Nutrition care of cancer patients-A survey among physicians and nurses.

In order to quantify gaps in the provision of medical nutrition care in Germany and pinpoint specific areas of need, we collected data from patients, nurses and physicians. The results from the patient survey were published separately. A total of 506 participants from 69 certified centers answered the questions developed in cooperation with representatives from different professional groups (physicians, nurses and dietitians). Only about a third of participants reported that their institution provides structured pathways to nutritional counseling. 70.1% of those physicians reported that there was a specialist in nutrition available at their center while only 55.8% of nurses agreed. Only a quarter (24.2% and 26.9%) of physicians and nurses reported that their institution provided continuation of nutrition care after dismissal. A gap exists between need and consistent delivery of nutrition care services. Structured nutrition care pathways provided by legally certified nutrition professionals pathways are lacking. Cancer organizations may support this process by requiring documented nutrition care pathways and provision of services on a need based system into guidelines and certification criteria.

Impact of the work environment on glycemic control and adaptation to diabetes.

OBJECTIVE: To evaluate quantitatively whether the work environments of adults with diabetes relate to the adequacy of metabolic control and/or to the individual's adaptation to diabetes and to explore qualitatively the interactions between an individual's life at work and ways of coping with diabetes. RESEARCH DESIGN AND METHODS: A total of 129 insulin-requiring adults who were employed outside of the home were assessed on a single occasion. They completed two work system measures (The Work Environment Scale and The Work Apgar Scale) and two quality-of-life measures (The Diabetes Quality of Life Scale and The Appraisal of Diabetes Scale). Subjects also participated in a semi-structured interview concerning the interaction of work and diabetes. Glycemic control was assessed by using HbAlc results. Demographic data (age, sex, diabetes type, duration of diabetes, number of diabetes-related medical complications) were gathered from the charts. RESULTS: Concerning glycemic control, neither of the work system measures was a significant predictor of HbAlc. Concerning psychosocial adaptation, supervisor support was found to be a significant predictor of positive appraisal and diabetes-related satisfaction. Involvement and coworker cohesion also predicted aspects of diabetes-related quality of life. Interview themes showed that for a minority (18%), diabetes affected choice of work and that for a majority (60%), diabetes affected relationships at work and raised financial/job concerns (49%). Most adjust their diet, blood glucose testing, and exercise regimen through work-related modifications. CONCLUSIONS: For insulin-treated adults with diabetes, work system variables do not directly relate to glycemic control, but they do relate to psychosocial adaptation. Future work should examine further the specific aspects of the workplace that might affect adaptation, with the goal being to develop worksite interventions that target not only the employee with diabetes but also their supervisors and coworkers.

Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum.

Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries.