Feasibility of a Tai Chi with Thera-Band Training Program: A Pilot Study.

Tai Chi, combined with Thera-band (TCTB) exercise may be associated with an improvement in health where it increases physical fitness, improves psychological well-being, and decreases pain. This paper aimed to determine the feasibility of TCTB exercise in older sedentary office workers. Forty office workers aged over 55 years participated in a pilot randomized controlled trial (i.e., 12-week TCTB exercise or Tai Chi exercise only). Feasibility of the TCTB exercise approach was ascertained through the recruitment and enrolment rate, acceptability of the study intervention by participants including retention and adherence rates, participants' learning process, the appropriateness of data collection as well as the participants' evaluation of the intervention. Recruitment took longer than planned, with a low recruitment rate of 2.0% (42/2020), but a high enrolment rate of 95.2% (40/42). Thirty-one participants (i.e., 77.5%) completed the intervention. Of those who completed the trial, the overall average attendance was reported as 85.2%; 84.7% in the TCTB group and 85.7% in the Tai Chi only group. A total of 58.3% of participants (n = 21) could independently practice the TCTB or Tai Chi exercise motions at the end of the learning stage. There were no missing data except for the nine participants who withdrew during the intervention. No adverse events or effects were reported, and all participants were satisfied with the 12-week exercise intervention. Results support the feasibility of a large-scale randomized controlled trial to explore the efficacy of a TCTB program for improving health in older sedentary office workers.

The Use of Modified Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy Program for Family Caregivers of People Living with Dementia: A Feasibility Study.

PURPOSE: The aim of this study was to investigate the feasibility and preliminary efficacy of a modified mindfulness-based stress reduction (MBSR) program and mindfulness-based cognitive therapy (MBCT) program for reducing the stress, depressive symptoms, and subjective burden of family caregivers of people with dementia (PWD). METHODS: A prospective, parallel-group, randomized controlled trial design was adopted. Fifty-seven participants were recruited from the community and randomized into either the modified MBSR group (n = 27) or modified MBCT group (n = 26), receiving seven face-to-face intervention sessions for more than 16 weeks. Various psychological outcomes were measured at baseline (T0), immediately after intervention (T1), and at the 3-month follow-up (T2). RESULTS: Both interventions were found to be feasible in view of the high attendance (more than 70.0%) and low attrition (3.8%) rates. The mixed analysis of variance (ANOVA) results showed positive within-group effects on perceived stress (p = .030, Cohen's d = 0.54), depressive symptoms (p = .002, Cohen's d = 0.77), and subjective caregiver burden (p < .001, Cohen's d = 1.12) in both interventions across the time points, whereas the modified MBCT had a larger effect on stress reduction, compared with the modified MBSR (p = .019). CONCLUSION: Both the modified MBSR and MBCT are acceptable to family caregivers of PWD. Their preliminary effects were improvements in stress, depressive symptoms, and subjective burden. The modified MBCT may be more suitable for caregivers of PWD than the MBSR. A future clinical trial is needed to confirm their effectiveness in improving the psychological well-being of caregivers of PWD.

Tai Chi Combined With Resistance Training for Adults Aged 50 Years and Older: A Systematic Review.

BACKGROUND AND PURPOSE: Despite Tai Chi and resistance training being recommended as suitable exercise for older adults, there are no systematic reviews synthesizing the effectiveness of a combination of Tai Chi and resistance training on health promotion of older adults. This study aimed to review the existing literature regarding the effect of Tai Chi and resistance training on physical health, mental health, pain, health-related quality of life, and age-related impairment in adults aged 50 years and older. METHODS: A systematic review was conducted to report the health outcomes of Tai Chi combined with resistance training research in adults aged 50 years and older. Articles were identified by searching PubMed, Scopus, Web of Science, CINAHL, MEDLINE, Physiotherapy Evidence Database (PEDro), and the Cochrane library using search terms representing "Tai Chi" and "resistance" and "older adults." Quantitative experimental studies with participants aged 50 years and older, where one of the interventions was Tai Chi and resistance training, were included. RESULTS AND DISCUSSION: The literature search yielded 648 articles from which 7 met the inclusion criteria. Collectively, the studies involved 703 participants aged 50 years and older, including healthy older adults, older adults with history of falls, postmenopausal women, and people diagnosed with end-stage hip osteoarthritis. Studies included different Tai Chi forms in combination with various types of resistance training. Training sessions were 2 to 7.5 h/wk and lasted between 12 weeks and 12 months. After long-term Tai Chi and resistance training, the participants showed significant improvement in upper and lower extremity muscle strength, aerobic endurance, balance, and mobility. However, 1 study failed to show improvement in Functional Movement Screening compared with traditional Tai Chi and nonexercise groups. No study examined the effects of Tai Chi and resistance training on health-related quality of life, fear of falling, or mental health in adults aged 50 years and older. CONCLUSIONS: The review supports that Tai Chi in combination with resistance training improves physical function and muscle strength in adults aged 50 years and older.

Pain offset reduces rumination in response to evoked anger and sadness.

Four studies examined whether pain offset reduces rumination in response to anger or sadness. Past research has demonstrated that, following the offset of pain, individuals show a distinct state of relief involving both reduction in negative affect and an increase in positive affect. This response may help to explain why people sometimes seek out pain and discomfort (e.g., vigorous exercise, self-harm) to regulate negative emotion and suggests that following pain people should recover better from negative emotional states. To test this, we examined ruminative responses to anger and sadness. These negative, approach-related emotions often produce rumination; a response that is generally considered maladaptive. In Study 1, pain was manipulated through a cold pressor task, and participants were induced to experience anger through autobiographical recall. In Study 2, pain was also manipulated pain via a cold pressor task, and anger and sadness were induced through social exclusion using the Cyberball paradigm. In Study 3, pain was manipulated by squeezing exercise handgrips, and sadness was induced with imagery from a sad video. Study 4 replicated the methods of Study 3 and added measures of relief and distraction to examine whether these moderated the effect. A minimeta-analysis showed that, across all studies, individuals engaged in less rumination in the pain conditions as measured by a thought-listing task and a self-reported rumination questionnaire. These results suggest that the regulation of anger and sadness are improved following pain offset. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Feasibility and Effect of a Multidimensional Support Program to Improve Gerotranscendence Perception and Depression for Older Adults: A Pragmatic Cluster-Randomized Control Study.

Improving perception of gerotranscendence can increase life satisfaction in older adults to achieve successful aging. The purpose of this study was to evaluate the feasibility and effect of a multidimensional support program (MSP) on gerotranscendence and depression in community-dwelling older adults. Using a cluster-randomized control trial design, four sites (98 participants) were randomly assigned to a MSP or control group. The Gerotranscendence Scale and Geriatric Depression Scale were administered pre- and postintervention. A total of 91 participants completed the study. The mean attendance rates in the MSP and control groups were 85.5% and 84.3%, respectively. The MSP was found to significantly enhance the perception of gerotranscendence in older adults but not their level of depression. This study demonstrated the MSP is a feasible and effective program to improve perception of gerotranscendence and may potentially lead to positive psychological well-being for older adults. [Res Gerontol Nurs. 2019; 12(3):148-158.].

Genotypic and clinical heterogeneity within NCCN favorable-risk acute myeloid leukemia.

The National Comprehensive Cancer Network (NCCN) defines the following types of acute myeloid leukemia (AML) as favorable-risk: acute promyelocytic leukemia with t(15;17) (APL); AML with core-binding factor (CBF) rearrangements, including t(8;21) and inv(16) or t(16;16) without mutations in KIT (CBF-KITwt); and AML with normal cytogenetics and mutations in NPM1 (NPM1mut); or biallelic mutations in CEBPA (CEBPAmut/mut), without FLT3-ITD. Although these AMLs are categorized as favorable risk by NCCN, clinical experience suggests that there are differences in clinical outcome amongst these cytogenetically and molecularly distinct leukemias. This study compared clinical and genotypic characteristics of 60 patients with favorable-risk AML, excluding APL, and demonstrated significant differences between them. Patients with NPM1mut AML were significantly older than those in the other groups. Targeted next-generation sequencing on DNA from peripheral blood or bone marrow revealed significantly more mutations in NPM1mut AML than the other favorable-risk diseases, especially in genes related to DNA splicing and methylation. CEBPAmut/mut AMLs exhibited more mutations in transcription-related genes. Patients with NPM1mut AML and CEBPAmut/mut AML show significantly reduced overall survival in comparison with CBF-KITwt AML. These findings emphasize that favorable-risk AML patients have divergent outcomes and that differences in clinical and genotypic characteristics should be considered in their evaluation and management.

Seated T'ai Chi in Older Taiwanese People Using Wheelchairs: A Randomized Controlled Trial Investigating Mood States and Self-Efficacy.

OBJECTIVE: There is growing interest in t'ai chi, but little research has addressed whether t'ai chi is effective in older people using wheelchairs for mobilization. The aim of this study was to compare the effects of seated t'ai chi exercise and usual standard activities on mood states and self-efficacy in older people living in a long-term care facility and using wheelchairs for mobilization. DESIGN: Randomized controlled trial (trial registration no. ACTRN12613000029796). SETTING: One long-term-care facility in Taiwan. PARTICIPANTS: Sixty participants were randomly assigned by a computer-generated random sequence to a t'ai chi group (n = 30) or a usual exercise and entertainment activities group (n = 30). INTERVENTION: Seated t'ai chi exercise for 40 minutes three times a week for 26 weeks was provided. MAIN OUTCOME MEASURES: Mood states (Profile of Mood States Short Form [POMS-SF]) and self-efficacy (Self-Efficacy for Exercise [SEE]). RESULTS: At week 26, participants in the t'ai chi group reported significantly lower mood states on the fatigue-inertia dimension of the POMS-SF (mean score ± standard deviation, 3.56 ± 3.71) than did the control group (mean score, 7.16 ± 6.36) (F [1, 58] = 7.15; p < 0.05). The t'ai chi group recorded significantly higher SEE levels (mean, 35.66 ± 36.83) than did those in the control group (mean, 15.30 ± 26.43) (F [1, 58] = 6.05; p < 0.05). CONCLUSION: The findings highlight the importance of t'ai chi for a reduction in the fatigue-inertia mood state and an increase in self-efficacy for older people using wheelchairs.

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial.

OBJECTIVE: Compare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs. DESIGN: Randomized controlled trial. SETTING: One long-term care facility in Taiwan. PARTICIPANTS: 86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n=30), or usual activity (n=30). INTERVENTION: One certified trainer provided the intervention group with 40min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796. MAIN OUTCOME MEASURES: Quality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF) RESULTS: Participants in the Tai Chi group (M=3.76, SD=3.65) recorded significantly lower GDS-SF scores than participants in the control (M=7.76, SD=5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p=0.03], general health [p=0.04], and the associated domains: physical health [p=0.00], psychological health [p=0.02], social relations [p=0.00], and environment [p=0.00]. CONCLUSIONS: The findings highlight the importance of Tai Chi in improving QOL and depression in this population.

Australian midwives' awareness and management of antenatal and postpartum depression.

BACKGROUND: The detection of maternal depression can be improved with routine screening. This practice is expected to be integrated into midwifery practice under the Australia National Perinatal Depression Initiative. RESEARCH OBJECTIVE: To describe midwives' self-reported practice in caring for women suffering from antenatal and postpartum depressive symptoms; and assess midwives' ability to detect depression and their knowledge of therapeutic interventions for depressive symptoms in childbearing women. METHOD: Using a descriptive cohort study design, a postal survey was sent to all members of the Australian College of Midwives (n=3000). The survey consisted of items drawn from beyondblue's "National Baseline Survey--Screening Evaluation Questionnaire" and questions relating to a hypothetical case study of a depressed woman "Mary" developed by Buist et al. FINDINGS: A total of 815 completed surveys were received. 69.1% of midwives reported screening for antenatal and postpartum depression using instruments such as the Edinburgh Postnatal Depression Scale. Time constraints were perceived as the major barrier to effective emotional care. 63.3% of midwives correctly recognised depression in the case study and 82.4% reported that "Mary" required assistance. Antidepressants were more likely to be recommended postnatally (93.2%) than antenatally (61.5%) by midwives. CONCLUSIONS: Further training is required to ensure midwives' competency in psychosocial assessment and management of women experiencing antenatal and postpartum depression. Systemic issues (e.g. time constraints) encountered by midwives need to be addressed to support the delivery of effective emotional care to childbearing women.

Australian midwives' attitudes towards care for women with emotional distress.

OBJECTIVE: to assess Australian midwives' attitudes towards caring for women with emotional distress and their perceptions of the extent to which workplace policies and processes hindered such care. DESIGN: a postal survey. SETTING: members of the Australian College of Midwives. PARTICIPANTS: 815 Australian midwives completed the survey. MEASUREMENTS: a modified version of the 17-item REASON questionnaire (McCall et al., 2002) that was originally developed for used by General Practitioners to measure their attitudes towards their role in the management of patients with mental health disorders. FINDINGS: An exploratory factor analysis with Varimax rotation identified four factors that reflected midwives' (1) perceptions of systemic problems that hindered emotional care, (2) attitudes towards working with women experiencing emotional health problems, (3) perceived competence in using treatment techniques and (4) attitudes and perceived competence towards the referral of women with depression and anxiety to other health professionals. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: participating midwives indicated their willingness to offer assistance and acknowledged the importance of providing emotional care to women. In practice, emotional care by midwives is impeded by perceived lack of competency rather than a lack of interest. Midwives' competency in the assessment and care of women with conditions such as depression and anxiety may be enhanced through continuing professional education.

Australian midwives' knowledge of antenatal and postpartum depression: a national survey.

INTRODUCTION: Emotional care provided by midwives may improve health and well-being; reduce stress, trauma, and depressive symptoms; and enhance maternal outcomes in childbearing women. The provision of intrapartum and postpartum emotional care can be challenging and requires a good knowledge base for the provider to screen and assist distressed women. This study assessed Australian midwives' levels of knowledge and learning needs regarding antenatal depression and postpartum depression. METHODS: Eight hundred and fifteen members of the Australian College of Midwives completed a postal survey, which consisted of 20 items drawn from the literature and the National Baseline Survey-Health Professional Knowledge Questionnaire. RESULTS: On average, respondents correctly answered 62.9% of items related to antenatal depression and 70.7% of questions about postpartum depression. Many midwives were unable to identify the risk factors (70.6%) or prevalence of antenatal depression (49.6%). Nearly all (98.3%) respondents underestimated the percentage of antenatally depressed women that attempts suicide. Significant percentages of midwives did not correctly identify the incidence (44.4%), onset period (71%), and treatment options (32%) associated with postpartum depression. About half did not understand the use of antidepressant medications (48.6%) and incorrectly reported that the Edinburgh Postnatal Depression Scale was a suitable instrument to assess symptoms of psychotic depression (43.8%). DISCUSSION: There are key knowledge deficits relating to onset of, assessment of, and treatment for depressive symptoms during the antenatal and postpartum periods. There is a need for continuing professional education to improve midwives' knowledge and competency in the assessment and care of women suffering depression.

Enhancing patient care via a pharmacist-managed rural anticoagulation clinic.

Integrating specialized pharmacist services and follow-up with the laboratory, home care nursing, retail pharmacy and physicians can ensure optimal outcomes for patients receiving anticoagulation, or "blood thinner," therapy. Improved patient education and discharge care planning can bridge disconnects, enable patients to better manage their care and ensure better patient outcomes and more effective use of health system resources. Specially trained pharmacists can provide safe and effective management of a high-alert medication to help prevent potentially life-threatening clots or bleeding. With advanced prescribing authorization, the pharmacist can seamlessly provide this service both locally in a community and via Telehealth to surrounding areas, potentially for any Albertan. Warfarin therapy may be lifelong or short-term (three to six months), but all patients require regular monitoring with blood tests. Many variables, both lifestyle and medication related, can impact therapy, and through extensive education and access via telephone to an "expert" for questions and follow-up of blood tests, patients are empowered to better regulate their anticoagulants. Anticoagulation pharmacists, as part of an AMS (anticoagulation management service), can provide a continuum of care for patients while in hospital, when discharged home, as an outpatient in the community or as a resident of a long-term care facility or seniors' home.

Left frontal cortical activation and spreading of alternatives: tests of the action-based model of dissonance.

The action-based model of dissonance predicts that following decisional commitment, approach-oriented motivational processes occur to assist in translating the decision into effective and unconflicted behavior. Therefore, the modulation of these approach-oriented processes should affect the degree to which individuals change their attitudes to be more consistent with the decisional commitment (spreading of alternatives). Experiment 1 demonstrated that a neurofeedback-induced decrease in relative left frontal cortical activation, which has been implicated in approach motivational processes, caused a reduction in spreading of alternatives. Experiment 2 manipulated an action-oriented mindset following a decision and demonstrated that the action-oriented mindset caused increased activation in the left frontal cortical region as well as increased spreading of alternatives. Discussion focuses on how this integration of neuroscience and dissonance theory benefits both parent literatures.