Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement.

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.

Research Electronic Data Capture (REDCap) in an outpatient oncology surgery setting to securely email, collect, and manage survey data.

BACKGROUND: Nursing interventions in the post-operative time period including psychological and emotional support, adverse event education, and instructions for follow-up care contribute patient satisfaction, safety, and quality of life. However, the time spent in the post-anesthesia care unit (PACU) and hospital continues to shorten around the world to reduce health care spending and improve patient outcomes. Nurses conducting research during the important post-operative recovery period need to utilize unique techniques and emerging technologies to contact, recruit and collect data outside of the hospital setting including the Research Electronic Data Capture (REDCap) platform. AIMS: This paper describes the feasibility and acceptability, facilitators and barriers of the software application, REDCap, to complete a repeated-measures, descriptive correlational study in patients undergoing outpatient breast cancer surgeries. METHODS & MATERIALS: The recruitment, data collection and storage were completed utilizing the secure REDCap Platform. The Institutional Research Board (IRB)-approved study was a repeated-measures, descriptive, correlational study with data collection at three time points. The data points aligned with important transitions and routine visits to improve data collection feasibility and increase relevance to clinical practice. RESULTS: The sample consisted of women diagnosed with breast cancer undergoing breast conserving surgery between August 15 and October 15, 2020. There were 123 potential participants, of which 76 started the surveys and 75 participated (61%) responded and participated in the study on Post-operative Day 1. Fifty-nine participants (78%) completed the surveys on post-operative Day 14. DISCUSSION: As the frequency of outpatient treatment increases, nurses conducting post-operative research will need to collect the data outside of the hospital setting. CONCLUSION: Email provides a method of studying new phenomena by recruiting participants, providing information about the study, and collecting results in a non-traditional setting. REDCap provides a method to facilitate nursing research through a securely encrypted integrated process.

Data-driven clinical improvement: Oncology nurse leaders' perceptions and experiences of organisational data reports.

AIM: To elicit oncology nurse leaders' perceptions and experiences of accessing, using and interpreting report data at the unit level, and their suggestions for future reports. BACKGROUND: Nurse leaders are expected to use data reports for decisions about unit-level operations, yet data may be inaccessible, unavailable and lack relevance for improving patient care and unit-level outcomes. METHODS: A purposeful sampling was used to recruit 12 unit-level nurse leaders. Qualitative data were collected through semi-structured interviews and analysed using thematic content analysis. RESULTS: Consistent themes included the lack of accurate, useful and meaningful data specifically related to patient care. Accessibility Challenges, Limits to Applicability and Suggestions for Improvement were the main themes. CONCLUSION: Nurse leaders require real-time data to effectively implement clinical interventions and practice changes for improving unit-level patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders emphasized that their insight into the development of customizable reports is crucial for obtaining meaningful data relevant to the varied unit-level health care setting. Reports targeting unit-level outcomes would provide meaningful data to facilitate clinical improvement where patient care is provided. Improved reports increase the likelihood of their use and the potential for enhancing the quality and safe care outcomes.

Oral self-management of palbociclib (Ibrance®) using mobile technology protocol.

AIM: This study will test the feasibility and effectiveness of mobile technology intervention on the patients' self-management of oral anticancer medication. Secondary objectives include acceptability, the usefulness of text messages, and satisfaction by participants and nurses. METHODS: This prospective two-arm study will recruit patients (N = 220) with metastatic breast cancer and initiating treatment with palbociclib (Ibrance ®). Allowing for attrition, patients will be randomized into the control (N = 100) or intervention (N = 100) group. Unidirectional text message reminders will be sent during the treatment cycle through a secure web application using the patient's smartphone. Self-reported survey responses will be collected at three time points; at consent, end of treatment cycles, and the follow-up clinic visit and include a demographic questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Post study questionnaire and the R-15 Patient Satisfaction Questionnaire. Nurses providing care for study patients will complete the Adaptation of Stamps Nurse Workload questionnaire. Data will be analysed an intent-to-treat analysis comparing the two arms. Study approval was obtained in December 2019 and funded in January 2020. DISCUSSION: Smartphones are globally available and have text messaging capability which is increasingly being used as an intervention in healthcare studies. This study will test a low-cost, nurse-led intervention that enhances the patient's experience with oral anti-cancer medications, improves access to care, reduces costs, and improves the satisfaction of nurses caring for oncology patients. IMPACT: Despite the ease of administering oral anti-cancer medications, oncology patients maynot take them as prescribed and consequently, these factors affect patient outcomes and disease control. Given the importance of taking oral anti-cancer medications and the difficulties patients experience in achieving it, the effective use of mobile technology interventions can actively engage patients in their care and improve medication self-management of anticancer treatment regimens.

Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review.

To conduct a systematic review of the risks of short-term outcomes after major treatments for clinically localised prostate cancer. MEDLINE, EMBASE and the Cochrane Library were searched from 2004 to January 2013. Study arms that included ≥100 men with localised prostate cancer in receipt of surgery, radiotherapy or active surveillance and reported symptomatic and quality-of-life (QoL) data from 6 to 60 months after treatment were eligible. Data were extracted by one reviewer and checked by another. In all, 64 studies (80 treatment cohorts) were included. Most were single treatment cohorts from the USA or Europe. Radiotherapy was the most common treatment (40 cohorts, including 31 brachytherapy cohorts) followed by prostatectomy (39 cohorts), with only one active surveillance cohort. Most frequently measured symptoms were urinary, followed by sexual, and bowel; QoL was assessed in only 17 cohorts. Most studies used validated measures, although poor data reporting and differences between studies meant that it was not possible to pool data. Data on the precise impact of short-term symptomatic and QoL outcomes after treatment for localised prostate cancer are of insufficient quality for clear guidance to men about the risks to these aspects of their lives. It is important that future studies focus on collecting core outcomes through validated measures and comply with reporting guidelines, so that clear and accurate information can be derived for men considering screening or treatment for prostate cancer.

Oncology nursing research: a global perspective.

The specialty of oncology nursing began around the 1970s when oncology as a science became a significant practice in the clinical areas. As the practice of oncology grew in health care settings, physicians focused on providing care for individuals diagnosed with cancer with treatments like surgery, radiation, and novel chemotherapy agents. Physicians treated the physical disease, while oncology nurses cared for, and became specialised in, the assessment and management of side effects and symptoms, and supporting patients and families in coping with the impacts from the disease and treatments. Thus, the oncology nursing speciality focus is on physical, psychosocial, and practical management of patients' care; education of patients and families; and co-ordination of the complex care provided. This article focuses on how the science, or the evidence base, of oncology nursing has grown globally since those early years. The aim of this paper is to illustrate the growth and development in the body of evidence underpinning the oncology nursing specialty by highlighting scientific studies, publications, and evidence-based practice. Over the years, there has been a steady growth in the research evidence supporting the specialty, yet future challenges are ahead. These challenges include demonstrating impact of nursing interventions; infrastructure support; resources for capacity building; building research-mindedness; and strengthening equality, diversity, and inclusion.

Distress, Pain, and Nausea on Postoperative Days 1 and 14 in Women Recovering From Breast-Conserving Surgery: A Repeated-Measures Study.

OBJECTIVES: To determine the incidence and trajectory of distress, pain, and nausea and vomiting at postoperative day (POD) 1 and at POD 14 following breast-conserving surgery. SAMPLE & SETTING: 75 women aged 18 years or older receiving breast-conserving surgery with sentinel lymph node biopsy for treatment of early-stage primary breast cancer at an ambulatory surgery center. METHODS & VARIABLES: This prospective, repeated-measures study assessed distress, pain, and nausea and vomiting using the National Comprehensive Cancer Network Distress Thermometer and Problem List on POD 1 and POD 14. RESULTS: Pain and distress scores were highest on POD 1. The number of women who reported depression increased from POD 1 to POD 14. Thematic analysis revealed that family concerns, fears and worries, and postoperative issues contributed to pain and distress. IMPLICATIONS FOR NURSING: Women experience pain and distress during recovery at home after breast-conserving surgery. Nurses can use these results to apply evidence-based practice to reduce this symptom burden. Future nursing research should focus on targeted interventions outside of the hospital setting.

In their voices: Kenyan women's experiences with cancer treatment-related side effects.

Objective: This article reports on a secondary analysis of a qualitative study conducted in Nairobi, Kenya that reported several initial themes. In this article, the authors explore the theme of treatment-related side effect management by women receiving treatment for breast or cervical cancer. Methods: Women were interviewed at three points during their active treatment trajectory. Participants were purposefully selected and saturation was reached when interviews did not yield any new themes. The interviews were transcribed and analyzed for internal consistency, frequency, extensiveness, intensity and specificity. The Nvivo pro 12 software was used in organizing and managing the data to facilitate analysis. Results: Eighteen women were interviewed. Major side effects reported by participants included fatigue, alopecia, skin and nail changes as well as nausea and vomiting. Women who received information prior to treatment were more comfortable managing side effects. Participants described the impact of side effects on their daily life, body image, and many sought comfort through faith. Some women provided suggestions on strategies for patient education. Conclusions: This study attempted to capture the cancer treatment-related experiences of Kenyan women in their own voices and present strategies for future intervention and research. The care of individuals receiving treatment can be enhanced through the advancement of health human resources, the development of nationally accessible patient education materials and research on regionally relevant strategies to manage cancer treatment-related side effects.

Exploring research engagement among nurses in a Magnet®-recognized cancer center: An analysis of knowledge, attitudes, practices, and influencing factors.

Objective: Despite the significance of research in nursing practice and its role in enhancing the quality of life for cancer patients, nurses report limited opportunities to engage with research. Known barriers include limited organizational support, a lack of time, resources, and knowledgeable colleagues/mentors. The study aims to determine research knowledge, attitudes, and practices among cancer nurses and understand factors influencing nurses' involvement in research. Methods: Registered nurses responded to a cross-sectional questionnaire. Data were collected using a modified version of the Nursing Research Knowledge, Attitudes, and Practices survey and the Barriers to Nurses' Participation in Research Questionnaire. Results: Three hundred and sixty-six nurses responded, of whom 15% had previously been involved in research. Nurses reported moderate to high research knowledge ( µ = 1.72), attitudes ( µ = 1.92), and practice ( µ = 1.79) scores. The most common barriers to engagement with research included a lack of time (78.0%), lack of incentive or reward (61.4%), lack of knowledge or skills (54.2%), lack of training opportunities (51.4%), and lack of experienced nursing research mentors (44.8%). Holding a specialist, advanced practice, or administrative role, and a postgraduate qualification were associated with higher scores on the knowledge, attitudes and practice subscales. Previous experience of conducting research was associated with higher knowledge and attitudes scores. Previous experience of authoring a paper and submitting a grant were associated with higher knowledge scores. Conclusions: The study reveals a moderate-to-high level of knowledge, attitudes, and practice regarding research among nurses, but low engagement. Barriers include lack of time, incentive, knowledge, training, and mentorship. Nevertheless, attitude scores, reflecting nurses' willingness to engage in research were high on average. The findings highlight the potentially modifiable nature of barriers to research engagement. Increasing capacity for nursing research may be achieved through investment in research support and training to overcome barriers to research, which may discourage nurses engagement.

Treatment of obstructive sleep apnea with CPAP improves daytime sleepiness and fatigue in cancer patients.

BACKGROUND: Fatigue and sleep disorders are prevalent in cancer patients. Obstructive sleep apnea (OSA) commonly causes excessive daytime sleepiness (EDS) and fatigue. We hypothesize that treating cancer patients with OSA using positive airway pressure (PAP) will improve EDS and fatigue. METHODS: A retrospective chart review of sleep clinic visits of cancer patients with newly diagnosed OSA was performed. Epworth Sleepiness Scale (ESS) and fatigue reported at baseline and within 6 months of starting PAP therapy were compared between PAP-adherent and PAP-non-adherent patients. RESULTS: 65 cancer patients with OSA and ESS >10 were recommended PAP therapy, including 45 patients with fatigue. 29 patients pursued PAP therapy with 79% (n = 23) adherent at follow-up. The median baseline apnea hypopnea index (AHI) for OSA was 24.0 (interquartile range [IQR] 14.3, 32.3) and 23.8 (IQR 10.1, 42.8) events/hour among PAP-adherent and PAP-non-adherent patients, respectively (p = 0.90). Median baseline ESS was 14.0 (IQR 12.0, 17.0) among adherent and 17.0 (IQR 11.0, 17.3) among non-adherent patients (p = 0.73). The median ESS at follow-up of the adherent and non-adherent groups was 8.0 (IQR 6.0, 10.0) and 11.0 (IQR 8.0, 15.8), respectively (p = 0.08). Median ESS change was -5.0 (IQR -7.0, -4.0) in PAP adherent patients and -2.5 (IQR -5.25, -1.50) in PAP-non-adherent patients (p = 0.07). When the groups are examined separately, the median change in the PAP-adherent group was highly significant (p = 0.001), while the ESS median change in the PAP-non-adherent group was considerably less (p = 0.04). 17 out of the 21 PAP-adherent patients reporting fatigue at baseline indicated improvement at follow-up. CONCLUSIONS: PAP therapy for OSA in cancer patients improves EDS and fatigue. Larger studies are necessary to evaluate the efficacy of PAP in improving fatigue in this population.

Knowledge, Attitudes, and Practice of chemotherapy management among nurses at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.

Objective: Cancer is a leading global health challenge with increasing morbidity and mortality. In Nigeria, cancer leads to over 100,000 new cases and 70,000 deaths annually. In resource-constrained countries such as Nigeria, registered nurses (RNs) that provide oncology care lack specialty education in oncology nursing care. Nigerian nurses are the largest portion of the healthcare workforce and can play a key role in improving oncology care. This study aimed to assess RNs' knowledge, willingness, and ability to perform tasks related to chemotherapy administration and symptom management, assess current practices, identify available resources, and identify gaps in RNs' knowledge of oncology care. Methods: A descriptive, correlational, Institutional Review Board (IRB)-approved study was conducted using a modified Knowledge, Attitudes, and Practice questionnaire and a questionnaire adapted from the Organizational Readiness to Change Assessment. The principle investigator (PI) adopted the role as an observer to witness an accurate picture of nursing practice at Obafemi Awolowo University Teaching Hospital (OAUTH) and identify gaps in education and knowledge around oncology nursing care. A Research Electronic Data Capture database was developed using paper-formatted questionnaires that were exported to Excel for statistical analysis. Results: This study supports findings from literature highlighting that nurses working in oncology units lack specialized oncology training, which leads to gaps in knowledge and practice. Questionnaire responses and clinical observations at OAUTH support RNs' willingness to learn skills related to oncology nursing care. Nurses are self-aware that they have more to learn about how to prepare and administer chemotherapy, and 90% of nurses reported that an ongoing chemotherapy training program would be helpful at OAUTH. Conclusions: By identifying gaps in education and knowledge about oncology care and by identifying available resources, an oncology training program could be developed for nurses working in oncology units at OAUTH and other Nigerian hospitals, leading to improved oncology patient care and outcomes.

Development and initial psychometric properties of the Research Complexity Index.

Objective: Research study complexity refers to variables that contribute to the difficulty of a clinical trial or study. This includes variables such as intervention type, design, sample, and data management. High complexity often requires more resources, advanced planning, and specialized expertise to execute studies effectively. However, there are limited instruments that scale study complexity across research designs. The purpose of this study was to develop and establish initial psychometric properties of an instrument that scales research study complexity. Methods: Technical and grammatical principles were followed to produce clear, concise items using language familiar to researchers. Items underwent face, content, and cognitive validity testing through quantitative surveys and qualitative interviews. Content validity indices were calculated, and iterative scale revision was performed. The instrument underwent pilot testing using 2 exemplar protocols, asking participants (n = 31) to score 25 items (e.g., study arms, data collection procedures). Results: The instrument (Research Complexity Index) demonstrated face, content, and cognitive validity. Item mean and standard deviation ranged from 1.0 to 2.75 (Protocol 1) and 1.31 to 2.86 (Protocol 2). Corrected item-total correlations ranged from .030 to .618. Eight elements appear to be under correlated to other elements. Cronbach's alpha was 0.586 (Protocol 1) and 0.764 (Protocol 2). Inter-rater reliability was fair (kappa = 0.338). Conclusion: Initial pilot testing demonstrates face, content, and cognitive validity, moderate internal consistency reliability and fair inter-rater reliability. Further refinement of the instrument may increase reliability thus providing a comprehensive method to assess study complexity and related resource quantification (e.g., staffing requirements).

Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: A Multi-Modal Case Study Approach.

BACKGROUND: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeast, United States. OBJECTIVE: Explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. METHODS: The sample included 30 of 98 clinicians (31% response rate) managing at least five patients in the RPM program and responding to the m-Health Usability between March 2021- October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of five clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, and averaged 60 minutes each. RESULTS: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians' workload burden. Interview sessions revealed three main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. CONCLUSIONS: Clinicians support the value of RPM for improving symptom management and engaging with providers. Functional changes to enhance the program's utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices.

Assessing safe chemotherapy needs and practices in Ile-Ife, Nigeria: a multi-disciplinary quality improvement project.

OBJECTIVE: To explore the gaps in the safe handling, administration, preparation and disposal of chemotherapy agents in low and middle-income countries. DESIGN: Two surveys comprising a needs assessment survey and an American Cancer Society (ACS) ChemoSafe Facility Assessment. SETTING: 2019 African Research Group for Oncology Symposium in South-West Nigeria (needs assessment) and the 2021 virtual engagement (ChemoSafe Assessment). PARTICIPANTS: Health professionals (n=50 of 98) from multiple institutions across Nigeria (needs assessment survey) and a designated task force of health professionals (n=10) from one teaching hospital in Southwest Nigeria(ChemoSafe Facility Assessment). RESULTS: In 2019, 75% of survey respondents (n=50) reported a lack of training resources for safe handling of chemotherapy. Additionally, 61% felt dissatisfaction with assessment practices for preparing and administering chemotherapy. ChemoSafe is a programme developed by the ACS to assess the ability of a facility to handle hazardous drugs. The 2021 ACS ChemoSafe survey administered at one teaching hospital indicated several areas for improvement to promote concordance with international standards for safe handling. Thirty-three (19.5%) items received a 'Yes' response (ie, met compliance with international standards). CONCLUSION: There is a need for the implementation of training resources for handling, administering and disposing of chemotherapy at sites across Nigeria. Strategies to identify and prioritise areas of need must be implemented in the context of available resources.

Statins for the primary prevention of cardiovascular disease.

BACKGROUND: Reducing high blood cholesterol, a risk factor for cardiovascular disease (CVD) events in people with and without a past history of CVD is an important goal of pharmacotherapy. Statins are the first-choice agents. Previous reviews of the effects of statins have highlighted their benefits in people with CVD. The case for primary prevention was uncertain when the last version of this review was published (2011) and in light of new data an update of this review is required. OBJECTIVES: To assess the effects, both harms and benefits, of statins in people with no history of CVD. SEARCH METHODS: To avoid duplication of effort, we checked reference lists of previous systematic reviews. The searches conducted in 2007 were updated in January 2012. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2022, Issue 4), MEDLINE OVID (1950 to December Week 4 2011) and EMBASE OVID (1980 to 2012 Week 1).There were no language restrictions. SELECTION CRITERIA: We included randomised controlled trials of statins versus placebo or usual care control with minimum treatment duration of one year and follow-up of six months, in adults with no restrictions on total, low density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol levels, and where 10% or less had a history of CVD. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion and extracted data. Outcomes included all-cause mortality, fatal and non-fatal CHD, CVD and stroke events, combined endpoints (fatal and non-fatal CHD, CVD and stroke events), revascularisation, change in total and LDL cholesterol concentrations, adverse events, quality of life and costs. Odds ratios (OR) and risk ratios (RR) were calculated for dichotomous data, and for continuous data, pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated. We contacted trial authors to obtain missing data. MAIN RESULTS: The latest search found four new trials and updated follow-up data on three trials included in the original review. Eighteen randomised control trials (19 trial arms; 56,934 participants) were included. Fourteen trials recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). All-cause mortality was reduced by statins (OR 0.86, 95% CI 0.79 to 0.94); as was combined fatal and non-fatal CVD RR 0.75 (95% CI 0.70 to 0.81), combined fatal and non-fatal CHD events RR 0.73 (95% CI 0.67 to 0.80) and combined fatal and non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was also seen. Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects. There was no evidence of any serious harm caused by statin prescription. Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life. Recent findings from the Cholesterol Treatment Trialists study using individual patient data meta-analysis indicate that these benefits are similar in people at lower (< 1% per year) risk of a major cardiovascular event. AUTHORS' CONCLUSIONS: Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins.

Speech and language therapy interventions for children with cleft palate: a systematic review.

Objective : (1) To examine the evidence for the effectiveness of differences in timing and type of speech and language therapy for children with cleft palate with or without a cleft lip and (2) to identify types of interventions assessed. Design : Nine databases, including MEDLINE and EMBASE, were searched between inception and March 2011 to identify published articles relating to speech and language therapy for children with cleft palate with or without cleft lip. Studies that included at least 10 participants and reported outcome measures for speech and/or language measures were included. Studies where the experimental group had less than 90% of children with cleft palate with or without cleft lip were excluded. Two reviewers independently completed inclusion assessment, data extraction, and risk of bias assessment for all studies identified. Results : A total of 17 papers were evaluated: six randomized control trials and 11 observational studies. Studies varied widely on risk of bias, intervention used, and outcome measures reported. None of the studies had a low risk of bias. In terms of intervention approaches, seven studies evaluated linguistic approaches and 10 evaluated motor approaches. Outcomes measures did not support either approach over the other, and based on data reported it was difficult to ascertain which approach is more effective for children with cleft palate with or without cleft lip. Conclusions : The review found little evidence to support any specific intervention. Key uncertainties need to be identified and adequately powered, methodologically rigorous studies conducted to provide a secure evidence base for speech-language therapy practice in children with cleft palate with or without cleft lip.

The impact of telehealth on nursing care in the radiation oncology setting during the COVID-19 pandemic.

Objective: This article aims to explore care patterns and understand the impact of telehealth on nursing care in the radiation oncology setting at a comprehensive cancer center during the COVID-19 pandemic. Methods: Focus group interviews of radiation oncology nurses (n â€‹= â€‹18) were used to obtain data and describe current patient care patterns during the study period. Interviews were conducted over Zoom video conference, and content was analyzed. Results: Three major themes were determined: (1) the evolution of nurses' roles during the transition to telehealth, (2) the resilience of the human element, and (3) the benefits and constraints of the institution's infrastructure. Conclusions: Study results support radiation oncology nurses' ability to provide quality patient care using telehealth and can guide the expansion future care models for radiation oncology patients. Research exploring telehealth care outcomes among radiation patients is warranted. Radiation oncology nurses' training and scope of practice must be expanded to include telehealth care. As telehealth care models continue to develop, there will be a need to address training and technical disparities among certain patient demographics.

Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial.

Importance: Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown. Objective: To compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer. Design, Setting, and Participants: A multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment). Interventions: Weekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks. Main Outcomes and Measures: The primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life. Results: A total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of -2.53 (95% CI, -2.92 to -2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of -3.01 (95% CI, -3.38 to -2.63) points; the between-group difference was not significant (-0.48; 95% CI, -0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage). Conclusions and Relevance: In this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer. Trial Registration: ClinicalTrials.gov Identifier: NCT04095234.

Operable non-small cell lung cancer: correlation of volumetric helical dynamic contrast-enhanced CT parameters with immunohistochemical markers of tumor hypoxia.

PURPOSE: To assess the relationship between helical dynamic contrast material-enhanced (DCE) computed tomographic (CT) parameters and immunohistochemical markers of hypoxia in patients with operable non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: After institutional review board approval was obtained, 20 prospective patients who were suspected of having NSCLC underwent whole-tumor DCE CT with kinetic modeling (Patlak analysis) 24 hours before scheduled surgery. Flow-extraction product (in milliliters per 100 milliliters per minute) and blood volume (in milliliters per 100 milliliters) were derived. After surgery, matched whole-tumor sections were stained for exogenous and endogenous markers of hypoxia (pimonidazole infused intravenously 24 hours before surgery, immediately after DCE CT; glucose transporter protein). Correlation between DCE CT parameters and immunohistochemical markers was assessed by using the Spearman rank correlation. DCE CT parameters and immunohistochemical markers were also compared according to pathologic subtype, grade, stage, and nodal status by using the Mann-Whitney test. P values less than .05 indicated a statistically significant difference. RESULT: Fourteen patients with confirmed primary NSCLC underwent resection. There were negative correlations between blood volume and pimonidazole staining (r = -0.48, P = .004), and between flow-extraction product and glucose transporter protein expression (r = -0.50, P = .002). Flow-extraction product was significantly higher in adenocarcinomas than in squamous cell tumors (17.73 vs 11.46; P = .043). Glucose transporter protein expression was significantly lower for adenocarcinomas than for squamous tumors (14.07 vs 33.03; P < .001) and in node negative than in node positive tumors (15.63 vs 23.85; P = .005). CONCLUSION: Blood volume and flow-extraction product derived at DCE CT correlated negatively with pimonidazole and glucose transporter protein expression, indicating the potential of these CT parameters as imaging biomarkers of hypoxia.

Is MRI better than CT for detecting a vascular component to dementia? A systematic review and meta-analysis.

BACKGROUND: Identification of causes of dementia soon after symptom onset is important, because appropriate treatment of some causes of dementia can slow or halt its progression or enable symptomatic treatment where appropriate. The accuracy of MRI and CT, and whether MRI is superior to CT, in detecting a vascular component to dementia in autopsy confirmed and clinical cohorts of patients with VaD, combined AD and VaD ("mixed dementia"), and AD remain unclear. We conducted a systematic review and meta-analysis to investigate this question. METHODS: We searched eight databases and screened reference lists to identify studies addressing the review question. We assessed study quality using QUADAS. We estimated summary diagnostic accuracy according to imaging finding, and ratios of diagnostic odds ratios (RDORs) for MRI versus CT and high versus low risk of bias. RESULTS: We included 7 autopsy and 31 non-autopsy studies. There was little evidence that selective patient enrolment and risk of incorporation bias impacted on diagnostic accuracy (p = 0.12 to 0.95). The most widely reported imaging finding was white matter hyperintensities. For CT (11 studies) summary sensitivity and specificity were 71% (95% CI 53%-85%) and 55% (44%-66%). Corresponding figures for MRI (6 studies) were 95% (87%-98%) and 26% (12%-50%). General infarcts was the most specific imaging finding on MRI (96%; 95% CI 94%-97%) and CT (96%; 93%-98%). However, sensitivity was low for both MRI (53%; 36%-70%) and CT (52%; 22% to 80%). No imaging finding had consistently high sensitivity. Based on non-autopsy studies, MRI was more accurate than CT for six of seven imaging findings, but confidence intervals were wide. CONCLUSION: There is insufficient evidence to suggest that MRI is superior to CT with respect to identifying cerebrovascular changes in autopsy-confirmed and clinical cohorts of VaD, AD, and 'mixed dementia'.