Suzanne Ferrier

Correlates of exercise among coronary heart disease patients: review, implications and future directions

Despite the well-documented benefits of exercise, adherence among patients with coronary heart disease (CHD) has been low during and after cardiac rehabilitation (CR) as well as among patients not attending CR. Therefore, an understanding of the factors that influence exercise in this population is crucial to assist in the development of effective interventions. The goal of this review was to document the correlates of exercise of CHD patients in all CR contexts from a social-ecological perspective that addresses multiple levels of influence on exercise. The search strategy included PubMed, PsychINFO and Web of Science databases. In all, 121 studies, examining 32 different correlates of exercise, with a total of 25 217 participants were included. Across all CR contexts, six variables were consistently related to exercise (self-regulatory self-efficacy, health status, intention, perceived control, beliefs/benefits and previous physical activity). Several variables were also related to exercise in three of four contexts (e.g. task self-efficacy, perceived barriers, attitude, action planning, sex and employment status). Many of the variables consistently related to exercise may be amenable to change through the development and implementation of appropriate interventions. Specific suggestions are made for each relevant variable to assist CR staff and other healthcare practitioners in 32 promoting exercise among CHD patients. Current gaps in literature such as a lack of prospective studies and research examining broader (e.g. policy level) correlates are also discussed.

Behavioural interventions to increase the physical activity of cardiac patients: a review

To examine the behaviour change techniques that have been used in physical activity (PA) interventions to increase PA during and after completing cardiac rehabilitation (CR) and for patients who do not attend CR (non-CR). PubMed, PsychINFO, SPORTdiscus, Web of Science, Prowler and Cochrane databases were searched to identify studies that described an intervention delivered to adults in the CR and non-CR contexts that focused solely on promoting PA. Twenty-three studies (14 post-CR and nine non-CR) were included in this review. Findings showed that interventions can increase PA; however, there were notable differences across CR contexts in their purpose, the participant demographics, and some of the behaviour change techniques used. Techniques shown to be most effective in the post-CR context were self-monitoring, setting specific goals, identifying barriers and developing plans for relapse prevention. In the non-CR context, unsupervised home-based interventions were shown to be effective at increasing PA, particularly when accompanied by follow-up prompts, general encouragement, specific goals set by the researcher and self-monitoring. Post-CR and non-CR interventions can result in improved PA outcomes; however, the research in this area is limited. More interventions are needed that target PA-only, particularly in the non-CR context.

Visual field and optic disc progression in patients with different types of optic disc damage: A longitudinal prospective study

OBJECTIVE To evaluate the incidence of visual field and optic disc progression in glaucoma patients with distinct patterns of optic disc damage. DESIGN Prospective, observational case series. PARTICIPANTS One hundred five patients with open-angle glaucoma. METHODS Baseline optic disc photographs of 105 study eyes of 105 patients were reviewed by 2 masked observers and classified according to patterns of disc damage into the following categories: focal, myopic, senile sclerotic, and generalized disc damage. Patients were followed up every 6 months with standard automated perimetry (SAP), high-pass resolution perimetry (HRP), and scanning laser tomography (SLT) with the Heidelberg Retina Tomograph. MAIN OUTCOME MEASURES Visual field (SAP and HRP) and optic disc (SLT) progression were determined according to predefined criteria. RESULTS Twenty-four eyes were classified into the focal, 8 into the myopic, 12 into the senile sclerotic, and 28 into the generalized group. Eyes from 33 patients could not be classified by the observers into any of these groups and were excluded from further analysis. Although intraocular pressure during follow-up was similar among the four groups, some differences in frequency of progression were observed. Patients with senile sclerotic discs had the lowest rates of visual field progression (both with SAP and HRP) and optic disc progression, although the differences were significant only for optic disc progression (P = 0.05). CONCLUSIONS Patients with senile sclerotic discs showed a tendency towards less visual field and optic disc progression when compared with patients with other types of disc damage.

Learning in practice: experiences and perceptions of high-scoring physicians.

Purpose To increase understanding of informal learning in practice (e.g., consulting with colleagues, reading journals) through exploring the experiences and perceptions of physicians perceived to be performing well. Objectives were to find out how physicians learned in practice and maintained their competence, and how they learned about the communication skills domain specifically. Method Of 142 family physicians participating in a formal multisource feedback (360-degree) formative assessment, 25 receiving high scores were invited to participate in interviews conducted in 2003 at Dalhousie University Faculty of Medicine. Twelve responded. Interviews were 1.5 hours each, recorded, transcribed, and analyzed by the research team using accepted qualitative procedures. Results While formal learning appeared important to most, informal learning, especially through patients and colleagues, appeared to be fundamental. The physicians appeared to learn intentionally from practice and work experiences, and reflection appeared integral to learning and monitoring the impact of learning. Two findings were surprising: participants’ conceptions of competence and perceptions that communication skills were innate rather than learned. Conclusions These physicians’ ways of intentional learning from practice concur with current models of informal learning. However, informal learning is largely unrecognized by formal institutions. Additionally, the physicians did not in general share notions of professional competence held by educators and others in authority. These findings suggest the need to make implicit content and learning processes more explicit. Additional research areas include exploring whether physicians across the range of performance levels demonstrate similar processes of reflective learning.

Responses of rural family physicians and their colleague and coworker raters to a multi-source feedback process: a pilot study.

Purpose. To describe responses of family physicians, their medical colleagues, and coworker raters to a multisource feedback assessment process. Method. Data collection tools included multisource feedback self-assessment and medical colleague, coworker, and patient rating forms; and program evaluation physician and rater questionnaires. Results. The pilot study included 142 physicians and their raters, with 113 (80%) physicians completing evaluations. Positive correlations were found between familiarity scores and medical colleague and coworker mean ratings. Peer medical colleagues were significantly more familiar with physicians than were consultants. Consultants were unable to rate items most frequently. Physicians disagreed with colleague feedback more frequently. Agreement was positively correlated with scores. Conclusions. Familiarity, ability to observe physicians appropriately to rate them, and physicians’ responses to feedback are factors to consider when multisource feedback is used.

The role of outcome expectations and self-efficacy in explaining physical activity behaviors of individuals with multiple sclerosis.

Multiple sclerosis (MS) is a debilitating neurological disease with few successful interventions available for alleviating symptoms. Physical activity (PA) may aid in alleviating symptoms; however, most individuals with MS are inactive. To promote PA within this population, it is important to identify key theoretical correlates of PA specific to them and then target these in PA interventions. The purpose of this study was to examine the role of self-efficacy and outcome expectations in explaining PA. Seventy-six participants completed a baseline questionnaire measuring these variables and a telephone follow-up 1 month later concerning PA behaviors. Regression analyses showed that self-efficacy (β = .41) and outcome expectations (β = .27) directly influenced PA, and that self-efficacy directly influenced outcome expectations (β = .28). Therefore, to promote PA within this population, interventions should target both self-efficacy and outcome expectations. Individuals with MS need to better understand the benefits of PA and how it can alleviate or improve their symptoms.

Lifestyle counseling in primary care: opportunities and challenges for changing practice.

Background: Many patients today have health concerns related to lifestyle factors. This has created a situation where physicians are regularly confronted with the challenge of how to conduct lifestyle counseling with patients. Specific strategies can enable physicians to more effectively navigate this complex area of communication with patients, improving patient response in adopting healthy behaviours and increasing physician satisfaction with this task. Aim: To evaluate the impact of a lifestyle counseling workshop incorporating the motivational enhancement and transtheoretical models upon primary care clinicians’ counseling practice patterns, especially communication and counseling skills, and attitudes toward lifestyle counseling. Method: This study used a mixed method research design. Forty-three clinicians completed a post-workshop evaluation and identified intended changes to practice following the workshop. Twelve participated in interviews several months later to explore the kinds of changes made and influences upon them. Results: Forty-one (95.3%) questionnaire respondents reported an intention to change their practice. Main changes reported were: asking more questions, listening more, assessing patients’ readiness to change, tailoring counseling to patients’ readiness to change. They seemed to have acquired and retained new knowledge and most were able to apply the new skills in their practices. Many reported feeling more comfortable and/or confident when interacting with patients in need of lifestyle change. But, time constraints, comfort with current skills, lack of self-efficacy, and fears of missing opportunities to influence patients, moderated participants’ ability to adopt and maintain new approaches. Conclusions: While primary care clinicians can successfully learn specific lifestyle counseling skills and incorporate them into their practice following a two-hour evidence-based workshop, individual, educational and system factors can interfere.

Alzheimer's Disease and Other Dementias: An Organizational Approach to Identifying and Addressing Practices and Learning Needs of Family Physicians

ABSTRACT Caring for patients with dementia is complex and demanding. Since family physicians (FPs) provide much of this care, we examined their practices, learning needs, and barriers to care concerning Alzheimers disease and other dementias. We surveyed 392 (approximately 50%) Nova Scotia FPs and conducted focus groups and interviews with: FPs; staff of long-term care facilities; health professionals in home care; patients and their caregivers; FPs with advanced geriatric training; geriatricians; and psychiatrists. Results suggest that many FPs do not perform assessment and management practices as frequently as they ideally should. However, systemic factors, not only inadequate knowledge, affect care.

The Confused Robot: Two‐Year‐Olds’ Responses to Breakdowns in Conversation

Preschool children at two ages conversed with a toy robot during a play session. During the conversations the robot inserted either general (e.g., What?) or specific (e.g., Piggy is in what?) contingent queries in response to selected utterances. The children’s replies to these breakdowns in conversation indicated they were sensitive to the pragmatic requirements of these different types of query. By 33 months of age, the children replied to general queries with complete repetitions of their prior misunderstood utterance, and replied to specific queries with only the required constituentinformation. At 27 months of age, the children’s predominant strategy was to reply to both forms of query with complete repetitions, although the data suggest some degree of sensitivity to these different forms is also present in this younger group. These results are interpreted in terms of children’s sensitivity to Grice’s (1975) quantity rule and the potential changes in social cognition underlying children’s compliance with this rule.

Cardiology grand rounds: effect of videoconferencing on educational value

We studied four cardiology grand rounds transmitted by videoconference from a tertiary care centre to four other hospitals in eastern Canada. We collected data with evaluation questionnaires and by video recording participants at the receiving-site and the presentation they received from the presenting site. Receiving-site participants (n = 20) rated their satisfaction with all domains significantly lower than did presenting-site participants (n = 49). The greatest difference in ratings was in the ability to see slides (receiving sites 2.6/5, presenting site 4.6/5). Review of video recordings revealed that slides showing material copied from print sources was difficult to read at receiving sites. While 56% of discussion time was devoted to questions from receiving sites, participants there rated their ability to participate in discussion lower than those at the presenting site (3.9/5 vs 4.4/5). This may be because some parts of the discussion from the presenting site were not transmitted. Receiving-site participants rated the educational value of the rounds lower than their presenting-site colleagues (3.9/5 vs 4.4/5) but answered a similar percentage of knowledge questions correctly (85 vs 89%).