Continuous Psychological Nursing Based on Grey Clustering Algorithm in Patients after Transurethral Resection of Prostate.

Objective: To explore the effect of continuous psychological nursing based on the grey clustering algorithm on erectile function, bad psychological emotion, and complications in patients after transurethral resection of prostate (TURP). Methods: 98 patients who underwent TURP were randomly divided into observation and control groups (routine nursing). The observation group first used the grey clustering algorithm to evaluate the psychological intelligence, found patients with abnormal psychological behavior, and then implemented continuous psychological nursing combined with pelvic floor muscle exercise. The patients were followed up for 4 months. The International Index of Erectile Function-5 (IIEF-5), the incidence of complications, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA) scores, and the nursing satisfaction were analyzed and compared between these two groups. Results: The grey clustering algorithm can accurately reflect the characteristics of patients' psychological changes. After targeted nursing, compared with the control group, the IIEF-5 in the observation group was higher [(24.87 ± 1.85) vs. (22.24 ± 1.47), P < 0.05], the incidence of total complications was lower (10.20% vs. 26.53%, P < 0.05), the score of HAMA was lower [(6.11 ± 2.57) vs. (10.98 ± 2.29), P < 0.05], the score of HAMD was lower [(6.97 ± 2.85) vs. (11.35 ± 2.19), P < 0.05], and the nursing satisfaction was higher (100% vs. 85.71%, P < 0.05). Conclusion: Mental intelligence evaluation based on the grey clustering algorithm combined with pelvic floor muscle exercise can significantly improve the rehabilitation effect of erectile function in patients after TURP, reduce the incidence of postoperative complications, and alleviate patients' anxiety and depression.

Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Limites e possibilidades de agentes comunitários de saúde na identificação de sintomas depressivos / Límites y posibilidades de los agentes comunitarios de salud en la identificación de síntomas depresivos / Limitations and possibilities of community health workers in identifying depressive symptoms

RESUMO Objetivo: avaliar o conhecimento de agentes comunitários de saúde sobre identificação de sintomas depressivos na comunidade. Método: trata-se de pesquisa qualitativa, realizada em Unidade Básica de Saúde, em Teresina, Piauí, Brasil, com 15 agentes comunitários de saúde. Utilizou-se o método da Pesquisa-Ação. A produção dos dados aconteceu em janeiro e fevereiro de 2019, por meio de dois seminários temáticos, pautados no Método Criativo Sensível. Os discursos foram submetidos à análise temática. Resultados: agentes comunitários de saúde reconhecem os sintomas depressivos por tristeza, choro, isolamento, anedonia e solidão, manifestados pelos indivíduos. Os limites para essa identificação, relatados pelos profissionais, foram dificuldade de acesso aos usuários e às famílias e estigma e preconceito com a depressão. Quanto às possibilidades, destacaram-se acesso à informação sobre a temática pela mídia, diálogo/conversa estabelecido entre usuário e profissional e acesso à rede de apoio. Considerações finais: conclui-se que o reconhecimento, as limitações e as possibilidades de identificação de sintomas depressivos por esses profissionais refletem no diagnóstico, planejamento e implementação de ações no cuidado em saúde mental de forma precoce e segura.

RESUMEN Objetivo: evaluar el conocimiento de agentes comunitarios de salud sobre identificación de síntomas depresivos en la comunidad. Método: se trata de investigación cualitativa, realizada en Unidad Básica de Salud, en Teresina, Piauí, Brasil, con 15 agentes comunitarios de salud. Se utilizó el método de Investigación-acción. La producción de los datos tuvo lugar en enero y febrero de 2019, a través de dos seminarios temáticos, de acuerdo con el Método Creativo-sensible. Los discursos fueron sometidos al análisis temático. Resultados: Los agentes comunitarios de salud reconocen los síntomas depresivos por tristeza, llanto, aislamiento, anhedonia y soledad, manifestados por los individuos. Los límites para esa identificación, relatados por los profesionales, fueron dificultad de acceso a los usuarios y a las familias y estigma y prejuicio con la depresión. En cuanto a las posibilidades, se destacaron acceso a la información sobre la temática por los medios, diálogo/conversación establecido entre usuario y profesional y acceso a la red de apoyo. Consideraciones finales: se concluye que el reconocimiento, las limitaciones y las posibilidades de identificación de síntomas depresivos por parte de estos profesionales reflejan en el diagnóstico, la planificación e implementación de acciones en el cuidado en salud mental de forma precoz y segura.

ABSTRACT Objective: to evaluate the knowledge of community health workers about the identification of depressive symptoms in the community. Method: this is a qualitative research, conducted in a Primary Health Care Unit in Teresina, Piauí, Brazil, with 15 community health workers. We used the Action-Research method. Data production took place in January and February 2019, through two thematic seminars, guided by the Creative Sensitive Method.The speeches were submitted to thematic analysis. Results: community health workers recognize the depressive symptoms by means of sadness, crying, isolation, anhedonia and loneliness, manifested by individuals. The limitations to this identification, reported by professionals, were difficulty of access to users and families, as well as stigma and prejudice against depression. As for the possibilities, access to information about the theme through the media, dialogue/conversation established between users and professionals, besides access to a support network, were highlighted. Final considerations: we conclude that the recognition, limitations and possibilities of identification of depressive symptoms by these professionals are reflected in the diagnosis, planning and implementation of actions in mental health care in an early and safe way.

Effect of an Oncology Nurse-Led Primary Palliative Care Intervention on Patients With Advanced Cancer: The CONNECT Cluster Randomized Clinical Trial.

Importance: Guidelines recommend early specialty palliative care for all patients with advanced cancer, but most patients lack access to such services. Objective: To assess the effect of CONNECT (Care Management by Oncology Nurses to Address Supportive Care Needs), a primary palliative care intervention delivered by oncology nurses, on patient outcomes. Design, Setting, and Participants: This cluster randomized clinical trial of the CONNECT intervention vs standard care was conducted from July 25, 2016, to October 6, 2020. Participants were adult patients with metastatic solid tumors who were undergoing oncological care and for whom an oncologist would agree with the statement "would not be surprised if the patient died in the next year." The trial was conducted at 17 community oncology practices in western Pennsylvania. Data analyses adhered to the intention-to-treat principle. Interventions: The CONNECT intervention included 3 monthly visits with an existing infusion room nurse who was trained to address symptoms, provide emotional support, engage in advance care planning, and coordinate care. Main Outcomes and Measures: The primary outcome was quality of life. At baseline and 3 months, participants completed assessments of quality of life (Functional Assessment of Chronic Illness Therapy-Palliative care: score range, 0-184, with higher scores indicating better quality of life), symptom burden (Edmonton Symptom Assessment Scale: score range, 0-90, with higher scores indicating greater symptom burden), and mood symptoms (Hospital Anxiety and Depression Scale [HADS]: score range, 0-21, with higher scores indicating substantial anxiety and depression). Linear mixed-effects models were used to estimate adjusted mean differences in 3-month outcomes. Preplanned, intensity-adjusted analyses were conducted. Results: A total of 672 patients were enrolled (mean [SD] age, 69.3 [10.2] years; 360 women [53.6%]). The mean (SD) number of CONNECT visits completed was 2.2 (1.0). At 3 months, no difference in mean (SD) quality-of-life score was found between the CONNECT and standard care groups (130.7 [28.2] vs 134.1 [28.1]; adjusted mean difference, 1.20; 95% CI, -2.75 to 5.15; P = .55). Similarly, there was no difference between groups in 3-month mean (SD) symptom burden (23.2 [16.6] vs 24.0 [16.1]; adjusted mean difference, -2.64; 95% CI, -5.85 to 0.58; P = .11) or mood symptoms (HADS depression subscale score: 5.1 [3.4] vs 4.8 [3.7], adjusted mean difference, -0.08 [95% CI, -0.71 to 0.57], P = .82; HADS anxiety subscale score: 5.7 [3.9] vs 5.4 [4.2], adjusted mean difference, -0.31 [95% CI, -0.96 to 0.33], P = .34). Intensity-adjusted analyses revealed a larger estimated treatment effect for patients who received a full dose (3 visits) of the CONNECT intervention. Conclusions and Relevance: This cluster randomized clinical trial found that a primary palliative care intervention that was delivered by oncology nurses did not improve patient-reported outcomes at 3 months. Primary palliative care interventions with a higher dose intensity may be beneficial for most patients with advanced cancer who lack access to palliative care specialists. Trial Registration: ClinicalTrials.gov Identifier: NCT02712229.

Factors affecting anxiety and depression in young breast cancer survivors undergoing radiotherapy.

PURPOSE: This study examined anxiety and depression, and their relationship with symptom assessment, uncertainty, social support, and stress in young breast cancer patients receiving radiotherapy. METHODS: This is a descriptive quantitative study. The participants were 126 patients under 50 years of age with breast cancer undergoing radiotherapy. RESULTS: The anxiety and depression levels were higher among those who were married (t = -2.318, p = .022), non-religious (t = 4.510, p = .005), and had a higher monthly income (F = 2.840, p = .041). The hierarchical regression analysis model included symptom assessment, uncertainty, social support, and stress, and accounted for about 49% of the variance in anxiety and depression (F = 7.688, p < .001). Additionally, uncertainty (ß = 0.304, p = .001) and stress (ß = 0.308, p = .001) were significant predictors of anxiety and depression. CONCLUSIONS: Based on the results of this study, nursing interventions are needed to reduce uncertainty and stress in order to reduce anxiety and depression in young breast cancer patients undergoing radiation treatment.

The impact of intense nursing care in improving anxiety, depression, and quality of life in patients with liver cancer: A systematic review and meta-analysis.

BACKGROUND: Liver resection is a major, serious, and very delicate operation that should be done only by specialized, well-skilled, and experienced surgeons. However, the role of nurses, which has often been under-estimated, is also crucial for the success of the intervention or surgery. Intensive nursing care involves high quality nursing modes to achieve the expected goals of treatment smoothly and with less complications. In this analysis, we aimed to show the impact of intense nursing care in improving anxiety, depression, and quality of life in patients with intervention for liver cancers. METHODS: Data sources included EMBASE, MEDLINE, Web of Science, the Cochrane central, Google scholar, and http://www.ClinicalTrials.gov. Three authors independently extracted data from the selected original studies. The statistical analysis was carried out by the Cochrane based RevMan software. For dichotomous data, the number of events and the total number of participants were required and for the continuous data, mean, standard deviation as well as the total number of participants were required in the input for analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to represent the data following assessment. RESULTS: A total of 1205 participants with liver cancer enrolled between the years 2010 to 2018 were included in this analysis whereby 667 participants were assigned to an intensive nursing care. Our current analysis showed that most of the patients who were assigned to an intense nursing intervention were significantly very satisfied with their quality of life (OR: 4.07, 95% CI: 1.45 - 11.45; P = .008). However, a minor number of patients with liver cancer who were not assigned to intense nursing care were significantly dissatisfied with their quality of life with OR: 0.18, 95% CI: 0.04 - 0.77; P = .02. This analysis also showed that self-rating anxiety score (SAS) and self-rating depression score (SDS) were significantly in favor of the participants with intense nursing care with OR: - 7.66, 95% CI: [(-9.66) - (-5.66)]; P = .00001 and OR: -7.87, 95% CI: [(-8.43) - (-7.26)]; P = .00001 respectively. In addition, physical function (OR: 13.56, 95% CI: 12.39 - 14.74; P = .00001), and total activity score (OR: 16.58, 95% CI: 13.51 - 19.65; P = .00001) were also significantly in favor of an intense nursing care. CONCLUSIONS: Our current analysis showed that intense nursing care significantly improved anxiety, depression, and quality of life following interventions in patients with liver cancers. Most of the patients with liver cancers who were assigned to an intense nursing care were very satisfied with their quality of life. However, this hypothesis should further be confirmed in larger nursing related studies based on patients with liver cancers.

Depression treatment research in people with cancer does not reflect cancer prevalence: findings from a systematic review.

BACKGROUND: One in six people with cancer will develop depression at some point in their care. Untreated depression affects quality of life, cancer care satisfaction and healthcare expenditure. Treatments for this vulnerable heterogenous population should be evidence based and specific. A common sentiment is that psychiatric research does not reflect the prevalence of patients with cancer and comorbid depression and is biased towards certain cancers, but this has not been empirically shown. STUDY SELECTION AND ANALYSIS: A systematic review of studies on psychological and pharmacological treatments for depression in people with cancer was conducted. Of 4621 papers identified from a search of PubMed and PsycINFO up to 27 June 2020, 84 met inclusion criteria (eg, adults with cancer; depression diagnosis; treatment study) and comprised 6048 participants with depression with cancer. FINDINGS: Cancer types are not proportionally represented in depression research in accordance with their incidence. Breast cancer is over-represented (relative frequency in research 49.3%, but 11.7% of global cancer). Cancers of the head and neck and bone and soft tissue were close to parity. All other cancers are under-represented. Representativeness varied 40-fold across different cancers. CONCLUSIONS: The evidence base for depression treatments is dominated by a single cancer. Given heterogeneity in cancer populations (eg, stage of illness; psychological impact; cancer treatments), it is possible that depression treatments may not have the same benefits and harms across all cancers, impeding the ability to offer people with different cancers the best depression treatment. While the dominant opinion within this research field is that a cancer bias exists, this is the first study to demonstrate as such.

Antenatal and postnatal depression - Are Polish midwives really ready for them?

OBJECTIVE: Before January 2019, no established solutions regarding the screening, assessment, and treatment of patients suffering from perinatal depression existed in Poland. From 2019, a new standard of perinatal care has imposed the obligation to monitor the mental state of women during pregnancy and in the postpartum period on the healthcare providers (mainly on midwives). Thus, our study aimed to evaluate midwives' knowledge about prenatal and postnatal mental health disorders in the first six months of implementing the new standard of perinatal care in Poland. DESIGN: Polish midwives completed a survey consisting of the Test of Antenatal and Postpartum Depression Knowledge by Jones, Creedy, and Gamble (2001) and questions related to a hypothetical case study of a depressed woman named "Mary", developed by Buist and colleagues (2006). The midwives also rated their perceived knowledge and skills in assessing women' mental health condition. SETTING: The study was conducted in four Polish cities: Gdansk, Olsztyn, Szczecin, Wroclaw, and the surrounding rural areas. PARTICIPANTS: 111 Polish midwives with varied professional experience and socio-demographic characteristics participated in the study. MEASUREMENTS AND FINDINGS: Among all of their professional responsibilities, the midwives self-rated their knowledge and skills in assessing the mental state of patients as the lowest ones. A subsequent objective assessment revealed their insufficient knowledge about antenatal and postnatal depression and the ways of treatment of these disorders. KEY CONCLUSIONS: Midwives are not properly prepared for the new tasks resulting from the Polish standard of perinatal care: specifically, for the assessment of a woman's mental state. IMPLICATIONS FOR PRACTICE: Further trainings are required to ensure midwives' competency and knowledge about the assessment and dealing with mental disorders of patients who experience prenatal and postpartum depression.

Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial.

Importance: High-quality evidence on how to improve palliative care in nursing homes is lacking. Objective: To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes. Design, Setting, and Participants: A cluster-randomized clinical trial (2015-2017) in 78 nursing homes in 7 countries comparing PACE Steps to Success Program (intervention) with usual care (control). Randomization was stratified by country and median number of beds in each country in a 1:1 ratio. Interventions: The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Using a train-the-trainer approach, an external trainer supports staff in nursing homes to introduce a palliative care approach over the course of 1 year following a 6-steps program. The steps are (1) advance care planning with residents and family, (2) assessment, care planning, and review of needs and problems, (3) coordination of care via monthly multidisciplinary review meetings, (4) delivery of high-quality care focusing on pain and depression, (5) care in the last days of life, and (6) care after death. Main Outcomes and Measures: The primary resident outcome was comfort in the last week of life measured after death by staff using the End-of-Life in Dementia Scale Comfort Assessment While Dying (EOLD-CAD; range, 14-42). The primary staff outcome was knowledge of palliative care reported by staff using the Palliative Care Survey (PCS; range, 0-1). Results: Concerning deceased residents, we collected 551 of 610 questionnaires from staff at baseline and 984 of 1178 postintervention in 37 intervention and 36 control homes. Mean (SD) age at time of death ranged between 85.22 (9.13) and 85.91 (8.57) years, and between 60.6% (160/264) and 70.6% (190/269) of residents were women across the different groups. Residents' comfort in the last week of life did not differ between intervention and control groups (baseline-adjusted mean difference, -0.55; 95% CI, -1.71 to 0.61; P = .35). Concerning staff, we collected 2680 of 3638 questionnaires at baseline and 2437 of 3510 postintervention in 37 intervention and 38 control homes. Mean (SD) age of staff ranged between 42.3 (12.1) and 44.1 (11.7) years, and between 87.2% (1092/1253) and 89% (1224/1375) of staff were women across the different groups. Staff in the intervention group had statistically significantly better knowledge of palliative care than staff in the control group, but the clinical difference was minimal (baseline-adjusted mean difference, 0.04; 95% CI, 0.02-0.05; P < .001). Data analyses began on April 20, 2018. Conclusions and Relevance: Residents' comfort in the last week of life did not improve after introducing the PACE Steps to Success Program. Improvements in staff knowledge of palliative care were clinically not important. Trial Registration: ISRCTN Identifier: ISRCTN14741671.

Prevalência de sintomas depressivos no idoso hospitalizado: estudo comparativo / Prevalence of depressive symptoms in hospitalized older adults: a comparative study / Prevalencia de síntomas de depresión en el anciano hospitalizado: estudio comparativo

Objetivo: comparar a prevalência dos sintomas depressivos no idoso hospitalizado, mediante uso da Escala de Depressão Geriátrica­15 e por meio da avaliação realizada pelo enfermeiro na admissão do idoso. Método: estudo descritivo de abordagem transversal em hospital público de ensino. Utilizou-se a Escala de Depressão Geriátrica e instrumento com lista de sintomas depressivos, extraídos das características definidoras dos diagnósticos de enfermagem. Resultados: a prevalência de sintomas depressivos em idosos hospitalizados foi de 47%, segundo a Escala de Depressão Geriátrica, e de 25% segundo a avaliação do enfermeiro, no momento da admissão do paciente. Conclusão: a avaliação realizada pelo enfermeiro detectou baixa porcentagem dos sintomas depressivos no idoso em comparação ao instrumento específico para depressão.

Objective: : to compare the prevalence of depressive symptoms in hospitalized elderly using the Geriatric Depression Scale­15 and the nursing assessment of the older adult at admission. Method: this descriptive, cross-sectional study at a public teaching hospital used the Geriatric Depression Scale and an instrument listing depressive symptoms drawn from defining characteristics of nursing diagnoses. Results: the Geriatric Depression Scale returned a 47% prevalence of depressive symptoms in the hospitalized older adults, while the nursing assessment at admission found 25% prevalence. Conclusion: the nursing assessment detected a lower percentage of depressive symptoms in the older adults than the specific instrument for depression.

Objetivo: comparar la prevalencia de síntomas de depresión en el anciano hospitalizado, mediante uso de Escala de Depresión Geriátrica­15 y por medio de evaluación realizada por el enfermero en el momento de la admisión del anciano. Método: estudio descriptivo de abordaje transversal en hospital universitario. Se utilizó la Escala de Depresión Geriátrica y un instrumento con lista de síntomas de depresión, extraídos de las características definidoras de diagnósticos de enfermería. Resultados: la prevalencia de síntomas depresivos en ancianos hospitalizados fue del 47% según la Escala de Depresión Geriátrica y del 25% según evaluación del enfermero durante la admisión del paciente. Conclusión: la evaluación realizada por el enfermero detectó bajo porcentaje de síntomas de depresión en ancianos en comparación con el instrumento específico para la depresión.

Effectiveness of advanced nursing care on depression in patients with ovarian cancer: A protocol of systematic review of randomized controlled trial.

BACKGROUND: This systematic review will assess the effectiveness of advanced nursing care (ANC) on depression in patients with ovarian cancer (OC). METHODS: We will identify any relevant randomized controlled trial from Cochrane Library, MEDLINE, Embase, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their inceptions to March 5, 2019. The primary outcome includes depression. The secondary outcomes consist of anxiety, quality of life, and adverse events. Data that meets all the eligibility criteria will be extracted, pooled, and analyzed by using RevMan 5.3 software. Methodological quality for each eligible study will be assessed by using Cochrane risk of bias tool. RESULTS: This study will analyze depression, anxiety, quality of life, and adverse events of ANC on depression in patients with OC. CONCLUSION: The findings of this study will provide the latest evidence for the effectiveness and adverse events of ANC on depression in patients with OC. ETHICS AND DISSEMINATION: No ethic approval is required for this study, because all the data will be extracted from previous published studies. The results of this study will be presented at conference or will be published at a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019126374.

[The role of the nurse in supporting smoking cessation]. / Le rôle de l'infirmière dans l'aide au sevrage tabagique.

A study was carried out in May 2014 of the first 100 patients who came to seek help to stop smoking in 2013 with the first contact led by a nurse. A mail-questionnaire was sent to this group of patients to evaluate their smoking status and the nurse's first contact organization. Among 34% respondents, 40% had not smoked for at least eight months. Three quarters had found this nursing support useful highlighting the added value of a nurse in supporting first contact in the smoking cessation process.

Aplicação da Escala de Depressão Geriátrica de Yesavage em instituições de longa permanência / Application of the Yesavage Geriatric Depression Scale in long-term institutions

A presente pesquisa buscou identificar a prevalência de depressão em idosos residentes em instituições de longa permanência e descrever as características socioeconômicas e clínicas dos idosos estudados. Trata-se de uma pesquisa de campo, exploratória, de abordagem quantitativa, realizada em três instituições de longa permanência da cidade de Teresina/PI. A amostra foi constituída de 54idosos e a coleta foi realizada por meio da aplicação da Escala de Depressão Geriátrica de Yesavage, versão 15, e de um questionário sobre o perfil socioeconômico e clínico dos participantes. Dentre os idosos estudados, a prevalência de depressão foi de 98,1%. Em relação ao perfil socioeconômico, identificou-se a ocorrência de sintomas de depressão em idosos solteiros (87%), com renda de até um salário mínimo (81,5%), alfabetizados (44,4%) e católicos (92,6%). Quanto à situação clínica, predominaram idosos diabéticos (24,1%),hipertensos (37%), tabagistas (13%) e sedentários (75,9%). A depressão é uma patologia comum, com grande prevalência entre idosos institucionalizados e seu diagnóstico precoce pode colaborar para melhorar o cuidado e a qualidade de vida dos pacientes.

The present study aimed to identify the prevalence of depression in elderly people in long-term institutions and to describethe socioeconomic and clinical characteristics of the elderly studied. It is an exploratory field research with a quantitative approach carried out in three long-term institutions in the city of Teresina/PI. The sample consisted of 54 elderly people and the data collection was performed using the Yesavage Geriatric Depression Scale, version 15, and a questionnaire about the socioeconomic and clinical profile of the participants. Among the elderly studied, the prevalence of depression was of 98.1%. In relation to the socioeconomic profile, there were symptoms of depression in single elderly people (87%), who earn up to a minimum wage (81.5%), literate (44.4%) and Catholics (92.6%). Regarding the clinical situation, the elderly were predominantly diabetic (24.1%), hypertensive (37%), smokers (13%)and sedentary (75.9%). Depression is a common pathology, with a high prevalence among institutionalized elderly people and its early diagnosis can contribute to improve the care and quality of life of patients.

El presente estudio buscó identificar la prevalencia de depresión en ancianos residentes en instituciones de larga permanenciay describir las características socioeconómicas y clínicas de los ancianos estudiados. Se trata de una investigación de campo exploratoria,de abordaje cuantitativo, realizada en tres instituciones de larga permanencia de la ciudad de Teresina/PI. La muestra fue constituida de54 ancianos y los datos fueron recolectados por medio de la aplicación de la Escala de Depresión Geriátrica de Yesavage, versión 15, yde un cuestionario sobre el perfil socioeconómico y clínico de los participantes. Entre los ancianos estudiados, la prevalencia de depresiónfue 98,1%. En cuanto al perfil socioeconómico, se identificó la ocurrencia de síntomas de depresión en ancianos solteros (87%), queganan hasta un salario mínimo (81,5%), alfabetizados (44,4%) y católicos (92,6%). En cuanto a la situación clínica, predominaronancianos diabéticos (24,1%), hipertensos (37%), tabaquistas (13%) y sedentarios (75,9%). La depresión es una patología común, congran prevalencia entre ancianos institucionalizados y su diagnóstico precoz puede colaborar para mejorar el cuidado y la calidad de vidade los pacientes.

Factors associated with demoralisation syndrome in patients before and after cardiac surgery.

AIMS AND OBJECTIVES: To investigate the incidence of and contributors to demoralisation syndrome among patients before and after cardiac surgery. BACKGROUND: Demoralisation syndrome is a common but neglected phenomenon in nursing practice. Patients who require cardiac surgery experience demoralisation syndrome more often than they experience depression. DESIGN: A prospective correlational design was applied. METHODS: A convenience sample of 76 participants undergoing cardiac surgery was recruited from the cardiovascular wards of two medical centres in Taiwan. The instruments applied included the Demoralization Scale (DS), the Patient Outcome Questionnaire-9 (PHQ-9) and the Perception of Intensive Care Unit (ICU) Stay Questionnaire. RESULTS: High demoralisation was present in 44.7% of the participants before surgery but significantly decreased to 36.8% after surgery (p < .05); conversely, depression was present in 15.8% of participants before surgery and did not significantly decrease after surgery (rate after surgery, 9.2%; p > .05). A multiple regression analysis using the backward-selection method showed that depression (p < .001) and retirement (p < .05) were important predictors of pre-operative demoralisation syndrome (R2  = 0.250), whereas depression (p < .001) and perceptions of ICU stay (p > .05) remained in the regression model after surgery (R2  = 0.291). CONCLUSIONS: The study findings suggest that demoralisation syndrome is highly prevalent in patients undergoing cardiac surgery but is significantly reduced after cardiac surgery. Before surgery, depression and retirement were significant predictors of demoralisation. After surgery, depression was the only predictor. Although the perception of ICU stay was not an important predictor, it was significantly correlated with demoralisation. RELEVANCE TO CLINICAL PRACTICE: Before cardiac surgery, nurses should emphasise the importance of demoralisation development among patients who suffer from depressive symptoms and are retired. After cardiac surgery, continued follow-up is needed for the early detection and minimisation of the effect of depression and the development of demoralisation.

A psychological intervention programme for patients with breast cancer under chemotherapy and at a high risk of depression: A randomised clinical trial.

AIMS AND OBJECTIVES: To develop a nurse-led psychological intervention programme and to evaluate its effects on psychological distress and quality of life in patients with breast cancer undergoing chemotherapy and at a high risk of depression. BACKGROUND: Depression is common among patients with breast cancer undergoing chemotherapy. Psychological intervention programmes that improve psychological distress and quality of life have previously been lacking in South Korea. DESIGN: This was a pre- and post-test randomised controlled trial. METHODS: The nurse-led psychological intervention programme comprised seven weekly counselling sessions delivered face to face and telephonically. These aimed to provide emotional support to patients and to enable them to express their feelings. Patients at a high risk of depression were recruited from an oncology outpatient clinic in a university hospital. Sixty participants were evenly and randomly allocated to either the intervention group or the control group. The effects of the intervention on psychological distress (mood disturbance, anxiety and depression) and quality of life were examined using linear mixed models. RESULTS: Compared with the control group, the intervention group reported significantly lower mood disturbance, anxiety and depression and showed an improved global health status and physical, role and emotional functions. They also reported fewer symptoms such as fatigue, nausea/vomiting, pain and insomnia. CONCLUSIONS: Our nurse-led psychological intervention programme might reduce patients' uncertainty and encourage them to be proactive and self-controllable. RELEVANCE TO CLINICAL PRACTICE: Nurse-led psychological intervention programmes should be implemented to reduce psychological distress and improve quality of life in patients with breast cancer, particularly those at a high risk of depression.

A Distress Thermometer Intervention for Patients With Head and Neck Cancer
.

OBJECTIVES: To investigate the feasibility of an intervention using the National Comprehensive Cancer Network Distress Thermometer and Problem List with nurse-guided follow-up and the effect on depressive symptoms, health-related quality of life, and worry of cancer in patients with head and neck cancer.
. SAMPLE & SETTING: 110 patients with head and neck cancer in a two-arm randomized, controlled trial in an outpatient clinic of a university hospital. 
. METHODS & VARIABLES: Patients were randomized to usual care (n = 57) or the intervention group (n = 53), which consisted of screening with the Distress Thermometer and Problem List plus nurse-guided follow-up lasting about 20 minutes three to four times during 12 months. Intention-to-treat analysis was performed using linear mixed models with outcomes at 6 and 12 months and baseline adjustment.
. RESULTS: The intervention showed moderate compliance and acceptable session duration. Intervention participants were satisfied with nurses' care. Depressive symptoms, health-related quality of life, and worry of cancer were not significantly different in the two treatment groups. The intervention seemed feasible in clinical practice, but no effects on patient outcomes were seen.
. IMPLICATIONS FOR NURSING: Patients with head and neck cancer appreciated the opportunity to discuss their problems and challenges with a nurse. Nurses supported patients with basic psychosocial care, minor interventions, and referral possibilities.

The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study.

AIM: Our aim was to determine the feasibility and effectiveness of an individual, nurse-navigator intervention for relieving distress, anxiety, depression and health-related quality of life in women who have been treated for breast cancer (BC) and are experiencing moderate-to-severe psychological and physical symptoms. METHODS: Fifty women with newly diagnosed BC who reported distress (score ≥7 on distress thermometer) before surgery were included consecutively in a pilot study and randomized 1:1 to the intervention or the control group. The intervention comprised repeated screening with patient reported outcome measures and nurse navigation. A total of 66 women who were not distressed (score <7) were followed longitudinally as an observational group. Participants filled in four questionnaires, at baseline, after 6 months and 12 months. The primary outcome was psychological distress and the secondary outcomes were anxiety, depression, health-related quality of life and feasibility of the intervention. RESULTS: Women in the intervention group reported significantly greater satisfaction with treatment and rehabilitation and lower levels of distress (mean 2.7 vs. 5.1, p<.01), anxiety (mean 5.1 vs. 7.8, p = .02) and depression (mean 2.2 vs. 4.4, p = .04) after 12 months compared to the control group. No significant effects were seen on health-related quality of life. CONCLUSIONS: The study shows promising feasibility of the individually tailored nurse-navigation intervention and while no significant effects were observed after 6 months, we did find statistically significant effects on distress, anxiety and depression 12 months after diagnosis. Our results will assist in developing rehabilitation to the most vulnerable patients.

Chronic obstructive pulmonary disease.

Essential facts An estimated three million people have chronic obstructive pulmonary disease (COPD) in the UK, but less than one third are diagnosed. COPD refers to a group of lung conditions that make it difficult to empty air out of the lungs because the airways have narrowed.