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1.
Vitamin D and Skin Cancer: An Epidemiological, Patient-Centered Update and Review.
Martin-Gorgojo, A, Gilaberte, Y, Nagore, E
Nutrients. 2021;(12)
Abstract
BACKGROUND The current vitamin D deficiency epidemic is accompanied by an increase in endemic skin cancer. There are still multiple controversies. This review aims to give practical recommendations regarding vitamin D among people at risk or with a personal history of skin cancer. METHODS Narrative review including human research articles published between 2011 and 2021, elaborated bearing in mind an epidemiological, patient-centered approach. RESULTS Ultraviolet (UV) exposure (neither artificial nor natural) is not the ideal source to synthesize vitamin D. There is conflicting epidemiological evidence regarding vitamin D, non-melanoma skin cancer (NMSC), and cutaneous melanoma (CMM), confounded by the effect of sun exposure and other factors. CONCLUSIONS Current evidence is controversial, and there are no widely applicable strategies. We propose three practical recommendations. Firstly, sun protection recommendations should be kept among people at risk or with a personal history of skin cancer. Secondly, vitamin D should preferably be sourced through diet. In patients with melanoma or at risk of cutaneous cancer, serum vitamin D checks are warranted to detect and avoid its insufficiency.
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2.
Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool.
Simione, M, Sharifi, M, Gerber, MW, Marshall, R, Avalon, E, Fiechtner, L, Horan, C, Orav, EJ, Skelton, J, Taveras, EM
Health and quality of life outcomes. 2020;(1):179
Abstract
BACKGROUND Incorporating family-centered care principles into childhood obesity interventions is integral for improved clinical decision making, better follow-through, and more effective communication that leads to better outcomes and greater satisfaction with services. The purpose of this study is to evaluate the psychometric properties of a modified version of the Family Centered-Care Assessment (mFCCA) tool and to assess the family-centeredness of two clinical-community childhood obesity interventions. METHODS Connect for Health was a randomized trial testing the comparative effectiveness of two interventions that enrolled 721 children, ages 2-12 years, with a body mass index (BMI) ≥ 85th percentile. The two arms were (1) enhanced primary care; and (2) enhanced primary care plus contextually-tailored, health coaching. At the end of the one-year intervention, the mFCCA was administered. We used Rasch analyses to assess the tool's psychometrics and examined differences between the groups using multiple linear regression. RESULTS 629 parents completed the mFCCA resulting in an 87% response rate. The mean (SD) age of children was 8.0 (3.0) years. The exploratory factor analysis with 24 items all loaded onto a single factor. The Rasch modeling demonstrated good reliability as evidenced by the person separation reliability coefficient (0.99), and strong validity as evidenced by the range of item difficulty and overall model fit. The mean (SD, range) mFCCA score was 4.14 (0.85, 1-5). Compared to parents of children in the enhanced primary care arm, those whose children were in the enhanced primary care plus health coaching arm had higher mFCCA scores indicating greater perception of family-centeredness (β = 0.61 units [95% CI: 0.49, 0.73]). CONCLUSIONS Using the mFCCA which demonstrated good psychometric properties for the assessment of family-centered care among parents of children with obesity, we found that individualized health coaching is a family-centered approach to pediatric weight management. TRIAL REGISTRATION Clinicaltrials.gov NCT02124460.
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3.
Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society.
Zatloukal, J, Brat, K, Neumannova, K, Volakova, E, Hejduk, K, Kocova, E, Kudela, O, Kopecky, M, Plutinsky, M, Koblizek, V
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2020;(4):325-356
Abstract
This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years.
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4.
Familial hypercholesterolaemia: evolving knowledge for designing adaptive models of care.
Watts, GF, Gidding, SS, Mata, P, Pang, J, Sullivan, DR, Yamashita, S, Raal, FJ, Santos, RD, Ray, KK
Nature reviews. Cardiology. 2020;(6):360-377
Abstract
Optimal care for familial hypercholesterolaemia (FH) requires patient-centred management, multidisciplinary teamwork, involvement of primary care practitioners, patient networks, support groups and high-quality clinical registries, implemented through models of care adapted to FH. Models of care - evidence-based and context-specific frameworks that aim to deliver the highest quality of care for patients and their families - allow the application of precision and multidisciplinary medicine to FH care and can serve as paradigms for the prevention of premature atherosclerotic cardiovascular disease in all at-risk patients and families worldwide. The exponential growth in the number of publications on diverse aspects of FH has provided new knowledge for developing essential elements of existing models of care. These elements include clinical diagnostic criteria and genetic testing; risk restratification strategies; LDL-cholesterol treatment targets; management protocols for children; care of women in pregnancy; use of pharmacotherapies, including ezetimibe and PCSK9 inhibitors; use of lipoprotein apheresis for severe FH; and addressing barriers to care. However, substantial gaps remain that need to be addressed by a broad research agenda, implementation strategies and global collaboration and advocacy, aimed at improving the uptake, cost-effectiveness and routine implementation of evidence-based standards. In this Review, we summarize the dramatic increase in knowledge that informs adaptive models of care, with an emphasis on articles published since 2014.
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5.
The Impact of Exercise and Nutrition as Part of a Person-Centered Approach to Prehabilitation in Patients with Bladder Cancer.
Nahon, I, Paterson, C, Sayner, A
Seminars in oncology nursing. 2020;(5):151072
Abstract
BACKGROUND Muscle invasive bladder cancer (MIBC) is commonly treated with radical cystectomy. Patients who require radical cystectomy are often frail, unwell, have multiple comorbidities, and can experience unmet supportive care needs. Due to these complexities, patients requiring radical cystectomy are often considered high risk for anesthetics, and therefore improving their physical and psychological well-being is crucial prior to radical surgery. Prehabilitation is the practice of enhancing a patient's functional and psychological capacity before surgery, with the aim of improving postoperative outcomes. This narrative review aims to identify and evaluate the role of physical exercise, nutritional intervention, and person-centered holistic approaches to prehabilitation in people affected by MIBC treated by radical cystectomy. DATA SOURCES Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google scholar until June 2020. CONCLUSION Evidence to support specific prehabilitation clinical recommendations in people affected by MIBC is emerging. Prehabilitation including exercise prescription, nutritional intervention, and person-centered holistic support is an important part of the clinical pathway for people affected by MIBC. Individualized prehabilitation programs across the multidisciplinary team should be considered to provide specific individual recommendations to avoid "one size fits all". Given the limited research in this clinical area, future high-quality multi-center prospective trials are urgently needed. IMPLICATIONS FOR NURSING PRACTICE People affected by MIBC can experience a range of unmet supportive care needs in routine clinical care delivery at the time of diagnosis and into survivorship. Evidence is emerging around the role of multidisciplinary interventions in the form of exercise, nutritional input, and holistic supportive care to improve physical and psychological well-being prior to major surgery. Specialist nurses are ideally placed to ensure that individual holistic care needs are addressed, and appropriate care and support is provided. Nurses can trigger timely referrals to members of the multidisciplinary team to coordinate an integrated person-centered approach to prehabilitation service provision to address the unmet needs of people undergoing treatment for MIBC.
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6.
Supportive care in cancer-a MASCC perspective.
Olver, I, Keefe, D, Herrstedt, J, Warr, D, Roila, F, Ripamonti, CI
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2020;(8):3467-3475
Abstract
The term 'supportive care' arose from the medical oncology literature predominantly in the context of managing the toxicities of cancer treatment but embraces all symptom management through treatment and survivorship. Supportive care should be patient-centred with good communication which includes family and carers and applies across the cancer experience from diagnosis, treatment, survivorship to end of life care. Supportive care encompasses physical and functional, psychological, social and spiritual well-being to improve the quality of life. Supportive care must be evidence-based and thus further research is essential. Supportive care requires screening for some symptoms and tools for patients to report their outcomes. Supportive care has to accommodate new physical toxicities, emotional distress as well as financial toxicity. Supportive care is often delivered by medical oncologists but any organ-related specialist, geriatrician, palliative care clinician, pain specialist, nutritionist, psycho-oncologist, social worker, physiotherapist, nurse or allied health worker who is required to relieve a patient's symptoms or side effects may be involved in a multidisciplinary way. The field is evolving to embrace technology such as eHealth and mHealth capabilities which will enhance integrated care.
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7.
Impact of patient-centred diabetes self-management education targeting people with type 2 diabetes: an integrative review.
Olesen, K, Folmann Hempler, N, Drejer, S, Valeur Baumgarten, S, Stenov, V
Diabetic medicine : a journal of the British Diabetic Association. 2020;(6):909-923
Abstract
AIMS: To synthesize primary research into the impact of person-centred diabetes self-management education, and support that targets people with type 2 diabetes, on behavioural, psychosocial and cardiometabolic outcomes and to identify effective mechanisms underlying positive outcomes of person-centred diabetes self-management education and support. METHODS Using Whittemore and Knafl's integrative review method, we conducted a systematic search of peer-reviewed literature published between January 2008 and June 2019 using PubMed, Scopus and CINAHL. After article selection according to established criteria, study quality was assessed using Critical Appraisal Skills Programme checklists for cohort studies, randomized controlled trials and qualitative research. RESULTS From 1901 identified records, 22 (19 quantitative, two qualitative, and one mixed methods) were considered eligible for inclusion. Interventions were categorized by content, medium of delivery, and outcomes. Qualitative studies, quantitative cohort studies and randomized controlled trials demonstrated positive outcomes, with no differences in success rates across study design. Interventions were largely successful in improving HbA1c and patient-reported outcomes such as quality of life but had limited success in lowering cholesterol and weight, or initiating long-term improvements in lifestyle behaviours. Primary objectives were achieved more often than secondary objectives, and studies with fewer outcomes appeared more successful in achieving specific outcomes. CONCLUSIONS Person-centred diabetes self-management education and support has demonstrated a considerable impact on desired diabetes-related outcomes in people with type 2 diabetes. To advance the field further, new studies should take advantage of systematic and transparent approaches to person-centred diabetes self-management education.
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8.
Patient-centered communication and shared decision making to reduce HbA1c levels of patients with poorly controlled type 2 diabetes mellitus - results of the cluster-randomized controlled DEBATE trial.
Wollny, A, Altiner, A, Daubmann, A, Drewelow, E, Helbig, C, Löscher, S, Pentzek, M, Santos, S, Wegscheider, K, Wilm, S, et al
BMC family practice. 2019;(1):87
Abstract
BACKGROUND Does an intervention designed to foster patient-centered communication and shared decision making among GPs and their patients with poorly controlled type 2 diabetes mellitus reduce the level of HbA1c. METHODS The DEBATE trial is a cluster-randomized controlled trial conducted in German primary care and including patients with type 2 diabetes mellitus having an HbA1c level of 8.0% (64 mmol/mol) or above at the time of recruitment. Data was measured before intervention (baseline, T0), 6-8 months (T1), 12-14 months (T2), 18-20 months (T3), and 24-26 months (T4) after baseline. Main outcome measure is the level of HbA1c. RESULTS In both, the intervention and the control group the decline of the HbA1c level from T0 to T4 was statistically significant (- 0.67% (95% CI: - 0.80,-0.54%; p < 0.0001) and - 0.64% (95% CI: - 0.78, - 0.51%; p < 0.0001), respectively). However, there was no statistically significant difference between both groups. CONCLUSIONS Although the DEBATE trial was not able to confirm effectiveness of the intervention tested compared to care as usual, the results suggest that patients with poorly controlled type 2 diabetes are able to improve their blood glucose levels. This finding may encourage physicians to stay on task to regularly approach this cohort of patients. TRIAL REGISTRATION The trial was registered at ISRCTN registry under the reference ISRCTN70713571 .
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9.
Understanding illness perception in pulmonary tuberculosis patients: One step towards patient-centered care.
Min, J, Chung, C, Jung, SS, Park, HK, Lee, SS, Lee, KM
PloS one. 2019;(6):e0218106
Abstract
BACKGROUND Assessing the illness perception of patients with tuberculosis (TB) could improve our understanding of their beliefs about disease and help address problems in their health-seeking behavior. STUDY AIM We assessed illness perception in patients with pulmonary TB in association with patients' demographic, socioeconomic, and clinical features. METHODS Adult patients who were newly diagnosed with pulmonary TB at three tertiary hospitals in South Korea were included from November 2016 and September 2018. Participants' illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ) at the start of anti-TB treatment. RESULTS In total, 390 patients with pulmonary TB completed this survey. The mean BIPQ score was 31.6 ± 13.2, and that was positively correlated with clinical TB scores. Patients were highly concerned about their illness, but believed in the treatment. Unhealthy eating habits were mentioned as the most prevalent perceived cause. Coughing for more than one month and alarming symptoms were significantly associated with BIPQ scores ≥ 33. Non-adherent patients had significantly higher BIPQ scores. CONCLUSIONS Assessing the illness perceptions of those with severe TB-related symptoms and signs may help to identify TB patients with vulnerable to poor treatment outcomes.
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10.
The Contribution of Psychosocial Interventions to Precision Medicine for Heart Health.
Flynn, M, Moran, C, Rash, JA, Campbell, TS
Progress in cardiovascular diseases. 2019;(1):21-28
Abstract
This paper reviews the value of incorporating psychosocial interventions into precision medicine for heart health. First, we review the empirical literature on prevalence of common mental health comorbidities among individuals with cardiovascular disease (CVD). We then review transdiagnostic approaches for conceptualization and treatment of mental health in individuals with CVD. We highlight recent studies that have used novel methods to individualize psychosocial interventions. Finally, we propose a preliminary framework intended to support Health Care Providers in individualizing treatment, which includes: 1) assessment of patient risk factors, characteristics, and expectations; 2) consideration of transdiagnostic processes underlying several psychiatric symptoms that contribute to CVD risk; 3) patient engagement in shared decision-making for psychosocial treatment; and 4) ongoing outcome monitoring to evaluate treatment responsiveness. We anticipate that the proposed framework will evolve with the emergence of new empirical evidence; as such, future directions and challenges for research are discussed.