Qualitative Impressions of a Yoga Nidra Practice for Insomnia: An Exploratory Mixed-Methods Design.

Introduction: Insomnia affects up to half of the U.S. population, and due to limitations of current treatments, there is a growing interest in mind-body practices to reduce insomnia. To understand how a guided meditation practice, Yoga Nidra, may affect relaxation and align with current descriptions of nonpharmaceutical practices that could improve sleep, qualitative and quantitative methods were used to explore participant experience of a single Yoga Nidra practice, administered in a group setting. Methods: Current insomnia (Insomnia Severity Index), sleep practices, and mood (positive and negative affect schedule [PANAS]) were measured at intake. After 30 min of Yoga Nidra practice, the PANAS was readministered. In a focus group that followed, participants discussed their experience before, during, and after the practice and the likelihood of repeating it. Six groups were conducted. All interested adults were welcome to join. Results: In the final sample of 33 individuals (79% female), 80% of participants reported insomnia at intake and 45% reported a regular mind-body practice, supporting the prevalence of insomnia in the society as well as the interest in mind-body practices. After the Yoga Nidra intervention, mean negative affect decreased 5.6 ± 4.5 points, a 31% decrease from baseline, and positive affect decreased 3.5 ± 9.7 points, a 13% decrease. Three major themes were identified from focus group discussions: response to the practice (relaxation, perceived sleep, and sense withdrawal); factors that affect engagement (delivery method and intrapersonal factors); and potential as a clinical intervention (for conditions including sleep, anxiety, and pain). Conclusion: Yoga Nidra appeared tolerable within the sample, and descriptions suggest it may be useful for enhancing relaxation, facilitating sleep, easing anxiety, and reducing pain. Results from this study will inform the design of future studies of Yoga Nidra for insomnia and related conditions.

A rural shelter in Ontario adapting to address the changing needs of women who have experienced intimate partner violence: a qualitative case study.

INTRODUCTION: Intimate partner violence is a significant public health problem, with shelters offering the predominant community-based solution. Shelters in Canada are mandated to provide a safe place, protection planning, advocacy and counseling among other services. Recently it has been noted the role of the shelter was shifting from an inpatient to outpatient model with a focus on increased integration of health and social services. This changing role of the shelter is amplified within the rural context where resources and cultural norms may be limited or incompatible with help-seeking behaviors. Women's shelters located in rural settings provide services within a specific cultural context that can be at odds with the needs of women who have experienced abuse, because cultural values such as rural pride, lack of anonymity, and lack of services may inhibit access to health and social services. METHODS: The purpose of this in-depth qualitative case study was to examine and explore how one rural Canadian women's shelter role was changing and how the shelter was adapting to achieve the changing role. The theoretical framework utilized was a feminist intersectional lens. Qualitative interviews (averaging 60 minutes) were conducted with shelter service providers (n=6) and women staying in the shelter or utilizing shelter services (n=4). Throughout semi-structured interviews, data-trustworthy steps were taken including member-checking and paraphrasing to ensure data were an accurate representation of participants' experiences. Inductive content analysis of all interviews and field notes was conducted independently by two researchers. RESULTS: Analysis revealed the shelter's role was changing to include filling gaps, case management, and system navigation. To achieve the changing role, relationship building, community mobilization (both education and empowerment), and redesigning delivery were implemented as adaptation strategies. Together both the changing role of the shelter and the adaptation strategies being implemented were found to be working toward a larger goal of transformation of cultural and structural norms related to violence against women. CONCLUSIONS: This study uniquely identified the specific changes to the role of one rural Canadian shelter and the adaptations strategies utilized to adapt to the changing needs of women. The changing role of the shelter and the adaptation strategies being utilized have significant implications for the health of women given the increased use of healthcare services for women who have experienced violence. Specifically, the changing role of the shelter has the potential to decrease healthcare service use while increasing the potential fit of services. Further research is required to assess the impact of the changing role of the shelter on the healthcare needs and outcomes for women who have experienced intimate partner violence.

Improved decisional conflict and preparedness for decision making using a patient decision aid for treatment selection in psoriasis: a pilot study.

BACKGROUND: We developed a patient decision aid (pDA) to assist psoriasis patients in treatment decisions. OBJECTIVE: This pilot study evaluated the pDA in patient knowledge, decisional conflict, and preparation for decision making. METHODS: Newly referred psoriasis patients in a private dermatology office completed self-administered surveys at three time points: before (visit 1) and on two occasions after provision of the pDA (visit 2 up to 2 weeks after visit 1; visit 3 up to 6 weeks after visit 1). The survey included questions regarding knowledge of psoriasis and its treatment and validated questionnaires on decisional conflict and preparation for decision making. RESULTS: Ten psoriasis patients participated (seven men, three women; mean age 45.7 years), with a mean age of 11.4 years since diagnosis. Improvement by visit 3 was observed for knowledge (p  =  .06), reduced decisional conflict (p ≤ .001), and preparation for decision making (p ≤ .05). Patients tended to self-select treatment appropriate to the level of psoriasis severity. CONCLUSION: This pilot study of the pDA showed improved patient knowledge of psoriasis and its treatments, reduced decisional conflict, and increased patient preparation for decision making. LIMITATIONS: This small study was not randomized and did not have a comparator arm.

Evaluation of essential clinical components and features of current acne global grading scales.

BACKGROUND: Acne research is hindered by the absence of a universal, consistently applied standard for severity grading. Acne experts recently identified 4 essential clinical components and 2 features for an ideal acne global grading scale (AGGS). OBJECTIVE: This study evaluated current AGGSs against consensus criteria previously identified as necessary. METHODS: AGGSs were identified by systematic literature search and then evaluated independently by 4 raters against criteria (components and subcomponents; features and subfeatures) identified as essential. RESULTS: Eighteen AGGSs fulfilled selection criteria. Three scored 1 full SD above the mean for categorical scores. We also identified highest-ranked AGGSs for subcategory scores. LIMITATIONS: Only English-language scales were selected. Efficiency and acceptance were not evaluable. CONCLUSION: Although no singular scale fulfilled all essential criteria, this study did identify highly ranked AGGSs. Incorporation and rationalization of their components and features should facilitate development of an ideal standard.

A patient decision aid for psoriasis based on current clinical practice guidelines.

OBJECTIVE: To develop a patient decision aid (PDA) for psoriasis with content derived from current clinical practice guidelines. DESIGN: This PDA was developed in accordance with international patient decision aid standards. Primary sources of treatment outcome information were English-language, evidence-based clinical practice guidelines for plaque psoriasis published between January 1, 2006, and December 31, 2010. SETTING: Patients with psoriasis from a private practice in Windsor, Ontario, Canada, and a focus group of dermatologists across Canada. PARTICIPANTS: Focus groups of dermatologists (n=5) and patients with psoriasis (n=7) were convened to provide feedback on balance, clarity, practicality, and items for inclusion and exclusion. MAIN OUTCOME MEASURES: Physician's global assessment, overall lesional assessment, and 75% reduction in Psoriasis Area and Severity Index. RESULTS: Efficacy measures selected to reflect good control in the PDA were physician's global assessment (clear or almost clear) or overall lesional assessment (none or very mild) for topical agents and 75% reduction in Psoriasis Area and Severity Index for phototherapy and systemic agents. Where available, outcomes for serious adverse effects were displayed figuratively with efficacy measures. Deliberative questions for self-completion and a values clarification exercise were also incorporated. CONCLUSION: This psoriasis PDA was developed according to international standards based on content derived from current clinical practice guidelines.

Acne severity grading: determining essential clinical components and features using a Delphi consensus.

BACKGROUND: There are multiple global scales for acne severity grading but no singular standard. OBJECTIVE: Our objective was to determine the essential clinical components (content items) and features (property-related items) for an acne global grading scale for use in research and clinical practice using an iterative method, the Delphi process. METHODS: Ten acne experts were invited to participate in a Web-based Delphi survey comprising 3 iterative rounds of questions. RESULTS: In round 1, the experts identified the following clinical components (primary acne lesions, number of lesions, extent, regional involvement, secondary lesions, and patient experiences) and features (clinimetric properties, ease of use, categorization of severity based on photographs or text, and acceptance by all stakeholders). In round 2, consensus for inclusion in the scale was established for primary lesions, number, sites, and extent; as well as clinimetric properties and ease of use. In round 3, consensus for inclusion was further established for categorization and acceptance. Patient experiences were excluded and no consensus was achieved for secondary lesions. LIMITATIONS: The Delphi panel consisted solely of the United States (U.S.)-based acne experts. CONCLUSION: Using an established method for achieving consensus, experts in acne vulgaris concluded that an ideal acne global grading scale would comprise the essential clinical components of primary acne lesions, their quantity, extent, and facial and extrafacial sites of involvement; with features of clinimetric properties, categorization, efficiency, and acceptance.

Critical appraisal of quality of clinical practice guidelines for treatment of psoriasis vulgaris, 2006-2009.

Numerous international clinical guidelines for management of psoriasis have recently been published. We evaluated the quality of guidelines published between 2006 and December 2009 using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Eight guidelines from five separate working groups fulfilled inclusion criteria and were evaluated. Four used the standards established by the AGREE instrument in the process of development of their guidelines. Each of the guidelines uniformly received high domain scores (i.e., > 90%) for scope and purpose (range of 94-100%), and clarity and presentation (range of 92-100%). Nevertheless, each of the eight guidelines had important shortcomings (item scores < or = 2/4, in which 4 indicates strongly agree and 1 indicates strongly disagree that specific items have been adequately addressed) in at least one item including: stakeholder involvement (by lack of piloting and inadequate determination of patient views), development rigor (inadequate procedure for updating), applicability (by lack of discussion on organizational barriers), and editorial independence (from funding body). Despite the use of predefined standards in their development, important deficiencies exist in the most recent clinical treatment guidelines for psoriasis.

Beyond standard quality of life measures: the subjective experiences of living with inflammatory bowel disease.

INTRODUCTION: In order to facilitate our understanding of health-related quality of life (HRQoL) for inflammatory bowel disease (IBD) patients, it is critical to explore their subjective experiences with the disease. Research has suggested that current modes of assessing HRQoL (i.e., generic and disease-specific measures) may not fully represent all dimensions of patients' HRQoL. The purpose of this study was to examine IBD patients' subjective experiences of the daily impact of IBD, and categorize dimensions of their HRQoL affected by IBD, as identified by the patients themselves. METHODS: Two hundred and eighty-two patients with IBD provided answers to the qualitative question "How has IBD affected your daily activities?" A content analysis using NVivo 2.0 was conducted on the participants' responses to this question to reveal dimensions of their HRQoL. RESULTS: The analysis yielded six dimensions and several subdimensions of HRQoL, including physical (systemic functioning, daily functioning, energy/vitality, pain), emotional, social, cognitive (functioning, attending to disease), self-regulation (taking control, loss of control, and neutral), and practical functioning. DISCUSSION: These results reflect previous findings, but also reveal several dimensions of HRQoL not included in current measures of HRQoL for IBD patients (i.e., cognitive, self-regulation, and practical). The implications of these findings for future measurement of HRQoL and research with IBD patients are discussed.