Unmet supportive care needs associated with quality of life for people with lung cancer: A systematic review of the evidence 2007-2020.

INTRODUCTION: The aim of this review was to systematically examine the evidence on the relationship between quality of life (QoL) and unmet supportive care needs in patients with lung cancer. METHODS: Six databases were searched for studies published since 2007. Studies were included if they measured QoL using a standardised tool and examined its association with unmet supportive care needs in lung cancer patients. RESULTS: Six studies involving 562 patients were included. Nearly two thirds of the patients had been diagnosed with advanced cancer (Stage III or IV), and the majority had been diagnosed for less than 2 years. There was a negative association between QoL and unmet needs using two different measures (Supportive Care Needs Survey[SCNS] and Cancer Survivors Unmet Needs Survey [CaSUN]). In two studies, the relationship was limited to physical and/or psychological domains. CONCLUSIONS: Unmet supportive care needs are associated with poorer QoL for people with lung cancer: The findings suggest that unmet physical and psychological needs may have the most impact on QoL and reflect the high symptom burden and psychological distress associated with lung cancer. Further work is needed to examine these relationships to identify the services and interventions that address the range of care needs across the disease trajectory.

Variables associated with distress amongst informal caregivers of people with lung cancer: A systematic review of the literature.

OBJECTIVE: Informal caregivers of people with lung cancer often experience a substantial care burden and associated negative consequences due to the often-contracted course of the disease. The objective of this review was to systematically examine the evidence on the factors associated with lung cancer caregiver distress. METHODS: Five databases (MEDLINE, CINAHL, EMBASE, PsychINFO and Web of Science) were searched for studies investigating factors associated with distress amongst caregivers of people with lung cancer. Empirical studies published up to July 2020 were included if they measured distress using a valid and reliable measure and examined its association with at least one other factor, with a sample of 50 or more caregivers. RESULTS: Thirty publications describing 27 studies (16 cross-sectional; 6 prospective; 8 intervention) involving 3744 caregivers (primarily spouse or adult child) were included. A narrative synthesis of the findings is presented due to heterogeneity in study design, variables measured and analyses conducted. Patient variables associated with greater distress included: stage of cancer and quality of spousal relationship. Caregiver variables associated with higher distress included: social support, coping strategies and self-efficacy. CONCLUSIONS: Several variables were associated with distress amongst lung cancer caregivers. Understanding these variables could inform the development of interventions that will enable caregivers to care effectively while maintaining their own well-being. Screening for distress among caregivers may identify those caregivers who would benefit from early intervention.

The Effectiveness of Technology-Mediated Dance Interventions and Their Impact on Psychosocial Factors in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Engaging in physical activity contributes to healthy aging; however, adherence to exercise programs is often low among older adults. Technology-mediated dance systems, which can be used at home, and dance as a way of keeping physically active have been receiving attention as a means of not only enabling physical activity among older people but may also address key psychosocial factors that are amenable to change. OBJECTIVES: To assess the effectiveness of technology-mediated dance interventions and their impact on psychosocial factors in older adults (aged 65 or older). METHODS: A systematic review of randomized controlled trials from January 2000 to February 2017 using key search terms. Two independent reviewers screened articles using predetermined selection criteria. Risk of bias of selected articles was assessed in accordance with the Cochrane guidelines. RESULTS: From an overall 264 articles, six articles (five studies) were found, which assessed the impact of technology-mediated dance interventions on psychosocial factors in older adults. Studies' quality ratings were low, with exception of one study that was considered of moderate quality. None of the studies considered psychosocial factors as primary outcomes. Secondary outcomes assessed fear of falling, depression, and training enjoyment, but no study showed evidence of an effective impact on these variables. The meta-analysis revealed low quality evidence that there was little or no difference above that of the comparison groups for fear of falling (standardized mean difference [SMD] -0.02, 95% confidence interval [CI] -0.37 to 0.33; P = 0.91; five trials). Similarly, there was little or no difference on depression (SMD -0.06, 95% CI -0.59 to 0.47; P = 0.83; three trials). CONCLUSION: Existing evidence to support the effectiveness of technology-mediated dance interventions and their impact on psychosocial factors in older adults is weak and with a high risk for bias. The findings of this review may inform future, more rigorous research in the area.

Work Outcomes in Patients Who Stay at Work Despite Musculoskeletal Pain.

Purpose To assess self-reported work impacts and associations between psychosocial risk factors and work impairment amongst workers seeking care for musculoskeletal pain while continuing to work. Methods Patients were recruited from Musculoskeletal Assessment Clinics at 5 hospitals across Ireland. Participants completed questionnaires including assessments of work impairment (Work Productivity and Activity Impairment Questionnaire), work ability (single item from the Work Ability Index) and work performance (Work Role Functioning Questionnaire; WRFQ). Logistic and hierarchical regressions were conducted to analyse the relation between psychosocial variables and work outcomes. Results 155 participants (53.5% female; mean age = 46.50 years) who were working at the time of assessment completed the questionnaires. Absenteeism was low, yet 62.6% were classified as functioning poorly according to the WRFQ; 52.3% reported having poor work ability. Logistic regression analyses indicated that higher work role functioning was associated with higher pain self-efficacy (OR 1.51); better work ability was associated with older age (OR 1.063) and lower functional restriction (OR 0.93); greater absenteeism was associated with lower pain self-efficacy (OR 0.65) and poorer work expectancy (OR 1.18). Multiple regression analysis indicated that greater presenteeism was associated with higher pain intensity (ß = 0.259) and lower pain self-efficacy (ß = - 0.385). Conclusions While individuals continue to work with musculoskeletal pain, their work performance can be adversely affected. Interventions that target mutable factors, such as pain self-efficacy, may help reduce the likelihood of work impairment.

The Role of Philanthropic Funding in Building Research Evidence to Support an Aging Population: A Case Study from Ireland.

This case study examines the role of philanthropic funding in building capacity for aging research in Ireland, and how this investment has addressed the lack of evidence to support planning for an aging population. The funding has supported a range of initiatives including the national longitudinal study on aging (TILDA), the creation of three professorships/chairs, and the establishment of four new research centers. Important potential outcomes are emerging across other domains including research-informed policy development and the generation of health benefits. The efforts of academic researchers to ensure that their findings are readily accessible to end users and to forge robust working relationships with all stakeholders have helped to enhance the use of research findings. Overall, philanthropy has played a pivotal role in building capacity, infrastructure, and expertise in academic settings in Ireland. Moreover, this work provides an excellent example of how such efforts can begin to inform effective planning and service provision.

Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. DATA SOURCES: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. REVIEW METHODS: Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months' sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. RESULTS: A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. CONCLUSION: There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults.

BACKGROUND: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. OBJECTIVES: To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. SEARCH METHODS: We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. MAIN RESULTS: Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years).We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows.Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants).Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants).The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months' follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence.Neither study reported user satisfaction with the service. AUTHORS' CONCLUSIONS: There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries.

Q selection for an electro-optical earth imaging system: theoretical and experimental results.

This paper explores practical design considerations for selecting Q for an electro-optical earth imaging system, where Q is defined as (λ FN) / pixel pitch. Analytical methods are used to show that, under imaging conditions with high SNR, increasing Q with fixed aperture cannot lead to degradation of image quality regardless of the angular smear rate of the system. The potential for degradation of image quality under low SNR is bounded by an increase of the detector noise scaling as Q. An imaging test bed is used to collect representative imagery for various Q configurations. The test bed includes real world errors such as image smear and haze. The value of Q is varied by changing the focal length of the imaging system. Imagery is presented over a broad range of parameters.

Association between circadian rhythms, sleep and cognitive impairment in healthy older adults: an actigraphic study.

There is increasing evidence for the relationship between circadian rhythm disturbance and cognitive decline in the older adult. This study measured circadian activity rhythms in a small group of healthy community-dwelling older adults (n = 26). Each participant completed a battery of neuropsychological tests and completed sleep diaries and 6 days of actigraphy. Ten participants were identified as having very early signs of cognitive decline as indicated by their performance on the memory tests. Results showed minimal differences on the sleep/activity and circadian parameters across the two groups (declined vs. intact), although there was a significant difference in the acrophase between the declined and intact groups. These findings, although exploratory, suggest that very subtle changes in circadian rhythm may be detected in older adults showing pre-clinical changes in cognitive performance.

Acceptance versus distraction: brief instructions, metaphors and exercises in increasing tolerance for self-delivered electric shocks.

The current study compared the effects of an acceptance versus distraction rationale on coping with experimentally induced pain. Eighty participants were randomly assigned to one of five conditions: Full-Acceptance, Full-Distraction, Instruction-only-Acceptance, Instruction-only-Distraction and No-Instructions. Participants completed a simple matching task and were intermittently given the choice either to receive an electric shock and continue, or to avoid the shock and terminate the task. Only the Full-Acceptance strategy (that included experiential exercises and a metaphor) had a significant effect on task tolerance as measured by an increase in the number of shocks delivered post-intervention relative to baseline. In addition, the participants in both of the acceptance conditions showed lower levels of believability in that they were more likely to continue with the task even when reporting more pain. The results support the prediction that acceptance-based interventions work by undermining the behavioural-control functions of pain-related thoughts and feelings, and call for a systematic analysis of how metaphors and exercises work in analogue research.

Experiential avoidance and aversive visual images: response delays and event-related potentials on a simple matching task.

In Experiment 1, participants high (n=15) or low in avoidance (n=14), as measured by the Acceptance and Action Questionnaire, completed a simple matching task that required them to choose whether or not to look at an aversive visual image. Only the high-avoidance participants took longer to emit a correct response that produced an aversive rather than a neutral picture. Additionally, the high-avoiders reported greater levels of anxiety following the experiment even though they rated the aversive images as less unpleasant and less emotionally arousing than their low-avoidant counterparts. In Experiment 2, three groups, representing high-, mid- and low-avoidance (n=6 in each) repeated the matching task with the additional recording of event-related potentials (ERPs). The findings of Experiment 1 were replicated in terms of reaction times and subjective ratings. The ERPs confirmed that the participants attended to the content of the images and differentiated between the aversive and neutral image types. The ERPs also showed significantly greater negativity for electrodes over the left hemisphere relative to the midline for only the high-experiential avoidance (EA) group. Given the left hemisphere dominance for language, the data suggest that the high-EA group engaged in verbal strategies to regulate their emotional responses.