Comparative assessment of ActiGraph data processing techniques for measuring sedentary behavior in adults with COPD.

Objective.The ActiGraph is commonly used for measuring sedentary behavior (SB), but the best data processing technique is not established for sedentary adults with chronic illness. The purpose of this study was to process ActiGraph vertical axis and vector magnitude data with multiple combinations of filters, non-wear algorithm lengths, and cut-points and to compare ActiGraph estimates to activPAL-measured sedentary time in sedentary adults with chronic obstructive pulmonary disease (COPD).Approach.This study was a secondary analysis of adults ≥50 years (N = 59; mean age: 69.4 years;N = 31 males) with COPD. Participants woreActiGraph GT9XandactivPAL3for 7 d. ActiGraph vertical axis and vector magnitude data were processed using combinations of filters (normal, low frequency extension (LFE)), non-wear algorithm lengths (60, 90, 120 min), and cut-points for SB previously validated in older adults (two for vertical axis and three for vector magnitude data). The Bland-Altman method was used to assess concordance between sedentary time measured with 30 ActiGraph techniques and activPAL-measured sedentary time.Main results. Agreement between the two devices was moderate to strong for all techniques; concordance correlations ranged from 0.614 to 0.838. Limits of agreement were wide. The best overall technique was vector magnitude data with LFE filter, 120 min non-wear algorithm, and <40 counts/15 s SB cut-point (concordance correlation 0.838; mean difference -11.7 min d-1).Significance. This analysis supports the use of ActiGraph vector magnitude data and LFE filter in adults with COPD, but also demonstrates that other techniques may be acceptable with appropriate cut-points. These results can guide ActiGraph data processing decisions.

Assessment of Pediatric Chemotherapy-Induced Peripheral Neuropathy Using a New Patient-Reported Outcome Measure: The P-CIN.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is commonly experienced by children receiving neurotoxic chemotherapy. No validated pediatric CIPN patient-reported outcome (PRO) measures exist. Purpose: To test sensitivity, internal consistency reliability, content and convergent validity, and feasibility of the Pediatric Chemotherapy-Induced Neuropathy (P-CIN), an electronic PRO measure for assessing CIPN in children who received neurotoxic chemotherapy. Method: Five experts evaluated content validity of the 14-item P-CIN. Children 5 to 17 years old with CIPN (N = 79) completed the P-CIN via tablet computer; a subset (n = 26) also underwent neurological examinations using the Pediatric-Modified Total Neuropathy Score. Following preliminary analyses, one item was deleted and three others modified. The revised P-CIN was retested with patients (n = 6) who also completed the Bruininks-Oseretsky Test of Motor Proficiency motor function assessment. Means, item response ranges, standard deviations, content validity indexes, Cronbach's alphas, and correlation coefficients were calculated. Results: Mean participant age was 11.25 (SD = 4.0) years. Most had acute leukemia (62.5%) and received vincristine (98.7%). Content validity index coefficients ranged from .80 to 1.0 (p = .05). For 9 of 14 items, responses ranged from 0 to 4 or 5; response ranges for toe numbness, pick up a coin, and three of four pain items were 0 to 3. After deleting one item, Cronbach's alpha coefficient was .83. P-CIN scores were strongly associated with Pediatric-Modified Total Neuropathy Score (r = .52, p < .01) and Bruininks-Oseretsky Test of Motor Proficiency (r = -.83, p = .04) scores. Sixty-eight percent of children 6 to 17 years old completed P-CIN independently. Discussion: Preliminary evidence suggests that the 13-item P-CIN is internally consistent, is valid, and can be completed independently by children ≥ 6 years. However, we recommend additional testing.

Characterizing patient-clinician chemotherapy-induced peripheral neuropathy assessment and management communication approaches.

OBJECTIVE: To describe the frequency and characteristics of chemotherapy-induced peripheral neuropathy (CIPN) assessment and management communication approaches between patients receiving neurotoxic chemotherapy and clinicians. METHODS: The data used in this analysis originated from a randomized controlled trial in which adults with cancer self-reported treatment-related symptoms using web-based symptom assessment technology. Three-to-six weeks after study initiation, each participant's outpatient visit was audio-recorded. Audio recordings and associated clinician notes for 159 participants who received platinum and/or taxane-based chemotherapy were coded for the presence of several CIPN assessment and management communication characteristics. RESULTS: Participants received low cumulative neurotoxic chemotherapy doses (75%) at the time of audio recording. CIPN was discussed and documented in 44% and 46% of participant-clinician encounters. In symptomatic participants, clinicians asked an average of 0.7 open-ended questions, appropriately managed 70% of cases, and asked upper and lower extremity CIPN questions in 25% of cases. CONCLUSIONS: Clinicians infrequently discussed and documented CIPN in participants with low CIPN severity, however appropriately managed mild CIPN. Development of interventions to translate existing recommended CIPN communication approaches into practice are required. PRACTICE IMPLICATIONS: Effective participant-clinician communication is required at each clinic visit during chemotherapy treatment to identify initial signs of CIPN and offer appropriate treatment.

Chemotherapy-Induced Peripheral Neuropathy: Use of an Electronic Care Planning System to Improve Adherence to Recommended Assessment and Management Practices.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is often inadequately assessed and managed by advanced practice providers. OBJECTIVES: The aim is to explore the impact of CIPN assessment training and electronic care planning system (CPS) use on CIPN assessment documentation and guidelines adherence. METHODS: The authors used a pre-/post-test, prospective design with two retrospective chart reviews. Six providers received CIPN assessment training and used the CPS to manage CIPN for 75 women receiving neurotoxic chemotherapy. FINDINGS: CPS use significantly improved documentation of numbness and nonpainful CIPN management strategies but had no effect on documentation of additional assessment variables or painful CIPN management.

Examining the Impact of a Web-Based Intervention to Promote Patient Activation in Chemotherapy-Induced Peripheral Neuropathy Assessment and Management.

Lack of activation in self-care can compromise a patient's ability to monitor and manage cancer treatment-related side effects, such as chemotherapy-induced peripheral neuropathy (CIPN). The web-based Carevive® Care Planning System (CPS) was developed to promote evidence-based symptom assessment and treatment by enhancing patients' involvement in their own care. The purpose of this single-arm, pre-test/post-test, prospective study was to examine whether the CPS can promote patient activation in CIPN symptom assessment and management. Seventy-five women with breast cancer receiving neurotoxic chemotherapy were recruited from a Comprehensive Cancer Center. Using standardized neuropathy measures embedded within the CPS, patients reported their CIPN symptoms over three consecutive clinical visits and completed the Patient Activation Measure (PAM) at the first and third visits. Mean changes in PAM scores between visits were compared using repeated measure analysis of covariance, adjusting for age. At baseline, patients were diagnosed with cancer within the past year (94.7%), highly activated (85% Level III/IV), and had a mean age of 51.3. PAM scores improved significantly from 67.15 (SD = 13.5; range = 47-100) at visit one to 69.29 (SD = 16.18; range = 47-100) (p = 0.02) (n = 62) at visit three. However, patients perceived the CPS to be of minimal value because it solely focused on CIPN and, for many, CIPN was not severe enough to motivate them to seek out symptom management information. Further research is needed to assess the utility of the CPS in promoting activation in the assessment and management of varying cancer treatment-related symptoms.

Pilot Testing a Web-Based System for the Assessment and Management of Chemotherapy-Induced Peripheral Neuropathy.

Because numerous barriers hinder the assessment and management of chemotherapy-induced peripheral neuropathy in clinical practice, the Carevive Care Planning System, a novel Web-based platform, was developed to address these barriers. It provides patients an opportunity to report their symptoms before their clinic visit and generates customizable care plans composed of evidence-based management strategies. The purpose of this study was to evaluate patient and provider perspectives of feasibility, usability, acceptability, and satisfaction with the Carevive platform. We used a single-arm, pretest/posttest, prospective design and recruited 25 women with breast cancer who were receiving neurotoxic chemotherapy and six advanced practice providers from an academic hospital. At three consecutive clinical visits, patients reported their neuropathy symptoms on a tablet via the Carevive system. The Diffusion of Innovations Theory served as an overarching evaluation framework. The Carevive platform was feasible to use. However, patients had higher ratings of usability, acceptability, and satisfaction with the platform than did the providers, who disliked the amount of time required to use the platform and had difficulty logging into Carevive. If issues regarding provider dissatisfaction can be addressed, the Carevive platform may aid in the screening of neuropathy symptoms and facilitate the use of evidence-based management strategies.

An Assessment of Family Planning Decision Makers' and Advocates' Needs and Strategies in Three East African Countries.

CONTEXT: Despite decades of evidence-based advocacy for family planning in developing countries, research on how decision makers perceive and respond to such efforts is lacking. METHODS: A literature review yielded 10 peer-reviewed journal articles published between 1999 and 2012 on decision makers' needs for and experiences with health advocacy and evidence. Two sets of questions about family planning research and advocacy-one for decision makers and another for advocates-were developed from emerging themes and used in structured interviews with 68 key informants in Ethiopia, Kenya and Malawi. RESULTS: Decision makers reported understanding family planning's value and confirmed that advocacy had helped to spur recent favorable shifts in government support of family planning. Key informants stressed that advocacy messages and formats must be tailored to the needs and interests of particular audiences to be effective. Messages must also consider barriers to decision makers' support for family planning: constituents' negative attitudes; fear that increased adherence to family planning will shrink the size and influence of specific voting blocs and ethnic groups; and competing economic, social, cultural, religious and political priorities. Decision makers reported valuing the contributions of international family planning organizations and donors, but were more comfortable receiving advocacy messages from local sources. CONCLUSIONS: According to decision makers, sustained and strategic family planning advocacy developed and delivered by culturally attuned national actors, with support from international actors, can diminish barriers to government support for family planning.

Multidimensional needs of caregivers for patients with cancer.

This pilot study describes the multidimensional (physical, psychological, social, and spiritual) needs of caregivers of cancer survivors. A regional comprehensive cancer center and nine community-based rural and urban cancer clinics in New Hampshire assembled a convenience sample. Patients with cancer completed an online survey, the cancer survivor Web-based needs assessment survey (CS-WEBS), to identify needs and desire for intervention. Patients then identified a caregiver who was recruited to complete a caregiver version of the CS-WEBS. Caregivers reported challenges within all four domains of the survivorship model. The highest reported physical symptoms were fatigue, insomnia, and weight gain. Social symptoms included financial issues. Although visiting nurse services were the most commonly used resource, many caregivers used no supportive services. The most common caregiver task was listening and talking. Caregivers frequently experienced fatigue, anxiety, and insomnia. Exploring effective ways to alleviate their symptom burden should be a priority. Local and national attention should be directed toward easing the financial burden of caring for a patient with cancer.

Current methods for the assessment and management of taxane-related neuropathy.

Taxane-induced peripheral neuropathy (TIPN) affects a number of patients with breast cancer. To properly manage these patients, nurses must be able to identify and assess TIPN, as well as educate patients on TIPN as a side effect of taxane therapy. This article provides practical suggestions regarding how nurses can incorporate clinically feasible measurement approaches into practice and includes examples of grading TIPN that illustrate the limitations of the current tools and techniques for assessment. For example, a shortened and revised version of the Total Neuropathy Score and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale should be considered for future use. In addition, neuropathy-related results from numerous phase III trials in breast cancer are discussed, and the latest evidence regarding pharmacologic interventions for TIPN is briefly summarized.

Confirmatory factor analysis of the pain care quality surveys (PainCQ©).

OBJECTIVE: To examine the reliability and validity and to decrease the battery of items in the Pain Care Quality (PainCQ(©) ) Surveys. DATA SOURCES/STUDY SETTING: Patient-reported data were collected prospectively from 337 hospitalized adult patients with pain on medical/surgical oncology units in four hospitals in three states. STUDY DESIGN: This methodological study used a cross-sectional survey design. Each consenting patient completed two PainCQ(©) Surveys, the Brief Pain Inventory-Short Form, and demographic questions. Clinical data were extracted from the medical record. DATA COLLECTION/EXTRACTION METHODS: All data were double entered into a Microsoft Access database, cleaned, and then extracted into SPSS, AMOS, and Mplus for analysis. PRINCIPAL FINDINGS: Confirmatory factor analysis using Structural Equation Modeling supported the initial factor structure. Modification indices guided decisions that resulted in a superior, parsimonious model for the PainCQ-Interdisciplinary Care Survey (six items, two subscales) and the PainCQ-Nursing Care Survey (14 items, three subscales). Cronbach's alpha coefficients all exceeded .80. CONCLUSIONS: Cumulative evidence supports the reliability and validity of the companion PainCQ(©) Surveys in hospitalized patients with pain in the oncology setting. The tools may be relevant in both clinical research and quality improvement. Future research is recommended in other populations, settings, and with more diverse groups.

The unmet needs of partners and caregivers of adults diagnosed with cancer: a systematic review.

OBJECTIVES: The recognition that a partner or caregiver is typically the patient's primary support person and is also deeply affected by the cancer diagnosis has prompted efforts to document their unmet supportive care needs. This review aimed to: (1) quantify the prevalence of unmet needs reported by partners and caregivers, (2) categorise their unmet needs by domain and (3) identify the main variables associated with reporting more unmet needs. METHODS: Manuscripts were identified through systematically searching electronic databases, checking the reference lists of retrieved publications, online searching of key journals and contacting researchers in this field. RESULTS: Unmet need items across 29 manuscripts were clustered into six domains: comprehensive cancer care (prevalence 1.1%-96%), emotional and psychological (3%-93.2%), partner or caregiver impact and daily activities (2.8%-79%), relationship (3.7% and 58%), information (2.2%-86%) and spiritual (2%-43%). Studies of caregivers of palliative care or terminal patients often reported a higher prevalence of unmet needs than studies of caregivers of cancer survivors. Variables associated with higher unmet needs included being female, not being the spouse of the patient, having lower social support or reporting distress. CONCLUSIONS: Despite the ability to classify unmet needs within broad domains, quantification of unmet needs was challenging. This was mainly due to the diversity in methods used across studies (eg, different measures, variability in conceptualisation of unmet needs, etc). Rigorous, context-specific, longitudinal studies that use validated measures are needed to benefit future intervention research.

Trends in national family planning programs, 1999, 2004 and 2009.

CONTEXT: National family planning programs in the developing world vary greatly in strength and coverage, and in the nature of their outreach. Periodic measures of their types and levels of effort have been conducted since 1972. METHODS: In 2009, expert observers in 81 developing countries completed a questionnaire that assessed 31 features of family planning program effort, as well as other program measures. Data were compared with those from similar surveys fielded in 1999 and 2004 to examine trends over the decade. RESULTS: On average, national family planning programs improved their effort levels slightly from 1999 to 2004, and again from 2004 to 2009. The average effort in 2009, however, was only about half of maximum; component scores for service measures and for measures of access to contraception did not reach 50% of maximum in 2009. Differences by region and by effort quartile emerged in subgroup analyses. Overall, improvement of women's health and avoidance of unwanted births were the most important program justifications, ranking higher than fertility reduction, economic development or reduction of childbearing among unmarried adolescents. The subgroups given the most emphasis were poor and rural populations, while unmarried youth and postabortion women received the least. Among external influences, changes in donor and domestic funding were seen as more unfavorable than the merging of family planning programs into broader health services. CONCLUSIONS: Average program effort levels have been sustained, although deficiencies remain. Countries have not yet ensured universal access to a variety of contraceptive choices, through various channels, for both short- and long-term methods.

Preliminary assessment of a neuropathic pain treatment and referral algorithm for patients with cancer.

CONTEXT: The purpose of this case series study was to pilot test an evidence-based neuropathic pain (NP) treatment and referral algorithm for use by oncology nurses when managing cancer-related NP. OBJECTIVES: The primary study objective was to assess patient-reported outcomes (pain severity, changes in activities of daily living, and satisfaction) resulting from algorithm use. METHODS: Outpatients (n=20) with cancer-related NP scores ≥4 on a 0-10 numeric rating scale participated in the study. NP assessment, treatment, and referral to ancillary providers were guided by an evidence-based NP algorithm that was implemented by oncology nurse practitioners. Based on efficacy evidenced through randomized clinical trials published at the time of study implementation, the following drugs were included in the algorithm: lidocaine patch, gabapentin, oxycodone, tramadol, morphine, methadone, duloxetine, pregabalin, and nortriptyline. Recommendations for starting dose, dose escalation, drug combinations, treatment duration, and contraindications were included for first-tier drugs. Patient-reported outcomes (pain severity, functional capacity, and satisfaction) were assessed monthly over 12 weeks. RESULTS: Average NP severity (P=0.001), general activity (P<0.001), mood (P=0.002), walking ability (P=0.01), ability to perform normal work (P=0.002), relationships (P=0.002), sleep (P=0.01), life enjoyment (P<0.001), and patient satisfaction (P=0.003) all improved by 12 weeks. CONCLUSION: Evidence from this pilot study suggests that NP evidence-based treatment may result in improved symptoms, function, and patient satisfaction. A randomized controlled trial is needed to further assess algorithm efficacy.

Using quality improvement methodology to improve neuropathic pain screening and assessment in patients with cancer.

BACKGROUND: Quality improvement methodology was used to improve neuropathic pain (NP) screening at a comprehensive cancer center. METHODS: Nurses participated in educational sessions about screening and assessment. Clinical systems to facilitate documentation of NP severity scores were developed. RESULTS: Pretest and posttest score results demonstrated nurse acquisition of new knowledge. A 90% NP screening adherence rate was achieved (N = 3831). Patients with no reported general pain (n = 291) were found to have moderate to severe NP. CONCLUSIONS: Keys to success are (1) health care professional education and periodic reinforcement of learning and (2) system infrastructure changes.