Patient competencies, coping self-efficacy, and coping: Do they change during oncological inpatient rehabilitation and beyond?

OBJECTIVE: The construct of Patient Competencies (PCs) has been suggested to allow a more comprehensive understanding of cancer patients' abilities to confront emotion- and problem-focused coping tasks arising from the diagnosis, treatment and survivorship of cancer. While providing a reliable and valid measure of PCs, research thus far has not clarified whether PCs change across time and/or through intervention. This study asks whether PCs change during oncological inpatient rehabilitation and beyond. METHODS: N = 377 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation were included to complete self-report measures of PC, coping and self-efficacy for coping with cancer at the beginning and the end of rehabilitation and 9 months afterward. In order to determine differences between tumor diagnostic groups and changes across time 3 (tumor site) x 3 (time) repeated measures analyses of variance were computed. RESULTS: Tumor diagnostic groups differed only marginally in PCs, coping self-efficacy and coping. The PCs of self-regulation and managing distress and coping self-efficacy improved slightly during rehabilitation but returned to initial levels at 9 months. Differential improvement was evident in the competencies of seeking information and interest in social services. Two of five coping behaviors decreased markedly from the end of rehabilitation to follow-up. CONCLUSIONS: This study suggests that oncological inpatient rehabilitation may contribute to advancing PCs, albeit to a limited extent. Aside from addressing conceptual, diagnostic and measurement issues, future research should clarify which interventions may be most effective for advancing problem- and emotion-focused PCs.

Patients with Rheumatic Diseases do not have an Increased Risk of MRSA Carrier Status.

INTRODUCTION: The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) both in rheumatologic and non-rheumatologic rehabilitation centers. In addition, we sought to evaluate the practice value of existing screening recommendations of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO). METHODS: The analysis was performed in four rehabilitation clinics (rheumatology, psychosomatic medicine, oncology, and cardiology) with at least 200 patients per clinic tested for MRSA. RESULTS: Nine (1.1%) of the 842 patients were colonized with MRSA. Only five of them should have been tested according to the commission's recommendations. The prevalence was 0.5% (n = 207) in rheumatologic, 0.9% (n = 224) in psychosomatic, 1.4% (n = 209) in oncologic and 1.5% (n = 202) in cardiologic patients. We found a greater exposure to risk factors in cardiologic and oncologic patients. Among patients with carrier status, a higher percentage was exposed to three potential risk factors not applied by the commission. CONCLUSIONS: The prevalence of MRSA in our cohort correlates with data from previous studies. The low percentage among rheumatologic patients suggests that they are not more likely to reveal MRSA carrier status than other patient groups and that long-term immunosuppression does not necessarily represent a risk factor for MRSA colonization. Since only five out of nine patients with carrier status would have been detected following the recommendations of the KRINKO, further studies on potential risk factors are warranted.

Positive and negative religious coping in German breast cancer patients.

A growing interest has been focusing on the relationship between religious coping and psychosocial adjustment among cancer patients. However, previous research mostly has not differentiated between positive and negative components of religious coping. The current cross-sectional study investigated the role of both positive religious coping, i.e., a confident and constructive turning to religion, and negative religious coping, i.e., religious struggle and doubt, in a sample of 156 German breast cancer patients. Participants were assessed upon admission to an inpatient rehabilitation program. In addition to religious coping, two basic nonreligious coping styles (depressive coping and active problem-focused coping) and psychosocial adjustment (anxiety and depression) were measured. Major research questions concerning the mediating role of nonreligious coping and the relative predictive power of positive and negative religious coping were primarily addressed using structural equation modeling. Results indicated that the relationship between religious coping and psychosocial outcomes was completely mediated by nonreligious coping, whereby only depressive coping and not active problem-focused coping proved to be a mediating variable. Positive and negative religious coping were somewhat positively related to each other; their (indirect) predictive power on psychosocial adjustment was identical though in an opposite direction. All in all, the results correspond to previous Anglo-American research. There are, however, some discrepancies which may be due to the specific religious-cultural background in Germany.

Image-based hip navigation.

After experimental and preclinical evaluation (HAP Paul Award 2001) of a CT-free image-guided surgical navigation system for acetabular cup placement, the system was introduced into clinical routine. The computation of the angular orientation of the cup is based on reference coordinates from the anterior pelvic plane (APP) concept. A hybrid strategy for pelvic landmark acquisition has been introduced involving percutaneous pointer-based digitization with the noninvasive biplanar landmark reconstruction using multiple registered fluoroscopy images. From January 2001 to May 2002, 118 consecutive patients (mean age 68 years, 82 male, 36 female, and 62 left and 56 right hip joints) were operated on with the hybrid CT-free navigation system. During each operation, the angular orientation of the inserted implant was recorded. To determine the placement accuracy of the acetabular components, the first 50 consecutive patients underwent a CT scan 7-10 days postoperatively to analyze the cup position relative to the APP. This was done blinded with commercial planning software. There was no significant learning curve observed for the use of the system. Mean values for postoperative inclination read 43 degrees (SD 3.0, range 37-49) and anteversion 19 degrees (SD 3.9, range 10-28). The resulting system accuracy, i.e., the difference between intraoperatively calculated cup orientation and postoperatively measured implant position, shows a maximum error of 5 degrees for the inclination (mean 1.5 degrees, SD 1.1) and 6 degrees for the anteversion (mean 2.4 degrees, SD 1.3). An accuracy of better than 5 degrees inclination and 6 degrees anteversion was achieved under clinical conditions, which implies that there is no significant difference in performance from the established CT-based navigation methods. Image-guided CT-free cup navigation provides a reliable solution for future total hip arthroplasty (THA).