Disease Symptom Management Research Articles

Can general exercise training and pelvic floor muscle training be used as an empowering tool among women with endometriosis? Experiences among women with endometriosis participating in the intervention group of a randomized controlled trial

BackgroundThe potential benefit of exercise in alleviating symptoms of endometriosis is unclear. Still, exercise may be used to empower women and manage disease symptoms. The purpose of this study was to explore how regular supervised group- and individual exercise training, including pelvic floor muscle training (PFMT), is experienced among women with endometriosis after participating in a randomized controlled trial (RCT).MethodsAmong 41 women randomized to exercise training for four months, ten women were interviewed about their experiences with exercise training after participation in the trial. The weekly group training was led by women’s health physiotherapists and included individualized and progressive muscular strength training of large muscle groups and the pelvic floor muscles, in addition to endurance-, flexibility, and relaxation training. An individual training program followed the same principles as the group training and was to be performed 3–5 times per week, depending on the level of intensity. PFMT was recommended daily. The women also received a group pain management course emphasizing exercise training as self-management. Using inductive reflexive thematic analysis, responses to the question “Did participation in the study change your view of exercise as part of the treatment for endometriosis?“ were analyzed.ResultsThe women brought forward the importance of knowledge about the benefits of exercise to make informed decisions in disease management. Further, the women described how exercise training was perceived as less frightening and manageable when exposed to various intensities, dosages, and types of exercises in a safe and supportive environment. PFMT was especially brought forward as something new and appreciated, and for some of the women, to be performed on days when their bodies could not handle the general exercise training. They also expressed that the supervised exercise brought an extra dimension of belonging through group participation.ConclusionsIndividualization and regular supervision seem important to empower women with knowledge about exercise training as self-management and to experience exercise training as safe and non-threatening. Further, creating a sense of belonging through group training may improve social support and build active coping strategies that are essential for disease management of endometriosis.Trial registrationNCT05091268 (registered 23.09.2021).

A meta-analysis of person-centered care interventions for improving health outcomes in persons living with dementia.

Person-centered care emphasizes the importance of valuing and supporting the humanness of a person living with dementia as compared to focusing heavily on disease symptom management and treatment. The state of the evidence and outcomes from person-centered care is unclear and is an important knowledge gap to address informed evidence-based care for persons living with dementia. To synthesize the evidence on the efficacy of person-centered care in improving health outcomes in people living with dementia. Our search using the following databases: Academic Search Complete, CINAHL, COCHRANE library, EMBASE, MEDLINE, PubMed, and Google Scholar. The methodology quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were performed using the DerSimonian and Laird random effects model to investigate the effectiveness of person-centered care on improving health outcomes in persons living with dementia. Seventeen trials were included in this systematic review and meta-analysis. Person-centered care implementation was found to improve cognitive function (pooled SMD: 0.22; 9CRD420223808975% CI [0.04, 0.41], p = .02) in persons living with dementia, although outcomes including the impact of the care model on activities of daily living, agitation, depression, and quality of life remain inconclusive. Person-centered care improves the cognitive function of persons living with dementia, which is clinically meaningful and should not be ignored or overlooked in delivering evidence-based care to this population. The findings of this study emphasize the importance of person-centered care implementation among people living with dementia as an approach in improving health outcomes particularly on cognitive function improvement. Person-centered care emphasizes the personhood of individuals living with dementia while respecting their needs, values, and beliefs and is identified as a preferred model of delivering dementia care in all settings as a non-pharmacological approach.

Quality of life among adults with scabies: A community-based cross-sectional study in north-western Ethiopia.

Scabies undermines quality of life through its highly disturbing disease symptoms, by distorting self-perception, and secondary to social stigma. Knowledge of its effect on quality of life in general and on specific aspects of day-to-day life is key to addressing the health needs of individual patients and to evaluating gains from community-based disease control interventions. To measure the effect of scabies on the quality of life of people with the infestation. A community-based cross-sectional study was conducted in a scabies outbreak-affected district in north-western Ethiopia. The study involved 381 households and 86 adults with scabies. We used the ten-item Cardiff Dermatology Life Quality Index (DLQI) tool to collect data. Cronbach's alpha value was used to determine the internal consistency of the Amharic version of the scale. Overall and Dermatology Life Quality (DLQ) domain specific mean scores were calculated. The association between sociodemographic characteristics and scabies-related life quality impairment was tested using Kruskal-Wallis test. Scabies moderately affected the quality of life of adults with scabies. The overall mean DLQI (mDLQI) score was 9.2 (SD = 7.6). 'Symptoms and feelings' and 'daily activity' DLQ domains had the highest mDLQI scores (3.5, SD = 1.9 and 2.2, SD = 2.5, respectively). 'Leisure activities' was the least affected domain 0.8 (SD = 1.1). In terms of severity, scabies had moderate or severe effect on DLQ of 54.7% of the participants and extremely severe effect was reported among 27% of the participants. However, no association was observed between sociodemographic characteristics and quality of life impairment. Quality of life was moderately impaired among people affected by scabies. Refocusing attention on management of disease symptoms, using standard scabies treatment, and providing psychosocial support to improve self-perception of people affected with scabies may help reduce quality of life impairment.

Patient satisfaction in the use of non-pharmacological therapies in the management of postoperative pain: a study in a tertiary hospital, Ghana

ABSTRACT Background: Non-pharmacological therapies are complementary to pharmacological therapies for managing disease symptoms, including pain, and can be integrated into a self-management program, enhancing patient independence and autonomy. It has been discovered that therapies that are non-pharmacological for pain relief are effective with minimal side effects. This study, therefore, seeks to determine how frequently non-pharmacological methods (NPMs) are used in the management of postoperative pain (POP) and the influence of these NPMs on patient satisfaction. Methods: This study had a descriptive cross-sectional design. A quantitative approach was used with a structured questionnaire based on the International Pain Outcome Questionnaire (IPO-Q) to obtain responses from patients from October 2019 to December 2019. Results: The majority of the patients, 52.2%, responded using some form of (NPM) for pain relief. The most widely used non-pharmacological method of pain relief was mobilization, representing 79.2%. The male participants were observed to use more NPMs for pain relief. Most patients (51.4%) who used NPMs for pain relief reported that their pain was not relieved. A majority (90.6%) of the participants desired more pain treatment. The type of surgery the patients underwent had a statistically significant negative correlation with using NPMs for pain relief. A higher percentage (71%) of participants were highly satisfied with their overall pain treatment. Conclusion: Pain is subjective, and it would be appropriate if patients were allowed to describe the location and intensity of their pain and choose their preferred NPMs which would be of help.

Digital Solutions Available to Be Used by Informal Caregivers, Contributing to Medication Adherence: A Scoping Review.

Medication adherence is essential for managing chronic diseases and achieving optimal health outcomes. However, this process is often challenging, particularly for patients with complex care needs. Informal caregivers play a pivotal role in supporting medication management, but they may face resource limitations and a lack of necessary support. Digital health tools offer a promising avenue to enhance medication adherence by providing reminders, education, and remote monitoring capabilities. This scoping review aimed to identify and evaluate digital solutions available to informal caregivers for improving medication adherence. A systematic search of PubMed and Web of Science was conducted using relevant keywords. Four studies were included in the review, examining a variety of digital tools including mobile apps, SMS messaging, and wearable devices. These tools demonstrated efficacy in improving medication adherence, managing disease symptoms, and enhancing quality of life for patients and caregivers. Digital health interventions hold the potential to revolutionize medication adherence among chronic disease patients. By empowering informal caregivers, these tools can bridge the gaps in medication management and contribute to better health outcomes. Further research is warranted to optimize the design, implementation, and evaluation of digital interventions for medication adherence.

The Baseline Self-Efficacy Scores to Manage Chronic Diseases Amongst Nigerian Patients with Non-Communicable Diseases are Sub-Optimal.

Nigeria is one of the developing countries with a major burden of non-communicable diseases (NCDs) without a disease self-management program in its healthcare system. Thus, this study was aimed to assess the baseline self-efficacy levels of Nigerian patients with chronic NCDs at tertiary level hospitals. This is a cross sectional study of 286 NCD patients attending tertiary level clinics from 26 July to 27 October 2023. Patients were interviewed on a 10 Self-Efficacy to Manage Chronic Disease (SEMCD) item scales that were considered suitable for the Nigerian population. The 10 SEMCD questions covered: (i) Exercise regularly scale, (ii) Help from community, family and friends scale, (iii) Communication with Physician scale, (iv) Manage disease scale and (v) Manage symptom self-efficacy domains. Data were analyzed both descriptively and statistically using Student's t-tests and Chi-square tests as appropriate. The results showed that more female (59.4%) than males (40.6%) attended clinics during the study, and the mean age of the patients did not differ between gender (P > .05). About 40% of all the patients manage their NCDs with medications alone, a trend that is similar in male and female patients (P > .05). While all the patients had a relatively lower self-efficacy scores under regular exercise scale (52%-55%) and manage disease symptoms scale (53%-55%), they tended toward higher self-efficacy scores under getting assistance from community, family, and friends (79%-80%) and communication with attending physicians (81%-85%). It is concluded that Nigeria literate NCD patients registered at tertiary level institution routine clinics are less than optimal in disease self-management care. We recommend that this study population will benefit from introduction and implementation of disease self-management program in the healthcare system.

Impact of a transitional care program for heart failure patients at Baylor Scott & White Health: a pilot study

Heart failure is a chronic health condition characterized by complex symptom management and costly hospitalizations. Hospitalization for the treatment of heart failure symptoms is common; however, many hospitalizations are thought to be preventable with effective self-management. This study describes the small, pilot implementation of a new, interventional, self-management heart failure program, “Engagement in Heart Failure Care” (EHFC), developed to assist heart failure patients with the management of disease symptoms following discharge from an inpatient hospital stay. EHFC was designed to engage patients in managing their symptoms and coaching them in skills that enable them to access medical and supportive care services across community, clinic, and hospital settings to help address both their current and future needs. The results of this pilot study suggest that EHFC’s coaching model may have positive benefits on key health and well-being indicators of the patients enrolled.

Comparative Evaluation of Nutritional Pattern and Quality of Life the Subjects with Multiple Sclerosis as an Autoimmune Disease and Some of Its Risk Factors in Zabol City

Background: The autoimmune disease of multiple sclerosis is characterized by inflammation and nerve tissue destruction. There are documents for the nutritional factors' effects on the occurrence and disease cycle. Food pattern is an essential factor in chronic disease prognosis. This study was designed to investigate the status of the nutritional pattern and quality of life of MS patients.
 Methods: The number 40 MS patients who have been referred to Zabol Red Crescent and MS Association for Services and Medicine during the past year were enrolled in the initial stage of registration. Finally, 30 patients were included in the study and were examined in three types of diet (unhealthy, Mediterranean, and traditional).
 Results: Their Mean ± SD of age, height, and weight of women and men were (35.69 ± 1.8; 40.57 ± 4.22.) years, (162.69 ± 1.25; 175.29 ± 2.54) cm, and (64.0 ± 2.36; 71.14 ± 3.78) kg respectively. The majority of women and men were at the high school level 56.67% and 57.14% respectively. 61.89 percent of patients followed the Mediterranean pattern. 82.6% of the women and 71.42% of the men suffered from low levels of mental disorders. The most frequency of body mass index belonged to the women group in the third level (39.13%) and the lowest to the fourth group (8.69%). 63.33% of the patients did not do any type of sports. 6.7% of patients with high activity did not have any symptoms of physical disorders. The economic index of the good level in the women and men was 34.78% and 42.85% respectively.
 Conclusion: In this study, the Mediterranean pattern was the most attractive, and the number of physical disorders was more than the number of mental. It was uncovered that providing the required training for modifying dietary patterns can be very effective in the management of disease symptoms.

Addressing Preconception Behavior Change Through Mobile Phone Apps: Systematic Review and Meta-analysis.

Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period. This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies. Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence. Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care. Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods). PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a. RR2-10.1186/s13643-019-0996-6.

Aging-Related Mechanisms Contribute to Corticosteroid Insensitivity in Elderly Asthma.

Asthma in elderly populations is an increasing health problem that is accompanied by diminished lung function and frequent exacerbations. As potent anti-inflammatory drugs, corticosteroids are commonly used to reduce lung inflammation, improve lung function, and manage disease symptoms in asthma. Although effective for most individuals, older patients are more insensitive to corticosteroids, making it difficult to manage asthma in this population. With the number of individuals older than 65 continuing to increase, it is important to understand the distinct mechanisms that promote corticosteroid insensitivity in the aging lung. In this review, we discuss corticosteroid insensitivity in asthma with an emphasis on mechanisms that contribute to persistent inflammation and diminished lung function in older individuals.

Novel Bilayer Elasto-Hydrogel Adhesive Film for Facilitating Wet-Occlusive Therapy for Atopic Dermatitis

Abstract Atopic dermatitis (AD) is a common chronic multifactorial skin disease that causes skin inflammation owing to defects in the skin barrier, immune dysregulation, or infectious agents. The most common treatment of AD utilizes wet-occlusion therapies to create a protective skin barrier by providing moisture to the epidermis. However, these treatments are suboptimal in managing disease symptoms owing to their limited ability to retain or restore skin hydration and inefficient drug delivery. Currently, there are no effective approaches for treating AD that are specifically designed to improve drug delivery efficacy and skin hydration. This study aims to introduce a new approach of localized drug delivery and facilitate more efficient dermal hydration using hydrogels and elastomers. Herein, we report a simple yet effective bilayer elasto-hydrogel adhesive film (BEHAF) dressing made from an interpenetrating alginate and polyacrylamide (alginate/AAm) hydrogel layer backed by a thin film of polydimethylsiloxane elastomer. In an in vitro hydration study, it was found that the BEHAF dressing enabled efficient retention and delivery of hydration to porcine skin and model epidermis for more than 48 h and showed potential for drug delivery of both hydrophobic and hydrophilic drugs. Furthermore, mechanical testing results indicate that the BEHAF mimics the elastic behavior of human skin and shows good adhesion sensitivity, thereby suggesting biomechanical compatibility and suitability for long-term usage. Overall, the BEHAF dressing may provide a viable vehicle for dermal hydration and drug delivery, thereby improving the efficacy of wet-occlusive therapy for treating AD.

Unmet Care Needs in Breast Cancer Survivors: An Integrative Review

Introduction: Understanding the unmet care needs of breast cancer survivors is one of the important aspects of healthcare service. Objective: This study aimed to identify the unmet needs of breast cancer survivors. Materials and Methods: This research is an integrative review of evidence-based studies from five electronic databases (Web of Science, PubMed, Science Direct, Scopus, and Google Scholar), which was conducted with no time limit until December 2020. Eligible articles were critically reviewed and scored using the mixed methods appraisal tool (MMAT). Results: A total of 28 articles were reviewed, including 7 qualitative, 19 quantitative, and 2 mixed methods studies. “Survival care needs” are referred to information needs, unmet communication needs, and management of disease symptoms and complications. The “unperceived support needs” are referred to six themes of self-change, hurting hope, uncertain faith, unmet occupational needs, impaired sexual function, and forgotten social support. Conclusion: As the survival rate of breast cancer increases, developing flexible strategies for long-term and changing unmet needs of these patients should be a priority for health policymakers to promote care for breast cancer patients.

User testing to modify the MyHealthyGut digital health application for inflammatory bowel disease.

Inflammatory bowel disease, characterized by chronic intestinal inflammation, can be subcategorized into Crohn's disease and ulcerative colitis. The treatment for these conditions is unique to each patient and may include lifestyle changes, pharmaceutical intervention, and surgery. Lifestyle changes, such as dietary intervention, are a cornerstone of inflammatory bowel disease symptom management. Given the daily burden of this disease, self-management is paramount in coping with and/or minimizing symptoms. The MyHealthyGut application, successfully proven to be a self-management tool for celiac disease, shows promise for use in an inflammatory bowel disease patient population. To conduct user testing to gather valuable insights for the development of an IBD-focused version of the existing MyHealthyGut app. Participants included inflammatory bowel disease patients and healthcare practitioners. Participants used the application for a 2-week period, followed by participation in a focus group or individual interview to provide feedback. Qualitative questionnaires were administered verbally and feedback was recorded. Thematic analysis techniques were used for data quantification and analysis. 15 participants were recruited and enrolled. Of these, 14 participants took part in the focus group and/or individual interviews. The feedback suggested changes related to clinical uses, food and symptom tracking, ease of use, and educational content. All (100%) participants reported that they would either use the application themselves or recommend it to patients, once their suggestions were implemented. Through user testing and feedback collection, priorities for app modification were identified. Areas for modification in the app functions and features, ease of use, and content were identified. Once updated to meet the needs of inflammatory bowel disease patients, the MyHealthyGut app may be a useful tool for IBD self-management.

Sleep quality of inpatients with a positive diagnosis of COVID-19

Background: Low sleep quality and sleep disturbances are reported to be higher during the COVID-19 pandemic period. This study aimed to evaluate the sleep quality of hospitalized patients with COVID-19 and the factors that affect their sleep quality. Materials and methods: Patients with COVID-19 who were hospitalized at the pandemic clinic of a University Training and Training Hospital between 15 May-15 September 2020 were included. The study included 150 patients who agreed to participate in the study, who were hospitalized in the COVID-19 clinics in a Training and Research Hospital. Adult patients over the age of 18 who had been accepted to participate in were enrolled in the study. The patients who had any diagnosed sleep-related disorders or neurological and psychiatric diseases were excluded. Data were collected using the Personal Information Form, Pittsburgh Sleep Quality Index. Results: The patient’s PSQI score average was significantly higher in females, illiterate, married, and individuals with the first three days of diagnosis of disease. During their 75.2% hospitalization time, sleep patterns deteriorated and 90.0% of those patients also deteriorated 1-3 days after hospitalization. Given the conditions that caused sleep disorders during the time hospitalized, there were causes such as respiratory distress (41.3%), hospital environment (36.1%) and pain (32.0%). The requirements that patients need most to improve their sleep quality during the hospital period may be said to be good management of disease symptoms (36.4%), increased social support systems (33.3%), and communication with health staff (20.0%). Conclusion: For sleep disorders in hospitalized patients with a positive (+) diagnosis of COVID-19, it can be said that 71.3% of the patients have poor sleep quality.

Long-Term Patient-Reported Outcomes Following Treatment with betibeglogene autotemcel in Patients with Transfusion-Dependent β-Thalassemia

Introduction: Patients (pts) with transfusion-dependent β-thalassemia (TDT) have increased morbidity and mortality and reduced quality of life (QoL) compared with the general population owing to the mental, physical, and time demands of chronic transfusions and iron chelation. Autologous gene therapy with betibeglogene autotemcel (beti-cel) therapy uses a modified β-globin gene that establishes stable production of functional adult hemoglobin (Hb), thus allowing for transfusion independence (TI). Pts with TDT were treated with beti-cel in 2 completed phase 1/2 studies (HGB-204, HGB-205) and 2 ongoing phase 3 studies as of Aug 2021 (HGB-207, HGB-212). After 2 years of follow-up, pts could enroll in a long-term follow-up study (LTF-303 [NCT02633943]) for up to an additional 13 years. QoL improvement in the 1-2 years post beti-cel treatment was previously described. Here, we evaluate long term (3 years post-treatment) patient reported outcomes after beti-cel treatment in pts with TDT enrolled in LTF-303. Methods: Pts with TDT underwent hematopoietic stem progenitor cell collection followed by myeloablative busulfan conditioning and beti-cel infusion. TI is defined as weighted average Hb ≥9 g/dL without packed red blood cell transfusions for ≥12 months. Generic health related QoL (HRQoL) over time was assessed using the Pediatric Quality of Life Inventory (PedsQL; range, 0-100) for pediatric and adolescent pts (<18 years old [YO]). Short Form-36 Health Survey Physical Component Summary and Mental Component Summary (SF-36 PCS and MCS, respectively; range 0-100), and the EuroQol (EQ-5D-3L) visual analog scale (VAS; range 0-100) composite index score (range 0-1) for adult (≥18 YO) pts. HRQoL was assessed at baseline (BL), Months (M) 6, 12, 18, 24 (in the parent HGB studies), and M 36, 48, and 60 (in LTF-303) after beti-cel infusion. Pts were excluded from HRQoL analyses if BL or M36 HRQoL assessment was missing as of data cut (Aug 2021). Higher scores indicated improvement in HRQoL. A bespoke questionnaire assessing β-thalassemia and pt-centric aspects of daily living (i.e., ability to work or attend school, physical activity, and perceived benefit from treatment) was completed at M 36. Results: As of August 18, 2021, 57 pts were enrolled in LTF-303 (phase 1/2: 22 pts; phase 3: 35 pts), of which 26 (45.6%) were pediatric / adolescent pts and 31 (54.4%) were adult pts. Among pts <18 YO with PedsQL data who achieved TI, the mean (standard error (SE)) PedsQL total score (population norm = 80.9) increased from 77.4 (3.4) at BL (n=19) to 92.1 (4.2) at M 36 (n=4). Among adult pts with SF-36 data who achieved TI, the mean (SE) SF-36 PCS and MCS scores (US general population norm = 50) increased from 53.8 (1.4) and 50.9 (1.7), respectively, at BL (n=12) to 55.7 (1.7) and 56.3 (1.4) at M 36 (n=9), respectively. The mean (SE) EQ-5D-3L Composite Index and VAS scores increased from 0.92 (0.04) and 85.2 (3.0), respectively, at BL (n=12), to 0.95 (0.03) and 91.4 (2.2) at M 36 (n=9) (Table 1). Data from the M 36 testimonial questionnaire (Figure 1) showed the ability to seek employment or be employed, increased from 68.8% (11/16) of pts at BL to 93.8% (15/16) at M 36. There was a reduction in school absences at M 36 (44.4% [4/9] missing school) compared with BL (83.3% [15/18] missing school). 50% (10/20) of pts still required management of disease symptoms at M 36. 80% (16/20) of pts reported improvement in physical activity at M 36. 100% (19/19) of pts reported an overall benefit from undergoing treatment with beti-cel. Conclusions: Published data shows beti-cel is potentially curative in pts with TDT, defined as having TI with normal or near-normal Hb. It was previously shown that with high-range QoL at BL, QoL improved at 1-2 years post-beti-cel. The updated data indicates durability of QoL improvement through year 3. A trend towards a positive impact on employment, school attendance, physical activity, and other aspects of life is also observed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

O51 - Reviewing the evidence: preconception behaviour change through mobile phone apps

Mobile phone applications offer the potential of extensive reach for public health interventions in the preconception period. Women are often motivated to positively change their behaviour in preparation for pregnancy to enhance health and wellbeing. Positive health behaviour changes can optimise perinatal outcomes of both mother and baby and future generations. To synthesize evidence of the effectiveness of mobile phone applications in promoting positive behaviour changes for women of reproductive age that may improve future outcomes for mothers and babies. Five databases were searched in February 2021 for studies exploring the use of mobile phone applications as an intervention pre-pregnancy or post-pregnancy to promote positive behaviour change. Risk of bias and data extraction was conducted by two independent reviewers. Data was pooled using a random-effects model and the GRADE system was used to assess the certainty of the evidence. Of 2,973 publications identified, seven studies were included. Four studies included postpartum participants and three included women considered to be in the preconception period. Five studies focused on behaviours for weight reduction, assessing outcomes of reduction in adiposity and weight. Nutrition and dietary outcomes were assessed in two studies with collected data including kilojoule and caloric and macronutrient intake. Two studies used dietary risk scores to assess this outcome. Blood pressure was measured in four studies and a range of biochemistry tests and markers associated with management of disease symptoms were included. Meta-analysis showed that mobile phone applications were favourable when compared against standard care however the results were not statistically significant. This systematic review suggests there is potential for mobile phone applications to influence behaviour in the preconception period. Most information is for weight reduction and dietary changes in the general population. Future research must address more preconception issues in both general and high-risk populations.

Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study

BackgroundEnd-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU).MethodsThis quasi-experimental study was conducted with a pretest–posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR).ResultsA significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001).ConclusionsEnd-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

Orally administered antigen can reduce or exacerbate pathology in an animal model of inflammatory arthritis dependent upon the timing of administration.

Currently, treatments for rheumatoid arthritis (RA) are focussed on management of disease symptoms rather than addressing the cause of disease, which could lead to remission and cure. Central to disease development is the induction of autoimmunity through a breach of self-tolerance. Developing approaches to re-establish antigen specific tolerance is therefore an important emerging area of RA research. A crucial step in this research is to employ appropriate animal models to test prospective antigen specific immunotherapies. In this short communication, we evaluate our previously developed model of antigen specific inflammatory arthritis in which ovalbumin-specific T cell receptor transgenic T cells drive breach of tolerance to endogenous antigens to determine the impact that the timing of therapy administration has upon disease progression. Using antigen feeding to induce tolerance we demonstrate that administration prior to articular challenge results in a reduced disease score as evidenced by pathology and serum antibody responses. By contrast, feeding antigen after initiation of disease had the opposite effect and resulted in the exacerbation of pathology. These preliminary data suggest that the timing of antigen administration may be key to the success of tolerogenic immunotherapies. This has important implications for the timing of potential tolerogenic therapies in patients.

Considerations for clinical trial design and conduct in the evaluation of novel advanced therapeutics in neurodegenerative disease.

The recent advances in the development of potentially disease modifying cell and gene therapies for neurodegenerative disease has resulted in the production of a number of promising novel therapies which are now moving forward to clinical evaluation. The robust evaluation of these therapies pose a significant number of challenges when compared to more traditional evaluations of pharmacotherapy, which is the current mainstay of neurodegenerative disease symptom management. Indeed, there is an inherent complexity in the design and conduct of these trials at multiple levels. Here we discuss specific aspects requiring consideration in the context of investigating novel cell and gene therapies for neurodegenerative disease. This extends to overarching trial designs that could be employed and the factors that underpin design choices such outcome assessments, participant selection and methods for delivery of cell and gene therapies. We explore methods of data collection that may improve efficiency in trials of cell and gene therapy to maximize data sharing and collaboration. Lastly, we explore some of the additional context beyond efficacy evaluations that should be considered to ensure implementation across relevant healthcare settings.

Examination of Self-Efficacy and Quality of Life of Patients with Type 2 Diabetes Regarding Diabetes Management

Purpose: Good self-management in patients with diabetes will help them to maintain their well-being and quality of life, and the control of risk factors will make it possible to manage disease symptoms and to prevent complications. This study was carried out to determine the self-efficacy levels of patients with type 2 diabetes regarding their care and the factors affecting them and to examine the relationship between patients’ self-efficacy and quality of life. &#x0D; Methods: This study used a cross-sectional design and was carried out with a total of 342 patients with type 2 diabetes. The Diabetes Management Self-Efficacy Scale (SES) was employed to evaluate diabetes self-efficacy levels of the patients, and the WHO Quality of Life Scale-Brief Form was used to evaluate their quality of life. &#x0D; Results: The mean of the scores that the patients obtained from the SES scale was 64.16 ± 12.09. Diabetes self-efficacy was higher in patients who were married, were university graduates, had received training/information related to the disease, did not have any other chronic diseases, and did not exhibit any complications (p