Empowering patient education on self-care activity among patients with colorectal cancer - a research protocol for a randomised trial.

BACKGROUND: Chemotherapy-induced side effects may have a negative effect on nutrition intake, thus increasing the risk of malnutrition and consequently, other serious complications for patients with cancer. The prevalence of malnutrition is common among patients with colorectal cancer. Nurse-led empowering education may have a positive effect on self-care activity in this patient group. Therefore, our purpose is to develop an empowering educational nursing intervention and test its effect on self-care activation and knowledge level among patients with colorectal cancer during chemotherapy. Secondary outcomes are quality of life and risk of malnutrition. METHODS: An interdisciplinary expert group developed a face-to-face empowering educational intervention using teach-back method. A two-arm, single-centre, superiority trial with stratified randomisation (1:1) and pre-post measures will be used to assess the effect of the intervention compared to standard care. Patients (N = 40 + 40) will be recruited in one university hospital outpatient clinic in Finland. Eligibility criteria are adult patients diagnosed with colorectal cancer starting oral fluoropyrimidine or combination chemotherapy treatment. A registered nurse experienced in oncology will deliver the intervention 2 weeks after the first chemotherapy. Outcomes are measured before intervention (M0) and after a two-month follow-up period (M1). DISCUSSION: This study will assess whether nurse-led empowering education using teach-back method is effective on self-care activity among patients with colorectal cancer. If the intervention has a positive effect, it may be implemented into patient education in a corresponding context. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04160650 Registered 12 November 2019 - retrospectively registered.

The effect of nurse-led empowering education on nutrition impact side effects in patients with colorectal cancer undergoing chemotherapy: A randomised trial.

OBJECTIVE: This study assessed the effect of empowering education on patient-reported outcomes and morbidity. METHODS: A randomised controlled trial was conducted on adults with colorectal cancer (43 + 40). The intervention consisted of one-hour empowering patient education on nutrition impact side effects. The effect was compared with standard care. The difference between the groups was analysed pre and post intervention. RESULTS: The change in malnutrition-related knowledge level was higher in the intervention group compared to control group (median 0.0, IQR 1.00 vs median 0.0, IQR 0.0, p = 0.028). Additional contacts with outpatient clinic were fewer in intervention group (median 0.00, IQR 0.00) compared to control group (median 1.00, IQR 2.00, p < 0.001). We did not find a statistically significant difference in the change in activation level, risk of malnutrition and quality of life between the groups. CONCLUSION: Empowering education may affect positively on patients' knowledge level related to malnutrition and reduce the number of additional contacts with health care thus reduce health care costs. PRACTICE IMPLICATIONS: Empowering education may be used in patients with colorectal cancer to improve knowledge and reduce additional contacts with health care. Further research is needed on the effect of empowering education in self-care.

Cd-specific mutants of mercury-sensing regulatory protein MerR, generated by directed evolution.

The mercury-sensing regulatory protein, MerR (Tn21), which regulates mercury resistance operons in Gram-negative bacteria, was subjected to directed evolution in an effort to generate a MerR mutant that responds to Cd but not Hg. Oligonucleotide-directed mutagenesis was used to introduce random mutations into the key metal-binding regions of MerR. The effects of these mutations were assessed using a vector in which MerR controlled the expression of green fluorescent protein (GFP) and luciferase via the mer operator/promoter. An Escherichia coli cell library was screened by fluorescence-activated cell sorting, using a fluorescence-based dual screening strategy that selected for MerR mutants that showed GFP repression when cells were induced with Hg but GFP activation in the presence of Cd. Two Cd-responsive MerR mutants with decreased responses toward Hg were identified through the first mutagenesis/selection round. These mutants were used for a second mutagenesis/selection round, which yielded eight Cd-specific mutants that had no significant response to Hg, Zn, or the other tested metal(loid)s. Seven of the eight Cd-specific MerR mutants showed repressor activities equal to that of wild-type (wt) MerR. These Cd-specific mutants harbored multiple mutations (12 to 22) in MerR, indicating that the alteration of metal specificity with maintenance of repressor function was due to the combined effect of many mutations rather than just a few amino acid changes. The amino acid changes were studied by alignment against the sequences of MerR and other metal-responsive MerR family proteins. The analysis indicated that the generated Cd-specific MerR mutants appear to be unique among the MerR family members characterized to date.

Screening of community-dwelling older patients by the emergency medical services: An observational retrospective registry study.

BACKGROUND: Inadequate nutrition, falls, and cognitive impairment are common problems among acutely ill older people and are associated with complicated and prolonged health problems and mortality. OBJECTIVES: To assess if the emergency medical services can identify patients with nutritional risk, falls risk, and cognitive impairment by using simple screening tools and to assess the prevalence of risks and rate they are reported to the emergency department. SETTING: The study was carried out in Espoo, Finland to patients over the age of 70 requiring non-urgent ambulance transfer to the emergency department. OUTCOME MEASURES: A set of validated electronic screening tools was used to identify patients at nutritional risk, risk of falling and having cognitive impairment. MAIN RESULTS: A total of 488 (8%) out of 5792 patients were screened. Of the patients 60%, (n = 292) had at least one risk: 17% (n = 81) had nutritional risk, 43% (n = 209) falls risk, and 28% (n = 137) cognitive impairment. Twenty-two (5%) were screened positive in all three categories. The observed risk was reported to the emergency department staff in 59% (n = 173) of the patients. CONCLUSION: The emergency medical services can be used in preventive health care to identify patients having nutritional risk, falls risk, or cognitive impairment.

Low-phase angle in body composition measurements correlates with prolonged hospital stay in head and neck cancer patients.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a method for estimating body composition. Clinically the most important parameter is the phase angle (PA), which decreases with progressing malnutrition and is highly predictive for impaired survival and mortality. AIM: To evaluate the association of low PA with the complication rate and length of hospital stay. MATERIAL AND METHODS: A cohort of 61 head and neck cancer (HNC) patients underwent BIA prior to surgical treatment. Information on patient and tumour characteristics, treatment, and surgical complications were gathered from hospital records and correlated with BIA results. RESULTS: The median PA was 4.5 (range, 2.7-6.5), and, in 67% of the patients, it was lower than reference values. Low PA was associated with longer hospital stay (p = .002) in the whole cohort and in the patient group with radical neck dissections it correlated with a higher surgical complication rate (p = .014), but not with Clavien-Dindo scoring for surgical complications. CONCLUSIONS AND SIGNIFICANCE: BIA is a feasible instrument for analysing body composition that reflects nutritional status in cancer patients. Our results show that HNC patients have a low PA at diagnosis. Low PA is associated with a long hospital stay and an increase in the complication rate. BIA can be of clinical value in preoperative risk evaluation.

Bioelectrical impedance analysis of head and neck cancer patients at presentation.

CONCLUSION: Finnish head and neck cancer (HNC) patients show signs of severe malnutrition already at presentation, measured by bioelectric impedance analysis (BIA). BIA may be a practical method to detect malnutrition, analyze body composition, and to identify high-risk patients in this population. OBJECTIVES: BIA is a validated method for evaluating body composition and detecting malnutrition. Low phase angle (PA) is associated with increased mortality and morbidity. Vector analysis (BIVA) provides a qualitative measure for hydration and cell mass, independent of body size. This study describes BIA results in Finnish HNC patients at presentation. METHODS: Forty-one newly-diagnosed HNC patients at the Helsinki University Hospital were included. BIA measures (resistance, reactance, PA, fat-free mass index [FFMI], and fat mass index [FMI]), body mass index (BMI), and Charlson Comorbidity Index (CCI) were determined. RESULTS: The majority of patients were men (78%), with a normal average BMI of 25.2. Low FFMI was seen in 44% of women and 28% of men. The PA (median = 4.6; IQ range = 4-5) was lower than the reference values in 76% (n = 31) of cases. In BIVA, only 13 (32%) of the patients were within normal range and 15 (37%) were plotted in the quadrant indicating malnutrition.