Lynn Kilbride

The frequency and cause of anxiety and depression amongst patients with malignant brain tumours between surgery and radiotherapy

IntroductionBetween surgery and radiotherapy patients with a malignant glioma may encounter a number of psychosocial issues that could invoke an anxious or depressive response. This study explored the frequency, severity and cause of anxiety and depression in patients with presumed malignant brain tumours in the period between their surgery and radiotherapy.MethodsA prospective study of 51 patients used mixed methods to measure anxiety and depression at three time points; post surgery, three weeks post surgery and pre radiotherapy. Analysis was undertaken using statistical and content analysis of the Hospital Anxiety and Depression (HAD) scores and unstructured interviews respectively.ResultsAnalysis of HAD scores indicated a heightened level of anxiety in patients pre radiotherapy. This anxiety is more prevalent in younger patients and is not related to the patients change in functional state. Five patients had a significant depression at one or more time points between surgery and radiotherapy. Four of the five patients who reported scores consistent with depression had past histories of depression. Content analysis of unstructured interviews indicated that the HAD scores underestimated the presence of anxiety and depression amongst this group of patients.ConclusionAnxiety was more common in younger patients. Anxiety was slightly more frequent pre-radiotherapy. A past medical history of depression is a predictor of significant depression in the post-operative period. The HAD scale although useful is not an adequate measurement tool for detecting anxiety and depression amongst all patients and health care professionals should adopt other means to monitor for these signs and symptoms.

Managing blood glucose during and after exercise in Type 1 diabetes: reproducibility of glucose response and a trial of a structured algorithm adjusting insulin and carbohydrate intake

AIMS AND OBJECTIVES To enable people with Type 1 diabetes to exercise safely by investigating the reproducibility of the glucose response to an algorithm for carbohydrate and insulin adjustment during and after exercise compared to their self-management strategies. BACKGROUND Difficulties in managing blood glucose levels in Type 1 diabetes whilst exercising is known to deter people from exercise. Currently there is a limited evidence base to aid health care professionals enable people with diabetes to exercise safely. This study seeks to address this gap. DESIGN A quasi-experimental study was undertaken amongst people with Type 1 diabetes. METHODS Over 14 days, 14 participants undertook four exercise sessions (40 minutes at 50%VO2max). Two sessions were undertaken in week 1 self-managing their diabetes and two sessions in week 2 using an algorithm for carbohydrate and insulin adjustment. RESULTS The mean reduction of glucose levels detected by Continuous Glucose Monitoring during exercise was 3·1 (SD 2·03) mmol/l. Time spent within the range of 4-9 mmol/l during exercise was not significantly different between the self-managed and the algorithm weeks (-3-22·4 min). The mean reduction of blood glucose for each individual over all four exercise sessions ranged between 0·8-5·95 mmol/l. The technical error between days one and two was 2·4 mmol/l (CV=33·2%) and between days 3-4 the technical error was 2·7 mmol/l (CV=33·7%). CONCLUSIONS The results provide useful data about the reproducibility of the blood glucose response to moderate intensity exercise, despite the variability of individual responses 40 minutes of moderate intensity exercise decreases Continuous Glucose Monitoring glucose by 3 mmol/l with or without a 30% decrease of insulin before exercise. RELEVANCE TO CLINICAL PRACTICE This information provides valuable baseline information for people with diabetes and health care professionals who wish to encourage physical activity and undertake further research in this area.

Metastatic spinal cord compression: a review of practice and care

AIM AND OBJECTIVES The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? BACKGROUND Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment. DESIGN A structured literature review to synthesise the available evidence about the management of MSCC. METHODS The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included. RESULTS The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered. CONCLUSION Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike. RELEVANCE TO CLINICAL PRACTICE Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit.

Breast cancer surveillance in women with intellectual disabilities

Breast cancer is the most frequent malignant neoplasm observed among women. For the subgroup of women with learning/intellectual disability, it is unclear whether their risk for breast cancer is as high as it is for the general population. Objective: Evaluation of breast cancer frequency and breast cancer screening in women with learning disability, focusing on Down syndrome. Method: Review of the literature. Results: The rather scant literature on the topic suggests women with learning disability may have the same or lower risk of breast cancer. The subgroup of women with Down syndrome has a lower risk of breast cancer. The absence of adequate, good-quality epidemiological data on this topic makes it difficult to evaluate any trend of increasing or decreasing risk for these women. However, given that medical achievements have seen significant gains in life expectancy for this group, it is likely that the number of women presenting with symptomatic breast cancer is increasing, even if the rate is unchanged. Evaluation of the literature on the use of mammography screening services suggests that women with learning disability may be either deliberately or passively excluded from screening programs. Uptake among those who are invited for mammography appears to be poor, and alternatives, such as clinical breast examination, appear to be underutilized. Conclusion: We suggest that women with learning disability should not be excluded from breast cancer screening services. Increased awareness of the risks of breast cancer among general practitioners and other health personnel is needed, as is the evaluation and development of appropriate screening methods for this special-needs population.

Paid- and family-carers' views on supporting women with intellectual disability through breast screening

The cancer needs of people with intellectual disabilities are increasingly being debated. This paper explores the views and experiences of paid- and family-carers when supporting women with intellectual disabilities through breast screening. An ethnographic approach was drawn on and purposive sampling methods were employed. One-to-one semi-structured interviews with 13 carers (10 paid-carers, three family-carers) were undertaken and supported by periods of focused observation on behaviour related to breast awareness and breast screening. Findings indicated that most women with intellectual disabilities needed some support but the quality and quantity of support depended upon both the womans level of intellectual disability and who was supporting them. In terms of breast screening, the findings suggested that the women were potentially being let down at all the different stages of the breast screening process, from the arrival of the invitation letter to the experience of having a mammogram. The conclusion drawn was that there was evidence of equality of service provision but inequality of service delivery and uptake.

Acute effects of weight training on glycaemia in type 1 diabetes

Exercise is regarded as a potential strategy to assist in the management of blood glucose in people with type 1 diabetes. However, currently there is little evidence‐based information detailing the acute effects weight training has on glycaemia in type 1 diabetes. The aim of this review is to identify studies investigating the acute effects of weight training on blood glucose levels in type 1 diabetes.

Can laboratory based research regarding type 1 diabetes and exercise be applied into the real-life environment?

The aim of this study was to determine whether results from laboratory based research examining glycaemic control during and after exercise can be applied to a real‐life (non‐laboratory) environment.

The design and evaluation of a self-management algorithm for people with type 1 diabetes performing moderate intensity exercise

Limited evidence is available to advise people with type 1 diabetes about self‐management strategies for maintaining acceptable glycaemic control when exercising.

Delayed hypoglycaemia in people with type 1 diabetes after performing moderate intensity exercise before the evening meal

For a person with type 1 diabetes, participation in exercise may increase the risk of hypoglycaemia. Research has been performed during or immediately after exercise in a laboratory environment, with limited evidence regarding strategies for post‐exercise hypoglycaemia prevention.

How women manage their type 1 diabetes during the menopausal transition: a qualitative study using a grounded theory approach

This study aimed to explore the experiences of women with type 1 diabetes during the menopausal transition using a grounded theory approach and, from the data, develop a substantive theory with implications for service users and service providers. A qualitative exploratory research framework was employed using a grounded theory approach. Data were collected from 10 participants using transcribed audiotaped semistructured interviews and field notes. The transcripts, audio recordings and field notes were reviewed and a coding process facilitated data analysis. This approach enabled themes to emerge from the data and ultimately a theory. A wide range of conceptions was revealed. Data are presented in seven categories that reflect the experience of the subjects: ‘Blank wall’ (relates to the lack of information regarding menopause and diabetes); ‘Juggling game’ (relates to glycaemic control); Anxiety and fear; ‘Haywire’ (relates to the signs and symptoms of menopausal transition); Treating symptoms; Depression and mood; and ‘I’m old’ (relates to ageing and mortality). A substantive theory emerged. Absence of information regarding the menopause and its impact on type 1 diabetes (‘Blank wall’) was identified as the main problem facing women with type 1 diabetes during their menopausal transition. The findings could enable practitioners to identify the types of information, advice and support that should be made available to these women, and contribute to the limited knowledge base currently available. The findings indicate also that further research into this under-studied but important area of diabetes care is required. Copyright