Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the autologous stem cell transplant population: a theory-based interview study.

PURPOSE: Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant. METHODS: Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses), and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium, or low priority. RESULTS: Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g. multidisciplinary teamwork); Beliefs about consequences (e.g. patient benefit); Memory, attention, and decision processes (e.g. refer as early as possible); and Environmental context and resources (e.g. electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention, and decision processes (e.g. conflicting views about who should be referred); Environmental context and resources (e.g. lack of time); Social influences (e.g. families); and Emotions (e.g. patient distress). CONCLUSION: Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.

Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre.

PURPOSE: Evaluate the impact of a new multidisciplinary allied health prehabilitation service in haematologic cancer patients receiving high-dose chemotherapy with autologous stem cell transplant (AuSCT). METHODS: In a tertiary cancer centre, 12 months of prospectively collected data was retrospectively analysed. Patients were referred to an allied health service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated using the RE-AIM framework: patient uptake of the service and sample representativeness (reach); effectiveness in terms of changes in outcomes from initial to pre-transplant assessment; adoption of the service by key stakeholders; fidelity of the prescribed exercise program (implementation); and the extent to which the new service had become routine practice (maintenance). RESULTS: One hundred and eighty-three patients were referred to the AuSCT service over 12 months, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Patients were representative of Australian AuSCT patients. Eighty-nine patients reached pre-transplant assessment by data censoring; 6-min walk distance (n = 45/89, 51%) improved a mean (95% CI) of 39.9 m (18.8 to 61.0, p = < 0.005) from baseline. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended exercise interventions. The referral trend over time (maintenance) was high after the initiation period. CONCLUSION: The prehabilitation service was well adopted by clinicians. Clinically relevant improvements in outcomes were demonstrated. Recommendations, including development of well-integrated discipline-specific assessment intervention and measurement protocols, are highlighted for service improvement. Prehabilitation should be routinely considered to support patients undergoing AuSCT.

The digital health divide: Understanding telehealth adoption across racial lines in rural Illinois.

Due to long-standing barriers to healthcare access in rural areas, telehealth has been promoted as an effective means of delivering healthcare services. However, there is a general absence of quantitative data showing how geographic residence and race affect telehealth adoption. This study examines variations in telehealth adoption based on race and geographic residence in Southern Illinois using a mail survey. It finds that residents of urban Carbondale, compared to those in rural Cairo, have better access to broadband and are more likely to use telehealth. Respondents significantly differ from each other based on their geographic location of residence and race when it came to using telehealth to save money on travel and to save money on childcare. A significant barrier to telehealth adoption identified across all groups is privacy protection concern. The findings highlight the crucial role of broadband infrastructure in healthcare access and the need for trust in telehealth systems to ensure data privacy.

Infected myometrial hematoma due to malpositioned levonorgestrel intrauterine device: A case report.

This case report highlights serious permanent sequelae of a malpositioned levonorgestrel intrauterine device. Initial cervical injury resulted in fistula formation and large hematoma eventually requiring hysterectomy. Uterine depth less than 5.5 cm should prompt timely evaluation, and immediate replacement is not advised when there is concern for injury.

Exercise recommendations and referral patterns of oncology professionals.

BACKGROUND: Exercise physiologists and physiotherapists can provide exercise interventions for cancer survivors; however, many do not access this support. Our primary aim explored referral habits to exercise professionals and attitudes of oncology professionals. Secondary aims explored fitness levels of oncology professionals and the relationship between fitness and exercise referral habits. METHODS: Oncology professionals (n = 67) attending a national cancer conference in Australia participated in this cross-sectional study (23% doctors, 11% nurses, 25% allied health, and 41% other). A subgroup (n = 49) completed a fitness assessment measuring aerobic fitness (3-minute step test), muscle strength (handgrip dynamometry), and body composition (waist-to-hip ratio). Oncology professionals in a position to refer patients to exercise professionals were assessed on their history of patient referrals. RESULTS: Sixty-seven of 750 eligible conference delegates participated (9% recruitment rate), of which 73% completed fitness assessments. Participants displayed above average physical activity and fitness levels with 60% meeting exercise guidelines. The majority (92%) agreed that exercise is important among cancer survivors to attenuate treatment-associated symptoms. Most understand the role of exercise physiologists (61%) and physiotherapists (64%) in cancer care. Seventy-three percent reported that referral to exercise professionals is optimal to increase exercise participation. Most (82%) oncology professionals who are able to refer patients to exercise professionals have self-reported doing so, while 91% recommended exercise themselves. Sixty-two percent were aware of evidence-based exercise guidelines. Fitness levels (p = 0.25), strength (p = 0.88), and physical activity (p = 0.33) did not impact referrals made to exercise professionals. CONCLUSION: There was high awareness exercise-oncology benefits and evidence-based guidelines existed among sampled participants. Oncology professionals understand the role of exercise professionals, reflected by high self-reported referral rates. Implementing referral pathways to exercise professionals in cancer care may facilitate improved patient outcomes.

Electrophilic chemistry of propargylic alcohols in imidazolium ionic liquids: propargylation of arenes and synthesis of propargylic ethers catalyzed by metallic triflates [Bi(OTf)3, Sc(OTf)3, Yb(OTf)3], TfOH, or B(C6F5)3.

Metallic triflates M(OTf)(3) (M = Bi, Sc, Yb), immobilized in imidazolium ionic liquids [BMIM][BF(4)], [BMIM][PF(6)] and [BMIM][OTf] are efficient systems for one-pot reactions of propargylic alcohols 1,3-diphenyl-2-propyn-1-ol Ia, 1-methyl-3-phenyl-2-propyn-1-ol Ib, and 2-pentyn-1-ol Ic, with a wide range of arenes bearing activating substituents, under mild conditions. The [BMIM][PF(6)]/B(C(6)F(5))(3) and [BMIM][PF(6)]/TfOH systems were superior in propargylation with Ib and Ic, while reaction of 3-phenyl-2-propyn-1-ol Id with activated aromatics resulted in the formation of diaryl-propanones instead. Propargylation of anisole with Ib under M(OTf)(3) catalysis is highly para selective, but with TfOH or B(C(6)F(5))(3) as catalyst the ortho isomer was also formed. Steric influence of the propargylic moiety on substrate selectivity is reflected in the lack of ortho propargylation for phenol and ethylbenzene by using propargylic alcohol Ia, and notable formation of the ortho isomer employing alcohol Ib. In the later case para selectivity could be increased by running the reaction at r. t. for 10 h. The Bi(OTf)(3)-catalyzed reaction of 1,3-dimethoxybenzene with Ia led to minor formation of dipropargylated derivative, along with the monopropargyl product. Propargylation of the less reactive arenes (mesitylene, ethylbenzene, toluene), using Sc(OTf)(3) as catalyst, led increasingly to the formation of dipropargylic ethers and propargyl ketones, with no ring propargylation product with toluene. Concomitant formation of dipropargylic ether was also observed in Yb(OTf)(3)-catalyzed propargylation of ß-naphthol, whereas propargylation of 2-nitro and 4-nitro-aniline led to N-propargylation. The recycling/reuse of the IL was demonstrated in representative cases with no appreciable decrease in the conversions over 3 cycles. It was also shown that recycled IL could be used to propargylate a different aromatic compound. The efficacy of IL/M(OTf)(3) and IL/TfOH systems for cross-breeding two propargylic alcohols or a propargylic alcohol with a non-propargylic alcohol and/or self-coupling, to form a wide variety of functionalized ethers is also demonstrated.