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Commentary on : McDowell, C, Dishman, RK, Gordon, BR, et al . Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies. Am J Prev Med 2019;574:545–56. Anxiety is a debilitating1 and costly chronic illness.2 Pharmacological treatment of anxiety disorders and symptoms can be challenging with side effects and expensive for many,3 which makes prevention strategies critical. Physical activity has been previously shown to reduce the symptoms of anxiety and depression.4 Whether physical activity may be effective in preventing anxiety has not yet been previously investigated, presenting a knowledge gap and …

Problematic substance use (PSU) among nurses has wide-ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use.

Pediatric oncology patients with an external central venous catheter (CVC) in situ can be discharged from the hospital. Caregivers are expected to learn how to care for the CVC prior to discharge while also dealing with their child's new cancer diagnosis. This study aimed to evaluate the perceptions of a CVC education program received by caregivers to identify opportunities for improvement. A qualitative study was conducted in 3 stages, using an evidence-based co-design approach, involving caregivers and one adolescent patient discharged from the British Columbia Children's Hospital Oncology/Hematology/BMT inpatient unit. Stage I involved semi-structured interviews to gain feedback on the existing CVC education program. In Stage II, educational resources were updated or developed and implemented. For Stage III, the revised CVC education program was evaluated through a focus group and semi-structured interviews. Interview transcripts were analyzed using QSR NVivo®. The original CVC education program was overall well received. Repeated instruction and support provided by nurses was reported to have increased confidence with performing CVC skills. Participants appreciated the multimodal approach to meet learning needs and expressed interest in additional visual aids. Inconsistencies in nurses’ practice and offers of “tips and tricks” were identified to be challenging for caregivers while learning a new skill. Videos depicting CVC care were developed to provide an additional visual tool, decreased inconsistencies in care, and support to caregivers at home. Caring for a CVC at home is challenging and overwhelming for caregivers. A standardized multimodal education program is required to support caregivers at home.

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

AbstractPolice services face daily challenges dealing with the health issues displayed by individuals in their custody. They often find themselves isolated from the services that can help the most. This paper scopes relevant literature on these challenges and some of the interprofessional interventions which have emerged to address them, such as the diversionary practices of crisis intervention teams, street triage, nurses in custody suites, and court liaison and diversion. Remote presence technology is proposed to be an innovative solution that can help to provide more efficient and effective pathways for care in Police Detention Centres. Remote presence technology has the ability to significantly affect the way interprofessional collaboration can take place for those in police custody.

The first part of this article, published in an earlier issue of this journal, provided an overview of how the death-denial thesis took shape and spread in the social sciences between the 1930s and...

IntroductionFatigue is commonly identified by clinicians who evaluate and treat swallowing impairment despite a lack of research in this area. The purpose of this study was to understand the current role of swallowing-related fatigue in dysphagia evaluation with respect to (a) clinician practices, (b) perspectives, and (c) desire for resources regarding swallowing-related fatigue.MethodA survey was conducted by licensed speech-language pathologists who evaluate and treat adult dysphagia. The survey was distributed via dysphagia-focused groups on Facebook and Special Interest Group 13. Data were analyzed descriptively and by thematic analysis for free-text response questions.ResultsOut of 426 prospective respondents, 311 completed the survey (response rate = 73.0%). While 86% of respondents agreed that fatigue may be a concern for individuals with swallowing impairment, there was wide variability in how clinicians define and evaluate swallowing-related fatigue, and the majority (62%) define fatigue in two or more ways. Explicit evaluation of fatigue was reportedly conducted by 45% of respondents during the Clinical Swallowing Evaluation, by 38% during videofluoroscopic swallowing study, and by 53% during Flexible Endoscopic Evaluation of Swallowing. The most common methods for identifying fatigue were general declines in performance over the course of the assessment. Respondents reported much more reliance on patient report during Clinical Swallowing Evaluation (41%) compared to videofluoroscopic swallowing study (7%) and fiberoptic endoscopic evaluation of swallowing (5%). Only 7% of respondents reported being aware of any standardized methods for assessing fatigue, while 97% of respondents affirmed interest in incorporating standardized methods for assessing swallow-related fatigue.ConclusionsOur results demonstrated wide variability in how currently practicing clinicians define and evaluate swallowing-related fatigue, despite the vast majority considering fatigue to be an important factor in dysphagia evaluation. This study highlights a critical gap in the clinical evaluation of swallowing and requires significant further study to guide clinical practice.

Objectives To compare the attributions and emotions held by patients with lung cancer (affected individuals) and family caregivers in their management of the disease. . Sample & setting A secondary data analysis of 304 affected individuals and 304 family caregivers. Participants were selected from five oncology outpatient settings. . Methods & variables Comparative analysis and regression modeling. Variables include responsibility, anger, and pride in managing lung cancer. . Results Affected individuals reported higher self-oriented blame, fault, and anger than did family caregivers. Family caregivers reported more blame, fault, and anger toward the affected individual than toward themselves. Current smoking behavior of either the affected individual or family caregiver was associated with increased reports of self-oriented blame, fault, and anger. Additional research is needed to understand the attributional and emotional responses affected by the type of lung cancer, gender differences, and characteristics of the caregiving dyad. . Implications for nursing Nurses should be aware of the potential for affected individuals to experience internal (self) and external (family caregiver) sources of blame, fault, and anger. Knowledge of the reasons for current smoking behavior is important for understanding emotional responses and determining interventions.

Research on global migration has grown substantially in occupational science over the past decade. While literature reviews have focused on the results and recurrent themes emerging in occupation-f...