Effectiveness of communication skill training on cancer truth-telling for advanced practice nurses in Taiwan: A pilot study.

OBJECTIVE: Advanced practice nurses (APNs) can best support physicians in improving the quality of truth-telling. However, the effectiveness of communication skill training (CST), based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs' and recipients' viewpoints, motivating the author to conduct the present study. METHODS: A two-group before-after model design was adopted, and 61 APNs from two hospitals were randomly assigned to either an experimental group (EG; N = 28) or an control group (CG; N = 33). APNs in the EG received 6 h of CST under the guidance of qualified facilitators and simulated patients. This study used APNs' subjective assessment (N = 61) (self-confidence and perceptions on truth-telling) and recipients' opinions (N = 480) (cancer patients' and their caregivers' satisfaction with truth-telling and emotional status) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline, T0), immediately after (T1), and 2 weeks after (T2). RESULTS: APNs in the EG had more confidence (p < 0.05) and better perceptions of cancer truth-telling (p < 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth-telling, emotional distress, and anxiety (p > 0.05). In addition, patients in the EG had higher depression than patients in the CG (ß = 1.65, p = 0.01). CONCLUSIONS: SHARE CST can improve APNs' confidence and perceptions of cancer truth-telling. However, more rigorous studies are required to test the effectiveness of CST from recipients' viewpoint.

Using intestinal segments during secondary salvage procedures after failed reconstructions of the cervical oesophagus.

OBJECTIVES: The free anterolateral thigh (ALT) flap is commonly used for the reconstruction of the cervical oesophagus with satisfactory results. Its convenience and popularity make it a popular flap for reconstructive surgeons. The use of intestinal flaps, however, carries a higher level of technical difficulty and is normally performed as a primary reconstructive procedure. This report investigates the feasibility of intestinal flaps for the reconstruction of the cervical oesophagus and strategies to optimize its success when used as a secondary flap after primary ALT flap failure. METHODS: We retrospectively reviewed 22 patients (age 39-72 years) who were men, between April 2013 and January 2015, with intestinal segments (free and pedicled ileocolon, jejunal and colon flaps) that were used secondarily to salvage failed primary free ALT flap reconstructions after hypopharyngeal cancer resection. Ten patients presented with leakage and 2 with tracheo-oesophageal fistulae as complications from the primary flap failure. RESULTS: Oral intake commenced around 1-month postoperatively. One case of flap failure was observed. The majority had no major postoperative complications. Patients were followed up (6-27 months), and 21 cases of a secondary intestinal flap were successful with the restoration of oesophageal continuity and oral intake. CONCLUSIONS: Intestinal flaps, free or pedicled, can be used secondarily after failed ALT flap reconstructions with minimal complications or morbidity. Intestinal flaps successfully allow restoration of gastrointestinal continuity with early commencement of oral intake and swallowing function.

Plasmon hybridization in individual gold nanocrystal dimers: direct observation of bright and dark modes.

We apply a nanomanipulation technique to assemble pairs of monodispersed octahedral gold nanocrystals (side length, 150 nm) along their major axes with a varying tip-to-tip separation (25-125 nm). These pairs are immobilized onto indium tin oxide coated silica substrates and studied as plasmonic dimers by polarization-selective total internal reflection (TIR) microscopy and spectroscopy. We confirm that the plasmon coupling modes with the scattering polarization along the incident light direction result from the transverse-magnetic-polarized incident light, which induces two near-field-coupled dipole moments oriented normal to the air-substrate interface. In such cases, both in-phase (antibonding) and antiphase (bonding) plasmon coupling modes can be directly observed with the incident light wave vector perpendicular and parallel to the dimer axis, respectively. The observation of antiphase plasmon coupling modes ("dark" plasmons) is made possible by the unique polarization nature of the TIR-generated evanescent field. Furthermore, with decreasing nanocrystal separation, the plasmon coupling modes shift to shorter wavelengths for the incident light perpendicular to the dimer axis, whereas relatively large red shifts of the plasmonic coupling modes are found for the parallel incident light.