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The article suggests the important role of cardiovascular health professionals in advocating for and advancing health equity in their cardiovascular care practice, including prevention, disease management and rehabilitation.

Objectives: While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation. Methods: Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach. Results: Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP–patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations. Discussion: When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach. [ABSTRACT FROM AUTHOR]

The article discusses about impact of ChatGPT, an AI chatbot with advanced text generation capabilities, on higher education in health science. Topic include It highlights ChatGPT's potential to generate educational content, provide tutoring, and assist in assessments, along with ethical considerations. The article presents three hypothetical scenarios for nursing and health science's response to ChatGPT, emphasizing the importance of addressing its influence rather than avoiding it.

Background: Priority patients in primary care include people from low-income, rural, or culturally and linguistically diverse communities, and First Nations people. Aim: To describe the effectiveness, feasibility, and acceptability of behaviour change tools that have been tested by family doctors working with priority patients. Design and setting: A global systematic review. Method: Five databases were searched for studies published from 2000 to 2021, of any design, that tested the effectiveness or feasibility of tangible, publicly available behaviour change tools used by family doctors working with priority patients. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. Results: Thirteen of 4931 studies screened met the eligibility criteria, and described 12 tools. The health-related behaviours targeted included smoking, diet and/or physical activity, alcohol and/or drug use, and suicidal ideation. Six tools had an online/web/app-based focus; the remaining six utilised only printed materials and/or in-person training. The effectiveness of the tools was assessed in 11 studies, which used diverse methods, with promising results for enabling behaviour change. The nine studies that assessed feasibility found that the tools were easy to use and enhanced the perceived quality of care. Conclusion: Many of the identified behaviour change tools were demonstrated to be effective at facilitating change in a target behaviour and/or feasible for use in practice. The tools varied across factors, such as the mode of delivery and the way the tool was intended to influence behaviour. There is clear opportunity to build on existing tools to enable family doctors to assist priority patients towards achieving healthier lifestyles. [ABSTRACT FROM AUTHOR]

Background: The 5As framework is a recognized underpinning of behaviour change guidelines, teaching, and research in primary care. Supporting patients to improve their lifestyle behaviours, including diet and physical activity, is a common aspect of type 2 diabetes mellitus (T2DM) management. The 5As framework often informs behaviour change for patients with T2DM.Objective: To explore the experience and perspectives of general practitioners (GPs) and primary care academics and behaviour change experts regarding using the 5As framework when caring for patients with T2DM to better understand how and why the 5As are effective in practice.Methods: We recruited 20 practising GPs, primary care academics, and behaviour change experts for an individual semistructured interview and analysed the data using a realist evaluation approach.Results: There were diverse accounts of how GPs use the 5As in practice and few of the participants could name each "A." The 5As were commonly regarded as a framework best suited to beginners and although GPs expressed they followed the broad direction of the 5As, they did not consciously follow the framework in an instructive manner. Elements that could enhance the 5As included more emphasis on motivational interviewing, changing how "Ask" is included in the consultation, and increased person-centredness.Conclusion: Although it is a ubiquitous framework in primary care, the 5As are understood in diverse ways and applied variably in practice. There is room to enhance how the 5As support behaviour change consultations to optimize outcomes in primary care. [ABSTRACT FROM AUTHOR]

An editorial is presented on Nursing's preoccupation with leadership references to leaders and leadership abound in discourse not only about nursing, nurses and healthcare organizations around all professions and workplaces. Topics include Nurse leader are senior in rank or credential in nursing organizations or academic departments; and conceptions of nursing leaders and leadership that consider alternative approaches empower nurses of organizations to embrace leadership practices.

The article focuses on the prevalence of questionable research practices (QRPs), the negative effects they have on the public's trust in research, and the cultural pressures that incentivize the practices. Topic include understanding the nature of QRPs and the pressures researchers face to prioritize research quantity and career advancement over quality; and the pressure to prioritize research impact, reach, and quantity over quality is often a significant contributor to QRPs.

"Stream of consciousness" writing is writing what comes to mind with no regard for cohesion or the fit of that thought with the previous thought or any sort of perfection of language. Your reading of your data is a transaction, your writing of your data is another transaction, and the readers of your writing will engage in transactions of their own. Here's the Catch: Permission was Right in Front of You All Along Those writing qualitative research appear to hunger for pragmatic writing strategies to stimulate their thinking and further enhance their methods. [Extracted from the article]

Purpose: To identify the influence of the therapeutic alliance on the effectiveness of obesity interventions delivered in primary care.Method: Systematic review of randomized controlled trials of primary care interventions for adult patients living with obesity. Comprehensive search strategy using the terms 'obesity', 'primary care' and 'intervention' of seven databases from 1 January 1998 to March 2018. Primary outcome was difference in weight loss in interventions where a therapeutic alliance was present.Results: From 10 636 studies, 11 (3955 patients) were eligible. Only one study had interventions that reported all aspects of therapeutic alliance, including bond, goals and tasks. Meta-analysis was not included due to high statistical heterogeneity and low numbers of trials; as per our protocol, we proceeded to narrative synthesis. Some interventions included the regular primary care practitioner in management; very few included collaborative goal setting and most used prescriptive protocols to direct care.Conclusions: We were surprised that so few trials reported the inclusion of elements of the therapeutic alliance when relational aspects of primary care are critical for effectiveness. Interventions could be developed to maximize therapeutic relationships and research reports should describe interventions comprehensively.Systematic Review Registration Number: CRD42018091338 in PROSPERO (International prospective register of systematic reviews). [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Most patients with advanced heart failure are ill-prepared and poorly supported during the end of life. To date, research has focused primarily on generalized patient accounts of the management or self-care phase of the syndrome. Little research has examined the end of life in depth or from the perspectives of family members. Aims: The purpose of this study is to describe how people diagnosed with heart failure and their family members describe uncertainty related to impending death. Methods and results: A narrative inquiry was undertaken using a social constructionist perspective. Twenty participants took part in over 60 interviews: 12 participants with heart failure (eight male and four female; mean = 67.3 years) and eight family members (mean = 61.6 years) engaged in two in-depth interviews, approximately 3–4 months apart, followed by a telephone follow-up 2–3 months later. Six key themes/storylines were identified. These included: prognosis messages received from physicians; whenever I die, I die; loss isn't new to me but ... ; carrying on amidst the fragility of life; ultimately living not knowing; and the need to prepare. Conclusion: The six key storylines of death and dying with advanced heart failure were consistent for both patients and family members. There was a desire for better communication with physicians. Many participants were critical of how the prognosis of advanced heart failure was communicated to them, even if they anticipated the news. Participants wanted frank, open conversations with their healthcare providers that both acknowledged that they were at end of life but did not remove all hope. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation, an evidence-based CHD secondary prevention programme, remains underutilized. Telehealth may offer an innovative solution to overcome barriers to cardiac rehabilitation attendance. We aimed to determine whether contemporary telehealth interventions can provide effective secondary prevention as an alternative or adjunct care compared with cardiac rehabilitation and/or usual care for patients with CHD. Methods: Relevant randomized controlled trials evaluating telehealth interventions in CHD patients with at least three months' follow-up compared with cardiac rehabilitation and/or usual care were identified by searching electronic databases. We checked reference lists, relevant conference lists, grey literature and keyword searching of the Internet. Main outcomes included all-cause mortality, rehospitalization/cardiac events and modifiable risk factors. (PROSPERO registration number 77507.) Results: In total, 32 papers reporting 30 unique trials were identified. Telehealth was not significant associated with a lower all-cause mortality than cardiac rehabilitation and/or usual care (risk ratio (RR)=0.60, 95% confidence interval (CI)=0.86 to 1.24, p=0.42). Telehealth was significantly associated with lower rehospitalization or cardiac events (RR=0.56, 95% CI=0.39 to 0.81, p<0.0001) compared with non-intervention groups. There was a significantly lower weighted mean difference (WMD) at medium to long-term follow-up than comparison groups for total cholesterol (WMD= −0.26 mmol/l, 95% CI= −0.4 to −0.11, p <0.001), low-density lipoprotein (WMD= −0.28, 95% CI = −0.50 to −0.05, p=0.02) and smoking status (RR=0.77, 95% CI =0.59 to 0.99, p=0.04]. Conclusions: Telehealth interventions with a range of delivery modes could be offered to patients who cannot attend cardiac rehabilitation, or as an adjunct to cardiac rehabilitation for effective secondary prevention. [ABSTRACT FROM AUTHOR]

Conceptualize Your Poster Design Reflecting on your success indicators, your audience, and main messages, how can you create a poster design that helps rather than hinders conveying the content? Helpfully, faced with the prospect of producing an academic poster for the first time, new researchers both consciously and unconsciously base this poster on their understanding of the genre of the academic conference poster. Yet genre makes it hard for good posters to even be made due to the sheer dominance of poor posters because each bad poster both reflects and also constitutes the future genre of the conference poster. To develop proficiency in producing academic conference posters, and to effectively represent the academic poster genre, new researchers are likely to already have knowledge of this genre through their own previous experiences of conference posters ([9]). [Extracted from the article]

In this article, the author talks about minimizing research misconduct and also talks about priorities for academics in nursing. It mentions need for researchers to deposit their study data using Findable, Accessible, Interoperable, and Reusable (FAIR) principles and institutions need to encourage and reward researchers for doing so. It mentions workplace strategies to prevent misconduct needs to encourage senior academics, to explore their personal emotions and fears.

An editorial is presented on nursing’s research problems. Topics include the importance of research on nursing for its development; the prevalence of research studies led by nurses on units and as valid indicators to influence of research in nursing; and use of research skills for practice which is established during pre‐registration education which include developing search questions, searching for the right research studies.

Background and objectives Obesity is a common chronic condition, and general practitioners are seeking more effective strategies for assisting their patients. The therapeutic relationship between patients and practitioners is increasingly recognised as a fundamental part of intervention effectiveness. The influence of therapeutic relationships in obesity interventions in primary care has not been systematically studied. We plan to undertake a systematic review and meta-analysis to identify the influence of the therapeutic alliance on the effectiveness of obesity interventions in primary healthcare. The aim of this article is to outline the study protocol. Methods and analysis A systematic review of primary care interventions for patients with obesity will be undertaken. Using Bordin's framework for the therapeutic alliance, interventions will be categorised as to whether they incorporate the alliance or not. A meta-analysis will be performed if studies of sufficiently homogenous primary outcome data are found. Discussion Understanding the role of the therapeutic alliance on interventions for obesity management will have implications for both future intervention development and the translation of current interventions from trial settings to the real world. Trial registration: CRD42018091338 in PROSPERO (International prospective register of systematic reviews). [ABSTRACT FROM AUTHOR]

Every year thousands of presentations of qualitative research findings are made at conferences, departmental seminars, meetings, and student defenses. Yet scant scholarship has been devoted to these presentations, their nature and relevance to qualitative research, and how they can be improved. This article addresses this important gap by positioning "research findings" presentations as a distinctive genre, part of qualitative method, and an expression of scholarly discourse. From the theoretical basis of genre theory, a number of common and damaging mistakes are found to be evident in the manner in which qualitative research findings are usually presented. These have negative implications: reducing the methodological quality of, engagement with, and overall influence of the qualitative research presented. We draw on genre theory to make recommendations for future qualitative research findings presentations to improve the rigor, influence, and impact of such presentations. [ABSTRACT FROM AUTHOR]

A challenge that speech-language pathologists (SLPs) face is the translation of research into clinical practice. While randomised controlled trials (RCTs) are often touted as the “gold standard” of efficacy research, much valuable information is lost through the process; RCTs by nature are designed to wash out individual client factors and contexts that might influence the outcome in order to present the “true” impact of the intervention. However, in the area of behavioural interventions, the interaction of client factors and contexts with the treatment agent can substantially influence the outcome. This paper provides an overview of the theoretical background and methods involved in critical realistic evaluation (CRE) and discusses its current and potential application to speech-language pathology. CRE is based on the premise that a behavioural intervention cannot be evaluated without considering the context in which it was provided. While the ways in which contextual aspects and treatment mechanisms interact may seem endless, CRE methodology attempts to operationalise them into hypotheses to be empirically tested. Research based on these principles has the potential to support clinical translation of research outcomes and reduce the costs of unsuccessful treatment attempts for SLPs, clients and the service provider. [ABSTRACT FROM PUBLISHER]

Cardiovascular disease exerts an enormous burden on women's health. The intake of a healthy diet may reduce this burden. However, social norms and economic constraints are often factors that restrain women from paying attention to their diet. Underpinned by critical realism, this study explores how gender/sex influences decision‐making regarding food consumption among women of low socioeconomic status (SES). The study was carried out at two cardiac facilities in Karachi, Pakistan, on 24 participants (male and female from different ethnic backgrounds), who had received health education. Using an interpretive descriptive approach, the study identified major barriers to a healthy diet: proscribed gender roles and lack of women's autonomy, power, male domination, and abusive behaviours. Cardiovascular risk and disease outcomes for the Pakistani women of low SES are likely to further escalate if individual and structural barriers are not reduced using multifactorial approaches. [ABSTRACT FROM AUTHOR]

This research conception is not a descriptive end in itself but also constitutes future discourses of research which shape and influence the expectations and experiences of new and emerging researchers. Despite apparent invisibility in formal discourse, researchers' social conversations around research are characterized by laments of personal and work-related failings and failures. [Extracted from the article]

An editorial is presented which discusses about the life and work balance, career goals and employment, the career crisis, suffering from denial, depression, bargaining, the challenges and failure in academic work and individualization. It talks about focusing on what an individual can control, helping them to feel better, controlling personal values, to try not to get defensive and to be wary of inappropriate conducts.

Objective: To identify the main mechanisms of heart failure (HF) disease management programmes based in hospitals, homes or the community.Methods: Systematic review of qualitative and quantitative studies using realist synthesis. The search strategy incorporated general and specific terms relevant to the research question: HF, self-care and programmes/interventions for HF patients. To be included, papers had to be published in English after 1995 (due to changes in HF care over recent years) to May 2014 and contain specific data related to mechanisms of effect of HF programmes. 10 databases were searched; grey literature was located via Proquest Dissertations and Theses, Google and publications from organisations focused on HF or self-care.Results: 33 studies (n=3355 participants, mean age: 65 years, 35% women) were identified (18 randomised controlled trials, three mixed methods studies, six pre-test post-test studies and six qualitative studies). The main mechanisms identified in the studies were associated with increased patient understanding of HF and its links to self-care, greater involvement of other people in this self-care, increased psychosocial well-being and support from health professionals to use technology.Conclusion: Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use. [ABSTRACT FROM AUTHOR]

Background: Effective heart failure (HF) self-care can improve clinical outcomes but is dependent on patients’ undertaking a number of complex self-care behaviors. Research into the effectiveness of HF management programs demonstrates mixed results. There is a need to improve understanding of patient perspectives’ of self-care need in order to enhance supportive interventions. Aim: This paper reports selected findings from a systematic review of qualitative research related to HF self-care need from the patients’ perspective. The focus here is on those facets of patient-healthcare professional relationships perceived by patients to influence HF self-care. Method: We searched multiple healthcare databases to identify studies reporting qualitative findings with extractable data related to HF self-care need. Joanna Briggs Institute systematic review methods were employed and recognized meta-synthesis techniques were applied. Critical realist theory provided analytical direction to highlight how individual and contextual factors came together in complex ways to influence behavior and outcomes. Results: Altogether 24 studies (1999–2012) containing data on patient-healthcare professional relationships and HF self-care were included. Interaction with healthcare professionals influenced self-care strongly but was notably mixed in terms of reported quality. Effective HF self-care was more evident when patients perceived that their healthcare professional was responsive, interested in their individual needs, and shared information. Poor communication and lack of continuity presented common barriers to HF self-care. Conclusion: Interactions and relationships with clinicians play a substantial role in patients’ capacity for HF self-care. The way healthcare professionals interact with patients strongly influences patients’ understanding about their condition and self-care behaviors. [ABSTRACT FROM AUTHOR]

Aims This systematic review aimed to generate patient-focussed recommendations to enhance support of heart failure self-care by examining patients' experiences, perspectives and self-care behaviours. Background Despite increased recognition of the importance of heart failure self-care, patients' knowledge and practices around this self-care and interventions to improve it are inconsistent. Consequently, current guidelines focus on what the domains of heart failure self-care are, more so than the ways to improve this care. Design Systematic review and qualitative interpretive synthesis. Data sources A systematic, comprehensive and detailed search of 11 databases was conducted until March, 2012 for papers published 1995-2012: 37 studies were included (1343 patients, 75 caregivers, 63 health care professionals) that contained a qualitative research component and data on adult patients' heart failure self-care. Review methods This interpretive synthesis used a recognized approach consisting of a multi-stage analytic process; in addition, the included studies underwent quality appraisal. Results Findings indicate that while patients could often recall health professionals' self-care advice, they were unable to integrate this knowledge into daily life. Attempts to manage HF were based on how patients 'felt' rather than clinical indicators of worsening symptoms. Self-efficacy and learning from past management experiences facilitated favourable outcomes - these enabled patients and caregivers to adeptly apply self-care strategies into daily activities. Conclusions Addressing common but basic knowledge misconceptions regarding the domains of HF self-care is insufficient to increase effective HF self-care; this should be supplemented with strategies with patients and family members to promote self-efficacy, learning and adaptation/application of recommendations to daily life. [ABSTRACT FROM AUTHOR]

The author reflects on the nursing leadership in academia. Topics discussed include the importance of leadership in academia, effective academic leadership in academic settings, and authoritarian working cultures. Also being discussed are the higher deference to external agencies, and lowered autonomy in thought and action.

The article highlights lessons from art which can bring benefits to research for motivation, creativity and meaning. It mentions that values are an important facilitator of research rigor, credibility and ethics, instead of detracting from the scientific inquiry's rigor. It states that it is significant for people who do innovative research to seek of being featured in mainstream journals and be influential, like the artists of old who fought consistently for their work to be recognized.

The article discusses five reasons why so many nursing authors publish their work in a predatory journal. Topics covered include suggestions to counter the risk of credible research being published in predatory journals, ways to identify predatory publishers, and the role of academic leaders, supervisors and mentors in raising awareness of the practices and perils of predatory journals.

Aims To discuss issues in the theorization and study of gender observed during a qualitative meta-synthesis of influences on uptake of secondary prevention and cardiac rehabilitation services. Background Women and men can equally benefit from secondary prevention/cardiac rehabilitation and there is a need to understand gender barriers to uptake. Design Meta-method analysis secondary to meta-synthesis. For the meta-synthesis, a systematic search was performed to identify and retrieve studies published as full papers during or after 1995 and contained: a qualitative research component wholly or in a mixed method design, extractable population specific data or themes for referral to secondary prevention programmes and adults ≥18 years. Data sources Databases searched between January 1995-31 October 2011 included: CSA Sociological Abstracts, EBSCOhost CINAHL, EBSCOhost Gender Studies, EBSCOhost Health Source Nursing: Academic Edition, EBSCOhost SPORTDiscus, EBSCOhost Soc INDEX. Review methods Studies were reviewed against inclusion/exclusion criteria. Included studies were subject to quality appraisal and standardized data extraction. Results Of 2264 screened articles, 69 were included in the meta-method analysis. Only four studies defined gender or used gender theories. Findings were mostly presented as inherently the characteristic of gendered worldviews of participants. The major themes suggest a mismatch between secondary prevention/cardiac rehabilitation services and consumers' needs, which are usually portrayed as differing according to gender but may also be subject to intersecting influences such as age or socioeconomic status. Conclusion There is a persistent lack of theoretically informed gender analysis in qualitative literature in this field. Theory-driven gender analysis will improve the conceptual clarity of the evidence base for gender-sensitive cardiac rehabilitation programme development. [ABSTRACT FROM AUTHOR]

Purpose: To produce a meta-study by completing a systematic review of qualitative research examining determinants of independent active free play in children. Method: Following systematic electronic and manual searches and application of inclusion/exclusion criteria, 46 studies were retained and subjected to meta-method, meta-theory, and meta-data analyses, followed by a final meta-synthesis. Results: Identified determinants of independent active free play were child characteristics (age, competence, and gender), parental restrictions (safety concerns and surveillance), neighborhood and physical environment (fewer children to play with, differences in preferences for play spaces between parents and children, accessibility and proximity, and maintenance), societal changes (reduced sense of community, good parenting ideal, changing roles of parents, privatization of playtime and play spaces), and policy issues (need to give children voice). An ecological model depicting these factors, and the relationships therein, was created. Conclusions: This comprehensive meta-study helps establish a knowledge base for children's independent active free play research by synthesizing a previously fragmented set of studies. Parents' perceived safety concerns are the primary barrier to children's active free play. These safety concerns are moderated by child-level factors (age, competence, gender) and broader social issues. Interventions should focus on community-level solutions that include children's perspectives. From a methods perspective, the reviewed studies used a range of data collection techniques, but methodological details were often inadequately reported. The theoretical sophistication of research in this area could be improved. To this end, the synthesis reported in this study provides a framework for guiding future research. [ABSTRACT FROM AUTHOR]

Purpose To produce a meta-study by completing a systematic review of qualitative research examining determinants of independent active free play in children. Method Following systematic electronic and manual searches and application of inclusion/exclusion criteria, 46 studies were retained and subjected to meta-method, method-theory, and metadata analyses, followed by a final meta-synthesis. Results Identified determinants of independent active free play were child characteristics (age, competence, and gender), parental restrictions (safety concerns and surveillance), neighborhood and physical environment (fewer children to play with, differences in preferences for play spaces between parents and children, accessibility and proximity, and maintenance), societal changes (reduced sense of community, good parenting ideal, changing roles of parents, privatization of playtime and play spaces), and policy issues (need to give children voice). An ecological model depicting these factors, and the relationships therein, was created. Conclusions This comprehensive meta-study helps establish a knowledge base for children’s independent active free play research by synthesizing a previously fragmented set of studies. Parents’ perceived safety concerns are the primary barrier to children’s active free play. These safety concerns are moderated by child-level factors (age, competence, gender) and broader social issues. Interventions should focus on community-level solutions that include children’s perspectives. From a methods perspective, the reviewed studies used a range of data collection techniques, but methodological details were often inadequately reported. The theoretical sophistication of research in this area could be improved. To this end, the synthesis reported in this study provides a framework for guiding future research. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease. Background Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-dialysis despite its benefits. Design This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age. Methods Thirteen people (seven men and six women, aged 65-83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis. Results The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home-dialysis selection. Conclusion The social and contextual factors associated with age influenced home-dialysis decision-making. Adequate social support, functional status and resources enabled home-dialysis selection. Relevance to clinical practice Understanding more about the decision-making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services. [ABSTRACT FROM AUTHOR]

Background: Nationally, symptomatic heart failure affects 1.5-2% of Canadians, incurs $3 billion in hospital costs annually and the global burden is expected to double in the next 1–2 decades. The current one-year mortality rate after diagnosis of heart failure remains high at >25%. Consequently, new therapeutic strategies need to be developed for this debilitating condition. Methods/Design: The objective of the Alberta HEART program (http://albertaheartresearch.ca) is to develop novel diagnostic, therapeutic and prognostic approaches to patients with heart failure with preserved ejection fraction. We hypothesize that novel imaging techniques and biomarkers will aid in describing heart failure with preserved ejection fraction. Furthermore, the development of new diagnostic criteria will allow us to: 1) better define risk factors associated with heart failure with preserved ejection fraction; 2) elucidate clinical, cellular and molecular mechanisms involved with the development and progression of heart failure with preserved ejection fraction; 3) design and test new therapeutic strategies for patients with heart failure with preserved ejection fraction. Additionally, Alberta HEART provides training and education for enhancing translational medicine, knowledge translation and clinical practice in heart failure. This is a prospective observational cohort study of patients with, or at risk for, heart failure. Patients will have sequential testing including quality of life and clinical outcomes over 12 months. After that time, study participants will be passively followed via linkage to external administrative databases. Clinical outcomes of interest include death, hospitalization, emergency department visits, physician resource use and/or heart transplant. Patients will be followed for a total of 5 years. Discussion: Alberta HEART has the primary objective to define new diagnostic criteria for patients with heart failure with preserved ejection fraction. New criteria will allow for targeted therapies, diagnostic tests and further understanding of the patients, both at-risk for and with heart failure. Trial registration: ClinicalTrials.gov NCT02052804. [ABSTRACT FROM AUTHOR]

Purpose: To explore the effects of targeted physical activity (PA) print material on PA and quality of life (QOL) in young adult cancer survivors (YACS) aged 18-39 either on or off treatment. Methods: YACS ( N=212) recruited from a cancer registry were randomly assigned to a Targeted Physical Activity Guidebook (TPAG) or the Canadian Physical Activity Guidelines (CPAG). An online or mailed survey assessed the primary outcome of self-reported PA minutes and secondary QOL outcomes. Assessments were conducted at baseline, 1 month, and 3 months for PA and at baseline and 3 months for QOL. Results: At 3 months, analyses of covariance showed no differences between the groups for the primary outcome of PA minutes/week (adjusted mean group difference=+8 minutes; 95% confidence interval [CI]: −60 to +77; p=0.81). The TPAG was superior to the CPAG for the mental component of QOL (adjusted mean group difference=+3.1; 95% CI: +0.1 to +7.3; p=0.043). In an exploratory analysis of YACS reporting ≤300 PA minutes/week at baseline ( N=108), the TPAG group was superior to the CPAG group at 3 months for PA minutes/week (adjusted mean group difference=+90; 95% CI: +10 to +170; p=0.028). Conclusion: Targeted PA print material did not increase PA compared to generic PA print material in a highly active sample of YACS. In YACS reporting ≤300 PA minutes/week at baseline-the group of interest from a PA behavior change perspective-the targeted PA print material was effective in increasing PA. [ABSTRACT FROM AUTHOR]

Context Disease management interventions for heart failure (HF) are inconsistent and very seldom incorporate the views and needs of patients and their caregivers into intervention design. Objective and data To improve intervention effectiveness and consistency, a systematic review identified 49 studies which examined the views and needs of patients with HF and their caregivers about the nature and determinants of effective HF self-care. Results The findings identify key drivers of effective self-care, such as the capacity of patients to successfully integrate self-care practices with their preferred normal daily life patterns and recognise and respond to HF symptoms in a timely manner. Conclusions Future interventions for HF self-care must involve family members throughout the intervention and harness patients' normal daily routines. [ABSTRACT FROM AUTHOR]

Taking debates about the roles of structure and agency in health as a lens, this essay asks how Critical Realist and Feminist Intersectional approaches might inform health interventions research. Despite recognition of multiple determinants of health, health problems are often thought of as individual and interventions, in turn, target risky individual behaviours. Such approaches are rooted in a liberal model of personhood. This paper critiques enduring individualist assumptions linked to Western liberal underpinnings embedded in health interventions. It posits the need to include a robust conception of the social world in which change depends on shifting power relations, and individual agency is shaped by power as well as individual will. We propose preliminary steps for undertaking critical realist intersectional interventions research. [ABSTRACT FROM AUTHOR]