Surgical training of gynecologic oncology fellows: Long-term trends and implications for future education.

OBJECTIVES: The surgical training of gynecologic oncology (GO) fellows is critical to providing excellent care to women with gynecologic cancers. We sought to evaluate changes in techniques and surgical volumes over an 18-year period among established GO fellowships across the US. METHODS: We emailed surveys to 30 GO programs that had trained fellows for at least 18 years. Surveys requested the number of surgical cases performed by a fellow for seventeen surgical procedures over each of five-time intervals. A One-Way Analysis of Variance was conducted for each procedure, averaged across institutions, to examine whether each procedure significantly changed over the 18-year span. RESULTS: 14 GO programs responded and were included in the analysis using SPSS. We observed a significant increase in the use of minimally invasive (MIS) procedures (robotic hysterectomy (p < .001), MIS pelvic (p = .001) and MIS paraaortic lymphadenectomy (p = .008). There was a concurrent significant decrease in corresponding "open" procedures. There was a significant decrease in all paraaortic lymphadenectomies. Complex procedures (such as bowel resection) remained stable. However, there was a wide variation in the number of cases reported with extremely small numbers for some critical procedures. CONCLUSIONS: The experience of GO fellows has shifted toward increased use of MIS. While these trends in care are appropriate, they do not diminish the need in many patients for complex open procedures. These findings should help spur the development of innovative training to maintain the ability to provide these core, specialty-defining procedures safely.

Social isolation, coping efficacy, and social well-being over time in patients with lung cancer.

BACKGROUND: Little work has examined how coping efficacy and lung cancer-related social isolation relate to social well-being in the context of a patient's computed tomography (CT) scan. Researchers tested the cross-sectional relationship of social isolation and social well-being, and the longitudinal relationship between coping efficacy and social well-being before CT scans. METHOD: 25 patients with lung cancer, within 6 months of their upcoming CT scan, participated. Baseline surveys collected clinical information, demographics, and social isolation; repeated monthly surveys collected coping efficacy and social well-being every 30 days until one's scan. RESULTS: [Cross-sectional] High levels of social isolation were associated with low levels of social well-being. [Longitudinal] On months patients reported high coping efficacy, they also reported increases in social well-being. CONCLUSIONS: Social interventions may improve well-being among those with lung cancer as our work shows that getting and receiving support are strongly related to well-being in the time surrounding a scan.

Coping With 'Scanxiety': Within-Person Processes in Lung Cancer.

Background: Patients with early-stage lung cancer undergo potentially curative therapy, and continue to undergo regularly scheduled CT scans to determine if cancer has reappeared, spread, or stayed the same. This process can be fraught with anxiety, coined 'Scanxiety'. The present study examined how coping and scan-related anxiety fluctuate within-person before one's scan. Method: Twenty five individuals with lung cancer who had received curative intent treatment (M age = 62.33, [SD = 8.10], 96% women, 80% white) participated in the study, which had two parts. First, participants provided information about proactive coping and scan-related anxiety every 30 days. Next, a daily diary study was implemented for 7 consecutive days before their CT scan, as well as the day of their CT scan, where participants reported on their daily anticipatory coping and scan-related anxiety. The 25 participants provided 59 monthly and 146 daily surveys for analysis. Results: Multilevel models revealed significant main effects of monthly proactive coping on monthly scan-related anxiety, as well as daily anticipatory coping on daily scan-related anxiety. On months when participants decreased their use of proactive coping, they also reported decreases in scan-related anxiety for that month. On days when participants reported decreases in outcome fantasy and stagnant deliberation, they reported decreases in scan-related anxiety for that day. Finally, a significant interaction was found such that on days when middle-aged adults reported increases in problem analysis, they also reported increases in scan-related anxiety for that day. Conclusion: These findings are the first to characterize how participants' coping and scanxiety fluctuate in the months and days prior to their CT scans. Results indicated that focusing on the present may be more beneficial in reducing scan-related anxiety rather than thinking about the future. Future work should implement strategies to reduce scanxiety by focusing on the present among those with lung cancer.

No Pain, No Gain? Personality Associations With Awareness of Aging Depend on Arthritis.

Background: Awareness of aging brings to light one's own perceived behavioral, physical, and cognitive changes associated with getting older. Personality and physical illness are each related to two components of awareness of aging: attitudes toward own aging (ATOA), and awareness of age-related changes (AARC). Here, we move beyond main effects to examine how personality and arthritis interact with respect to awareness of aging. Materials and Methods: 296 participants (M age = 64.67, SD = 4.36, Range = 60-90 years, 49.7% women) completed online self-report questionnaires of personality, arthritis, ATOA, and AARC gains and losses. Results: We ran three hierarchical multiple regression models to test how personality traits and arthritis interacted to predict ATOA, AARC gains, and AARC losses, respectively. Higher extraversion was related to positive ATOA, and higher openness was related to positive ATOA and more AARC gains. Higher neuroticism was related to negative ATOA, more AARC losses, and less AARC gains. We found a main effect for arthritis, where those with arthritis reported more AARC losses. Lastly, we found a significant interaction between arthritis and agreeableness when predicting AARC gains. Among those with low agreeableness, people with arthritis reported significantly more AARC gains compared to those without arthritis. Conclusion: Personality and arthritis are each important for awareness of aging. Overall, our study suggests that for those with arthritis, it is especially important to consider behavioral and cognitive factors related to agreeableness, as they may be important means of promoting positive views on aging.

Long-term care and nursing management of a patient who is the recipient of a renal transplant.

This is the final article in a three-part education series on renal transplantation, which addresses the specialist knowledge required in the long-term management of the people undergoing renal transplantation. The first article in this series (Murphy F., Trevitt R., Chamney M. et al. (2011). Patient health and well-being while waiting for renal transplantation: Part 1. Journal of Renal Care 37(4), 224-231) addressed patient health and well being while waiting for a renal transplant. The second article (Trevitt R., Dunsmore V., Murphy F., Piso L., Perriss C., Englebright B. & Chamney M. (2012) Pre- and post-transplant care: nursing management of the renal transplant recipient: Part 2. Journal of Renal Care 38(2), 107-114) examined pre- and post-operative care and management.

Pre- and post-transplant care: nursing management of the renal transplant recipient: part 2.

This is the second article in a three part continuing education series on renal transplantation which addresses the specialised knowledge and skills required in order to prepare a patient admitted to hospital for renal transplantation and then how to care for that patient afterwards. The first article in this series addressed patient health and well-being while waiting for a renal transplant. The third article will look at the long-term care of kidney recipients.