Improving the physical status and quality of life of women treated for breast cancer: A pilot study of a structured exercise intervention

Background and Objectives: This pilot project assessed the acceptability of a mixed-type, moderate-intensity exercise programme following breast cancer treatment, and the impact on presence of lymphoedema, fitness, body composition, fatigue, mood and quality of life. Methods: Ten women completed the programme and measures of fitness (submaximal ergometer test), body composition (bio-electrical impedance), lympoedema (bio-electrical impedance and arm circumferences), fatigue (revised Piper Fatigue Scale), mood (Hospital Anxiety and Depression Scale), quality of life (FACT-B) and general well-being, at baseline, completion of the programme, and 6-week and 3-month follow-up. Results: Participation in the programme caused no adverse effect on the presence of lymphoedema. There was a trend towards reduction in fatigue and improved quality of life across the testing phases. Women rated the programme extremely favourably, citing benefits of the support of other women, trained guidance, and the opportunity to experience different types of exercise. Conclusions: A mixed-type, moderate-intensity exercise program in a group format is acceptable to women following breast cancer treatment, with the potential to reduce fatigue and improve quality of life, without exacerbating or precipitating lymphoedema. This pilot work needs to be confirmed in larger randomised studies. (C) 2004 Wiley-Liss, Inc.

Quality of Reporting of Observational Longitudinal Research

Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making. However, there are no structured reporting requirements for studies of this design to assist authors, editors, and readers. The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies. The checklist criteria concerned recruitment, data collection, biases, and data analysis and descriptive issues relevant to study rationale, study population, and generalizability. Two raters independently assessed 49 randomly selected articles describing stroke research published from 1999 to 2003 in six journals: American Journal of Epidemiology, Journal of Epidemiology and Community Health, Stroke, Annals of Neurology, Archives of Physical Medicine and Rehabilitation, and American Journal of Physical Medicine and Rehabilitation. On average, 17 of the 33 checklist criteria were reported. Criteria describing the study design were better reported than those related to internal validity. No relation was found between study type (etiologic or prognostic) or word count and quality of reporting. A flow diagram for summarizing participant flow through a study was developed. Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research.

Linking client and employee perceptions of the organization: A study of client satisfaction with health care services

Client satisfaction with health care sen ices has usually been researched in terms of socio-demographic and predispositional characteristics associated with the client. The present study included organizational characteristics as predictors of client satisfaction with health care services. Participants in the research were clients and employees of an Australian public-sector health care organization who responded to separate client and employee questionnaires. Hierarchical regression analyses indicated that, after controlling for a number of client characteristics, organizational characteristics, as perceived by employees, accounted for a significant proportion of additional variance in client satisfaction with health care services. Results of the present study provided some support for the proposition that employee perceptions of the working environment should be considered in a more comprehensive understanding of client satisfaction with health care services. Limitations of the study highlight practical difficulties in the assessment of client outcomes and methodological complexities in linking individual and organizational processes.

Improved beef production from supplementation of Hereford, Brahman and crossbred cattle grazing low and medium quality pastures in the subtropics of Australia

Subtropical grasslands are low in organic matter digestibility (OMD) (0.60) and nitrogen (N) (15 g/kg) for much of the year and this limits cattle production which is characterized by low calving rates and low weaning weights. Production has been based on Bos taurus British breeds of cattle but this is changing and now many breeding herds comprise B, indicus cows and their crosses. This change has increased some aspects of production, but low calving rates persist. A 4-year study was undertaken with a view to improve calving rates and weaner output by supplementing cows grazing either native or improved pastures with a high protein oilseed meal (cottonseed meal; CSM) on four sites. These sites were subdivided into a total of 36 paddocks to allow for two replications in a 3 breeds X 3 supplementation rates X 2 pastures factorial design. Selected cows (no. = 216) from Hereford (H), Brahman (B) and Brahman X Hereford (BH) breed types were set to graze either native pastures (0.45 to 0.62 OMD, 8 to 15 g N per kg; low quality) or improved pastures (0.47 to 0.67 OA ID, 10 to 22 g N per kg; medium quality). Cows were given either 0, 750 or 1500 g/day of CSM for 130 days from calving until 4 weeks into a 12- to 13-week mating period. The CSM was given as two meals per week. Live weight at mating of cows on the low quality pasture was increased (P < 0.01) over those not supplemented by feeding either 750 g CSM per day (H and B cows) or 1500 g CSM per day tall cows). There was no significant effect of supplementation on the mating weights of B cows grazing the medium quality sites. Calving rate of B cows was not increased by their supplementation on either low (4-year mean 58.3 %) or medium quality pastures (66.8%) but did tend to be higher in H cows when supplemented at 1500 g CSM per day on the low (66.7 v. 78.0 (s.e. 6.09) %; P < 0.1) and medium quality pastures (70.5 v. 93.5 (s.e. 4.72) %). An increased calving rate (65.8 (s.e. 6.6) % to 83.2 (s.e. 5.82) % in supplemented BH cows grazing low quality pastures approached significance (P < 0.1) when given CSM at 1500 g/day but there was no increased trend in calving rate when this breed type was supplemented on medium quality pastures. Weaning weights of calves from and B and BH cows were increased (P < 0.05) by supplementation of their darns at 750 g/day and for calves weaned from H cows supplemented at 1500 g/day of CSM. Supplementation at 1500 g/day on low quality pastures increased weaner output per cow mated by 120% for H, by 65% for BH cows and by 50% for B cows. Weaner output was increased by 34 and 40%, respectively, for B and H cows when supplemented at 750 g/day and grazing medium quality pastures but there teas no significant effect of supplementation on output from BH cows. Responses in many parameters differed between years. These results were interpreted as a response to the protein in the oilseed meal supplement by B, taurus and B. taurus X B. indicus cross cows grazing on the subtropical pastures. The study also highlighted that responses to the meal differed between breed types, between the quality of the grazed pasture and between the years of supplementation.