Effect of Foot Reflexology and Aromatherapy on Anxiety and Pain During Brachytherapy for Cervical Cancer.

OBJECTIVES: To determine if the addition of aromatherapy and foot reflexology to the standard of care improves pain and anxiety in patients receiving brachytherapy for cervical cancer. SAMPLE & SETTING: 41 women with locally advanced cervical cancer who received intracavitary brachytherapy as part of their treatment. METHODS & VARIABLES: Participants were randomized to either the control group, which received the standard-of-care management during brachytherapy, or the intervention group, which received the addition of aromatherapy and foot reflexology to standard of care. Participants rated their pain on a numeric rating scale and anxiety on the State-Trait Anxiety Inventory (STAI) and a numeric rating scale at five different time points. RESULTS: All average pain and anxiety scores were equal or lower at each key time point for the intervention group. Statistically significant differences were found for the intervention group for anxiety on the numeric rating scale and on the STAI, but only post-reflexology. IMPLICATIONS FOR NURSING: Nurses and other healthcare providers can be trained to provide reflexology during painful, anxiety-producing procedures to increase patient tolerance of these treatments and overall quality of life.

Microbial Growth on the Nails of Direct Patient Care Nurses Wearing Nail Polish.

OBJECTIVES: To determine whether nurses wearing nail polish pose a greater infection risk to patients than nurses who are not wearing nail polish. SAMPLE & SETTING: 89 direct patient care oncology nurses at a large midwestern National Cancer Institute-designated comprehensive cancer center. METHODS & VARIABLES: The investigators assigned participants' three middle fingers of their dominant hand to three groups. RESULTS: Comparison of colony-forming units revealed that one-day-old polish exhibited fewer gram-positive microorganisms than the unpolished nail (p = 0.04). The four-day-old polish showed significantly more microorganisms than the one-day-old polish (p = 0.03). The same trend was demonstrated for gram-negative microorganisms, but the difference was not statistically significant (p = 0.3 and p = 0.17, respectively). IMPLICATIONS FOR NURSING: The results should be interpreted and applied to expert nursing practice in the care of vulnerable patient populations. Each institution and practitioner should make their own decisions and interpretation of evidence into practice.

The THRIVE© Program: Building Oncology Nurse Resilience Through Self-Care Strategies.

OBJECTIVES: To develop an evidence-based program for addressing the concerns of burnout and secondary trauma and building on the concept of resilience in oncology healthcare providers. SAMPLE & SETTING: 164 oncology staff, of which 160 were nurses, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, Ohio. METHODS & VARIABLES: Oncology nurses and other providers participated in the THRIVE© program, which consists of an eight-hour retreat designed to teach self-care strategies, a six-week private group study interaction on a social media platform, and a two-hour wrap-up session. The Compassion Fatigue Short Scale and the Connor-Davidson Resilience Scale were used to evaluate the program. RESULTS: In self-assessments prior to THRIVE, nurse managers demonstrated the greatest degree of burnout, and bedside/chairside nurses demonstrated the greatest degree of secondary trauma. The greatest improvement in average scores from pre- to postprogram assessment was in increased resilience and decreased burnout. Increased resilience scores were sustained for a six-month period after THRIVE participation. IMPLICATIONS FOR NURSING: Oncology healthcare providers must identify self-care strategies that build their resilience for long, successful careers.

Acute Leukemia: Diagnosis and Treatment.

OBJECTIVE: To provide an overview of acute leukemia, comparing incidence, presenting symptoms, diagnosis, prognosis, and treatment of the major subtypes. DATA SOURCES: Review of articles dated 2010 to present in PubMed and CINAHL, and National Comprehensive Cancer Network Guidelines. CONCLUSION: The diagnosis of acute leukemia is comprised of a variety of hematopoietic neoplasms that are both complex and unique. Each subtype of acute leukemia has defining characteristics that affect prognosis and treatment. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an integral role in the care of the patient with acute leukemia during and beyond hospitalization. Therefore, baseline knowledge of these diseases is essential. Early symptom recognition is central in the management of oncologic emergencies.

The Use of Comfort Kits to Optimize Adult Cancer Pain Management.

BACKGROUND: Pain is one of the most feared of all symptoms for the cancer patient. Some studies estimate that up to 90% of all cancer patients experience pain. Advances in pharmaceuticals and expert provider knowledge have improved pain management overall for the patient with cancer; however, complementary therapies can synergize medications to provide optimal pain relief while decreasing the side effect profile. Despite this, nurses may have limited access to such resources. Many therapies can be administered directly by the bedside/chairside nurse with minimal training and the nurse can then teach the patient and family how to use the selected complementary therapy after leaving the hospital or clinic. OBJECTIVES: The oncology nurse will be able to identify several easy-to-implement complementary therapies that can supplement pharmacologic pain management for cancer patients. METHODS: As a quality project, comfort kits, containing such items as handheld massagers, guided imagery audiotapes, and aromatherapy essential oils, were distributed for use with patients through unit-based pain resource nurses. ANALYSIS: More than 500 comfort kit items were tracked by the pain clinical nurse specialist during the comfort kit trial, both by medical record review and by follow-up phone calls to patients. During the comfort kit trial, average pain intensity decreased by 2.25 points on a 0-10 scale in the 24-hour period after use of the item from the comfort kit. Patients also had an overall decrease in the use of pharmacologic pain interventions and an increase in ambulation in the 24-hour period after implementation. CONCLUSIONS: Comfort kits allow nurses easy access to inexpensive tools to supplement pharmaceutical pain management. Optimizing nonpharmacologic pain management can increase patient and nurse satisfaction, improve overall pain management, and decrease untoward side effects.

The Development of an Oncology Clinical Nurse Specialist Fellowship Program.

New graduate clinical nurse specialists (CNSs) face many challenges when starting their new role. To address this, a CNS fellowship program was developed to mentor new CNSs during their first year of practice. This CNS fellowship program would provide opportunities to increase skills related to each of the CNS spheres of influence, including nursing practice, patient care, and systems and organization. Experienced CNSs mentored CNS fellows and identified learning opportunities. The fellows completed an online self-assessment based on the National Association of Clinical Nurse Specialists CNS Competency Checklist during week one of orientation and again at months 3, 6, 9, and 12. The CNS fellows completed and presented three projects designed to explore the spheres of the CNS role, along with a formal onboarding. The results of the fellowship depicted significant competency development within all three CNS spheres at program completion. The CNS fellowship program provided structure and guidance to the newly graduated CNSs and clearly transitioned staff nurses to advanced practice nurses. The fellowship has demonstrated a positive effect on both the new CNSs and the organization in which it was developed.

Pain Assessment: Use of the Defense and Veterans Pain Rating Scale in Patients With Cancer.

BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice. From postimplementation chart review and clinician satisfaction surveys, the DVPRS was evaluated for the following. FINDINGS: Seventy-eight percent of nurses surveyed (N = 64) preferred the DVPRS over any other pain assessment tool. Inpatient and ambulatory patients surveyed (N = 144) agreed that a Likert-type scale in the DVPRS was easier to understand, easier to use, and better in describing their pain than the numeric rating scale.

Leukostasis: Management to Prevent Crisis in Acute Leukemia
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BACKGROUND: Hyperleukocytosis, a peripheral white blood cell count greater than 100,000/mm3,is most commonly seen in patients with newly diagnosed or relapsed acute lymphoblastic leukemia and acute myeloid leukemia. Leukostasis is a reduction in blood flow related to hyperviscosity. Hyperleukocytosis, causing leukostasis, is an oncologic emergency and requires an exacting assessment and rapid response with appropriate intervention to prevent morbidity and mortality in the first week after diagnosis. OBJECTIVES: The objectives of this article are to equip oncology nurse to identify patients with hyperleukocytosis and to provide nursing interventions that will ensure safe, quality care. METHODS: A case study is used to demonstrate key concepts that are critical in early assessment, identification, and treatment of patients with leukostasis.
. FINDINGS: Oncology nurses well versed in the pathophysiology, clinical presentation, and management of leukostasis can make a significant contribution to the safe management of patients with cancer.

The Effect of Aromatherapy on Insomnia and Other Common Symptoms Among Patients With Acute Leukemia

Purpose/Objectives: To determine if the use of aromatherapy improves insomnia and other common symptoms in hospitalized patients with newly diagnosed acute leukemia. Design: A randomized, crossover, washout trial. Setting: An inpatient acute leukemia unit at the Arthur G. James Cancer Hospital and Richard L. Solove Research Institute of the Wexner Medical Center at Ohio State University in Columbus. Sample: 50 patients who were newly diagnosed with acute leukemia and hospitalized to receive their initial four weeks of intensive induction chemotherapy. Methods: Patients were offered a choice of three scents to be used during the trial: lavender, peppermint, or chamomile. Each patient was randomized to receive either the chosen aromatherapy intervention or a placebo intervention during alternate weeks, with a washout period in between. Sleep quality and other common symptoms were measured. Main Research Variables: Aromatherapy, sleep, insomnia, pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and well-being. Findings: Most patients reported poor quality sleep at baseline, but aromatherapy had a statistically significant positive impact. Improvements were noted in tiredness, drowsiness, lack of appetite, depression, anxiety, and well-being because of aromatherapy. Conclusions: Aromatherapy is a viable intervention for improving insomnia and other symptoms commonly experienced by patients with acute leukemia. Implications for Nursing: Oncology nurses can employ aromatherapy safely and inexpensively, and with minimal training, as an effective tool in decreasing many symptoms that plague patients with leukemia. Patients can exercise a greater sense of control over their treatment environments through the use of aromatherapy.

Impact of an Alert System on Quality Indicators in Patients With Acute Promyelocytic Leukemia.

BACKGROUND: Acute promyelocytic leukemia (APL), once the most lethal form of adult acute leukemia, has become the most curable. The goal of early and well-managed treatment induction is to reduce the malignant burden of promyelocytes to below the cytologically detectable level. OBJECTIVES: Oncology nurses who care for patients with APL need to be acutely aware of the basic differences in this disease from other forms of leukemia, including the two main complications for the newly diagnosed patient. METHODS: This article will briefly review APL and its associated presenting symptoms, prognosis, treatment, and complications. FINDINGS: These complications require immediate activation of expert staff and resources to protect critically ill patients with APL from associated morbidity and mortality.

Fecal microbiota transplantation in patients with cancer undergoing treatment.

Fecal microbiota transplantation (FMT) is a technique used to restore the normal body flora to the gut in cases of Clostridium difficile infection (CDI). It involves instillation of the stool of a healthy donor through a nasogastric tube or colonoscopy into the gastrointestinal tract of the patient. More research is needed to determine the parameters of FMT use in patients with cancer.

Using failure-to-rescue simulation to assess the performance of advanced practice professionals.

The use of advanced practice professionals (APPs) has been established in oncology care. APPs are frequently the most readily available ordering provider for care guidance when it becomes evident that a patient with cancer is failing. The purpose of the current preliminary descriptive project was to determine the best method for assessing APP performance in oncology-specific circumstances, particularly in the failing patient with cancer. A test group of 14 APPs completed a competency self-assessment, the Basic Knowledge Assessment Tool (BKAT)-8SR, and attended a four-hour simulation and classroom experience. Competency checklists with 30 priority interventions for each scenario had been anticipated by an expert panel. The APP competency self-assessment was measured for knowledge base and critical thinking. All of the APPs scored at or above the level of a critical care nurse with one year of experience on the BKAT-8SR. Twenty-seven of the anticipated interventions were enacted by all APPs. Five additional interventions were ordered that had not been anticipated. The success of this educational strategy has stimulated new learning opportunities, including initiation of a full-team oncology failure-to-rescue simulation, course restructuring, and other innovative simulation experiences.

Preliminary Screening of Potential Control Products against Drosophila suzukii.

The first recording of Drosophila suzukii in the UK occurred in the south of England during August 2012. Since then sticky traps have continued to record the presence of individuals. Several products (both chemical and biological) were investigated for their efficacy against different life-stages of the pest. Both direct and indirect exposure to control products was assessed. Spinosad, chlorantraniliprole and the experimental product, TA2674, showed excellent potential as control agents when used as either a pre- or post-dipping treatment for blueberries with mortalities of 100%, 93% and 98% mortality, respectively, being achieved following pre-treatment. Direct spray application of all products tested had limited impact upon adult flies. Highest mortality (68%) was achieved following direct application of TA2674. Entomopathogenic agents (nematodes and fungi) tested appeared to reduce fly population development (ranges of 34-44% mortality obtained) but would seem unable to eradicate outbreaks. The potential of the tested products to control D. suzukii is discussed.

Efficacy of Commercially Available Invertebrate Predators against Drosophila suzukii.

Drosophila suzukii has been recorded in the UK since the end of 2012. To date, reports of serious damage have been rare. Previous research has demonstrated that there are chemicals available within the UK that are efficient in dealing with D. suzukii. However, few effective chemicals for use by the organic sector have been identified; equally the addition of "new" insecticides into previously stable ecosystems can have negative impacts upon natural enemies and so disrupt control strategies that have developed over a period of time. Therefore, there is a need also to screen for potential biological control agents for D. suzukii. The following commercially available predatory species were evaluated for their potential to act as control agents for D. suzukii: Orius majusculus, Orius laevigatus, Atheta coriaria, Hypoaspis miles and Anthocoris nemoralis. This set of natural enemies could potentially target several life stages of D. suzukii (larvae, pupae and adults). All species, except H. miles, fed on D. suzukii life stages to some extent. Hypoaspis miles displayed no impact upon D. suzukii populations. Anthocoris nemoralis displayed a tendency to feed upon more male than female adult D. suzukii and caused 45% mortality after five days. None of the natural enemies trialed were able to control D. suzukii individually. However, these and other non-commercially produced species will all play a role within a given ecosystem in controlling D. suzukii populations.

Population Development of Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae) under Simulated UK Glasshouse Conditions.

Tomato leafminer Tuta absoluta (Meyrick) is a major pest of tomato plants in South America. It was first recorded in the UK in 2009 where it has been subjected to eradication policies. The current work outlines T. absoluta development under various UK glasshouse temperatures. The optimum temperature for Tuta development ranged from 19-23 °C. At 19 °C, there was 52% survival of T. absoluta from egg to adult. As temperature increased (23 °C and above) development time of the moth would appear to decrease. Population development ceases between 7 and 10 °C. Only 17% of eggs hatched at 10 °C but no larvae developed through to adult moths. No eggs hatched when maintained at 7 °C. Under laboratory conditions the total lifespan of the moth was longest (72 days) at 13 °C and shortest (35 days) at both 23 and 25 °C. Development from egg to adult took 58 days at 13 °C; 37 days at 19 °C and 23 days at 25 °C. High mortality of larvae occurred under all temperatures tested. First instar larvae were exposed on the leaf surface for approximately 82 minutes before fully tunnelling into the leaf. Adult longevity was longest at 10 °C with moths living for 40 days and shortest at 19 °C where they survived for 16 days. Generally more males than females were produced. The potential of Tuta absoluta to establish populations within UK protected horticulture is discussed.

Prey consumption rates and compatibility with pesticides of four predatory mites from the family Phytoseiidae attacking Thrips palmi Karny (Thysanoptera: Thripidae).

BACKGROUND: Predatory mites (Amblyseius swirskii Athias-Henriot, Typhlodromips montdorensis Schicha, Neoseiulus cucumeris (Oudemans) and Iphiseius degenerans Berlese) were investigated for their potential to act as control agents for Thrips palmi Karny. Prey consumption rates and compatibility with pesticides were assessed. RESULTS: Second-instar larvae were the preferred life stage. Typhlodromips montdorensis consumed the most larvae (2.8) and also an average of 1.2 adult T. palmi per 5 day period. Both 24 and 48 h assessments following application of abamectin, spinosad and imazalil demonstrated mortality of predatory mites (across all species), which was significantly higher than with the other treatments (P < 0.001). Spraying with pymetrozine did not provide any increased mortality when compared with the water control. Application of thiacloprid proved detrimental only to I. degenerans. Following indirect exposure of predatory mites to pymetrozine and imazalil, no significant differences in mite mortality were obtained. Indirect exposure to spinosad was identified as the most detrimental treatment (P < 0.001) to all mites. Abamectin also proved detrimental, with only T. montdorensis showing any potential tolerance. CONCLUSION: All predatory mites investigated offer potential for controlling T. palmi. Compatibility with chemicals varied between the mites. The potential of incorporating the mites into eradication strategies for T. palmi is discussed.

Screening Commercially Available Entomopathogenic Biocontrol Agents for the Control of Aethina tumida (Coleoptera: Nitidulidae) in the UK.

The Small hive beetle, Aethina tumida, is an invasive pest of honey bees. Indigenous to sub-Saharan Africa, it has now become established in North America and Australia. It represents a serious threat to European honey bees. Commercially available entomopathogenic agents were screened for their potential to control beetle larvae. Entomopathogenic fungi investigated had minimal impact. The nematodes Steinernema kraussei and S. carpocapsae provided excellent control with 100% mortality of larvae being obtained. Sequential applications of the nematodes following larvae entering sand to pupate also provided excellent control for up to 3 weeks. The information gained supports the development of contingency plans to deal with A. tumida should it occur in the UK, and is relevant to the management of Small hive beetle where it is already present.