Exercise Preferences, Barriers, and Facilitators of Individuals With Cancer Undergoing Chemotherapy Before Stem Cell Transplantation: A Mixed-Methods Study.

BACKGROUND: Exercise can help mitigate side effects of hematopoietic stem cell transplantation (HSCT), particularly when initiated before HSCT. However, the exercise-related barriers, facilitators, and preferences of this population remain unclear. OBJECTIVE: This study aimed to explore the patient experience to inform future implementation of a prehabilitation intervention. INTERVENTIONS/METHODS: A 2-phase sequential explanatory mixed-methods study was conducted using (1) cross-sectional survey and (2) focus groups. Survey questions aligned with the Theoretical Domains Framework. Focus group data were analyzed using a directed content analysis approach, followed by inductive thematic analysis to generate themes that represented the exercise-related barriers, facilitators, and preferences of participants. RESULTS: Twenty-six participants completed phase 1 (n = 22 with multiple myeloma). Fifty percent of participants (n = 13) were fairly/very confident in their ability to exercise pre-HSCT. Eleven participants completed phase 2. Exercise barriers included knowledge/skill limitations, inadequate healthcare provider support, and the emotional toll of treatment. Facilitators included social support and goals. Exercise preferences were related to 2 themes: (1) program structure (subthemes: prescription and scheduling, mode of delivery) and (2) support (subthemes: support from personnel, tailoring, and education). CONCLUSION: Key exercise-related barriers included knowledge limitations, disease/treatment effects, and inadequate support. Prehabilitation should be tailored, flexible, and include education and a virtual or hybrid delivery model in this population. IMPLICATIONS FOR PRACTICE: Nurses are well positioned to identify functional limitations and counsel and refer patients to exercise programming and/or physiotherapy services. Including an exercise professional in the pretransplant care team would provide key supportive care assistance for the nursing team.

Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study.

Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.

Simplified guideline for prescribing medical cannabinoids in primary care.

OBJECTIVE: To develop a clinical practice guideline for a simplified approach to medical cannabinoid use in primary care; the focus was on primary care application, with a strong emphasis on best available evidence and a promotion of shared, informed decision making. METHODS: The Evidence Review Group performed a detailed systematic review of 4 clinical areas with the best evidence around cannabinoids: pain, nausea and vomiting, spasticity, and adverse events. Nine health professionals (2 generalist family physicians, 2 pain management-focused family physicians, 1 inner-city family physician, 1 neurologist, 1 oncologist, 1 nurse practitioner, and 1 pharmacist) and a patient representative comprised the Prescribing Guideline Committee (PGC), along with 2 nonvoting members (pharmacist project managers). Member selection was based on profession, practice setting, location, and lack of financial conflicts of interest. The guideline process was iterative through content distribution, evidence review, and telephone and online meetings. The PGC directed the Evidence Review Group to address and provide evidence for additional questions as needed. The key recommendations were derived through consensus of the PGC. The guideline was drafted, refined, and distributed to a group of clinicians and patients for feedback, then refined again and finalized by the PGC. RECOMMENDATIONS: Recommendations include limiting medical cannabinoid use in general, but also outline potential restricted use in a small subset of medical conditions for which there is some evidence (neuropathic pain, palliative and end-of-life pain, chemotherapy-induced nausea and vomiting, and spasticity due to multiple sclerosis or spinal cord injury). Other important considerations regarding prescribing are reviewed in detail, and content is offered to support shared, informed decision making. CONCLUSION: This simplified medical cannabinoid prescribing guideline provides practical recommendations for the use of medical cannabinoids in primary care. All recommendations are intended to assist with, not dictate, decision making in conjunction with patients.

Lignes directrices simplifiées en matière de prescription de cannabinoïdes médicaux en soins de première ligne.

OBJECTIF: Élaborer des lignes directrices de pratique clinique visant à simplifier l'approche à l'emploi de cannabinoïdes à des fins médicales en soins de première ligne; le projet visait l'application en soins de première ligne, en insistant fortement sur les meilleures données probantes disponibles, et la promotion de la prise de décision éclairée et partagée. MÉTHODES: Le Groupe d'examen des données a effectué une revue systématique détaillée de 4 domaines cliniques dotés des meilleures données probantes en matière de cannabinoïdes : douleur, nausées et vomissements, spasticité et événements indésirables. Neuf professionnels de la santé (2 omnipraticiens, 2 médecins de famille spécialisés en gestion de la douleur, 1 médecin de famille en milieu urbain, 1 neurologue, 1 oncologue, 1 infirmière praticienne et 1 pharmacien) et une représentante de patients composaient le Comité des lignes directrices en matière de prescription (CLDP), de même que 2 membres sans droit de vote (pharmaciens gestionnaires de projet). Les membres ont été sélectionnés en fonction de leur profession, et de leur contexte et de leur lieu de pratique, de même qu'en fonction de l'absence d'un conflit d'intérêts de nature financière. Les lignes directrices sont le fruit d'un processus itératif incluant la distribution de contenu, l'examen minutieux des données probantes, et des rencontres téléphoniques et en ligne. Le CLDP a confié au Groupe d'examen des données la responsabilité de répondre aux questions additionnelles et de fournir des données probantes, au besoin. Les principales recommandations découlent d'un consensus au sein du CLDP. Les lignes directrices ont été rédigées, peaufinées et distribuées à un groupe de cliniciens et de patients aux fins de commentaires, puis ont été peaufinées à nouveau et finalisées par le CLDP. RECOMMANDATIONS: Les recommandations consistent à limiter la consommation générale de cannabinoïdes médicaux, mais elles décrivent aussi l'emploi restreint potentiel dans un petit sous-groupe de conditions de santé pour lesquelles des données probantes existent (douleur neuropathique, douleur en soins palliatifs et en fin de vie, nausées et vomissements induits par la chimiothérapie, et spasticité causée par la sclérose en plaques ou une lésion de la moelle épinière). L'article examine en détail d'autres points importants en matière de prescription, et offre du contenu étayant la prise de décision éclairée et partagée. CONCLUSION: Ces lignes directrices simplifiées en matière de prescription de cannabinoïdes médicaux offrent des recommandations pratiques quant à l'emploi de cannabinoïdes en soins de première ligne. Toutes les recommandations visent à contribuer à la prise de décision conjointement avec le patient et non à la dicter.

Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus (GDM) together with other aspects of maternal health and obstetric and neonatal outcomes. METHODS: This randomized controlled trial allocated women with a history of GDM to an exercise intervention (14-week supervised home-based stationary cycling program) or to a control group (standard care) at 13±1 weeks of gestation. The primary outcome was a diagnosis of GDM. Secondary outcomes included maternal fitness, psychological well-being, and obstetric and neonatal outcomes. A sample size of 180 (90 in each group) was required to attain 80% power to detect a 40% reduction in the incidence of GDM. RESULTS: Between June 2011 and July 2014, 205 women provided written consent and completed baseline assessments. Of these, 33 (16%) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test (OGTT), leaving 172 randomized to exercise (n=85) or control (n=87). Three women miscarried before the assessment of outcome measures (control=2; exercise=1). All remaining women completed the postintervention OGTT. The recurrence rate of GDM was similar between groups (control 40% [n=34]; exercise 40.5% [n=34]; P=.95) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT (glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L; P>.05). Maternal fitness was improved by the exercise program (P<.01) and psychological distress was reduced (P=.02). There were no differences in obstetric and neonatal outcomes between groups (P>.05). CONCLUSION: Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM; however, it was associated with important benefits for maternal fitness and psychological well-being. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT01283854.

Chemotherapy at home: keeping patients in their "natural habitat".

Escalating cancer rates and an increase in the complexity and duration of chemotherapy regimens have brought the issue of cancer treatment at home to the forefront. For the participants of this study, home chemotherapy was offered as a potential treatment choice. Ten patients who accepted home chemotherapy were interviewed using the methodology of interpretive description. They shared their experiences of receiving chemotherapy at home, and identified home as being a "natural habitat" in which they were better able to adapt to their circumstances. Patients were able to redistribute their resources including time, energy, and finances in ways that were meaningful to them. They felt the care provided was enhanced and they were more receptive to teaching. Lastly, participants viewed themselves as being less ill and better able to cope with their treatments. Given the results of this study and other research available, chemotherapy at home should be considered an option for patients with cancer.

Optimising sprint interval exercise to maximise energy expenditure and enjoyment in overweight boys.

The aim of this study was to identify the sprint frequency that when supplemented to continuous exercise at the intensity that maximises fat oxidation (Fat(max)), optimises energy expenditure, acute postexercise energy intake and enjoyment. Eleven overweight boys completed 30 min of either continuous cycling at Fat(max) (MOD), or sprint interval exercise that consisted of continuous cycling at Fat(max) interspersed with 4-s maximal sprints every 2 min (SI(120)), every 1 min (SI(60)), or every 30 s (SI(30)). Energy expenditure was assessed during exercise, after which participants completed a modified Physical Activity Enjoyment Scale (PACES) followed by a buffet-type breakfast to measure acute postexercise energy intake. Energy expenditure increased with increasing sprint frequency (p < 0.001), but the difference between SI(60) and SI(30) did not reach significance (p = 0.076), likely as a result of decreased sprint quality as indicated by a significant decline in peak power output from SI(60) to SI(30) (p = 0.034). Postexercise energy intake was similar for MOD, SI(120), and SI(30) (p > 0.05), but was significantly less for SI(60) compared with MOD (p = 0.025). PACES was similar for MOD, SI(120), and SI(60) (p > 0.05), but was less for SI(30) compared with MOD (p = 0.038), SI(120) (p = 0.009), and SI(60) (p = 0.052). In conclusion, SI(60) appears optimal for overweight boys given that it maximises energy expenditure (i.e., there was no additional increase in expenditure with a further increase in sprint frequency) without prompting increased energy intake. This, coupled with the fact that enjoyment was not compromised, may have important implications for increased adherence and long-term energy balance.

The importance of quality of life for patients living with myelodysplastic syndromes.

Myelodysplastic syndromes (MDS) are a group of myeloid stem cell clonal disorders characterized by a wide variation in illness trajectory and potential treatment. The physical, functional, emotional, social, and spiritual well-being of individuals with MDS can be affected by both disease and treatment-related factors. As a result, the quality of life (QOL) in patients with MDS may vary throughout the course of the illness. To date, most research exploring QOL in patients with MDS has been conducted as part of clinical trials evaluating the effectiveness of a therapeutic intervention. Although data from those studies are useful, they do not fully address the issues critical to maintaining or maximizing QOL. Oncology nurses are in a key position to assist patients with MDS to maintain their QOL. Findings from comprehensive QOL assessments will guide nurses in providing relevant interventions and evaluating their outcomes. In this manner, oncology nurses can assist their patients to maximize QOL while living with this challenging illness.

Adding sprints to continuous exercise at the intensity that maximises fat oxidation: implications for acute energy balance and enjoyment.

The objective was to examine the effect of adding sprints to continuous exercise at the intensity that maximises fat oxidation (Fat(max)) on energy expenditure, substrate oxidation, enjoyment and post-exercise energy intake in boys. Nine overweight and nine normal weight boys (8-12 years) attended the laboratory on three mornings. First, body anthropometrics, peak aerobic capacity and Fat(max) were assessed. On the remaining two sessions, resting metabolic rate was determined before participants completed 30 min of either continuous cycling at Fat(max) (MOD) or sprint interval exercise consisting of continuous cycling at Fat(max) interspersed with four-second maximal sprints every two minutes (SI). Energy expenditure and substrate oxidation were measured during exercise and for 30 min post-exercise, while participants completed a modified Physical Activity Enjoyment Scale (PACES). This was followed by a buffet-like breakfast to measure post-exercise energy intake. Fat oxidation rate was similar between groups and protocols (P>0.05). Both groups expended more energy with SI compared to MOD, resulting from increased carbohydrate oxidation (P<0.05), which was not compensated by increased energy intake. Participants indicated that they preferred SI more than MOD, although there was no significant difference in PACES score between the protocols (P>0.05). In summary, the addition of short sprints to continuous exercise at Fat(max) increased energy expenditure without compromising fat oxidation or stimulating increased post-exercise energy intake. The boys preferred SI and did not perceive it to be any harder than MOD, indicating that sprint interval exercise should be considered in exercise prescription for this population.

Does exercise duration affect Fatmax in overweight boys?

To compare the assessment of Fat(max) using a single graded exercise test with 3 min stages against 30 min prolonged exercise bouts in overweight boys. Ten overweight boys (8-12 years) attended the laboratory on seven separate occasions. On the first visit, body anthropometrics and peak aerobic capacity ([Formula: see text]O(2peak)) were assessed. Following this, each participant attended the laboratory after an overnight fast for six morning cycling sessions. During the first session, participants completed a continuous, submaximal graded exercise protocol with seven 3 min stages (GRAD) at 35, 40, 45, 50, 55, 60 and 65% [Formula: see text]O(2peak). The final five visits consisted of a 30 min bout of prolonged exercise (PROL) performed in a counterbalanced order at 40, 45, 50, 55 and 60% [Formula: see text]O(2peak). There was no effect of exercise duration on Fat(max) or the absolute rate of fat oxidation during PROL (p > 0.05). At the group level, GRAD and PROL provided similar estimates of Fat(max) (GRAD: 53 ± 10% [Formula: see text]O(2peak); PROL: 53 ± 10% [Formula: see text]O(2peak); p = 0.995); however, individual variation between the two protocols is shown by a systematic bias and residual error of 0 ± 11% [Formula: see text]O(2peak). Fat oxidation rates remained stable across 30 min of steady-state exercise in overweight boys. Furthermore, Fat(max) was similar at 3, 10, 20 and 30 min of exercise, suggesting that for exercise lasting ≤ 30 min, exercise duration does not affect Fat(max). However, Fat(max) determined with GRAD may need to be interpreted with caution at the individual level given the variation in Fat(max) between protocols.

Substrate oxidation in overweight boys at rest, during exercise and acute post-exercise recovery.

OBJECTIVE: To compare substrate oxidation between normal weight (n = 10) and overweight (n = 10) boys at rest, during exercise at 50% VO(2peak) and during the first 30 minutes of recovery post-exercise. STUDY DESIGN: Twenty boys (8-11 years) were tested over two separate occasions. At the first session, body composition was measured by Dual-Energy X-ray Absorptiometry and peak aerobic capacity (VO(2peak)) was assessed using an incremental treadmill protocol. At least one week later, substrate oxidation was determined via indirect calorimetry in the fasted state at rest, during 10 minutes of exercise at 50% VO(2peak) and during the first 30 minutes of acute recovery post-exercise. RESULTS: There were no significant differences in substrate oxidation between the two groups at rest or during exercise. However, during early recovery, respiratory exchange ratio (RER) transiently increased in the overweight boys (p = 0.034) but not in the normal weight boys (p = 0.796), with a shift towards greater carbohydrate oxidation in the former group at 15-20 (p = 0.044) and 25-30 (p = 0.052) minutes post-exercise. In contrast, absolute post-exercise fat oxidation was similar between the two groups. CONCLUSION: Overweight boys may oxidise fat less efficiently than normal weight boys during recovery post-exercise, deriving a greater proportion of energy from carbohydrate oxidation.