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147 Successful Strategies Supporting Recruitment, Intervention Delivery and Retention Targets in a Randomized Controlled Trial of a Complex Intervention

Background: Complex interventions are widely used in modern health care practice and are defined as those having potentially interacting components. Evaluation can be challenging due to difficulties in logistics, standardisation and delivery. In addition, there can be difficulty recruiting to time and to target (particularly in multicentre studies) and minimising attrition and data loss. We report how the RAFT study [a seven-centre randomized controlled trial (RCT) comparing a complex group cognitive-behavioural (CB) intervention with standard care for the reduction of fatigue impact in patients with RA) is implementing successful strategies to meet recruitment, intervention delivery and retention targets. The study requires patients to make a substantial commitment over a 2 year period and for the intervention to be delivered by routine clinical staff trained for this purpose. Methods: The following strategies were agreed upon during the planning and design phase: Maximising recruitment: Funded research nurse time at all seven sites; mailshot option for approach; recruitment posters for clinics; flexible and pragmatic approach to session attendance; telephone, email and postal contact; newsletter and regular knowledge exchange between the central trial management team and sites; weekly recruitment updates and reviews. Ensuring intervention delivery: Flexible course dates and times set by each site, regular communication with the central management team to discuss foreseeable issues and preventative actions, provision of real-time clinical supervision and full-time telephone/email support. Minimising attrition and data loss: Primary outcome collection by telephone, ensuring regular personal contact; secondary data collection by postal questionnaire, reducing the number of hospital visits; telephone reminders; partial withdrawal options; personalized letters and thank you cards. Patient involvement: We had a number of acceptability and feasibility consultations with our two patient partners. Both partners had prior experience attending the intervention, were co-applicants on the grant proposal and continue to provide a patient perspective as members of the trial management group. Results: Our target was to recruit 300 participants with no recent medication changes and a fatigue level ≥6 (on a 1–10 scale where 10 is totally exhausted). During the 2 year recruitment phase, 333 participants were randomized (11% over target). All 28 programmes successfully delivered, with 7/7 sites and 14/15 tutors remaining fully engaged with the study. Retention at 6 months is currently 92.5% (sample size allows for 20% attrition). Data returned by those reaching the 6 month time point are 100% for the primary outcome and 97% for secondary outcomes. Conclusion: Advanced planning and consistent application of these strategies has ensured success so far. A flexible and pragmatic approach, regular communication between local and central teams, personal contact with participants and extensive patient partner input are key components.

Factors Related to the Use of Herbal Products and Derivatives from Consumers’ Perspective in Kota Kinabalu, Sabah: An Initial Study

ABSTRACT: This initial study was done to identify consumers’ inclinations and perspectives on issues regarding health and natural resources in using herbs and herbal products. Questionnaires were distributed at three different locations around Kota Kinabalu, Sabah, Malaysia to respondents of different ethnic and working groups. The respondents were required to respond to questions which probed factors such as consumers’ habits and behaviours, awareness and perceptions, preferences and choices as well as influences of the mass media. The study found that factors impinging on consumers’ inclinations such as product commercialisation, preferences, media influences, and job opportunities have positive impacts. The identification and property of these factors contribute to enhancement of a model for consumers development towards healthier lifestyle through increased consumption of natural and herbal products. The future application of an enhanced model which acknowledge these contributing factors would benefit planning and implementation of consumer development strategies. Key words : natural, herbal, model, consumer development, healthy lifestyle, and healing practices. About the Authors: Noraini Abdullah is a Lecturer at the Mathematics and Finance Program in the School of Science & Technology UMS (Malaysia University of Sabah). She is contactable via noraini@ums.edu.my ; and Suhaimi Salleh is a Senior Lecturer at the Communication Program of the School of Social Sciences UMS (Malaysia University of Sabah). His e-mail contact is suhaimi.binsalleh@gmail.com How to cite this article? Abdullah, Noraini & Suhaimi Salleh. (2010). “Factors Related to the Use of Herbal Products and Derivatives from Consumers’ Perspective in Kota Kinabalu, Sabah: An Initial Study” in SOSIOHUMANIKA: Jurnal Pendidikan Sains Sosial dan Kemanusiaan , Vol.3, No.1 [Mei], pp.143-154. Bandung, Indonesia: Minda Masagi Press, UNIPA Surabaya, and UMS Kota Kinabalu, Malaysia, ISSN 1979-0112. Chronicle of article: Accepted (February 7, 2010); Revised (March 9, 2010); and Published (May 20, 2010).

Corrections: Mental Health Status of Patients With HIV/AIDS in the South of Iran

Recently, we published an article in the Health Scope journal entitled “Mental Health Status of Patients with HIV/AIDS in the South of Iran” (1). We are regret to inform that we missed referencing the following sentence from the paper written by Haghdoost et al. (2011) (2): “It is suggested that by 2014 about 106000 individuals in Iran will be living with HIV infection and there are estimated to be approximately 7,000 new cases annually.” We contacted the publisher of this journal with email and telephone contacts to add the missed reference to the article, however it was impossible as the article was recently published. Authors very much apologize authors of this paper and also the Health Scope journal for this discomfort.

Faculty Role: A Choice of Styles.

Most faculty receive copious amounts of information about the various generations and their characteristics - the Millennials, the Gen-Xers, etc. - and strategies to engage them. Although meeting the needs of learners and tailoring our strategies to be optimally effective with each group have merit, it is important to consider the roles we choose. It is inappropriate to assume that, as faculty, we will simply mold ourselves to the needs of various students. Rather, we need to consider our role and the interactions that best fit the situation.Potentially more significant than generation definitions is the fact that our speedy technology brings new demands, challenges, and opportunities for the faculty role. With vast social media networks and direct email contact, it is easy to understand how students fall into interactions where they treat faculty like their best buddies. I still gasp when I receive an email addressed, Hi Dean, as if dean were my first name and not my title. We select the role style, not the students.In the mid-1900s, universities and colleges often emphasized their roles as in loco parentis, in the place of parents. Here the action is to guide and direct the next phase of a learner's development. As a community, we continue teaching learners about making good choices. The university's code of conduct sets standards and assigns consequences for unacceptable behaviors such as cheating and binge drinking. Taking the parental role to guide is part of what faculty do, as we construct curricula and courses to build the intellect. We use a parental approach often to nurture the formation of young professionals, particularly in strengthening their caring hearts as respect for all persons. We shape concepts of professional conduct as personal integrity and responsibility in the professional life. In loco parentis is part of faculty life.Faculty sage (whetheron the stage or off)is another rolechoice. In this mode, faculty knowledge is revered, and faculty members are approached with deference. In many ways, the sage guides all interactions, because ultimately the sage knows the best choice. In nursing, those who bring true practice situations into dialogues often are the most revered, because they demonstrate real-world knowledge and answers. There are distinct advantages to this role, when well executed, in that learners are captivated by the scenarios and may grasp important concepts that would have escaped them without the real-world illustration.Leamnson (1999) speaks of another role, the adult friend, someone who approves of [students] as learners and persons (p. …

농촌거주 여성독거노인의 우울성향에 영향을 미치는 변인에 관한 연구 - 도시여성독거노인과의 비교를 중심으로 -

The purpose of this study was to explore the factors related to depression of female elderly living alone by region. Data for this study was based on the 2011 National Survey on Elderly. Total of 1,684(689 rural elderly, 995 urban) community samples of female elderly living alone participated in this study. Even though there was no difference of depression score by region, this study found that the effects of factors on depression were significantly different by region. Yearly income, subjective health, balanced exchange of emotional support and satisfaction with their children were significantly associated with depression of both rural and urban female elderly living alone. For rural female elderly living alone, average daily television viewing time, number of close friends and frequency of contact with friends/neighbors were significant predictors to their depression. In the case of urban female elderly living alone, exercise, frequency of message, email or telephone contact with friends/ neighbors and balanced exchange of economic support contributed significantly to the prediction of depression. Subjective health had the strongest effect on depression for both rural and urban female elderly living alone.

Lessons learned while building the Deepwater Horizon Database: Toward improved data sharing in coastal science

Process studies and coupled-model validation efforts in geosciences often require integration of multiple data types across time and space. For example, improved prediction of hydrocarbon fate and transport is an important societal need which fundamentally relies upon synthesis of oceanography and hydrocarbon chemistry. Yet, there are no publically accessible databases which integrate these diverse data types in a georeferenced format, nor are there guidelines for developing such a database. The objective of this research was to analyze the process of building one such database to provide baseline information on data sources and data sharing and to document the challenges and solutions that arose during this major undertaking. The resulting Deepwater Horizon Database was approximately 2.4GB in size and contained over 8 million georeferenced data points collected from industry, government databases, volunteer networks, and individual researchers. The major technical challenges that were overcome were reconciliation of terms, units, and quality flags which were necessary to effectively integrate the disparate data sets. Assembling this database required the development of relationships with individual researchers and data managers which often involved extensive e-mail contacts. The average number of emails exchanged per data set was 7.8. Of the 95 relevant data sets that were discovered, 38 (40%) were obtained, either in whole or in part. Over one third (36%) of the requests for data went unanswered. The majority of responses were received after the first request (64%) and within the first week of the first request (67%). Although fewer than half of the potentially relevant datasets were incorporated into the database, the level of sharing (40%) was high compared to some other disciplines where sharing can be as low as 10%. Our suggestions for building integrated databases include budgeting significant time for e-mail exchanges, being cognizant of the cost versus benefits of pursuing reticent data providers, and building trust through clear, respectful communication and with flexible and appropriate attributions.

Getting home care right.

❛Even if they are not in regular contact with many of those receiving home care, community nurses can help support the knowledge needs of home care workers.❜ At last, the National Institute for Health and Care Excellence (NICE) with the support of the Social Care Institute for Excellence (SCIE) has published guidance (NICE, 2015) setting out the principles for high-quality home care together with the essential elements of acceptable home-care delivery, including the use of telecare. The guidance also recommends close joint working between health-care staff and those delivering home care, with particular reference to medications and other aspects of health support, so that home care workers are able to provide the necessary high-quality, person-centred support to maximise the health and wellbeing of their clients. The growing need for and expansion of home-care services is inevitable as the population ages. Yet, there are major concerns about the sustainability of the current levels of recruitment and retention across the UK, in part reflecting the rising expectations of the workforce (Hussein et al, 2015). Hussein et al’s study, using a national dataset 2008–2010 and comprising 2964 employers, found that although vacancy rates had fallen slightly, the workforce was characterised by high turnover with variability across individual employers. They particularly noted that the home-care workforce had lower stability and higher vacancy rates than those working in care homes, which bodes ill for meeting the future needs of the growing population of older people living in their own homes. The NICE (2015) guidance emphasises the importance of person-centred care, which supports the preferences and aspirations of those receiving care while recognising the higher risk of unmet social care needs of people with cognitive impairments or among those living alone. The importance of respectful care with the involvement of clients and their carers in decision making is stressed, together with the agreement of mutual expectations regarding care delivery. A major challenge for care providers is continuity of care when there are multiple visits each day, but it is the basis for relational trust; moreover, for many, the face-to-face contact is crucial for their psychological wellbeing. For the first time, a minimum visit time of 30 minutes is recommended, but visits may need to be longer where the care visits comprise many activities, including supporting a client’s eating and drinking. Community nurses are also important contributors to supporting people in their homes. Even if they are not in regular contact with many of those receiving home care, community nurses can help support the knowledge needs of home-care workers with regard to medications, pain management, and skin care, in addition to the health conditions of their clients, such as heart failure; diabetes mellitus; neurological conditions; physical disabilities; and mental health problems such as anxiety, depression, cognitive impairment, and dementia. They may also help to undertake the risk assessment and contribute to the risk plan. The NICE (2015) guidance also makes clear that telecare should not replace human contact, but it may be used as an adjunct offering reassurance to the client and/or their carer between visits or other social contacts. Indeed, a recent, large longitudinal study (Teo et al, 2015), involving 11 065 people aged 50 years and over, found that the probability of depressive symptoms increase as face-to-face contacts of children, other family members, and friends decrease. They also found that telephone, written, and email contacts had no benefit in preventing depressive symptoms, and are therefore not a substitute for face-to-face contact with older people. With the Christmas–New Year period approaching, community nurses should be especially watchful of their older clients who have few or no contacts with their family members or friends. BJCN

Pediatric emergence delirium: Canadian Pediatric Anesthesiologists' experience.

Pediatric emergence agitation/delirium (ED) is a cluster of behaviors seen in the early postanesthetic period with negative emotional consequences for families and increased utilization of healthcare resources. Many studies have looked at identifying risk factors for ED and at pharmacologic regimens to prevent ED. There are few published reports on treatment options and efficacy for established ED episodes, and essentially no data concerning current practice in the treatment of ED. We sought to elicit the experience and opinions of Canadian Pediatric Anesthesiologists on the incidence of ED in their practice, definitions and diagnostic criteria, preventative strategies, treatments, and their perceived efficacy. A web-based survey was sent to pediatric anesthesiologists working at academic health science centers across Canada. The participants were selected based on being members of the Canadian Pediatric Anesthesia Society (CPAS), which represents the subspecialty in Canada. All members of CPAS who had e-mail contact information available in the membership database were invited to participate. A total of 209 members out of the total of 211 fulfilled these criteria and were included in the study population. The response rate was 51% (106/209). Of respondents, 42% felt that ED was a significant problem at their institutions, with 45% giving medication before or during anesthesia to prevent the development of ED. Propofol was the most common medication given to prevent ED (68%) and to treat ED (42%). Total intravenous anesthesia (TIVA) was considered by 38% of respondents as a technique used to prevent ED. Medications used for treatment included propofol (42%), midazolam (31%), fentanyl (10%), morphine (7%), and dexmedetomidine (5%), with 87% of respondents rating effectiveness of treatment as 'usually works quickly with one dose'. We present information on current practice patterns with respect to prophylaxis and treatment of ED among a specialized group of pediatric anesthesiologists and highlight the importance of further research in improving the treatment of this common and challenging peri-anesthetic occurrence.

Comparison of methods for recruiting and engaging parents in online interventions: study protocol for the Cry Baby infant sleep and settling program.

BackgroundAnticipatory guidance around the management of sleep and crying problems in early infancy has been shown to improve both infant behaviour and parent symptoms of postnatal depression. Digital technology offers platforms for making such programs widely available in a cost-efficient manner. However, it remains unclear who accesses online parenting advice and in particular, whether the parents who would most benefit are represented amongst users. It is also unknown whether the uptake of online programs can be improved by health professional recommendations, or whether parents require additional prompts and reminders to use the program. In this study we aim to: (1) determine whether weekly email prompts increase engagement with and use of a brief online program about infant sleeping and crying, (2) determine whether encouragement from a maternal and child health nurse promotes greater engagement with and use of the program, (3) examine who uses a brief online program about infant sleeping and crying; and, (4) examine the psychosocial characteristics of participants.Methods/DesignThis study is a randomised, parallel group, superiority trial, with all participating primary carers of infants aged 2 to 12 weeks, receiving access to the online program. Two modes of recruitment will be compared: recruitment via an online notice published on a non-commercial, highly credible and evidence-based website for parents and carers and via the parent’s Maternal and Child Health nurse. After baseline assessment, parents will be randomised to one of two support conditions: online program alone or online program plus weekly email prompts. Follow up data will be collected at 4 months of infant age.DiscussionResults from this trial will indicate whether involvement from a health professional, and/or ongoing email contact is necessary to engage parents in a brief online intervention, and promote parental use of strategies suggested within the program. Results of this trial will inform the development of recruitment and engagement strategies for other online interventions.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12613001098729. Registered 01 October 2013.

Re-Infection Outcomes following One- and Two-Stage Surgical Revision of Infected Hip Prosthesis: A Systematic Review and Meta-Analysis.

BackgroundThe two-stage revision strategy has been claimed as being the “gold standard” for treating prosthetic joint infection. The one-stage revision strategy remains an attractive alternative option; however, its effectiveness in comparison to the two-stage strategy remains uncertain.ObjectiveTo compare the effectiveness of one- and two-stage revision strategies in treating prosthetic hip infection, using re-infection as an outcome.DesignSystematic review and meta-analysis.Data SourcesMEDLINE, EMBASE, Web of Science, Cochrane Library, manual search of bibliographies to March 2015, and email contact with investigators.Study SelectionCohort studies (prospective or retrospective) conducted in generally unselected patients with prosthetic hip infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision. No clinical trials were identified.Review MethodsData were extracted by two independent investigators and a consensus was reached with involvement of a third. Rates of re-infection from 38 one-stage studies (2,536 participants) and 60 two-stage studies (3,288 participants) were aggregated using random-effect models after arcsine transformation, and were grouped by study and population level characteristics.ResultsIn one-stage studies, the rate (95% confidence intervals) of re-infection was 8.2% (6.0–10.8). The corresponding re-infection rate after two-stage revision was 7.9% (6.2–9.7). Re-infection rates remained generally similar when grouped by several study and population level characteristics. There was no strong evidence of publication bias among contributing studies.ConclusionEvidence from aggregate published data suggest similar re-infection rates after one- or two-stage revision among unselected patients. More detailed analyses under a broader range of circumstances and exploration of other sources of heterogeneity will require collaborative pooling of individual participant data.Systematic Review RegistrationPROSPERO 2015: CRD42015016559

The Practice of Electroconvulsive Therapy in US Correctional Facilities: A Nationwide Survey.

There are little data regarding the practice of electroconvulsive therapy (ECT) in correctional settings in the United States. A survey was conducted to study the current practice of ECT in US prisons. We hypothesize that ECT is underutilized in the correctional setting. We also review the ethical aspects of using ECT for the treatment of mental illness in the prison population. A 12-question survey via a Survey Monkey link was emailed to chiefs of psychiatry, or the equivalent, of each state's department of corrections. We examined the frequency of Likert-type responses, tabulated individual comments for qualitative review, and grouped for comparison. Email contacts for chiefs of psychiatry, or the equivalent, for the department of corrections in 45 states (90%) were obtained and a survey link was sent. Thirty-one (68.9%) of 45 responded to the survey. Respondent estimates of the number of inmates with mental illness in 31 prison systems varied from less than 500 to more than 4500. Of these 31, 12 (38.7%) had more than 4500 inmates with mental illness. Four systems reported the use of ECT within the last 5 years. Of those, one reported use in the last 1 to 6 months, and 3 reported use in the last 2 to 5 years. Of these 4 prison systems, all felt that they had up to 10 patients who would benefit if ECT continued to be offered or became available in the future. None of these systems provided ECT within the prison. The inmates were referred to a local state psychiatric facility, a university hospital, or other institutions. The reasons for not using ECT as reported by the respondents are grouped under subheadings of stigma, ethical concerns, logistical concerns, and others. Considering the high prevalence of mental illness in prisons, one might expect a high prevalence of ECT responsive mental illness and, hence, provision of ECT to some prisoners with mental illness. However, our survey suggests that the use of ECT in prisons in the United States is low. Stigma, ethical concerns, and logistical concerns were the main hindrances for providing ECT to prisoners with mental illness. Given that ECT is the standard of care in certain clinical scenarios, physicians are obligated to offer such treatment to inmates when necessary. It can be argued that failure of the prison to offer the standard of care is unethical and unconstitutional.

Loop diuretic therapy in the critically ill: a survey

Objectives: To describe the self-reported practice of loop diuretic therapy (LDT) administration by intensivists in Australia and New Zealand and to ascertain the anticipated clinical and physiological effects of LDT for several common clinical indications.Design: Structured online questionnaire distributed to intensivists via the Australian and New Zealand Intensive Care Society Clinical Trials Group email contact list. Descriptive statistics were used to analyse the results.Participants: Intensivists in Australia and New Zealand.Results: A total of 146 intensivists responded to the survey with most (99 [67.8%]) being Fellows of the College of Intensive Care Medicine or the Joint Faculty of Intensive Care Medicine. Overall, 88 (60.2%) had worked in ICUs for 10 years or more. A positive fluid balance, acute pulmonary oedema (APO) and acute lung injury (ALI) were considered key indications for LDT (> 80.0% positive response), in contrast to an elevated central venous pressure (CVP) (20.3%) and acute kidney injury (AKI) (3.8%), which were not. LDT by bolus therapy was preferred (by 60.0%–89.4%, according to indication) over continuous infusion (3.6%– 11.1%, according to indication). The dominant initial LDT dose was furosemide 40mg as an intravenous (IV) bolus. There was a lack of consensus regarding what would be an adequate response, and for many of the clinical indications, no target was specified.Conclusions: Australian and New Zealand intensivists typically give frusemide as a 40mg IV bolus for a positive fluid balance, ALI and APO, but not for an elevated CVP or AKI. However, such therapy is given without explicit definitions of an adequate response under these different clinical circumstances.

An Exploratory Investigation of Communication Technologies to Alleviate Communicative Difficulties and Depression in Older Adults.

To explore associations between older adults' communicative difficulties, depressive symptoms, and e-mail and telephone use with adult children. We examined these associations using data from 1,634 participants (age M = 71.16, SD = 0.89; 54% female) in the 2011 wave of the Wisconsin Longitudinal Study. Better vision and worse speech were associated with more frequent e-mail contact with the selected child. Worse hearing was associated with more depressive symptoms for participants with low e-mail use but not for those with average or high e-mail use. Telephone use was not associated with communicative difficulties or depressive symptoms. This study provides preliminary evidence that older adults might use communication technologies such as e-mail in their close relationships to compensate for communicative difficulties. The text-based format of e-mail might also help older adults mitigate hearing impairments and associated depressive symptoms.

Suicide rates in five-year age-bands after the age of 60 years: the international landscape

Background: There is paucity of studies examining suicide rates in narrow five-year age-bands after the age of 60 years. This study examined suicide rates in eight five-year age-bands between the age of 60 and 99 years because this will allow more precise comparison between the young old (60–79 years) and the oldest old (80+ years) age groups.Methods: Data on the number of suicides (International Classification of Diseases – ICD-10 codes, X60-84) in each of the eight five-year age-bands between the age-bands 60–64 years and 95–99 years in both gender for as many years as possible from 2000 were ascertained from three sources: colleagues with access to national data, national statisics office websites and email contact with the national statistics offices. The population size for the corresponding years and age-bands was estimated for each country using data provided by the United Nations website.Results: In men, suicide rates continued to increase for each of the seven five-year age-bands from 60–64 years to 90–94 years age-band, and then declined slightly for the 95–99 year age-band. In women, suicide rates continued to increase for each of the six five-year age-bands from 60–64 years to 85–89 years age-bands, and then declined slightly for the 90–94 years and 95–99 years age-bands.Conclusions: The overall global suicide rates for each of the eight five-year age-bands are sufficiently large for them to constitute a public health concern. This is especially important given the ongoing rise in the elderly population size and the paucity of data on risk and protective factors for suicide in the five-year age-bands after the age of 60 years.

Technologies of Serendipity

In reckoning with the digital restructuring of the scholarly discourse network circa 2004, Patrick Leary begins with a story. It is a story about how, thanks to web discovery and email contacts, scholarship on Letitia Elizabeth Landon took a major turn. This happened because of the “fortuitous electronic connections” of people and documents facilitated by the internet. 1 And making sense of this experience, rather than detailing specific resources for digital scholarship, becomes Leary’s abiding concern in “Googling the Victorians.” His essay ponders a “profound shift” towards casual discovery, “a serendipity of unexpected connections to both information and people that is becoming increasingly central to the progress of Victorian research.” 2 If, in the subtitle to their 1982 volume The Victorian Periodical Press, Joanne Shattock and Michael Wolff nominate “Samplings and Soundings” as our only reasonable approach, Leary begins to clarify how such casual discoveries should not merely be viewed as symptoms of trying to find specifics amid superabundance, whether in terms of the Victorian archive or networked digital information. 3 Instead, that characteristic research experience has been absorbed into the technological routines of how we work now. In other words, chance discovery is not a bug; it is a feature. It is the very condition of “Googling the Victorians,” as Leary calls it. A decade later, we find ourselves deeper in the networked experience of such unexpected connections, with more perspective that allows us to acknowledge, critique, and perhaps even credit serendipity as scholarly technique. “Googling the Victorians” also reveals the scholar’s reflex to enfold fortuitous discoveries within descriptive explanation. The essay shows a consistent dynamic between the item of scholarly interest, serendipitously found, and the narrative in which the researcher governs the unexpected. In drawing this connection, Leary makes a crucial distinction between serendipity and randomness. If we all have random encounters all the time, serendipity requires recognizing such an encounter for its meaning, requir

Abstract P5-15-16: Breast cancer survivor advocacy at the University of Wisconsin Breast Center

Abstract Peer-to-peer support programs provide unique psychosocial and educational support for breast cancer patients. With the support of funding from the South Central Wisconsin Affiliate of Susan G. Komen for the Cure, we developed a Patient-Survivor Advocacy (PSA) program to complement University of Wisconsin Breast Center (UWBC) patient navigator to facilitate peer-to-peer support between those who have completed primary breast cancer treatment and those newly diagnosed patients. We evaluated the feasibility and utility of this peer-to-peer support program for both patients and advocates. Methods: We recruited advocates from the pool of women previously treated for breast cancer at UWBC. PSAs completed 3 training sessions over a 5 month period, including a volunteer orientation and the After Breast Cancer Diagnosis (ABCD) program. Training topics included a patient survivor advocacy orientation, guidance for communication with patient matches, and documentation and reporting of patient contact to the UWBC patient navigator. Following training, PSAs were matched to patients based on age, type of breast cancer and other life factors identified as important by each referee. PSAs contacted matches via phone and documented communication frequency and content. PSAs and patients then completed surveys describing their experience and satisfaction with the PSA program. Survey questions were tailored to the program strengths, deficits, and areas for improvement. PSAs were also surveyed regarding curriculum and the training process. Results: Between 11/2012 and 4/2014, 14 PSAs were recruited and trained, and 40 patients were referred to the program. Half of patient referrals (20) were from UWBC physicians, while 18 were from UWBC nursing staff, in addition to 9 self-referrals (this includes overlapping referrals from multiple providers). Six decided not to participate, and one was transferred to hospice before being matched, while 8 patients were referred to the ABCD program due to lack of suitable UWBC PSA matches. Twenty six patients were successfully matched to active PSAs. The number of patients matched to each PSA ranged from 1 to 8; an average of 3 phone and 4 email contacts were made by each PSA-patient dyad. Communication topics included the effect of diagnosis and treatment on mood and mental health, physical health, daily life, and interpersonal relationships, as well as additional community resources for support. Patients and PSAs expressed positive impressions of the program: feeling supported by UWBC staff, experiencing a sense of accomplishment (PSAs) or direct benefit (patients). Responses suggested new topics for PSA training and cancer education, including surgical interventions, radiology, chemotherapy, integrative medicine, medical updates, and new topics in social support. Conclusions: The first year of the UWBC PSA program saw a successful peer-to-peer psychosocial support infrastructure for newly diagnosed breast cancer patients. PSA and patient survey responses provided useful feedback critical to development of the program. Future goals for this program include increased patient utilization, provision of additional education topics and materials during PSA training, and documentation of the impact of PSA program support on the UWBC nursing burden. Citation Format: Jennifer A Mirrielees, Lee G Wilke, Kayla R Breckheimer, Teresa A White, Deborah A DeNure, Michelle M Schroeder, Amye J Tevaarwerk. Breast cancer survivor advocacy at the University of Wisconsin Breast Center [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-16.

Re-infection outcomes following one- and two-stage surgical revision of infected hip prosthesis in unselected patients: protocol for a systematic review and an individual participant data meta-analysis.

BackgroundSeveral aggregate published reviews have compared the effectiveness of one- and two-stage surgical revision to prevent re-infection following prosthetic hip infection and have reported inconsistent results. In addition, there were several features of these previous reviews which limited the validity of the findings. In the absence of a well-designed clinical trial, we propose the Global Infection Orthopaedic Management (INFORM) collaboration, a worldwide collaborative systematic review and meta-analysis of individual participant data (IPD) to address the existing uncertainties.MethodsCohort studies (prospective or retrospective) and randomised controlled trials conducted in unselected patients with infection treated exclusively by one- or two-stage revision and reporting re-infection outcomes within 2 years of revision will be retrieved by searching the following databases: MEDLINE, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Registry Platform. Reference lists of relevant studies will be manually scanned and there will be email contact with investigators of grey literature and conference abstracts. Investigators will be invited to join the Global INFORM collaboration and share their individual level data. The primary outcome of the analyses will be incidence of re-infection within 2 years of commencement of revision surgery. Primary analyses will be conducted comparing the one-stage to the two-stage surgical revision. IPD analyses will be based on Cox proportional hazard (PH) models estimated for each study separately. Study-specific log hazard ratios will be combined using random-effects meta-analysis with fixed-effects meta-analysis in subsidiary analyses. Hazard ratios for re-infection according to different individual level characteristics such as sex, age groups, body mass index and comorbidities will also be assessed.DiscussionThe analyses will enable a consistent approach to the definition of re-infection outcomes, more detailed analyses under a broader range of circumstances and exploration of potential sources of heterogeneity and produce much more valid and precise estimates of re-infection outcomes.Systematic review registrationPROSPERO 2015: CRD42015016664Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0044-0) contains supplementary material, which is available to authorized users.

A randomised controlled trial of a physical activity and nutrition program targeting middle-aged adults at risk of metabolic syndrome in a disadvantaged rural community

BackgroundApproximately 70% of Australian adults aged over 50 are overweight or obese, with the prevalence significantly higher in regional/remote areas compared to cities. This study aims to determine if a low-cost, accessible lifestyle program targeting insufficiently active adults aged 50-69 y can be successfully implemented in a rural location, and whether its implementation will contribute to the reduction/prevention of metabolic syndrome, or other risk factors for type 2 diabetes, and cardiovascular disease.Methods/DesignThis 6-month randomised controlled trial will consist of a nutrition, physical activity, and healthy weight intervention for 50–69 year-olds from a disadvantaged rural community. Five hundred participants with central obesity and at risk of metabolic syndrome will be recruited from Albany and surrounding areas in Western Australia (within a 50 kilometre radius of the town). They will be randomly assigned to either the intervention (n = 250) or wait-listed control group (n = 250). The theoretical concepts in the study utilise the Self-Determination Theory, complemented by Motivational Interviewing. The intervention will include a custom-designed booklet and interactive website that provides information, and encourages physical activity and nutrition goal setting, and healthy weight management. The booklet and website will be supplemented by an exercise chart, calendar, newsletters, resistance bands, accelerometers, and phone and email contact from program staff. Data will be collected at baseline and post-intervention.DiscussionThis study aims to contribute to the prevention of metabolic syndrome and inter- related chronic illnesses: type 2 diabetes mellitus, cardiovascular disease, and some cancers; which are associated with overweight/obesity, physical inactivity, and poor diet. This large rural community-based trial will provide guidelines for recruitment, program development, implementation, and evaluation, and has the potential to translate findings into practice by expanding the program to other regional areas in Australia.Trial registrationAustralian and New Zealand Clinical Trials Registry [ACTRN12614000512628, registration date 14th May 2014].Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1613-9) contains supplementary material, which is available to authorized users.

Impact of Self-Help Schema Therapy on Psychological Distress and Early Maladaptive Schemas: A Randomised Controlled Trial

Self-help cognitive behaviour therapy has been found helpful in treating anxiety and depression. Recent evidence suggests that self-help schema therapy may represent another treatment alternative. The present study aimed to provide a preliminary assessment of the efficacy of self-help schema therapy on psychological distress and early maladaptive schemas (EMSs) using a 6-week treatment protocol with minimal email contact. Method: Participants were recruited from the general population and randomly assigned to self-help schema therapy (n = 32) or a waitlist (n = 32). Intent-to-treat analyses and study completer analyses were conducted using repeated-measures analyses of variance (time × group). Results: Intent-to-treat analyses revealed that treatment produced a marginal improvement in distress, but no change in EMSs. Among study completers (n = 34), self-help schema therapy yielded large reductions in distress scores on the Outcome Questionnaire-45.2 (partial eta squared = .16). Compared to the waitlist, self-help schema therapy also produced a moderate decrease in EMSs (partial eta squared = .10). The majority of study completers showed reliable clinical change in distress and reported high levels of satisfaction with the intervention. Conclusion: Self-help schema therapy may be an effective treatment for those individuals who persist in treatment. Self-help schema therapy has the potential to help a large number of individuals who may not otherwise have access to services. More research is needed to determine variables associated with treatment adherence and successful outcome.

Efficacy of Online Psychotherapies in Poker Gambling Disorder: an Online Randomized Clinical Trial

Introduction Online clinical trial is an emergent design that could be of particular interest in problem gamblers, due to poor access to health care system. Online gamblers could benefit from non face-to-face therapy. Our study is the first exclusively online randomized controlled trial among problem gamblers with a naturalistic recruitment in their gambling environment. Objectives This randomized clinical trialassessed the efficacy of 3 internet-based brief interventions on problem poker gamblers compared to a control group at 6 and 12 weeks. Methods All poker gamblers who have started a poker session on Winamax site, on Day-1 during the inclusion period were screened; subjects could be included only once. Subjects could be included if they obtained minimum scores of the Canadian Problem Gambling Index – Problem Gambling Severity (CPGI-PGSI) ≥5. 1109 Subjects were randomized in 4 groups: (1) Control= waiting list, n=264; (2) email with personal normative information, n= 288; (3) self-help program to be downloaded, based on Cognitive Behavioral Therapy (CBT) and Motivational Interviewing(MI), n= 259; (4) same program of CBT and MI dispensed weekly by email contacts with a psychologist, n= 298. Subjects were followed and gambling behavior was assessed at the end of the program at 6 weeks and after a maintenance phase at 12 weeks. The main judgment criterion was change in CPGI-PGSI at 6 weeks. Results High dropout rate occurred on the CPGI-PGSI and was higher in groups 3 and 4. Mean CPGI-PGSI scores decrease in all the 4 groups. No significant difference could be shown between the 3 intervention groups vs control group in any of the measured outcomes (no missing data due to automatic collection by the operator except for CPGI). Discussion In non-treatment –seekers problematic poker gamblers, inclusion process in a clinical trial could be equivalent to 'prompt commitment there and then”, which is a recognized brief, and therefore have a therapeutic effect. This could explain that no difference could be shown between the groups. High dropout rate could be explained by the non-treatment-seeking status, but also by poor acceptability of therapeutic interventions requiring high personnel investment in this population.