A retrospective cohort study describing chemotherapy-induced peripheral neuropathy in Non-Hodgkin lymphoma patients treated with EPOCH ± R: does HIV status matter?

The frontline immuno-chemotherapy regimen for HIV-associated non-Hodgkin Lymphoma is dose-adjusted EPOCH ± R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). Chemotherapy-induced peripheral neuropathy (CIPN), caused by vincristine, is a common adverse effect of EPOCH ± R, negatively impacting long-term patient outcomes. The primary objective of this study was to determine the incidence of CIPN, stratified by HIV status, in patients treated with EPOCH ± R. A retrospective cohort study at a tertiary referral comprehensive cancer center evaluated patients treated with EPOCH ± R from 2011 to 2018. The final sample included 27 patients with HIV compared to 279 without HIV (total n = 306). Overall, the incidence of CIPN was 29.4% (n = 90), including 5 with HIV (18.5%) and 85 without HIV (30.5%). Propensity scores were used to match patients by HIV status. Although no relationship was found between HIV status and neuropathy, CIPN affects too many undergoing treatments for lymphoma, supporting future investigations to minimize toxicities.

Educational Intervention to Enhance Nursing Comfort With Advance Care Planning and Documentation.

The objectives of this quality improvement project were to increase documentation of advance care planning (ACP) in the electronic health record (EHR) and improve nurses' self-reported comfort during discussions about end-o.

Describing Remembrance & Renewal: A Holistic Self-Care Program.

Background: Holistic care interventions include support for healthcare worker grief in a relationship-based care paradigm. Few programs support oncology healthcare worker grief and renewal prior to and during the COVID-19 pandemic. Objective: Describe "knowledge of" and "engagement with" a program about grief and resilience, Remembrance & Renewal (R&R). Method: An anonymous, electronic survey was available to healthcare workers at an academic, comprehensive cancer center. Demographic questions were analyzed against "knowledge of" and "engagement with." Results: Of 105 responding to "awareness of," 81 knew about R&R and 48 had "engaged with" the program. Statistically significant relationships between a characteristic and awareness were found for education (p = .03), setting (p < .01), and the frequency of learning about a death (p = .04). Statistically significant relationships between a characteristic and level of participation were found for profession (p = .02) and length of time in job (p = .03). Open-ended questions asked about impact of patient death (n = 93), barriers to participation (n = 54), and feelings after "engagement with" (n = 45). Responses to impact, barriers, and feelings were respectively: sadness (75.3%); time (77.8%); and calm (75.6%). Conclusion: This study describes "knowledge of" and "engagement with" a holistic grief and renewal program. Further study will add to healthcare worker holistic self-care.

Influence of Patient Functional Status and Depression on Strain in Caregivers.

BACKGROUND: Individuals who provide care to older adult women with breast cancer can experience distressing caregiver strain. OBJECTIVES: The purpose of this study was to determine whether functional status and depression in older adult women with breast cancer relates to strain in their caregivers. Relationships among caregiver characteristics and strain were also evaluated. METHODS: This multivariate, cross-sectional study used activities of daily living, instrumental activities of daily living, Timed Up and Go Test, Geriatric Depression Scale, and Modified Caregiver Strain Index (MCSI). Statistical analyses included Wilcoxon rank-sum tests and Spearman rank correlations. Logistic regression was used to predict MCSI scores. FINDINGS: Patient Timed Up and Go Test and Geriatric Depression Scale scores had the greatest impact on MCSI, with lower function and greater depression associated with increased caregiver strain. Advanced disease was associated with increased caregiver strain. When cancer stage is controlled for, caregiver employment is associated with increased strain.

Efficacy of Inhaled Essential Oil Use on Selected Symptoms Affecting Quality of Life in Patients With Cancer Receiving Infusion Therapies.

OBJECTIVES: To evaluate the effects of inhaled ginger, German chamomile, and bergamot essential oil (EO) versus an odorless control oil on appetite, anxiety, fatigue, and nausea in individuals with cancer receiving IV therapy. SAMPLE & SETTING: 248 adults with gastrointestinal, neuroendocrine, or skin cancer receiving IV therapy from an academic cancer center. RETHODS & VARIABLES: Participants were randomized to EO or control oil groups. Participants rated their symptoms during a seven-day period using a Likert-type scale ranging from 0 (no symptoms) to 10 (worst symptoms ever). RESULTS: Symptom burden was low. More men than women completed the study. The majority of participants had gastrointestinal cancer, followed by skin and neuroendocrine cancer. Ginger EO produced statistically significant results for anxiety and fatigue. IMPLICATIONS FOR NURSING: Most participants were men and had gastrointestinal cancer. The high number of zero scores for symptoms may indicate the success of current symptom management regimens. Improvements in anxiety and fatigue using ginger EO warrant further study for validation.

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.

Implementation of Universal Adolescent Depression Screening: Quality Improvement Outcomes.

INTRODUCTION: Despite the increasing incidence of adolescent depression, suicide and evidence-based recommendations for adolescent depression screening, 70% of teens report not discussing depression with their provider. The aim of this quality improvement project was to improve the identification and management of adolescent depression by implementing a practice-based, universal depression screening. METHOD: The Patient Health Questionnaire-9 modified for Adolescents was implemented during annual wellness visits for adolescents aged 12-18 years over 3 months. Retrospective chart reviews were conducted to determine a change in the rates of depression screening, depression diagnoses, referrals to mental health, and pharmaceutical treatment of depression. RESULTS: Pre/postimplementation data were compared. Documented adolescent depression screening increased from 0% to 74.5%. Increased rates of diagnosed depression (12.1%), mental health referrals (8%), and pharmaceutical treatment of depression (4.9%) were clinically and statistically significant. DISCUSSION: Adopting evidence-based recommendations for universal depression screening in pediatric primary care can improve the early diagnosis and management of adolescent depression.

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.

Childhood Bullying: Screening and Intervening Practices of Pediatric Primary Care Providers.

INTRODUCTION: Many adverse outcomes related to childhood bullying are treated in primary care, although little is known about how often providers are screening for, and intervening in, bullying. METHODS: A descriptive survey on the practices, attitudes, self-confidence, and knowledge of health care providers was sent to pediatric primary care providers in the state of Ohio. RESULTS: One hundred and two health care providers responded to the survey. More than half of the providers reported screening their patients for bullying. Interventions frequently used were providing counseling to the patient, referring patients to mental health, and documenting bullying in the chart. Providers with stronger attitudes and self-efficacy scores were more likely to screen for bullying, whereas knowledge was not related to screening for bullying. DISCUSSION: Despite national calls to screen for bullying, many providers do not routinely carry out screening. When bullying is suspected, many interventions are used in lieu of a paucity of evidence-based interventions.

An Electronic Medical Record Training Conversion for Onboarding Inpatient Nurses.

In recent times, policies stemming from the American Recovery and Reinvestment Act of 2009 have served as a stimulus for healthcare organizations to adopt an electronic medical record. As a result, nurses are now more knowledgeable of and experienced with an electronic medical record. In August 2016, our facility converted from instructor-led training to electronic learning for inpatient nurse electronic medical record training, hoping to capitalize on previous experience with the clinical information system. However, a complete program evaluation of this transition had yet to be conducted. The purpose of this study was to evaluate electronic learning usability and the return on investment of an electronic medical record training conversion. Evaluations of electronic medical record electronic learning training were collected from 75 newly hired, inpatient nurses from November and December 2017, and compared to our instructor-led program. Results showed that users found it effective and were satisfied with this training method. The electronic learning had superior efficiency, reducing training time by ~50% compared to instructor-led training, while proving to yield effectiveness and satisfaction. The return on investment was $18 540, with a gain of 593.25 hours in nursing time during the study period of two months. These results support the organizational decision to convert to electronic learning, further supporting the conversion for other clinical roles.

Differences in inflammatory markers between nulliparous women admitted to hospitals in preactive vs active labor.

OBJECTIVE: To determine whether labor-associated inflammatory markers differ between low-risk, nulliparous women in preactive vs active labor at hospital admission and over time. STUDY DESIGN: Prospective comparative study of low-risk, nulliparous women with spontaneous labor onset at term (n = 118) sampled from 2 large Midwestern hospitals. Circulating concentrations of inflammatory markers were measured at admission and again 2 and 4 hours later: namely, neutrophil, and monocyte counts; and serum inflammatory cytokines (interleukin -1ß, interleukin-6, tumor necrosis factor-α, interleukin-10) and chemokines (interleukin-8). Biomarker concentrations and their patterns of change over time were compared between preactive (n = 63) and active (n = 55) labor admission groups using Mann-Whitney U tests. RESULTS: Concentrations of interleukin-6 and interleukin-10 in the active labor admission group were significantly higher than concentrations in the preactive labor admission group at all 3 time points. Neutrophil levels were significantly higher in the active group at 2 and 4 hours after admission. The rate of increase in neutrophils and interleukin-10 between admission and 2 hours later was faster in the active group (P < .001 and P = .003, respectively). CONCLUSION: Circulating concentrations of several inflammatory biomarkers are higher and their rate of change over time since admission is faster among low-risk, nulliparous women admitted to hospitals in active labor, as compared with those admitted in preactive labor. More research is needed to determine if progressive changes in inflammatory biomarkers might be a useful adjunct to improving the assessment of labor progression and determining the optimal timing of labor admission.

Prevention of UV-induced damage to the anterior segment using class I UV-absorbing hydrogel contact lenses.

PURPOSE: To determine whether class I ultraviolet (UV) light-blocking contact lenses prevent UV-induced pathologic changes in a rabbit model. METHODS: Twelve rabbits were assigned to 1 of 3 treatment groups (n = 4), as follows: senofilcon A (class I UV blocking) contact lenses; lotrafilcon A contact lenses (no reported UV blocking); no contact lens. The contralateral eye was patched without a contact lens. Animals received UV-B (1.667 J/cm(2)) exposure daily for 5 days. Postmortem tissue was examined as follows: in the cornea, the expression of matrix-metalloproteinases (MMPs) was evaluated by zymography, and apoptosis was evaluated by TUNEL and caspase-3 ELISA; ascorbate in the aqueous humor was evaluated by nuclear magnetic resonance spectroscopy; crystalline lens apoptosis was evaluated by TUNEL and caspase-3 ELISA. RESULTS: Exposed corneas showed a significant increase in MMP-2 and -9, TUNEL-positive cells, and caspase-3 activity in the lotrafilcon A group compared with the senofilcon A group (all P = 0.03). A significant decrease in aqueous humor ascorbate was observed in the exposed lotrafilcon A lens-wearing group compared with the exposed senofilcon A lens-wearing group (P = 0.03). Exposed crystalline lenses had significantly increased caspase-3 activity in the lotrafilcon A group compared with the senofilcon A group (P = 0.03). Increased numbers of TUNEL-positive cells were noted in both the lotrafilcon A and the non-contact lens groups. CONCLUSIONS: The authors show that senofilcon A class I UV-blocking contact lenses are capable of protecting the cornea, aqueous humor, and crystalline lens of rabbits from UV-induced pathologic changes.