Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement.

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.

Thoracic Society of Australia and New Zealand Position Statement: Respiratory nursing.

The Thoracic Society of Australia and New Zealand's (TSANZ) Position Statement recognizes the pivotal role respiratory nurses play in the lung health of Australians and New Zealanders. The national and international lung health strategies are evidence based to ensure optimal professional clinical support for patients. Respiratory nurses are essential to the success of these strategies as a professional workforce, irrespective of healthcare setting, as they are at the forefront of the delivery of world-class evidence-based respiratory care. Respiratory nursing, as an entity, does not have the status as a nursing specialist area despite its range of professional practice across the life span and diverse settings, including disease prevention, public health, occupational health, symptom management, health education, surgery, rehabilitation, non-invasive ventilation, support for a life-limiting illness and adjustments to living with a chronic disease. Recognition of the specialized nature of work and specialist nursing practice status has been conferred by nurse registration boards upon cancer, emergency, cardiac, critical care, midwifery, mental health and palliative care nurses. It is time to confer this speciality practice recognition upon respiratory nurses of Australia and New Zealand. Through this position statement, the TSANZ advocates for respiratory nursing as a speciality area of professional nursing practice, thus supporting registered nurses in respiratory practice as well as the development of future generations of respiratory nurses. Furthermore, this statement validates the strong partnerships between all professions within the society for the advancement of lung health.

Review of Fever Management Advice on Government and Hospital Websites in Australia.

BACKGROUND: The public often searches the Internet for information about managing symptoms of various diseases, with government and major hospital websites often providing valid and freely available information. OBJECTIVES: Fever is a common symptom of viral illness, and this review sought to identify information related to fever self-management on government and major hospital websites. METHODS: Two distinct search strategies were used. The first was an Internet-based search reviewing fever management advice published on Australian government websites (state, territory, and federal). The second search strategy pertained to fever management advice posted by major Australian tertiary adult and children's hospitals. RESULTS: A total of 4,797 results were identified during the two searches, with a total of 12 websites on fever self-management identified for inclusion; four were from either federal or state government, with the remaining eight from tertiary hospital websites. The information identified showed a discordant definition of fever and lack of consistency in self-management advice. DISCUSSION: This review identified a lack of consistent online government and hospital information. The information discrepancy across multiple websites was not underpinned by clinical evidence to support the self-management of fever.

Use of non-pharmaceutical interventions to reduce the transmission of influenza in adults: A systematic review.

During seasonal influenza epidemics and pandemics, virus transmission causes significant public health concern. Reduction of viral transmission by non-pharmaceutical interventions (NPI) has a significant appeal and is often recommended. However, the efficacy of such interventions is unclear. A systematic literature review was undertaken to identify and evaluate the published literature on NPI efficacy to prevent human transmission of influenza virus in adults. Reviewers assessed the quality of eligible studies utilizing the Critical Appraisal Skills Programme for bias and the Scottish Intercollegiate Guidelines Network for methodological quality. Studies were assessed for risk of bias domains of random sequence generation, allocation concealment, attribution bias, selective reporting and blinding. Relevant citations of 2247 were reduced to 100 for full-text evaluation. Only seven met all selection criteria and pooled analysis was not feasible. Of the seven studies, two were randomized controlled trials (RCT) and five were cluster RCT. The main NPI studied were disinfection and hygiene; barriers; and combined NPI. However, these seven RCT had significant design flaws. Only two studies used laboratory confirmed influenza and poor statistical power was a major problem. Positive significant interventions included professional oral hygiene intervention in the elderly and hand washing. Despite the potential for NPI in preventing influenza transmission, there is very limited data available. Hand washing and dental hygiene may be useful, but other interventions have not been fully assessed. Properly designed studies evaluating large populations including 'at risk' patients and in a variety of communities are needed.

COPD in Never-Smokers: BOLD Australia Study.

Purpose: Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods: We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results: The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio

Effectiveness of strategies to increase uptake of pertussis vaccination by new parents and family caregivers: A systematic review.

OBJECTIVES: Cocoon immunisation strategies involve administration of Bordetella pertussis containing vaccines to parents and family members who are in close contact with newborns. The objective of this systematic review was to evaluate the effectiveness of strategies to increase uptake of vaccination against Bordetella pertussis infection by parents and family caregivers of newborn children (< 3 months of age). DESIGN: A protocol driven systematic review was conducted between 2005 and February 2020. CINAHL, Medline, and Google Scholar databases were searched. SETTING: Inpatient maternity care units, ante-natal and post-natal clinics based in acute care or primary/community care contexts. PARTICIPANTS: (i) mothers, (ii) fathers and (iii) family caregivers or other regular household contacts of infants < 3 months of age. INTERVENTIONS: Health promotion interventions and immunisation clinics designed to promote "cocoon immunisation" against Bordetella pertussis infections of the newborn. MEASUREMENTS: Change in uptake of adult vaccination with a pertussis containing vaccine (dTpa or Tdap) by new parents and family caregivers. FINDINGS: Eight studies were included in this review. Strategies used to promote vaccination included: written and verbal education, promotional videos, provision of vaccine prescriptions and financial incentives, opportunistic vaccination of family members and population-based health promotional messaging. Six of the eight studies reported positive impacts on vaccination uptake. Four studies evaluating providing opportunistic immunisation during the obstetric admission reported statistically significant increases in maternal (+39% to +57%), paternal (+21% to +52%) and household members (+32%) vaccination rates. Targeted public health campaigns were also found to increase vaccination uptake but in isolation were insufficient to achieve vaccination of all household contacts. CONCLUSION: Promotion of pertussis vaccination to new parents and the provision of opportunistic vaccination during the obstetric admission or post-natal visit, was the most successful strategy to increase uptake of pertussis vaccination by family caregivers.

A review of hand-washing techniques in primary care and community settings.

AIM: This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care. BACKGROUND: Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection. DESIGN: Systematic review. METHOD: Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care. RESULTS: Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care. CONCLUSION: This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice. RELEVANCE TO CLINICAL PRACTICE: Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care.

Technology and its role in respiratory care.

INTRODUCTION: Telemonitoring, telemedicine, clinical and medical informatics or telecare, are terms used to describe the use of technology along with local clinical protocols to monitor remotely a patient's medical condition in their own home. In respiratory medicine, where large numbers of people have long term conditions such as asthma and chronic obstructive pulmonary disease (COPD), the role of such monitoring technology in the management of patients is of great interest. AIM: This review seeks to explore what evidence exists to support the deployment of technology to improve the care of people with respiratory conditions. METHOD: Narrative review. RESULT: A wide variety of technologies have been involved in asthma and COPD care, from management systems to self monitoring devices. Many studies report that staff and patients 'liked' the technology. The service, care and financial benefits to both patients and the health care system were less obvious. Many studies suffered from poor methodology and lacked clear endpoints. CONCLUSION: There is an enormous potential for telemonitoring to assist in the provision of better care for those with long term lung diseases. However, evidence of benefit is unclear and there remains a need for robust studies and answers to clear research questions for specific patient populations before such technologies can be recommended for widespread implementation.

Emergency oxygen delivery 2: patients with asthma and COPD.

This is the second of a two-part unit on the use of emergency oxygen in adults. Part 1 outlined the main recommendations of the recently published British Thoracic Society guidance. It also examined managing breathlessness in non-hypoxaemic patients. This part discusses some potential changes to clinical practice and provides practical examples on administering oxygen to patients with acute asthma and COPD. It also outlines issues around administering oxygen that lack evidence and need good-quality studies.

Emergency oxygen delivery in adults 1: updating nursing practice.

The first in this two-part unit discusses new British Thoracic Society guidance on using emergency oxygen in adults. This is the first national guidance on this area and the implications for possible changes to practice are highlighted here. This part outlines the philosophy behind the guideline, the differences between hypoxaemic and hypercapnic patients and essential assessments for critically ill patients who need emergency oxygen. It also discusses using this therapy for patients with lung cancer in acute situations.

Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition. Improvements in therapies have resulted in better patient outcomes. The use of technology such as telemonitoring as an additional intervention is aimed at enhancing care and reducing unnecessary acute hospital service use. The influence of verbal communication between health staff and patients to inform decision making regarding use of acute hospital services within telemonitoring studies has not been assessed. METHOD: A systematic overview of published systematic reviews of COPD and telemonitoring was conducted using an a priori protocol to ascertain the impact of verbal communication in telemonitoring studies on health service outcomes such as emergency department attendances, hospitalisation and hospital length of stay. The search of the following electronic databases: Cochrane Library, Medline, Pubmed, CINAHL, Embase, TROVE, Australian Digital Thesis and Proquest International Dissertations and Theses was conducted in 2017 and updated in September 2019. RESULTS: Six systematic reviews were identified. All reviews involved home monitoring of COPD symptoms and biometric data. Included reviews reported 5-28 studies with sample sizes ranging from 310 to 2891 participants. Many studies reported in the systematic reviews were excluded as they were telephone support, cost effectiveness studies, and/or did not report the outcomes of interest for this overview. Irrespective of group assignment, verbal communication with the health or research team did not alter the emergency attendance or hospitalisation outcome. The length of stay was longer for those who were assigned home telemonitoring in the majority of studies. CONCLUSION: This overview of telemonitoring for COPD had small sample sizes and a wide variety of included studies. Communication was not consistent in all included studies. Understanding the context of communication with study participants and the decision-making process for referring patients to various health services needs to be reported in future studies of telemonitoring and COPD.

Concordant Evidence-Based Interventions in Cardiac and Pulmonary Rehabilitation Guidelines.

Chronic conditions such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) contribute to a significant burden to patients and many experience a reduction in physical functioning, psychological health, and quality of life. The sentinel symptom for COPD and CVD is breathlessness. Rehabilitation programs have been proven to reduce disease symptoms and increase levels of physical and psychological wellness. Pulmonary and cardiac rehabilitation programs have been recommended in international and national guidelines for managing COPD and CVD. Given that these programs seek to reduce breathlessness and improve the physical and psychological functioning of people with COPD and CVD, this review examines the concordant evidence-based interventions in rehabilitation guidelines. The findings of this review indicate that there was concordance in the program design, location of programs, types of health professionals involved in program delivery, assessments of patient at commencement and completion of program, and the delivery of educational topics with minor deviations that were related to disease-specific topics. Apart from disease-specific recommendations, the main divergence from rehabilitation guidelines was found to be dietary screening, inspiratory muscle training, and psychological assessments in evidence-based recommendations for cardiac and pulmonary programs.

An investigation of methods to improve recall for the patient-reported outcome measurement in COPD patients: a pilot randomised control trial and feasibility study protocol.

BACKGROUND: Patient-reported outcomes (PRO) are used to measure the effectiveness of interventions for management of chronic conditions such as chronic obstructive pulmonary disease. Many of these instruments require respondents to describe the change in their health status from baseline to a follow-up assessment and poor recall of previous health status often limits the usefulness and validity of these PRO measures. The use of technology has recently increased in PRO measurement. This study aims to mitigate the problems of poor recall by evaluating different strategies as a way to improve the validity of recall of health status among adults with COPD. METHODS: A pilot randomised controlled trial of three strategies to improve patient recall will be tested in an acute care clinical environment. The first strategy is the use of tablet computer technology's audio-visual facility, the second strategy is the provision of base line PRO responses prior to patients completing their follow-up questionnaires and third is standard practice of completing a questionnaire independently of previous responses. The feasibility of conducting this study in a busy clinical environment will be ascertained using the NIHR criteria for assessing feasibility. DISCUSSION: There is variability in a person's ability to recall past events. With studies utilising patient-reported outcome measurement, it has become critically important to develop strategies and ways of supporting the patient to be more accurate recalling their health status. The adaptation of various technological features within mobile devices may provide an opportunity in clinical research studies to improve patient recall of their health status. TRIAL REGISTRATION: ANZCTR12618001605280.

A review of inpatient ward location and the relationship to Medical Emergency Team calls.

OBJECTIVE: To identify the relationship between in-hospital location and patient outcomes as measured by Medical Emergency Team calls. STUDY DESIGN: A narrative systematic review of the literature. DATA SOURCES: A systematic search of the literature was conducted in October 2014 using the electronic databases: Embase, Cochrane, Medline, CINAHL, Science Direct and Google Scholar for the most recent literature from 1997 to 2014. INCLUSION CRITERIA: Non-randomised study designs such as case control or cohort studies were eligible. Articles were selected independently by two researchers using a predetermined selection criterion. DATA SYNTHESIS: The screening process removed manuscripts that did not meet the inclusion criteria resulting in an empty review with one manuscript meeting most of the criteria for inclusion. The protocol was revised to a narrative synthesis including a broader scope of studies. The search strategy was expanded and modified to include manuscripts of any study design that comprise both inlier and outlier patients. Two manuscripts were selected for the narrative synthesis. CONCLUSION: Two recently published studies investigated the incidence of MET calls for outlier patients, and whilst MET calls were increased in outlier hospital patients, definitive conclusions associated with patient outcomes cannot be made at this time due to paucity of studies.

Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care.

Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

A review of the effectiveness of psychological interventions used for anxiety and depression in chronic obstructive pulmonary disease.

BACKGROUND: Anxiety and depression are recognised co-morbidities associated with COPD and have been related to poor health outcomes. Therapies to relieve anxiety and depression are currently not detailed in clinical guidelines. METHODS: A systematic review of psychological interventions for anxiety and depression in adults with COPD was conducted. Meta-analysis utilising the random effects model was undertaken for 4 studies that employed the same psychological intervention type, Cognitive Behavioural Therapy (CBT). RESULTS: Seven studies met the inclusion criteria. Four studies used CBT. Included studies utilised psychotherapy, uncertainty management and minimal psychological therapy. 70% of participants were male. Many studies had poor methodological quality. The meta-analysis showed a small decrease in symptoms for both anxiety (SMD -0.49, 95% CI -1.04, 0.06, P=0.08, n=193) and depression (SMD -0.37, 95% CI -0.86, 0.11, P=0.13, n=193). No change occurred when sensitivity analyses were conducted. CONCLUSION: Anxiety and depression in COPD patients are known to impact on health outcomes. Effective psychological interventions such as CBT may assist people with COPD in reducing psychological burden. There remains a need for well-designed studies to provide substantive evidence for the use of psychological interventions in this patient population.