Factors associated with response to compression-based physical therapy for secondary lower limb lymphedema after gynecologic cancer treatment: a multicenter retrospective study.

BACKGROUND: Lower limb lymphedema (LLL) is one of the most refractory and debilitating complications related to gynecological cancer treatment. We investigated factors associated with response to compression-based physical therapy (CPT) for secondary LLL after gynecologic cancer treatment. METHODS: We performed a multicenter retrospective study using the records of seven medical institutions from 2002 and 2014. Patients who developed LLL after gynecological cancer treatment were included. Limb volumes were calculated from the lengths of the limb circumferences at four points. All participants underwent compression-based physical therapy for LLL. Factors, including MLD, indicative of circumference reductions in LLL were determined. RESULTS: In total, 1,034 LLL met the required criteria of for the study. A multivariate linear regression analysis identified age; body mass index (BMI); endometrial cancer; radiotherapy; and initial limb circumference as significant independent prognostic factors related to improvement in LLL. In analysis of covariance for improvement in LLL adjusted by the initial limb circumference and stratified by BMI and radiotherapy, patients with BMI 28 kg/m2 or higher and receiving radiation rarely responded to CPT. CONCLUSIONS: Improvements in the lower limb circumference correlated with clinical histories and physical characteristics, which may be used as independent prognostic factors for successful CPT for LLL after gynecological cancer treatment.

Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study.

INTRODUCTION: Late-onset lower limb lymphedema (LLL) is a significant clinical challenge for physicians dealing with patients that undergo treatment involving the pelvic cavity. We aimed to clarify the prevalence of and risk factors for late-onset LLL after treatment for gynecological cancer. METHODS: We conducted a multicenter retrospective study using records of cases in which LLL diagnosed by physical findings and measurement of limbs girths. Patients with LLL after treatment for uterine cervical, endometrial, and ovarian cancer were sequentially enrolled. We examined the timing of LLL onset and the associations between the time to onset and clinical characteristics, including age, type of cancer, lymphadenectomy sites, and performance of radiotherapy. We also investigated the risk factors for late-onset LLL and their effects on the cumulative incidence of late-onset LLL. RESULTS: In total, 711 patients fulfilled the required criteria. Mean age of was 50.2 years old and median follow-up period was 5.05 years. More than half of them (50.5%) presented with LLL ≥5 years after undergoing treatment for gynecological cancer. A substantial number of patients (29.4%) developed LLL ≥10 years after undergoing treatment for gynecological cancer. Being aged <50 years [(odds ratio (OR): 1.919, P = 0.001), cervical cancer (OR: 1.912, P = 0.001), and radiotherapy (OR: 1.664, P = 0.017) were identified as significant risk factors for late-onset LLL in multivariate logistic regression analysis. CONCLUSIONS: A substantial number of patients present with LLL ≥5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of the risk of late-onset LLL.

Information Sharing and the Nursing Practice for the Certified Nurse in Radiation Therapy Nursing.

This study is conducted in order to clarify, however practice and get or sharing information in the Radiation Therapy Nursing of Certified Nurses. We have the group interviews from the four members the Certified Nurses in Radiation Therapy Nursing. It was found that Certified Nurses in Radiation Therapy Nursing felt that don't have the information about the patients who receives radiation therapy. In addition, they thought not able to even determine about whether time required, and not provide the professional nursing care practice. They say that we need the time, place and information. They were determined to be there to be necessary in for exhibiting their abilities. In particular, the most important problems that there aren't systematic information of the patients who receives radiation therapy. It's mean that, not have described the information for Radiation Therapy Nursing, and not obviously structure of nursing process or important assessment's, yet.

Analysis the Nursing Documentation of the Observation Plans and Practices of Breast Cancer Using Nursing NAVI.

We analyzed in nursing observation planning and practices circumstances of a breast cancer patient using the Nursing NAVI® Contents. The result of this analyzed were clearly that the master plan item was satisfying a vital signature, so it could be practiced 100%. But even if the observation item of in-out balance were not records so the implementation rate of the 50%, comparison with the Nursing NAVI® Contents. About the item esteemed as required item, like, the thing with the low observation implementation rate became clear. We found that problem about estrangement of the difference between the planning the observation drafting and the implementation. The implementation item can see a little tendency much, and later, the plan item will be also a problem about the current state to which the necessary item is inferior.

Developing the structured knowledge model to navigate the nurses' thinking process in their professional judgment and action.

Authors have defined the function of the nursing observation as "monitoring the onset and course of health problems" and that of nursing action as "preventing health problems". We have also identified three foci of the nursing observation and nursing action respectively. The foci of nursing observation are: "signs and symptoms related to the diseases", "complications related to the invasive medical procedures such as surgery" and "adverse effects related to the pharmacotherapy". Those of nursing action are: "nursing care to fulfill the needs arising from the diseases and the medical interventions", "nursing care to prevent the complications", and "nursing care to prevent the adverse effects". Finally, we have categorized hospitalized patients' conditions into "pre-surgery", "post-surgery" and "rehabilitative phase" for the surgical patients and "severe", "moderate" and "mild" for non-surgical ones. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions.

Structural visualization of expert nursing: Diabetes self-management education program.

In the Japanese clinical setting, expert nursing, and at the same time quality and safety assurance, are demanded. To provide nursing service with reliable assurance of nursing quality and safety, structural visualization of the thought, judgment and behavior processes of nursing practice and widespread application through development of IT applied systems are required. We have discussed and developed the structural visualization of programmed care in the field of diabetes self-management education, which is an area of expert nursing care. In this article, we report the programmed care for dietary therapy.

Structural visualization of expert nursing: Development of an assessment and intervention algorithm for delirium following abdominal and thoracic surgeries.

An assessment and intervention algorithm for delirium following abdominal and thoracic surgeries was developed based upon the current knowledge-base. The sources of information included literature and clinical expertise. The assessment and intervention algorithm was structured and visualized so that patient-tailored and risk-stratified prediction/prevention, assessment, and intervention could be carried out. Accumulation of clinical outcome data is necessary in the future validation study to identify the relative weight of risk factors and clinical utility of the algorithm.

Structural visualization of expert nursing: Expert nursing care for a patient undergoing outpatient radiotherapy.

In the past, almost all patients underwent radiotherapy during the hospital stay. So nurses took care of patients after radiotherapy in the hospital where patients could receive nursing care 24 hours a day. However, recently more and more patients have undergone radiotherapy at clinics as outpatients. This benefits them in enabling them to receive the therapy with improving QOL and maintaining their style of living--on the other hand this requires much self-care ability on their part and patient compliance of outpatient visits depends on their own positive decision-making. Nurses are considered to make decisions or take implementation of various kinds of intervention in the limited time of pre and post proceedings of the therapy when they accommodate patients directly. The process of their intervention has not so far been clarified so that the quality of the care depends on the degree of each individual's capacity or devotion. In addition, with the trend in decreasing hospitalized days, it is predicted that more and more patients will undergo outpatient radiotherapy. So it is significant to clarify the process for quality assurance of nursing.

Structural visualization of expert nursing: Expert nursing care for extravasation of anticancer agent.

Chemotherapy aims to cure cancer or inhibit the growth of cancer cells by administering the anticancer agent in blood vessels (BV) to the cancer body. So it is very important to inject the agent in BVs without fail because there is risk of extravasation which brings about the chemical necrosis of the tissue around. Thus, nurses involved in chemotherapy care should learn to take interventions for prevention from extravasation and immediate treatment for it, in case. In the interventions there are care practices with advanced thinking processes. Clarification of such thinking processes contributes to the visualization of nursing practice and the support for nurses to learn expert nursing practices. Also it is supposed to realize the nursing quality assurance for care receiver-patients.

Structural visualization of expert nursing: Cancer pain management.

Nurses' knowledge and making decisions in Cancer Pain Management contribute much to the improvement of cancer patients' QOL. Based on the practice of a expert nurse involved in Cancer Pain Management, we have developed the algorithm, which clarified that nurses implement much of observations or complicated decision-makings in Cancer Pain Manage Hereafter it is a significant challenge to examine its consistency and validity to develop its system.

Structured visualization of expert nursing--An educational program for stoma self-care.

To provide an adequate educational program for patients with a stoma, we have developed an algorithm which was divided into three parts according to the period, i.e., the preoperative period, postoperative period, and rehabilitation period. It was composed of action nodes, thinking nodes, choice branches, assessment item tables, reference tables, and candidate logic tables. Wound Ostomy Continence Nurses (WOCNs) used this algorithm. The results indicated that the algorithm did not omit any important points involved in stoma care, and that it could therefore be successfully applied to patients with a stoma.