Stephanie Tierney

Adherence of heart failure patients to exercise: barriers and possible solutions A position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology

The practical management of heart failure remains a challenge. Not only are heart failure patients expected to adhere to a complicated pharmacological regimen, they are also asked to follow salt and fluid restriction, and to cope with various procedures and devices. Furthermore, physical training, whose benefits have been demonstrated, is highly recommended by the recent guidelines issued by the European Society of Cardiology, but it is still severely underutilized in this particular patient population. This position paper addresses the problem of non‐adherence, currently recognized as a main obstacle to a wide implementation of physical training. Since the management of chronic heart failure and, even more, of training programmes is a multidisciplinary effort, the current manuscript intends to reach cardiologists, nurses, physiotherapists, as well as psychologists working in the field.

The Dangers and Draw of Online Communication: Pro-Anorexia Websites and their Implications for Users, Practitioners, and Researchers

Recent advances in communication have enabled an underground interest group, unrestricted by geographic boarders, to evolve. The so-called pro-anorexia movement has a particular presence in the form of Internet discussion boards. This paper examines the potential impact of such online activity for those visiting these resources, for practitioners working with individuals who have anorexia, and for those conducting research into the condition. It contributes to the debate about this controversial development in the world of eating disorders.

MOMENT -- Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey

BackgroundCleft palate (CP) has an incidence of approximately 1 in 700. Children with CP are also susceptible to otitis media with effusion (OME), with approximately 90% experiencing nontrivial OME. There are several approaches to the management of OME in children with CP. The Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) study is a feasibility study that includes the development of a core outcome set for use in future trials of the management of OME in children with CP.Methods/DesignThe MOMENT study will include a systematic review of the literature to identify a list of outcomes that have previously been reported. This list of outcomes will be used in a Delphi study with cleft clinicians. The Delphi study is anticipated to include three rounds. The first round will ask clinicians to score the outcome list and to add any outcomes they think are relevant. The second round involves presentation of scores according to stakeholder group and the opportunity for participants to rescore outcomes. To ensure that the opinion of parents and children are sought, qualitative interviews will be completed with a purposive sample in parallel. In the final round of the Delphi process, participants will be shown the distribution of scores, for each outcome, for all stakeholder groups separately as well as a summary of the results concerning outcomes from the qualitative interviews with parents. A final consensus meeting will be held with all stakeholders, including parents and children, to review outcomes.DiscussionA core outcome set represents the minimum that should be measured in a clinical trial for a particular condition. The MOMENT study will aim to identify a core outcome set that can be used in future trials of the management of OME, improving the consistency of research in this clinical area.

What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies.

OBJECTIVE The objective of this study is to synthesise views and experiences of South Asian (SA) older adults in relation to exercise and physical activity (PA). It was anticipated that this work would identify barriers and facilitators that could inform interventions aimed at promoting PA among this population. METHOD A systematic review of qualitative research was conducted. Six electronic databases were searched for relevant papers published from January 2000 to October 2011. Studies were appraised and data extracted by two reviewers. A synthesis was undertaken using framework analysis. Of 26 papers read in full, 11 were included in the review. RESULTS An overriding concept derived from the synthesis was the influence of empowering and disempowering contexts on PA levels of SA participants. It was supported by the following themes: communication (e.g. relying on relatives for translation of information, lack of understanding); relationships (e.g. social support from family, friends, community), beliefs (e.g. not culturally appropriate to exercise, fatalism) and environment (e.g. lack of accessible recreational areas/facilities). CONCLUSIONS Drawing on community resources to generate group norms appears to be important when trying to increase exercise and PA among SA older adults. Implications of the results for PA promotion and provision are discussed.

Living with the anorexic voice: a thematic analysis.

OBJECTIVES A factor said to drive the behaviours of people with the eating disorder anorexia nervosa is the inner voice some recount hearing. However, little systematic examination has been made of this entity. The study aimed to investigate experiences of and reflections on living with an anorexic voice. DESIGN A qualitative approach was used because the study sought to establish the perspectives of those with anorexia who identified with the concept of living with an anorexic voice. METHOD Individuals from three self-help organizations were invited to write about their life with an anorexic voice in the form of a poem, a reflection, a letter, or a descriptive narrative. Recruitment continued until data saturation was reached. Thematic analysis was employed by two researchers. RESULTS Written contributions were provided by 21 participants. These data underlined the positive and negative attributes individuals bestowed upon their anorexic voice; the former appeared stronger during the early stages of their eating disorder, the latter coming into force as it developed. In spite of their voices harsh and forceful character, participants felt an affiliation towards it. DISCUSSION The bond between individuals and their anorexic voice could explain their ambivalence to change. Therapists must persist in their endeavours to penetrate this tie, whilst acknowledging the hold this entity has over those with anorexia. Interventions that address this component of the eating disorder could prove fruitful in helping people towards recovery.

What can we learn from patients with heart failure about exercise adherence? A systematic review of qualitative papers.

OBJECTIVES Keeping physically active has been shown to bring positive outcomes for patients diagnosed with heart failure (HF). However, a number of individuals with this health problem do not undertake regular exercise. A review of extant qualitative research was conducted to explore what it can tell us about barriers and enablers to physical activity among people with HF. METHODS A systematic search, involving electronic databases and endeavors to locate gray literature, was carried out to identify relevant qualitative studies published from 1980 onward. Data from retrieved papers were combined using framework analysis. Papers read in full numbered 32, and 20 were included in the review. RESULTS Synthesis of results from the 20 studies resulted in 4 main themes: Changing soma, negative emotional response, adjusting to altered status, and interpersonal influences. How individuals responded to their diagnosis and their altered physical status related to their activity levels, as did the degree of encouragement to exercise coming from family, friends, and professionals. These findings can be connected to the theory of behavioral change developed by Bandura, known as social cognitive theory (SCT). CONCLUSIONS SCT may be a useful framework for developing interventions to support patients with HF in undertaking and maintaining regular exercise patterns. Specific components of SCT that practitioners may wish to consider include self-efficacy and outcome expectancies. These were issues referred to in papers for the systematic review that appear to be particularly related to exercise adherence.

The importance of integration of stakeholder views in core outcome set development : otitis media with effusion in children with cleft palate

Background Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of “consensus in” to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children.

What strategies are effective for exercise adherence in heart failure? A systematic review of controlled studies

Physical activity is recommended for people with stable heart failure (HF), because it is known to improve quality of life and health outcomes. However, adherence to this recommendation has been poor in many studies. A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF. The following databases were searched for relevant literature published between January 1980 and December 2010: British Nursing Index; CINAHL; Cochrane Library; Embase; Medline and PsycINFO. Papers with a control group focused on adults with HF that measured exercise or physical activity adherence were included. Nine randomised controlled trials were identified, involving a total of 3,231 patients (range 16–2,331). Six of these studies were informed by specific psychological theories. Positive outcomes occurred in the short-term from interventions using approaches such as exercise prescriptions, goal setting, feedback and problem-solving. However, longer-term maintenance of exercise was less successful. There was some support for interventions underpinned by theoretical frameworks, but more research is required to make clearer recommendations. Addressing self-efficacy in relation to exercise may be a particularly useful area to consider in this respect.

Learning Journeys: The Experiences of Students Working towards a Foundation Degree.

Abstract This article reports on a series of interviews held with individuals in the middle of a Foundation Degree, during which they were asked for their views of studying for this qualification. It draws on a research project conducted with part-time students involved in work-based learning. The research into their ‘learning journeys’ aimed to explore the process of becoming and being a student. Findings suggested that individuals had embarked on a Foundation Degree for career-related reasons, although they also noted that their course returned secondary benefits, such as an increase in self-confidence and additional life skills. Interviewees found it difficult to juggle competing demands on their time, and needed emotional and practical support from those around them to do so. Other areas of concern were the lack of adequate assistance from tutors that some students felt when it came to writing assignments and the financial hardship that undertaking such a vocational qualification could bring. Results from this study highlight facets of Foundation Degrees that need to be considered by those delivering such courses.

The Treatment of Adolescent Anorexia Nervosa: A Qualitative Study of the Views of Parents

Semi-structured, qualitative interviews with parents of young people treated for anorexia nervosa were conducted to find out their views in relation to treatment received by their children. Parents recalled how they had to adopt a proactive stance in order to ensure that their daughters received appropriate services. They had mixed opinions about the care provided for their children by professionals. Talking to parents of youngsters with anorexia can provide valuable insight into their needs and experiences of treatment.