Introduction Chronic breathlessness is common and distressing in advanced lung disease; interventions which support patients and caregivers are needed to improve self-management and quality of life. BMi are increasingly recommended as gentle movement practices and for psychological support, yet studies of mindfulness/yoga/taichi/qigong (BMi) in populations with advanced lung disease reveal mixed findings across quantitative and qualitative paradigms. Aims We employed a realist (theory-driven) synthesis to cut through this complexity to understand how and why BMi ''work'' in the context of breathlessness-related distress, for whom and under what circumstances. Following MRC guidance, our theoretical framework will underpin intervention development and context-relevant implementation. Methods Following quality and publication standards we: Developed an initial programme theory to explain how core features of BMi are proposed to ''work'' to alleviate breathlessness-related distress, consulting with breathless experts by experience, practitioners and health professional advisors. Systematically searched 8 databases for primary data to refine and test the initial theory with iterative searching as our theories developed. Successively screened, extracted and appraised data for iterative analysis to develop theoretically-driven and evidence-informed explanations supported by neuroscience/affect regulation theory. Results 62 documents were analysed with stakeholder/advisory group input to produce an overarching programme theory: Safety First. We found that safe relationship (person/people/place) is a central context + mechanism interaction influencing BMi uptake, adherence and distress-related outcomes. Conclusions Where BMi are recommended and delivered by trusted professionals, tailored to breathlessness-specific accessibility needs, include caregivers and are chosen by patients, process and distress-related outcomes are likely to be most effective. In those with higher anxiety, 8 week mindfulness protocols can increase distress; short trauma-informed and compassion-focused BMi delivered flexibly are most effective. Impact BMi can increase a felt sense of safety and breath literacy for people living with breathlessness-related distress to end of life. Social, cultural and organisational mechanisms currently prevent access and uptake across the UK breathlessness pathway.
This book comprises 17 chapters based on research papers undertaken by internationally recognized authors in the field of historical cartography presented at the 7th International Symposium of the ICA Commission on the History of Cartography, held in Oxford from 13 to 15 September 2018
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of drinking extra water or other non-caloric beverages for promoting weight loss or preventing weight gain.
Despite the significant global burden of gastroenteritis and resulting sequelae, there is limited evidence on risk factors for sequelae development. We updated and extended previous systematic reviews by assessing the role of antibiotics, proton pump inhibitors (PPI) and symptom severity in the development of sequelae following campylobacteriosis and salmonellosis. We searched four databases, including PubMed, from 1 January 2011 to 29 April 2016. Observational studies reporting sequelae of reactive arthritis (ReA), Reiter's syndrome (RS), irritable bowel syndrome (IBS) and Guillain-Barré syndrome (GBS) following gastroenteritis were included. The primary outcome was incidence of sequelae of interest amongst cases of campylobacteriosis and salmonellosis. A narrative synthesis was conducted where heterogeneity was high. Of the 55 articles included, incidence of ReA (n=37), RS (n=5), IBS (n=12) and GBS (n=9) were reported following campylobacteriosis and salmonellosis. A pooled summary for each sequela was not estimated due to high level of heterogeneity across studies (I2>90%). PPI usage and symptoms were sparsely reported. Three out of seven studies found a statistically significant association between antibiotics usage and development of ReA. Additional primary studies investigating risk modifying factors in sequelae of GI infections are required to enable targeted interventions.
An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
