Efficacy of a telephone outcall program to reduce caregiver burden among caregivers of cancer patients [PROTECT]: a randomised controlled trial.

BACKGROUND: Informal caregivers provide extended support to people with cancer but they receive little support from the health care system to assist them in their caring role. The aim of this single-blind, multi-centre, randomised controlled trial was to test the efficacy of a telephone outcall program to reduce caregiver burden and unmet needs, and improve psychological well-being among cancer caregivers, as well as evaluating the potential impact on patient outcomes. METHODS: Cancer patient/caregiver dyads (N = 216) were randomised to a telephone outcall program (n = 108) or attention control group (n = 108). The primary outcome was self-reported caregiver burden. Secondary endpoints included depressive symptoms, unmet needs, self-esteem, self-empowerment, and health literacy. Data were collected at baseline and at both 1 and 6 months post-intervention. An intention to treat analysis was performed. RESULTS: The intervention had no effect on the primary outcome (caregiver burden), but reduced the number of caregiver unmet needs (intervention group baseline, mean = 2.66, 95% confidence interval (CI) [1.91-3.54]; intervention group 1 month post intervention, mean = 0.85, 95%CI [0.42-1.44]; control group baseline, mean = 1.30 95%CI [0.80-1.94], control group 1 month post intervention, mean = 1.02 95%CI [0.52-1.69]; p = 0.023). For caregivers at risk for depression, the intervention had a significant effect on caregivers' confidence in having sufficient information to manage their health (p = 0.040). No effects were found for patients' depressive symptoms, unmet needs, self-empowerment, and other health literacy domains. CONCLUSIONS: While caregiver burden was not reduced, the outcall program was effective in reducing unmet needs in caregivers. Provision of cancer information and support via a telephone service may represent a feasible approach to reducing unmet needs among cancer caregiver populations. TRIAL REGISTRATION: ACTRN12613000731796 ; prospectively registered on 02/07/2013.

Efficacy and cost-effectiveness of an outcall program to reduce carer burden and depression among carers of cancer patients [PROTECT]: rationale and design of a randomized controlled trial.

BACKGROUND: Carers provide extended and often unrecognized support to people with cancer. The aim of this study is to test the hypothesis that excessive carer burden is modifiable through a telephone outcall intervention that includes supportive care, information and referral to appropriate psycho-social services. Secondary aims include estimation of changes in psychological health and quality of life. The study will determine whether the intervention reduces unmet needs among patient dyads. A formal economic program will also be conducted. METHODS/DESIGN: This study is a single-blind, multi-centre, randomized controlled trial to determine the efficacy and cost-efficacy of a telephone outcall program among carers of newly diagnosed cancer patients. A total of 230 carer/patient dyads will be recruited into the study; following written consent, carers will be randomly allocated to either the outcall intervention program (n = 115) or to a minimal outcall / attention control service (n = 115). Carer assessments will occur at baseline, at one and six months post-intervention. The primary outcome is change in carer burden; the secondary outcomes are change in carer depression, quality of life, health literacy and unmet needs. The trial patients will be assessed at baseline and one month post-intervention to determine depression levels and unmet needs. The economic analysis will include perspectives of both the health care sector and broader society and comprise a cost-consequences analysis where all outcomes will be compared to costs. DISCUSSION: This study will contribute to our understanding on the potential impact of a telephone outcall program on carer burden and provide new evidence on an approach for improving the wellbeing of carers.

Australian adolescents' compliance with sun protection behaviours during summer: the importance of the school context.

Adolescents exhibit significantly lower sun protection behaviours than adults in Australia. While many studies have assessed the sun protection behaviours of adolescents during summer, few studies have explored the differences in sun protection behaviours of adolescents across key contexts relevant to adolescents during summer-notably school time, weekends and school holidays. Greater understanding of differences in behaviours across these contexts provides more detailed explanations of the nature of adolescent ultraviolet exposure and thereby facilitates improved targeting of interventions for this segment whose behaviour is considered hard to change. In this study, we explore the differences in self-reported, habitual, sun protection behaviours of adolescents across key contexts during summer. A sample of 692 adolescents aged between 12 and 18 completed a self-report survey concerning habitual sun-related behaviours across four key contexts. Comparisons were made between contexts in seven key sun protection behaviours. The results show that there are significant differences in habitual sun protection behaviours of adolescents between contexts and notably increased compliance with sun protection behaviours in the school context. These findings suggest that some sun protection behaviours are not transferred between key contexts relevant to adolescents and highlight an opportunity for public health programmes to focus more specifically on facilitating the transfer of positive sun protection behaviours between contexts.

Improving Efficiency Using Electronic Medical Record Rounding Report & Sign-Out Report.

INTRODUCTION: Standardized rounding and sign-out reports can improve provider efficiency and satisfaction. The purpose of this quality improvement project was to evaluate implementing an electronic medical record-integrated neonatal intensive care unit-specific rounding report and sign-out report on provider efficiency and satisfaction. METHOD: A pre- and post-quality improvement project was implemented to evaluate the effectiveness of standardized electronic rounding and sign-out reports on a 48-bed level-4 neonatal intensive care unit staffed daily by two neonatologists and four advanced practice providers. RESULTS: The electronic rounding and sign-out reports were implemented on 745 patient encounters. The process of using the electronic rounding report was found to be faster than the paper prerounding report. Completing the standardized sign-out report was faster than the previous method used. DISCUSSION: Improving efficiency is essential for optimizing patient care and improving provider satisfaction. Electronic rounding and standardized sign-out reports can improve efficiency and provider satisfaction.

Partner violence screening in rural health care clinics.

OBJECTIVES: We sought to determine the frequency of intimate partner violence by type in a large, clinic-based, nurse-administered screening and services intervention project. METHODS: A brief intimate partner violence screen, which included items to measure sexual and physical assaults and psychological battering (using the Women's Experience With Battering scale) was administered to consenting women receiving care at 1 of 8 rural clinics in South Carolina. RESULTS: Between April 2002 and August 2005, 4945 eligible women were offered intimate partner violence screening, to which 3664 (74.1%) consented. Prevalence of intimate partner violence in a current (ongoing) relationship was 13.3%, and 939 women (25.6%) had experienced intimate partner violence at some point in the past 5 years. Of those ever experiencing intimate partner violence, the majority (65.6%) experienced both assaults and psychological battering; 10.1% experienced assault only, and 24.3% experienced psychological battering only. Most women (85.5%) currently experiencing both psychological battering and assaults stated that violence was a problem in their current relationship. CONCLUSIONS: The intimate partner violence screening technique we used was feasible to implement, acceptable to women seeking health care at the targeted clinics, and indicated a high proportion of women reporting intimate partner violence in the past 5 years, with a majority of those women stating that such violence was a problem in their relationships. These findings demonstrated the viability of the screening technique, which supports the growing importance of implementing intimate partner violence screenings in clinical settings in order to reduce the prevalence of violence in intimate relationships.

Assessment of Knowledge of Critical Cardiovascular Risk Indicators among College Students: Does Stage of Education Matter?

The health risk of college students in the United States (US) is on the rise, with a significant increase in the prevalence of cardiovascular risk factors. Cardiovascular disease is the leading cause of death in the US, costing approximately $475.3 billion yearly. The goals of this "Know Your Numbers" study were to: (1) estimate the awareness of college students of their critical health numbers (CHN); and (2) compare a college of pharmacy entry class (IP1) with second semester non-commuter freshman college students (FCS) in knowing their numbers. A cross-sectional 15-item pre-test survey was conducted among a convenience sample of IP1 and FCS. All statistical tests were performed at α = 0.05. Awareness of their: cholesterol (7%), blood pressure (BP) (35%), glucose (8%), and body mass index (BMI) (42%) were low. The IP1, compared to FCS, were more knowledgeable of: (1) their BP (46% vs. 28%, p = 0.01); (2) BP normal range (74% vs. 63%, p = 0.02); and (3) BMI normal range (39% vs. 23%, p = 0.04). The IP1s maintained a healthier diet than the FCS (64% vs. 36%, p < 0.0001). Awareness of knowing CHN was very low. Knowledge of one's CHN was significantly associated with knowledge of normal reference values for BP, glucose, and BMI.

Sun protecting and sun exposing behaviors: testing their relationship simultaneously with indicators of ultraviolet exposure among adolescents.

The aim of this study was to build on existing understanding of adolescent sun-related behavior by combining sun protecting and sun exposing behaviors and testing their relationship simultaneously with indicators of ultraviolet (UV) exposure. Data were collected for 692 adolescents aged between 12 and 18 years. General linear modeling was undertaken to test the relationship of sun-related behaviors with indicators of UV exposure. Overall, the combined sun protection and sun exposing behaviors accounted for 13.8% of the variance in the number of sunburns, 28.1% of the variance in current tan and 57.5% of the variance in desired tan, respectively. Results indicated that having a strong desire for a tan was significantly associated with spending time tanning, delaying the use of sun protection, wearing brief clothing and using no sun protection; whereas the number of sunburns was significantly associated with sunscreen use, avoiding peak hours and delaying sun protection. Current tan was significantly associated with wearing sunglasses, shade use and time spent tanning. In examining sun-related behaviors among adolescents, consideration needs to be given to both sun exposing and sun protecting behaviors. This research has important implications for conceptualizing outcomes in programs designed to reduce UV exposure.

Intimate partner violence incidence and continuation in a primary care screening program.

There are few longitudinal estimates of intimate partner violence (IPV) incidence and continuation. This report provides estimates of IPV incidence and continuation in women receiving health care in clinics participating in an IPV assessment and services intervention study. The Women's Experience with Battering Scale was used in combination with questions addressing physical and sexual assault to annually screen women for IPV. Between April 2002 and August 2005, 657 women in rural South Carolina consented and were screened at least twice. Among those with a current partner (n = 530), the majority (86.2%) had never experienced IPV. Among prevalent victims, IPV continued over time for 37%. IPV continuation rates were higher among older women and those who considered abuse as a problem in their relationship. Of those women who were IPV negative at time 1, IPV incidence at time 2 was 4.2%. A higher score on the Women's Experience with Battering Scale at time 1, a marker of psychological abuse, was a strong predictor of physical IPV incidence (p(trend) = 0.0001). These data suggest that the incidence of IPV over a short follow-up period is relatively low and that the majority of IPV desists over this short follow-up period.