Microbiome-Modifiers for Cancer-Related Fatigue Management: A Systematic Review.

OBJECTIVES: This study systematically investigates the evidence regarding the use of probiotics in managing cancer-related fatigue (CRF). STUDY DESIGN: We conducted a systematic review of randomized controlled trials. DATA SOURCES: The systematic search encompassed six databases: PubMed, CINHAL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, and EMBASE, covering the period from inception to December 2023. The assessment of risk of bias employed the Cochrane risk of bias tool (RoB 2). A narrative synthesis and an exploratory meta-analysis were conducted to summarize the evidence. RESULTS: Among 460 records, three studies met the eligibility criteria and were included in the review. These studies involved a total of 284 participants with colorectal and breast cancer. One study demonstrated a marginal improvement in CRF postchemotherapy in colorectal cancer patients using probiotics. Another study, also using probiotics, reported a significant reduction in CRF among colorectal cancer patients undergoing chemotherapy. Additionally, a study employing synbiotics showed a substantial decrease in CRF severity in breast cancer patients receiving chemotherapy. CONCLUSION: The study presents initial but varied evidence suggesting the potential of probiotics and synbiotics as adjunctive therapies in managing CRF alongside anticancer treatments. IMPLICATIONS FOR NURSING PRACTICE: In nursing practice, large-scale clinical trials are urgently needed to evaluate the effectiveness of probiotics in treating cancer-related fatigue during cancer therapy. Insights from this review could guide nurses in selecting appropriate probiotic strains and integrating microbiome modifiers into comprehensive care plans, potentially enhancing the quality of life for cancer patients.

Non-pharmacologic interventions for improving cancer-related fatigue (CRF): A systematic review of systematic reviews and pooled meta-analysis.

INTRODUCTION: Literature encloses numerous systematic reviews (SRs) on nonpharmacologic interventions for improving cancer-related fatigue (CRF). The effect of these interventions remains controversial, and the available SRs have not been synthesized yet. We conducted a systematic synthesis of SRs and meta-analysis to determine the effect of nonpharmacologic interventions on CRF in adults. MATERIAL AND METHODS: We systematically searched 4 databases. The effect sizes (standard mean difference) were quantitatively pooled using a random-effects model. Chi-squared (Q) and I-square statistics (I²) tested the heterogeneity. RESULTS: We selected 28 SRs, including 35 eligible meta-analyses. The pooled effect size (standard mean difference, 95% CI) was -0.67 (-1.16, -0.18). The subgroup analysis by types of interventions showed a significant effect in all the investigated approaches (complementary integrative medicine, physical exercise, self-management/e-health interventions). CONCLUSIONS: There is evidence that nonpharmacologic interventions are associated with CRF reduction. Future research should focus on testing these interventions on specific population clusters and trajectories. PROSPERO REGISTRATION: CRD42020194258.

A Systematic Review of Systematic Reviews and a Pooled Meta-Analysis on Complementary and Integrative Medicine for Improving Cancer-Related Fatigue.

PURPOSE: Evidence supporting complementary and integrative medicine (CIM) for improving cancer-related fatigue (CRF) is still fragmented. This study therefore critically appraised all the systematic reviews (SRs) regarding the effectiveness of CIM in mitigating CRF in adults. METHODS: A systematic review of SRs and a meta-analysis were conducted in 4 databases. The effect sizes of the included SRs were quantitatively pooled (standardized mean difference [SMD]; 95% CI) using a random-effects model. Heterogeneity was tested by using χ2 (Q) tests and I² statistics. FINDINGS: Twenty-two SRs met the inclusion criteria, and results from 20 SRs underwent meta-analysis. The pooled significant estimate of fatigue reduction was as follows: SMD, -0.50; 95% CI, -0.67 to -0.32; P < 0.001. The subgroup analysis based on the type of CIM intervention revealed that the approach showing higher effects in reducing fatigue thus far is acupuncture: SMD, -0.99; 95% CI = -1.37 to -0.62, P < 0.001; I2 = 84%. CIM therapies showed a significant reduction of fatigue in patients with breast cancer: SMD, -0.46; 95% CI, -0.69 to -0.23; P < 0.001; I2 = 82%. IMPLICATIONS: CIM interventions showed effectiveness in reducing CRF. Subgroup analysis suggested some potential influencing, such as tumor type and specific CIM therapy factors, that require in-depth assessment in future research. Study protocol registration: PROSPERO CRD42020194254.

The Italian midwifery core outcome set (M-COS) for healthy childbearing women and newborns: Development and initial validation study.

OBJECTIVE: This study aimed to develop and validate a midwifery core outcome set (M-COS) for Italian settings based on a salutogenic framework of maternity care. DESIGN: A multi-phase and multi-method study was performed. In phase one, we conducted a literature review to identify a preliminary set of outcomes sensitive to midwifery care. In phase two, the qualitative and quantitative content validity of the M-COS was tested. Finally, in the third phase, construct validity was explored through a cross-sectional study to assess the psychometric properties of the M-COS through exploratory and confirmative factor analysis. This study was conducted from December 2019 to April 2020 in Italy. PARTICIPANTS: Three main groups of experts/midwives were involved. Group One (n = 10) was involved in the content validity phase, while the other two groups (Group Two and Group Three) were involved in the construct validity phase (n = 300). RESULTS: The M-COS includes six outcome domains and thirty-one core outcomes perceived as sensitive to midwifery care, namely: mortality and morbidity (n = 6 outcomes), childbirth (n = 3), postnatal period (n = 6), maternal health (n = 11), maternal-infant bonding (n = 3), and maternal self-care (n = 2). All domains showed good evidence of internal consistency. CONCLUSION: The Italian M-COS is a novel tool that will facilitate the consistent measurement of core outcomes sensitive to midwifery care from the antenatal to the postnatal period in Italian settings. This initial work will be followed by further studies, including validation by service users. IMPLICATIONS FOR PRACTICE: The use of the M-COS in clinical practice would facilitate evidence-based data collection and thus contribute to promoting high-quality maternity care.

The development of a self-efficacy scale for nurses to assess the nutritional care of older adults: A multi-phase study.

BACKGROUND & AIMS: A self-efficacy scale for nurses to assess nutritional care of older adults is pivotal for the development of precise educational interventions designed to promote behavioral changes among nurses by enhancing their self-efficacy. However, self-efficacy measurements associated with nutrition care is currently difficult due to the lack of valid and reliable tools. Therefore, this study aimed to develop and validate a self-efficacy scale for nursing nutritional care. METHODS: A multi-method and multi-phase design was adopted. Phase one comprised developmental tasks to generate scale items, based on emerging themes in the literature. Phase two comprised the validation, during which its content, construct, and concurrent validity and internal consistency were assessed. For determining construct validity, phase two encompassed two sequential cross-sectional data collection: the first data collection was designed to assess the psychometric characteristics of the scale, whereas the second aimed to confirm the emerging latent structure of the scale. RESULTS: The final version of the developed scale encompassed 27 items, within three domains, including knowledge (regarding nutritional care), assessment and evidence utilization, and care delivery. The scale exhibited evidence of face and content validity, adequate construct and concurrent validity, and good internal consistency. CONCLUSIONS: This study resulted in the development of a tool that could be strategically employed for clinical and educational research aimed at improving the quality of nutritional care by enhancing nursing self-efficacy. The developed scale can provide relevant insights for describing nursing competence and its associations with patient-related outcomes.