Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses.

The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87-41.22), 31.8% (95% CI 29.2-34.61) 29.4% (95% CI 27.13-31.84) 36.9% (95% CI 33.78-40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.

The development and structural validity testing of the Person-centred Practice Inventory-Care (PCPI-C).

BACKGROUND: Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. AIMS: In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)-The Person-centred Practice Inventory-Care (PCPI-C). METHODS: Based on the 'person-centred processes' construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework-the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 -Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 -Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. RESULTS: The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user's perspective of what constitutes person-centred care. CONCLUSION AND IMPLICATIONS: This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework.

Applying the COM-B behaviour model to understand factors which impact 15-16 year old students' ability to protect themselves against acquirement of Human Papilloma virus (HPV) in Northern Ireland, UK.

High-risk strains of Human Papillomavirus (HPV) can lead to the development of a number of cancers including cervical, vulvar, penile, anal and oropharyngeal. HPV vaccination programmes offer the HPV vaccine to males and females 12-13 years old in schools throughout the UK. However, knowledge of HPV remains low in post-primary schools. The aim of this study is to capture 15-16 year old students' perceptions regarding the current provision of HPV education, and whether providing HPV education to 15-16 year olds could influence their intention to be vaccinated and/or future sexual health decisions related to HPV. Between 5th November 2021 and 6th May 2022, seven focus groups were conducted with 34 students in post-primary schools in Northern Ireland, United Kingdom. The data was analysed using the COM-B behaviour model to explore the perceived facilitators and barriers impacting students' ability to protect themselves from acquirement of HPV. Students perceived their knowledge of HPV to be poor and supported the addition of comprehensive mandatory HPV education at 15-16 years old when many of them were becoming sexually active. They identified barriers including lack of parental education, school ethos and religion and insufficient education regarding their legal rights to self-consent to HPV vaccination. Students felt that removal of these barriers would lead to safer sexual practices, increased awareness of the importance of HPV screening and increased HPV vaccination uptake. The recommendations provided by students need to be supported by the Education Authority in conjunction with the Department of Health in order to be successfully implemented into the post-primary school curriculum.

Evaluating the effectiveness of mindfulness alone compared to exercise and mindfulness on fatigue in women with gynaecology cancer (GEMS): Protocol for a randomised feasibility trial.

BACKGROUND: In 2020 Globocan reported nearly 1.4 million new cases of gynaecology cancer worldwide. Cancer related fatigue has been identified as a symptom that can be present for gynaecology cancer patients many years after treatment. The current evidence around the management of this symptom suggests that exercise has the most positive outcome. However, some ambiguity remains around the evidence and whether it can address all areas of fatigue effectively. More recently, other interventions such as mindfulness have begun to show a favourable response to the management of symptoms for cancer patients. To date there has been little research that explores the feasibility of using both these interventions together in a gynaecology cancer population. This study aims to explore the feasibility of delivering an intervention that involves mindfulness and mindfulness and exercise and will explore the effect of this on fatigue, sleep, mood and quality of life. METHODS/DESIGN: This randomised control trial will assess the interventions outcomes using a pre and post design and will also include a qualitative process evaluation. Participants will be randomised into one of 2 groups. One group will undertake mindfulness only and the other group will complete exercise and mindfulness. Both groups will use a mobile application to complete these interventions over 8 weeks. The mobile app will be tailored to reflect the group the participants have drawn during randomisation. Self-reported questionnaire data will be assessed at baseline prior to commencing intervention and at post intervention. Feasibility will be assessed through recruitment, adherence, retention and attrition. Acceptability and participant perspective of participation (process evaluation), will be explored using focus groups. DISCUSSION: This trial will hope to evidence and demonstrate that combination of two interventions such as mindfulness and exercise will further improve outcomes of fatigue and wellbeing in gynaecology cancer. The results of this study will be used to assess (i) the feasibility to deliver this type of intervention to this population of cancer patients using a digital platform; (ii) assist this group of women diagnosed with cancer to manage fatigue and other symptoms of sleep, mood and impact their quality of life. TRIAL REGISTRATION: NCT05561413.

An experimental machine learning study investigating the decision-making process of students and qualified radiographers when interpreting radiographic images.

AI is becoming more prevalent in healthcare and is predicted to be further integrated into workflows to ease the pressure on an already stretched service. The National Health Service in the UK has prioritised AI and Digital health as part of its Long-Term Plan. Few studies have examined the human interaction with such systems in healthcare, despite reports of biases being present with the use of AI in other technologically advanced fields, such as finance and aviation. Understanding is needed of how certain user characteristics may impact how radiographers engage with AI systems in use in the clinical setting to mitigate against problems before they arise. The aim of this study is to determine correlations of skills, confidence in AI and perceived knowledge amongst student and qualified radiographers in the UK healthcare system. A machine learning based AI model was built to predict if the interpreter was either a student (n = 67) or a qualified radiographer (n = 39) in advance, using important variables from a feature selection technique named Boruta. A survey, which required the participant to interpret a series of plain radiographic examinations with and without AI assistance, was created on the Qualtrics survey platform and promoted via social media (Twitter/LinkedIn), therefore adopting convenience, snowball sampling This survey was open to all UK radiographers, including students and retired radiographers. Pearson's correlation analysis revealed that males who were proficient in their profession were more likely than females to trust AI. Trust in AI was negatively correlated with age and with level of experience. A machine learning model was built, the best model predicted the image interpreter to be qualified radiographers with 0.93 area under curve and a prediction accuracy of 93%. Further testing in prospective validation cohorts using a larger sample size is required to determine the clinical utility of the proposed machine learning model.

Applying the COM-B behaviour model to understand factors which impact school immunisation nurses' attitudes towards designing and delivering a HPV educational intervention in post-primary schools for 15-17 year old students in Northern Ireland, UK.

INTRODUCTION: Human Papilloma Virus (HPV) is responsible for the development of cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers. Throughout the UK, Immunisation nurses (IMNs) deliver school-based HPV vaccinations to students 12-13 years old. Providing HPV education to 15-17 year old students may promote decision-making regarding their sexual health and award opportunity for unvaccinated students to self-consent to the vaccination. This study aims to explore the perceptions of IMNs regarding the value of providing HPV education to 15-17 year old students and to explore whether IMNs feel that the design/delivery of this education should form part of their professional role. METHODS: Six focus groups were conducted online with IMNs from all five Health and Social Care Trusts in Northern Ireland, UK, between January-June 2021. Data were analysed using the COM-B model to identify factors that might influence IMNs' behaviour towards designing/delivering this education for 15-17 year old students. RESULTS: IMNs were highly motivated to design and deliver this HPV education. Facilitators promoting this behaviour included their specialist training, their previous sexual health teaching experience and their desire to educate young people. Barriers negatively influencing this behaviour included lack of time/resources, parental influences, lack of school support and lack of teaching/presentation skills training. CONCLUSION: IMNs feel that they are the most appropriate professionals to design/deliver HPV education for 15-17 year old students. National policy change, based on collaboration between the Public Health Agency and Education Authority, is a key factor in facilitating IMNs to implement this school-based HPV education intervention.

A Review of the Applicability of Current Green Practices in Healthcare Facilities.

BACKGROUND: Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare. METHODS: We conducted a scoping review guided by the Arksey and O'Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022. RESULTS: Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book. CONCLUSION: Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.

Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia.

OBJECTIVES: To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM). SETTINGS: Open-label, feasibility clinical trial. PARTICIPANTS: Eleven people with FM (10 women). INTERVENTIONS: The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention. RESULTS: One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation. CONCLUSIONS: This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support. TRIAL REGISTRATION NUMBER: NCT03764397.

Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review.

PURPOSE: This systematic review investigated qualitative and quantitative studies exploring patients and healthcare professionals' (HCP) experience of nutrition care throughout the cancer journey. METHODS: Five databases were systematically searched for studies reporting on patient and healthcare professionals' experience of nutrition advice. RESULTS: Fifteen studies including 374 patients and 471 healthcare professionals were included. Findings indicate that patients desire more specific nutrition advice supported by members of the multidisciplinary team and delivered in appropriate and understandable language. Healthcare professionals have highlighted a lack of time, funding, dietetic roles, and knowledge as barriers to integrating nutrition as a standard part of cancer care. Five themes were identified (current provision of nutrition advice, optimal provision of nutrition advice, tension between patient values and nutritional or HCP priorities, providing evidence-based nutrition care, and practical barriers to nutrition advice provision). CONCLUSIONS: Further work is essential to better understand and address identified barriers and improve the provision of nutrition advice to this population. IMPLICATIONS FOR CANCER SURVIVORS: Findings from this review will guide the delivery of nutrition advice for cancer survivors.

A systematic review examining the clinical and health-care outcomes for congenital heart disease patients using home monitoring programmes.

OBJECTIVES: This review aimed to present the clinical and health-care outcomes for patients with congenital heart disease (CHD) who use home monitoring technologies. METHODS: Five databases were systematically searched from inception to November 2020 for quantitative studies in this area. Data were extracted using a pre-formatted data-collection table which included information on participants, interventions, outcome measures and results. Risk of bias was determined using the Cochrane Risk of Bias 2 tool for randomised controlled trials (RCTs), the Newcastle-Ottawa Quality Assessment Scale for cohort studies and the Institute of Health Economics quality appraisal checklist for case-series studies.Data synthesis: Twenty-two studies were included in this systematic review, which included four RCTs, 12 cohort studies and six case-series studies. Seventeen studies reported on mortality rates, with 59% reporting that home monitoring programmes were associated with either a significant reduction or trend for lower mortality and 12% reporting that mortality trended higher. Fourteen studies reported on unplanned readmissions/health-care resource use, with 29% of studies reporting that this outcome was significantly decreased or trended lower with home monitoring and 21% reported an increase. Impact on treatment was reported in 15 studies, with 67% of studies finding that either treatment was undertaken significantly earlier or significantly more interventions were undertaken in the home monitoring groups. CONCLUSION: The use of home monitoring programmes may be beneficial in reducing mortality, enabling earlier and more timely detection and treatment of CHD complication. However, currently, this evidence is limited due to weakness in study designs.

NET-RMDs study: networks of fatigue and pain in rheumatic and musculoskeletal diseases - protocol for an international cross-sectional study.

INTRODUCTION: Fatigue and pain are the main symptoms of rheumatic and musculoskeletal diseases (RMDs). Healthcare professionals have a primary role in helping patients to manage both these symptoms, which are part of a complex network of co-occurring factors including sleep problems, psychological distress, social support, body weight, diet, inactive lifestyle and disease activity. The patterns of relationships (networks) between these factors and these symptoms, fatigue and pain, are largely unknown. The current proposal aims to reveal them using network estimation techniques. We will also consider differences in networks for subgroups of people with (1) different RMDs and (2) different clusters (profiles) of biopsychosocial factors. METHODS AND ANALYSIS: Adults with at least one RMD will be recruited to this online cross-sectional observational project. To provide a complete overview, a large sample size from different countries will be included. A brief online survey, using 0-10 numeric rating scales will measure, for the past month, levels of fatigue and pain as well as scores on seven biopsychosocial factors. These factors were derived from literature and identified by interviews with patients, health professionals and rheumatologists. Using this input, the steering committee of the project decided the factors to be measured giving priority to those that can be modified in self-management support in community health centres worldwide. Network estimation techniques are used to detect the complex patterns of relationships between these biopsychosocial factors, fatigue and pain; and how these differ for subgroups of people with different RMDs and profiles. ETHICS AND DISSEMINATION: Ethical approval of national Institutional Review Boards was obtained. The online survey includes an information letter and informed consent form. The findings will be disseminated via conferences and publications in peer-reviewed scientific journals, while public media channels will be used to inform people with RMDs and other interested parties.

Effects of mindfulness-based interventions on fatigue and psychological wellbeing in women with cancer: A systematic review and meta-analysis of randomised control trials.

BACKGROUND: Cancer diagnosis and treatment can cause fatigue, stress and anxiety which can have a detrimental effect on patients, families and the wider community. Mindfulness-based interventions appear to have positive effects on managing these cancer-related symptoms. OBJECTIVE: To investigate the efficacy of mindfulness on cancer related fatigue (CRF) and psychological well-being in female cancer patients. METHODS: Five databases (CINHAL, Ovid Medline, Ovid Psych Info, Scopus, and Cochrane), and two trial registers (WHO and Clinicaltrials.gov) were searched for randomised control trials from inception to April 2021 and updated in August 2022. Meta-analysis was performed using Review Manager 5.4. The standardised mean difference (SMD) and 95% confidence intervals (CI) were used to determine the intervention effect. Subgroup analysis was performed for adaptation to types of mindfulness, length of intervention and types of comparator used. RESULTS: Twenty-one studies with a total of 2326 participants were identified. Mindfulness significantly improved CRF (SMD -0.81, 95% CI -1.17 to -0.44), depression (SMD-0.74, 95% CI -1.08 to -0.39) and anxiety (SMD -0.92, 95% CI -1.50 to -0.33). No effect was observed for quality of life (SMD 0.32, 95% CI -0.13-0.87) and sleep (SMD -0.65, 95% CI -1.34-0.04). Subgroup analysis revealed that there was little difference in SMD for adapted type of mindfulness (p = 0.42), wait list control compared to active comparator (p = 0.05) or length of intervention (p = 0.29). CONCLUSION: Mindfulness appears to be effective in reducing CRF and other cancer related symptoms in women. Adaptations to mindfulness delivery did not have negative impact on results which may aid delivery in the clinical settings.

Participatory peer research exploring the experience of learning during Covid-19 for allied health and healthcare science students.

INTRODUCTION: The teaching and learning experience of allied health and healthcare science students has altered because of the Covid-19 pandemic. Limited research has explored the experience on the future healthcare workforce using participatory research design. The aim of this study was to explore the impact of a global pandemic on the clinical and academic experiences of healthcare student using a co-production approach with student peer researchers. METHODS: A participatory research approach adopting online focus groups facilitated by students trained as peer researchers was adopted. First, second and final year students from occupational therapy, physiotherapy, podiatry, healthcare science, diagnostic radiography and imaging, radiotherapy and oncology, and speech and language therapy were recruited to six focus groups. Data generated through focus groups were analysed thematically using the DEPICT model to support a partnership approach. RESULTS: Twenty-three participants took part in six focus groups. The themes identified were: rapid changes to learning; living alongside Covid-19 and psychological impact. Students preferred blended learning approaches when available, as reduced peer interaction, studying and sleeping in the same space, and technology fatigue decreased motivation. CONCLUSION: Due to rapid changes in learning and the stress, anxiety and isolation created by the pandemic, managing study, personal life and placement resulted in a gap in confidence in clinical skills development for students. Students took their professional identity seriously, engaged in behaviours to reduce transmission of Covid-19 and employed a range of coping strategies to protect wellbeing. A challenge with the move to online delivery was the absence of informal peer learning and students indicated that moving forward they would value a hybrid approach to delivery. Higher Education should capitalise on innovative learning experiences developed during the pandemic however it is important to research the impact this has on student skill acquisition and learning experience.

Academic, clinical and personal experiences of undergraduate healthcare students during the COVID-19 pandemic: A prospective cohort study.

BACKGROUND: Coronavirus disease 2019 has impacted upon the role and safety of healthcare workers, with the potential to have a lasting effect on their wellbeing. Limited research has been conducted during previous pandemics exploring how student healthcare workers are impacted as they study and train for their professional careers. OBJECTIVE: The aim of the current study was to examine the specific impact of COVID-19 on the academic, clinical and personal experiences of healthcare students. METHOD: Undergraduate students across three year groups within the School of Health Sciences at Ulster University completed online Qualtrics surveys at three timepoints during one academic year (2020/2021). Quantitative survey data was downloaded from Qualtrics into SPSS Version 25 for descriptive analysis of each cross-sectional sample. Qualitative survey data was downloaded into text format, which was thematically analysed using content analysis. RESULTS: 412 students completed the survey at Time 1 (October 2020), n = 309 at Time 2 (December 2020) and n = 259 at Time 3 (April 2021). Academically, the pandemic had mostly a negative impact on the learning environment, the development of practical skills, the assessment process and opportunities for peer learning and support. Students reported increased stress and challenges managing their workload and maintaining a sense of motivation and routine. Clinically, they felt unprepared by the university for placement where the pandemic had an increasingly negative impact over time on learning and skill development. In terms of personal experiences, despite the majority of students taking steps to keep physically and mentally well, negative impacts on friendships, mental wellbeing and concerns for family were reported. The pandemic had not impacted upon career choice for most students. CONCLUSION: Consideration must be given to the development of practical skills so students feel prepared for their professional careers given the practical nature of their roles. Programme coordinators should adopt a holistic approach to student wellbeing.

An insight into the current perceptions of UK radiographers on the future impact of AI on the profession: A cross-sectional survey.

INTRODUCTION: As a profession, radiographers have always been keen on adapting and integrating new technologies. The increasing integration of artificial intelligence (AI) into clinical practice in the last five years has been met with scepticism by some, who predict the demise of the profession, whilst others suggest a bright future with AI, full of opportunities and synergies. Post COVID-19 pandemic need for economic recovery and a backlog of medical imaging and reporting may accelerate the adoption of AI. It is therefore timely to appreciate practitioners' perceptions of AI used in clinical practice and their perception of the short-term impact on the profession. AIM: This study aims to explore the perceptions of AI in the UK radiography workforce and to investigate its current AI applications and future technological expectations of radiographers. METHODS: An online survey (QualtricsⓇ) was created by a team of radiography AI experts. The survey was disseminated via social media and professional networks in the UK. Demographic information and perceptions of the impact of AI on several aspects of the radiography profession were gathered, including the current use of AI in practice, future expectations and the perceived impact of AI on the profession. RESULTS: 411 responses were collected (80% diagnostic radiographers (DR); 20% therapeutic radiographers (TR)). Awareness of AI used in clinical practice is low, with DR respondents suggesting AI will have the most value/potential in cross sectional imaging and image reporting. TR responses linked AI as having most value in treatment planning, contouring, and image acquisition/matching. Respondents felt that AI will impact radiographers' daily work (DR, 79.6%; TR, 88.9%) by standardising some aspects of patient care and technical factors of radiography practice. A mixed response about impact on careers was reported. CONCLUSIONS: Respondents were unsure about the ways in which AI is currently used in practice and how AI will impact on careers in the future. It was felt that AI integration will lead to increased job opportunities to contribute to decision making as an end user. Job security was not identified as a cause for concern.

"Why would you not listen? It is like being given the winning lottery numbers and deciding not to take them": semi-structured interviews with post-acute myocardial infarction patients and their significant others exploring factors that influence participation in cardiac rehabilitation and long-term exercise training.

PURPOSE: Despite the clinical benefits, coronary artery disease patient participation rates in cardiac rehabilitation (CR) and long-term exercise are poor. This study explored the factors related to participation in these interventions from the perspectives of post-acute myocardial infarction (AMI) patients and their significant others. METHODS: Semi-structured interviews were performed with post-AMI patients (number (n) = 10) and their significant others (n = 10) following phase-III and phase-IV CR. Reflexive thematic analysis with an inductive orientation was utilised to identify themes within the dataset (ClinicalTrials.gov identifier: NCT03907293). RESULTS: The overarching theme of the data was a perceived need to improve health, with the participants viewing health benefits as the principal motive for participating in CR and long-term exercise training. Three further themes were identified: motivation, extrinsic influences, and CR experience. These themes captured the underlying elements of the participants' decision to take part in CR and long-term exercise training for the purpose of health improvements. CONCLUSION: An AMI collectively impacts the attitudes and beliefs of patients and their significant others in relation to CR participation, long-term exercise, and health. The factors identified in this study may inform strategies to promote patient enrollment in CR and adherence to long-term exercise.IMPLICATIONS FOR REHABILITATIONPost-AMI patients and their significant others reported that health benefits were the primary motive for participating in CR and long-term exercise, with aspects related to motivation, extrinsic influences, and CR experience underpinning the decision.Healthcare professionals should supply information about health benefits during the CR referral process, with insights into the experiences of CR graduates potentially improving the strength of recommendation.CR facilitators may promote long-term exercise adherence by assisting patients with the identification of an enjoyable exercise modality.Healthcare professionals should include significant others in the CR referral process, which may enable these individuals to support the patients' decisions.

Exercise and Cardioprotection in Coronary Artery Disease: A Pilot Quasi-Experimental Study.

Sirtuin-1 is a protein that may orchestrate the cardioprotective effect of exercise by controlling cellular processes. This pilot study assessed the feasibility of performing a quasi-experimental study in this area. Patients with postacute myocardial infarction were recruited across four hospital sites in the United Kingdom. The participants were offered one weekly exercise session at Phase-III and Phase-IV cardiac rehabilitation (CR). Measurements were obtained pre-Phase-III CR (Week 1), post-Phase-III CR (Week 8), and post-Phase-IV CR (Week 22). Twenty-eight patients were recruited (79% male, 100% White, 60.2 ± 10.5 years old). The recruitment rate was not fulfilled (<70% eligible patients recruited; 0.9 participants recruited per week over 30 weeks). The success criteria for dropout rate, adherence rate, and collection of sirtuin-1 measures were satisfied. A large increase in sirtuin-1 (0.14 ± 0.03, d ≥ 0.8) was seen after Phase-III and Phase-IV CR. Collectively, a quasi-experimental study is feasible with a revised recruitment strategy.

Beauty Is in the AI of the Beholder: Are We Ready for the Clinical Integration of Artificial Intelligence in Radiography? An Exploratory Analysis of Perceived AI Knowledge, Skills, Confidence, and Education Perspectives of UK Radiographers.

Introduction: The use of artificial intelligence (AI) in medical imaging and radiotherapy has been met with both scepticism and excitement. However, clinical integration of AI is already well-underway. Many authors have recently reported on the AI knowledge and perceptions of radiologists/medical staff and students however there is a paucity of information regarding radiographers. Published literature agrees that AI is likely to have significant impact on radiology practice. As radiographers are at the forefront of radiology service delivery, an awareness of the current level of their perceived knowledge, skills, and confidence in AI is essential to identify any educational needs necessary for successful adoption into practice. Aim: The aim of this survey was to determine the perceived knowledge, skills, and confidence in AI amongst UK radiographers and highlight priorities for educational provisions to support a digital healthcare ecosystem. Methods: A survey was created on Qualtrics® and promoted via social media (Twitter®/LinkedIn®). This survey was open to all UK radiographers, including students and retired radiographers. Participants were recruited by convenience, snowball sampling. Demographic information was gathered as well as data on the perceived, self-reported, knowledge, skills, and confidence in AI of respondents. Insight into what the participants understand by the term "AI" was gained by means of a free text response. Quantitative analysis was performed using SPSS® and qualitative thematic analysis was performed on NVivo®. Results: Four hundred and eleven responses were collected (80% from diagnostic radiography and 20% from a radiotherapy background), broadly representative of the workforce distribution in the UK. Although many respondents stated that they understood the concept of AI in general (78.7% for diagnostic and 52.1% for therapeutic radiography respondents, respectively) there was a notable lack of sufficient knowledge of AI principles, understanding of AI terminology, skills, and confidence in the use of AI technology. Many participants, 57% of diagnostic and 49% radiotherapy respondents, do not feel adequately trained to implement AI in the clinical setting. Furthermore 52% and 64%, respectively, said they have not developed any skill in AI whilst 62% and 55%, respectively, stated that there is not enough AI training for radiographers. The majority of the respondents indicate that there is an urgent need for further education (77.4% of diagnostic and 73.9% of therapeutic radiographers feeling they have not had adequate training in AI), with many respondents stating that they had to educate themselves to gain some basic AI skills. Notable correlations between confidence in working with AI and gender, age, and highest qualification were reported. Conclusion: Knowledge of AI terminology, principles, and applications by healthcare practitioners is necessary for adoption and integration of AI applications. The results of this survey highlight the perceived lack of knowledge, skills, and confidence for radiographers in applying AI solutions but also underline the need for formalised education on AI to prepare the current and prospective workforce for the upcoming clinical integration of AI in healthcare, to safely and efficiently navigate a digital future. Focus should be given on different needs of learners depending on age, gender, and highest qualification to ensure optimal integration.

Fatigue and Sleep Disturbance in Arabic Cancer Patients After Completion of Therapy: Prevalence, Correlates, and Association With Quality of Life.

BACKGROUND: Fatigue and sleep disturbance are 2 of the most common and distressing cancer symptoms that negatively affect quality of life. OBJECTIVE: The aim of this study was to assess the prevalence of, and factors contributing to, fatigue and sleep disturbance in Arabic-speaking cancer patients in Oman after completion of their cancer treatment. METHODS: A cross-sectional and descriptive correlational design was used. Data were collected using the Pittsburgh Sleep Quality Index where a score of >5 indicated as poorer sleep, the Functional Assessment of Cancer Therapy-Fatigue a score of ≤34 indicating clinically significant fatigue, and the Functional Assessment of Cancer Therapy-General. RESULTS: Of the 369 patients who participated, 77.5% (n = 286) reported clinically significant fatigue, and 78% (n = 288) reported poor sleep. Fatigue (P < .05) was significantly associated with age, cancer site, months since diagnosis, type of treatment received, and comorbidity. Those experiencing fatigue and poor sleep had the lowest quality of life among the cancer patients studied. CONCLUSION: Fatigue and sleep disturbance are significant problems for the Arabic patients diagnosed with cancer. Both fatigue and sleep disturbance should be routinely assessed in the case of such patients. IMPLICATIONS FOR PRACTICE: Routine assessments of fatigue and sleep disturbance are recommended so that appropriate interventions and treatment management plans can be introduced to reduce fatigue and improve sleep quality among patients with cancer.

Effectiveness of Exercise on Fatigue and Sleep Quality in Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Trials.

OBJECTIVES: To determine the effects of exercise on fatigue and sleep quality in fibromyalgia (primary aim) and to identify which type of exercise is the most effective in achieving these outcomes (secondary aim). DATA SOURCES: PubMed and Web of Science were searched from inception until October 18, 2018. STUDY SELECTION: Eligible studies contained information on population (fibromyalgia), intervention (exercise), and outcomes (fatigue or sleep). Randomized controlled trials (RCT) testing the effectiveness of exercise compared with usual care and randomized trials (RT) comparing the effectiveness of 2 different exercise interventions were included for the primary and secondary aims of the present review, respectively. Two independent researchers performed the search, screening, and final eligibility of the articles. Of 696 studies identified, 17 RCTs (n=1003) were included for fatigue and 12 RCTs (n=731) for sleep. Furthermore, 21 RTs compared the effectiveness of different exercise interventions (n=1254). DATA EXTRACTION: Two independent researchers extracted the key information from each eligible study. DATA SYNTHESIS: Separate random-effect meta-analyses were performed to examine the effects from RCTs and from RTs (primary and secondary aims). Standardized mean differences (SMD) effect sizes were calculated using Hedges' adjusted g. Effect sizes of 0.2, 0.4, and 0.8 were considered small, moderate, and large. Compared with usual care, exercise had moderate effects on fatigue and a small effect on sleep quality (SMD, -0.47; 95% confidence interval [CI], -0.67 to -0.27; P<.001 and SMD, -0.17; 95% CI, -0.32 to -0.01; P=.04). RTs in which fatigue was the primary outcome were the most beneficial for lowering fatigue. Additionally, meditative exercise programs were the most effective for improving sleep quality. CONCLUSIONS: Exercise is moderately effective for lowering fatigue and has small effects on enhancing sleep quality in fibromyalgia. Meditative exercise programs may be considered for improving sleep quality in fibromyalgia.