental design with stratified random assignment to 1 of 3 intervention groups. Measures were taken at baseline, 3 months and 6 months. SETTING: A Military Treatment Facility in the western U.S. SUBJECTS/INTERVENTION: 122 active duty service members were enrolled and randomly assigned to 1 of 3 lifestyle intervention programs: the Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB), the Better Body Better Life (BBBL) program or the Fitness Improvement Program (FIP). MEASURES: weight, abdominal circumference, lipid and HbA1c levels, physical activity, and well-being as measured by the RAND SF-36 questionnaire. ANALYSIS: Statistical analyses were performed to assess changes over time. RESULTS: 83 participants completed the study (BBBL N = 23, FIP N = 30, DPP-GLB N = 30). The DPP-GLB participants had statistically significant decreases in weight (-3.1 pounds, p = .01) and abdominal circumference (-0.9 inches; p = .01) over time. HbA1c was also significantly lower in this group at 6 months compared to baseline (p = .036). There were no statistically significant changes in weight, abdominal circumference, or HbA1c in the FIP or BBBL groups. No significant changes were observed in lipids in any of the groups. CONCLUSION: Results from this study indicate that the DPP-GLB program may be effective in reducing weight, abdominal circumference, and HbA1c in an active duty U.S. military population.
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Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Militares , Terapia Comportamental , Exercício Físico , Humanos , Estilo de VidaRESUMO
INTRODUCTION: Group prenatal care models have been in use in the USA for over 20 years and have shown benefits in reducing rates of preterm birth and low birth weight infants in high-risk civilian populations. Group prenatal care has been widely implemented at military treatment facilities, despite a lack of high-quality evidence for improved perinatal outcomes in this population. MATERIALS AND METHODS: In this randomized, controlled trial, 129 patients at a military treatment facility received either traditional one-on-one prenatal care or group prenatal care using the CenteringPregnancy model. CenteringPregnancy care was administered by certified nurse midwives and family medicine residents and faculty. The primary outcomes were infant birthweight appropriateness for gestational age, maternal anxiety (as measured by the State-Trait Anxiety Inventory) and depression (as measured by the Center for Epidemiologic Studies-Depression scale), and patient satisfaction (as measured by the Short-Form Patient Satisfaction Questionnaire). Infant birthweights were compared using Chi-square tests for the categorical variables of small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age. Maternal mood and satisfaction scores were evaluated before, during, and after the intervention and analyzed using rank sum tests. Additional demographic and outcome data were collected directly from participants and extracted from patient records. RESULTS: Patients receiving group care were more likely to deliver an infant that was appropriate for gestational age, with an incidence ratio of 1.12 [CI = 1.01-1.25, p = 0.04]. Depression and anxiety levels remained similar between groups throughout the study. Satisfaction was similar between groups, though patients receiving group care reported higher satisfaction with the accessibility and convenience of their care at the study's end [p = 0.048]. There were no differences between groups in preterm births, maternal or neonatal morbidity, mode of delivery, maternal weight gain, or breastfeeding rates. CONCLUSIONS: Military parturients receiving group prenatal care in the CenteringPregnancy model were less likely to deliver an small for gestational age or large for gestational age newborn and were more likely to be satisfied with their access to care. Group prenatal care is well received by patients and may positively influence neonatal metabolic status.
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Peso ao Nascer , Processos Grupais , Bem-Estar Materno/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Recém-Nascido , Bem-Estar Materno/estatística & dados numéricos , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Objectives: The Deployment Anxiety Reduction Training (DART) is a manualized tool that was developed and piloted with active duty service members and recently deployed veterans regarding their response to potential and experienced acute combat stress reactions. DART is low risk and has high potential to be beneficial. It is a brief, one-session, non-pharmacological approach designed to reduce symptoms of peritraumatic panic and increase resilience in the face of a potentially traumatic stressor. Methods: This study was a mixed-methods pilot study to assess the utility and acceptability of DART during deployment. Results: Self-report and interview responses indicated that participants generally found the DART techniques acceptable and easy to understand. Overall, the techniques were perceived as likely to be helpful with high utility, although there was variation in perceived helpfulness among the different techniques. Participants overwhelmingly positively endorsed delivery of the DART protocol through use of smartphone technology. Conclusions: Results indicate that the DART components were considered highly acceptable and feasible for use in the deployed environment.
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Ansiedade/prevenção & controle , Militares/psicologia , Ensino/normas , Adulto , Ansiedade/psicologia , Feminino , Humanos , Masculino , Militares/educação , Militares/estatística & dados numéricos , Projetos Piloto , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Fatores de Risco , Ensino/psicologiaRESUMO
Active duty personnel in the U.S. Air Force (USAF) are required to pass periodic fitness assessments in order to facilitate and evaluate physical readiness. Pregnant women are exempt from testing but must take the fitness test 6 months after childbirth. However, evidence from prior research indicates that in the first 6 months postpartum, women may not achieve prepregnancy fitness levels and may be more vulnerable to mental and physical health problems. It is important for health care clinicians to understand how training for the USAF fitness test after childbirth may impact health and well-being. The purpose of this study was to develop a deep understanding of the experiences of postpartum USAF women as they train for their fitness assessment. Understanding was sought through a phenomenological study by interpreting the meaning of the lived experiences of 17 active duty women at two USAF bases. Two overarching patterns emerged from this analysis: "Striving to Perform under Pressure through Profound Life Transitions of Childbirth" and "Seeking Understanding from Others." These results provide insight into the challenges postpartum women encounter while training for their fitness assessments, and they can inform practices that facilitate efforts of women in returning to optimal fitness and well-being.
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Atitude Frente a Saúde , Medicina Militar/métodos , Militares/educação , Parto/fisiologia , Aptidão Física , Período Pós-Parto , Adulto , Feminino , Seguimentos , Humanos , Gravidez , Estados UnidosRESUMO
BACKGROUND: Paediatric palliative care (PPC) is a growing specialty area in Australia and many families aim to care for their child at home as much as possible, including during the terminal phase. OBJECTIVE: This article aims to highlight the important role of the general practitioner (GP) in the management of PPC patients, especially if families want to care for their child at home. The support that specialist PPC teams can offer the GP is also emphasised. DISCUSSION: The GP has much to offer in conjunction with other local services, being part of a team managing the child with palliative care needs. Specialist PPC services can provide the GP with relevant information, specific education, advice and ongoing support to fulfil their important role for the child and family.
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Clínicos Gerais , Cuidados Paliativos , Equipe de Assistência ao Paciente , Papel do Médico , Adolescente , Austrália , Luto , Criança , Família/psicologia , Serviços de Assistência Domiciliar , Humanos , Masculino , Neoplasias/terapia , Doenças Neurodegenerativas/terapia , Cuidados Paliativos/psicologiaRESUMO
Pulmonary air leaks in children are most commonly due to infection or barotrauma. While cases of severe barotrauma are falling because of advances in neonatal care, the incidence of necrotising pneumonia is rising. The majority of air leaks can be managed conservatively, but more severe cases pose a significant challenge to the clinician. The use of occlusive endobronchial balloons is an established anaesthetic technique for a number of indications, but is not widely used in children. We conducted a review over a 12-year period, and report six cases of complex air leaks in which balloon occlusion was used. Balloon occlusion was successful in both cases of bronchopleural fistulae (secondary to severe necrotising pneumonia) and half of the cases of intrapulmonary air leak (due to barotrauma). In the other two cases (due to barotrauma and filamin A deficiency), it was transiently effective. No serious adverse effects or complications were encountered. In selected cases, endobronchial balloons are a useful adjunct in the management of life-threatening bronchopleural fistulae and cystic lung disease. The procedure is non-operative, minimally invasive and reversible. With the increasing incidence of bronchopleural fistulae, this may become an increasingly important therapy.
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Oclusão com Balão/métodos , Barotrauma/terapia , Fístula Brônquica/terapia , Proteínas Contráteis/deficiência , Proteínas dos Microfilamentos/deficiência , Doenças Pleurais/terapia , Doenças Respiratórias/terapia , Colúmbia Britânica , Criança , Pré-Escolar , Feminino , Filaminas , Humanos , Lactente , Masculino , Pneumotórax/terapia , Doenças da Traqueia/terapiaRESUMO
U.S. Air Force (USAF) personnel are required to take periodic fitness assessments with minimum requirements to earn satisfactory performance evaluations. Active duty women are exempt from fitness testing during pregnancy and until 6 months postpartum. Although there is evidence that many women do not achieve prepregnancy fitness levels by 6 months postpartum, no published studies were found that evaluated changes in fitness measurements and assessment pass rates in active duty USAF women after childbirth. The purpose of this study was to compare USAF fitness assessment component measurements and overall pass rates at 6 months postpartum to prepregnancy measurements. A paired t-test analysis of fitness component measurements of 107 active duty women showed significantly larger abdominal circumferences, fewer push-up repetitions, and longer run times at 6 months postpartum when compared to prepregnancy assessments. No significant difference was found in sit-up measurements. Secondly, there was a significantly lower pass rate at 6-months postpartum compared to the prepregnancy time frame. Results from this study indicate that women may struggle to achieve prepregnant fitness levels and pass their fitness test by 6 months postpartum. More research is needed to discover which factors impact women's ability to successfully meet fitness standards postpartum.