scholarly journals Practice review: Evidence-based and effective management of fatigue in patients with advanced cancer

2021 ◽  
pp. 026921632110467
Author(s):  
Emma J Chapman ◽  
Erica Di Martino ◽  
Zoe Edwards ◽  
Kathryn Black ◽  
Matthew Maddocks ◽  
...  
Keyword(s):  
Energy Conservation ◽  
Advanced Cancer ◽  
Healthcare Professionals ◽  
Nutritional Intervention ◽  
Evidence Base ◽  
Exercise Interventions ◽  
Fatigue Exercise ◽  
Cochrane Database ◽  
Pubmed Search ◽  
The Impact

Background: Fatigue affects most patients living with advanced cancer and is a symptom that healthcare professionals can find difficult to manage. Aim: To provide healthcare professionals with a pragmatic overview of approaches to management of fatigue in patients with advanced cancer that are commonly recommended by guidelines and to evaluate evidence underpinning them. Design: Scoping review methodology was used to determine the strength of evidence supporting use of interventions recommended in management of fatigue in patients with advanced cancer. Data sources: National or international guidelines were examined if they described the management of fatigue in adult cancer patients and were written within the last 6 years (2015–2021) in English. The Cochrane Database of Systematic Reviews (January 2011–December 2021) was searched for ‘cancer’ AND ‘fatigue’ in title, abstract or keywords. A PubMed search was also made. Results: Evidence indicates physical exercise interventions are effective and patients may benefit from energy conservation tactics. Evidence does not support use of psychostimulants such as methylphenidate. Limited data were found on efficacy of corticosteroids, psychological interventions, nutritional intervention, sleep optimization or complementary therapies for management of fatigue in advanced cancer. Conclusion: We recommend regular assessment, review and acknowledgement of the impact of fatigue. Exercise and energy conservation should be considered. Pharmacological interventions are not endorsed as a routine approach. Many interventions currently recommended by guidelines are not supported by a robust evidence base and further research on their efficacy is required.

scholarly journals Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Abdul Rouf Pallivalappila ◽  
Derek Stewart ◽  
Ashalatha Shetty ◽  
Binita Pande ◽  
James S. McLay
Keyword(s):  
Systematic Review ◽  
Healthcare Professionals ◽  
Herbal Medicines ◽  
Evidence Base ◽  
Validity And Reliability ◽  
Alternative Medicines ◽  
Cochrane Database ◽  
Medicines Use ◽  
Data Validity ◽  
Cam Use

Aims. To undertake a systematic review of the recent (2008–2013) primary literature, describing views and experiences of CAM use during pregnancy by women and healthcare professionals.Method. Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Review Library and Allied, and Complementary Medicine Database were searched. Studies reporting systemic CAM products (homeopathic preparations, herbal medicines, Vitamins and minerals, homeopathy, and special diets) alone or in combination with other nonsystemic CAM modalities (e.g., acupuncture) were included.Results. Database searches retrieved 2,549 citations. Removal of duplicates followed by review of titles and abstracts yielded 32 relevant studies. Twenty-two reported the perspectives of women and their CAM use during pregnancy, while 10 focused on healthcare professionals. The majority of studies had significant flaws in study design and reporting, including a lack of appropriate definitions of CAM and associated modalities, absence of detailed checklists provided to participants, the use of convenience sampling, and a general lack of scientific robustness in terms of data validity and reliability.Conclusion. To permit generalisability of study findings, there is an urgent need to expand the evidence base assessing CAMs use during pregnancy using appropriately designed studies.

scholarly journals Practice review: Evidence-based and effective management of pain in patients with advanced cancer

2020 ◽  
Vol 34 (4) ◽  
pp. 444-453
Author(s):  
Emma J Chapman ◽  
Zoe Edwards ◽  
Jason W Boland ◽  
Matthew Maddocks ◽  
Lucy Fettes ◽  
...  
Keyword(s):  
Pain Management ◽  
Advanced Cancer ◽  
Management Practice ◽  
Anaesthetic Techniques ◽  
Evidence Base ◽  
Medline Search ◽  
Strong Opioid ◽  
Drug Of Choice ◽  
Cochrane Database ◽  
Practice Review

Background: Pain of a moderate or severe intensity affects over half of patients with advanced cancer and remains undertreated in at least one-third of these patients. Aim: The aim of this study was to provide a pragmatic overview of the evidence supporting the use of interventions in pain management in advanced cancer and to identify where encouraging preliminary results are demonstrated but further research is required. Design: A scoping review approach was used to examine the evidence supporting the use of guideline-recommended interventions in pain management practice. Data sources: National or international guidelines were selected if they described pain management in adult cancer patients and were written within the last 5 years in English. The Cochrane Database of Systematic Reviews (January 2014 to January 2019) was searched for ‘cancer’ AND ‘pain’ in the title, abstract or keywords. A MEDLINE search was also made. Results: A strong opioid remains the drug of choice for treating moderate or severe pain. Bisphosphonates and radiotherapy are also effective for cancer-related bone pain. Optimal management requires a tailored approach, support for self-management and review of treatment outcomes. There is likely a role for non-pharmacological approaches. Paracetamol should not be used in patients taking a strong opioid to treat pain. Cannabis-based medicines are not recommended. Weak opioids, ketamine and lidocaine are indicated in specific situations only. Conclusion: Interventions commonly recommended by guidelines are not always supported by a robust evidence base. Research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies and transcutaneous electrical nerve stimulation.

scholarly journals Impact of clinical supervision on healthcare organisational outcomes: A mixed methods systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260156
Author(s):  
Priya Martin ◽  
Lucylynn Lizarondo ◽  
Saravana Kumar ◽  
David Snowdon
Keyword(s):  
Mixed Methods ◽  
Clinical Supervision ◽  
Systematic Reviews ◽  
Healthcare Professionals ◽  
Evidence Base ◽  
Qualitative Studies ◽  
Staff Retention ◽  
Variable Effect ◽  
Support Mechanism ◽  
The Impact

Objective To review the impact of clinical supervision of post-registration/qualification healthcare professionals on healthcare organisational outcomes. Background Clinical supervision is a professional support mechanism that benefits patients, healthcare professionals and healthcare organisations. Whilst evidence is growing on the impact of clinical supervision on patient and healthcare professional outcomes, the evidence base for the impact of clinical supervision on organisational outcomes remains weak. Methods This review used a convergent segregated approach to synthesise and integrate quantitative and qualitative research findings, as per the Joanna Briggs Institute’s recommendations for mixed methods systematic reviews. Databases searched included CINAHL, Embase, PubMed, PschINFO, and Scopus. Whilst a narrative synthesis was performed to present the findings of the quantitative and qualitative studies, the evidence from both quantitative and qualitative studies was subsequently integrated for a combined presentation. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results Thirty-two studies including 27 quantitative, two qualitative and three mixed methods studies, were included in the review. The results of the quantitative analysis showed that effective clinical supervision was associated with lower burnout and greater staff retention, and effective supervisor was associated with lower burnout and greater job satisfaction. Qualitative findings showed that healthcare professionals believed that adequate clinical supervision could mitigate the risk of burnout, facilitate staff retention, and improve the work environment, while inadequate clinical supervision can lead to stress and burnout. The evidence from quantitative and qualitative studies were complementary of each other. Conclusion Clinical supervision can have a variable effect on healthcare organisational outcomes. The direction of this effect appears to be influenced by the effectiveness of both the clinical supervision provided and that of the clinical supervisor. This highlights the need for organisations to invest in high quality supervision practices if maximal gains from clinical supervision are to be attained.

scholarly journals Neuromusculoskeletal Health in Pediatric Obesity: Incorporating Evidence into Clinical Examination

2021 ◽  
Author(s):  
Grace C. O’Malley ◽  
Sarah P. Shultz ◽  
David Thivel ◽  
Margarita D. Tsiros
Keyword(s):  
Physical Activity ◽  
Pediatric Obesity ◽  
Healthcare Professionals ◽  
Clinical Importance ◽  
Evidence Base ◽  
Obesity Treatment ◽  
Obesity Management ◽  
Exercise Interventions ◽  
Exercise Barriers ◽  
Impaired Balance

Abstract Purpose of Review The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence into practice. Recent Findings A growing evidence base suggests that children with obesity experience neuromusculoskeletal impairments and physical complications including increased pain, reduced muscle strength, impaired balance and motor skill, gait deviations, postural malalignment, greater fatigue, and potentially reduced flexibility and sub-optimal bone health. Such evidence supports the need to screen, assess, and optimize neuromusculoskeletal health as part of pediatric obesity management. Summary The likelihood of children with obesity experiencing neuromusculoskeletal impairments is high and can impact the way a child moves, and their interest or capacity to engage in physical activity and exercise. Barriers to movement should be minimized to promote optimal development of the neuromusculoskeletal system and to support engagement in sufficient physical activity for weight management. Healthcare professionals should screen for neuromusculoskeletal impairments as well as personalize interventions and modify standardized exercise interventions to optimize obesity treatment. Further research should explore whether neuromusculoskeletal impairments influence the success of obesity treatment or whether they improve following obesity treatment.

scholarly journals Impact of healthcare strikes on patient mortality: a protocol for a systematic review and meta-analysis of observational studies

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050826
Author(s):  
Ryan Essex ◽  
Sharon Marie Weldon ◽  
Trevor Thompson ◽  
Erika Kalocsanyiova ◽  
Paul McCrone ◽  
...  
Keyword(s):  
Observational Studies ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Well Being ◽  
Evidence Base ◽  
Risk Of Bias ◽  
Cross Sectional ◽  
The Impact ◽  
Hospital Clinic

IntroductionA strike is a collective, temporary and calculated action, which involves a temporary stoppage of work. For healthcare professionals strike action poses a unique dilemma. Perhaps most fundamentally, as strike action is designed to be disruptive it has the potential to impact the delivery of care and place patient well-being in jeopardy. The objective of this study is therefore to evaluate the impact of healthcare strike action on patient mortality outcomes globally using meta-analysis in order to provide a comprehensive evidence base that can advise healthcare professionals, governments and regulatory bodies on the impact that strike action has on patients.Methods and analysisA comprehensive literature search of major electronic databases (EMBASE, MEDLINE, CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE, OPEN GREY and SIGMA REPOSITORY) will be undertaken to identify observational studies of strike action among healthcare professionals where in-hospital/clinic and population/community mortality is examined, prestrike, during and poststrike. Meta-analysis will be performed to estimate in-hospital/clinic and population/community mortality during periods of strike action. The quality of evidence will be assessed using the National Institute of Health quality assessment tool for observational cohort and cross-sectional studies. Risk of bias will be assessed using the Cochrane Risk Of Bias In Non-Randomized Studies - of Interventions tool.Ethics and disseminationThis study does not require ethical approval. Findings will be submitted to an appropriate peer-reviewed journal.Trial registration numberCRD42021238879.

Nutritional intervention promoting Mediterranean diet improves dietary intake and enhances score adherence in adolescent athletes

2020 ◽  
Vol 13 (3) ◽  
pp. 237-253
Author(s):  
Rokia Sahnoune ◽  
Malika Bouchenak
Keyword(s):  
Mediterranean Diet ◽  
Energy Intake ◽  
Nutritional Intervention ◽  
Fiber Intake ◽  
Adequate Intake ◽  
Total Proteins ◽  
Adolescent Athletes ◽  
24 Hour Recall ◽  
The Impact ◽  
Kidmed Index

BACKGROUND: Appropriate nutrition is important to maintain health, growth, and development of adolescent athlete performance. OBJECTIVE: To evaluate the impact of nutritional intervention (NI) promoting Mediterranean diet (MD), on food consumption, and adherence to MD, in scholar adolescent athletes. METHODS: Eighty athletes (Females/Males, 39/41) aged 15±1 years participated to NI. MD Adherence was assessed, using Kidmed index, at baseline, and at 6 months. Food intake was evaluated by 24-hour recall at baseline, and at four NI times. RESULTS: At baseline, 61% of athletes had poor MD adherence, and after NI, this value decreased to 10%. At 6 months of NI, 73% of males vs 46% of females had good MD adherence (≥8). Energy intake represented 2369 Kcal/d, at baseline, and was less than recommended value. After NI, significant increase was observed in energy intake (p = 0.001). Mean fiber intake (19 and 21 g/d in females and males, respectively) was less than adequate intake (26/38 g/d), but increased after NI (p = 0.000). Enhancement was noted in total, and complex carbohydrates, and total proteins, and values were increased with time (p = 0.000, p = 0.000, p = 0.003). CONCLUSION: Nutritional intervention, based on Mediterranean diet, improves total energy, and macronutrients intake, and increases MD adherence scores in adolescents athletes.

Impact of roof shading on building energy performance in warm & humid climatic places of India

2020 ◽  
pp. 50-64
Author(s):  
Kuladeep Kumar Sadevi ◽  
Avlokita Agrawal
Keyword(s):  
Energy Consumption ◽  
Energy Conservation ◽  
Energy Performance ◽  
General Assumption ◽  
Climatic Conditions ◽  
Building Envelope ◽  
Passive Cooling ◽  
Base Case ◽  
U Value ◽  
The Impact

With the rise in awareness of energy efficient buildings and adoption of mandatory energy conservation codes across the globe, significant change is being observed in the way the buildings are designed. With the launch of Energy Conservation Building Code (ECBC) in India, climate responsive designs and passive cooling techniques are being explored increasingly in building designs. Of all the building envelope components, roof surface has been identified as the most significant with respect to the heat gain due to the incident solar radiation on buildings, especially in tropical climatic conditions. Since ECBC specifies stringent U-Values for roof assembly, use of insulating materials is becoming popular. Along with insulation, the shading of the roof is also observed to be an important strategy for improving thermal performance of the building, especially in Warm and humid climatic conditions. This study intends to assess the impact of roof shading on building’s energy performance in comparison to that of exposed roof with insulation. A typical office building with specific geometry and schedules has been identified as base case model for this study. This building is simulated using energy modelling software ‘Design Builder’ with base case parameters as prescribed in ECBC. Further, the same building has been simulated parametrically adjusting the amount of roof insulation and roof shading simultaneously. The overall energy consumption and the envelope performance of the top floor are extracted for analysis. The results indicate that the roof shading is an effective passive cooling strategy for both naturally ventilated and air conditioned buildings in Warm and humid climates of India. It is also observed that a fully shaded roof outperforms the insulated roof as per ECBC prescription. Provision of shading over roof reduces the annual energy consumption of building in case of both insulated and uninsulated roofs. However, the impact is higher for uninsulated roofs (U-Value of 3.933 W/m2K), being 4.18% as compared to 0.59% for insulated roofs (U-Value of 0.33 W/m2K).While the general assumption is that roof insulation helps in reducing the energy consumption in tropical buildings, it is observed to be the other way when insulation is provided with roof shading. It is due to restricted heat loss during night.

scholarly journals Impact of individualized management of breakthrough cancer pain on quality of life in advanced cancer patients: CAVIDIOPAL study

2021 ◽  
Author(s):  
Albert Tuca Rodríguez ◽  
Miguel Núñez Viejo ◽  
Pablo Maradey ◽  
Jaume Canal-Sotelo ◽  
Plácido Guardia Mancilla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Advanced Cancer ◽  
Low Doses ◽  
Breakthrough Cancer Pain ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
Individualized Management ◽  
The Impact

Abstract Purpose The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice. Methods A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded. Results Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 μg, 100 μg, or 133 μg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001–1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227–13.873). Conclusion Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug. Trial registration This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.

Does a carbon emissions trading scheme spur urban green innovation? Evidence from a quasi-natural experiment in China

2021 ◽  
pp. 0958305X2110153
Author(s):  
Chao Li ◽  
Xiangyou Li ◽  
Deyong Song ◽  
Meng Tian
Keyword(s):  
Energy Conservation ◽  
Alternative Energy ◽  
Positive Impact ◽  
Emission Trading ◽  
Green Innovation ◽  
Urban Green ◽  
Carbon Emissions Trading ◽  
The Government ◽  
Trading Scheme ◽  
The Impact

Based on the panel data of 277 cities between 2003 and 2017 and a unique city-level dataset of green patent applications, this study employs the difference-in-differences (DID) method to evaluate the effect of China’s carbon emission trading scheme (ETS) pilots on urban green innovation. The findings indicate that China’s ETS pilots have a positive impact on urban green innovation, and that impact is more significant for municipalities than for prefecture-level cities. Furthermore, the impact on different categories of urban green innovation is heterogeneous. More specifically, China’s ETS pilots have significantly spurred urban green innovation that is closely related to energy conservation and emission reduction, including alternative energy production, transportation, energy conservation and so forth. Moreover, the facilitating effect of China’s ETS pilots on urban green innovation suffers from a lagging effect, which began to show a significant positive effect in 2016. Overall, this paper identifies the effect of China’s ETS pilots on urban green innovation, and suggests that the government should consider the heterogeneity of urban green innovation when designing national ETS policies.

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