Health effects of desert dust storm events in the south-eastern Mediterranean: perceptions and practices of local stakeholders.

BACKGROUND: The south-eastern Mediterranean experiences frequent desert dust storm events (DDS) that have been shown to be associated with adverse health effects. AIMS: This study assessed the perceptions and practices towards DDS of local authorities and stakeholders from 3 countries in the region, Cyprus, Greece and Israel. METHODS: Between October 2017 and April 2018, we administered a semi-structured questionnaire to regulatory authorities involved in public protection from DDS as well as social stakeholders in the 3 countries. The questionnaire addressed their knowledge regarding DDS, perceptions on the relationship between DDS and health effects and relevant actions taken towards public protection. RESULTS: Out of 58 stakeholders contacted, 49 participated in the study (84.5% response rate). Fourteen (28.6%) were regulatory authorities and 35 (71.4%) were social stakeholders. All responders were familiar with DDS but several underestimated the frequency of events while the majority (73%) instinctively reported that elders, children and respiratory patients are susceptible subpopulations. Nevertheless, 71% were unaware of a national policy on DDS, or considered that this was lacking in their country. Although several stakeholders reportedly receive questions from the public regarding DDS effects, only few reply according to a pre-determined action plan. CONCLUSIONS: Regulatory authorities and social stakeholders in Cyprus, Greece and Israel are characterized by good knowledge of DDS and associated health effects, although implementation of pre-determined action plans for public protection is limited. Future efforts should concentrate on increasing awareness among stakeholders and the public and developing national policies, including effective measures to minimize DDS exposure.

The evaluation of the reliability and validity properties of the Greek version of the xerostomia questionnaire (ΧQ).

PURPOSE: Xerostomia is one of the multidimensional effects of cancer therapy that can impact on patients' quality of life. This study aims to evaluate the reliability and validity properties of the xerostomia questionnaire. METHODS: The data were retrieved from a randomized, interventional and longitudinal follow-up study of 72 head and neck cancer patients on active oral radiotherapy. Data were retrieved by the Xerostomia Questionnaire, the EORTC-QLQ C30 and EORT QLQ HN35. Data analyzes included intrinsic credibility of affinity Cronbach alpha factor, which is related to validity and cross-sectional validity. RESULTS: The Cronbach's alpha index of the Greek version of the questionnaire was high. Explicitly, the total scale of the questionnaire had an α = 0.97, and the individual dimensions - Degree of dryness and the quality of life had an alpha of 0.97 and 0.98 respectively. The xerostomia dimension of the questionnaire has a high positive correlation with QLQ C30 overall (r = 0.61, p < 0.001), and with the HN35 xerostomia dimension (r = 0.63, p < 0.001) which demonstrate its' concurrent validity. The dimensions of the xerostomia questionnaire were highly correlated with the EORTC-QLQ C30 dimensions which supports its' predictive validity. The level of xerostomia and the quality of life varied according to the level of pain of the patients (p < 0.001) that support the cross-sectional validity of the questionnaire. CONCLUSION: The Greek version of the xerostomia questionnaire is a reliable and valid tool for use in head and neck cancer patients on active oral radiotherapy.

Reliability and Validity of the Greek Version of the Oral Mucositis Weekly Questionnaire in the Head and Neck Cancer Context.

BACKGROUND AND PURPOSE: Oral mucositis is one of the most common treatment-induced adverse side effects in head and neck cancer patients. The purpose was to evaluate the reliability and validity of the Greek version of the Oral Mucositis Weekly Questionnaire-Head and Neck Cancer (OMWQ-HN). METHODS: The data were retrieved from 72 head and neck cancer patients who were undergoing oral radiotherapy as monotherapy or in combination with chemotherapy and surgery. Data analyses included internal consistency reliability, criterion related validity, and cross-sectional validity. RESULTS: The OMWQ-HN demonstrated good criterion validity. Strong correlations were observed between OMWQ-HN with EORTC QLQ-C30 and EORTC QLQ-H&N35 that showed good concurrent validity. The tool has a strong internal consistency index with α = .92. CONCLUSION: The Greek version of OMWQ-HN is a reliable and valid instrument that can be used for the assessment of oral mucositis in this context.

Barriers and facilitators for implementing the WHO's safety surgical checklist: A focus group study among nurses.

The World Health's Organization's safety surgical checklist has been described as a means for increasing patient safety during surgical procedures. However, its full implementation has not yet been achieved worldwide. The aim of this study, via a focus group study among nurses, was to explore the factors that serve as barriers and facilitators for the list's implementation. Findings reveal that the use of the checklist can be compromised by many factors but also supported by others.

The effect of the use of thyme honey in minimizing radiation - induced oral mucositis in head and neck cancer patients: A randomized controlled trial.

PURPOSE: Radiation-induced oral mucositis is one of the main side effects during and after the treatment of head and neck cancer patients. The study was designed to provide evidence on the effectiveness of thyme honey on oral mucositis management. METHODS: This was a randomised controlled trial (RCT) with 72 head and neck cancer patients who were divided either to the intervention group (thyme honey rinses) or to the control group (saline rinses). Oral mucositis was assessed according to the Radiation Therapy Oncology Group (RTOC criteria), and assessments were performed weekly starting at the 4th week of the radiotherapy for seven weeks and repeated once 6 months later. Additionally, the Oral Mucositis Weekly Questionnaire (OMWQ) was given at 4th week of radiotherapy, 1 month after the completion of radiotherapy and 6 months later. The ClinicalTrials.gov Identifier for this study is NCT01465308. This paper reports on the findings regarding thyme honey's effectiveness on oral mucositis. RESULTS: Generalized estimating equations revealed that patients in the intervention group were graded lower in the objective assessment of oral mucositis (p < 0,001), maintained their body weight (p < 0,001) and showed an improvement in their global health (p = 0.001) compared to the control group. Quality of life of the patients in the same group was also statistically significantly higher than that of the patients of the control group (p < 0,001). CONCLUSION: The study provided evidence on the positive effect of thyme honey on the management of radiation-induced oral mucositis and quality of life in head and neck cancer patients.

Quality of nursing care as perceived by cancer patients: A cross-sectional survey in four European countries.

PURPOSE: To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries. METHODS: Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care. RESULTS: Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p<0.001) as well as in the subscales responsiveness (p<0.001), individualization (p<0.001), coordination (p<0.001) and proficiency (p<0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care. CONCLUSION: Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

The effects on anxiety and quality of life of breast cancer patients following completion of the first cycle of chemotherapy.

OBJECTIVES: Breast cancer patients as part of their treatment need to undergo various forms of chemotherapy. This is considered as a burdensome experience for many patients often leading to significant levels of anxiety. The aim of the study was to explore the anxiety levels and any correlations to the quality of life of women with breast cancer that were undergoing chemotherapy. METHODS: This was a cross-sectional study utilizing an explanatory sequential design. Data were collected from 355 women with breast cancer with the Self Anxiety Scale, the EORTC QLQ-C30, the EORTC QLQ-BR23 and sociodemographic questionnaires. Further insight to patients' experiences was given through 12 in-depth interviews. RESULTS: Anxiety scores ranged between 24 and 75 (45.7 ± 10.11), with 44% reporting serious or/and intense anxiety. The results revealed statistically significant differences on patients' anxiety levels depending on their source of support. Overall, patients' global health-related quality of life was found to be low to average 55.91 ± 17.94. The results showed low emotional functioning (49.30 ± 29.12), low role functions (56.34 ± 27.50) and low sexual functioning (24.93 ± 20.75). Patients also reported experiencing problems with fatigue (49.04 ± 29.12), insomnia (44.32 ± 32.97), hair loss (48.25 ± 38.32) and arm symptoms (36.53 ± 23.71). Patients being solely supported by the family experienced higher anxiety levels (p < 0.001) and lower quality of life (p < 0.001). There was a statistically significant negative correlation between anxiety and quality of life (r = -0.623, p < 0.001). Statistically significant differences were also found in relation to demographics, anxiety and quality of life. The interviews provided further evidence on the impact of anxiety on patients' lives. CONCLUSION: The time following the completion of the first cycle of chemotherapy is associated with anxiety and lower quality of life levels in breast cancer patients. Healthcare providers should consider the supportive healthcare needs from the beginning of chemotherapy in patients to optimize their conventional and supportive healthcare outcomes.

The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial.

PURPOSE: Radiation-induced xerostomia is one of the most common side effects that head and neck cancer patients experience during and after treatment. Despite the various methods for the prevention and treatment of radiation-induced xerostomia, it remains highly prevalent among patients treated for head and neck cancers negatively influencing their lives. The purpose of this study was to evaluate the effectiveness of thyme honey as a means for managing radiation-induced xerostomia. METHOD: This was a parallel randomised controlled trial with two equal arms, the experimental arm (thyme honey) and the control arm (saline). 72 head and neck cancer patients receiving radiotherapy or/and chemotherapy or/and surgery were recruited in a specialised cancer centre. Patients in both arms followed the same administration protocol with thyme honey and saline respectively. Identical assessments at baseline, 1 month and 6 months following completion of the intervention were performed in both arms including the National Cancer Institute (NCI) xerostomia scale and the Xerostomia Questionnaire (XQ) additionally to weekly oral clinical assessments. The ClinicalTrials.gov Identifier for this study is NCT01465308. RESULTS: Linear Mixed Models revealed the statistically significant effect of the intervention on xerostomia (F = 8.474 p < 0.001) and overall quality of life (F = 13.158 p < 0.001). Moreover, Generalised Estimating Equations revealed a statistically significant effect on strong and unbearable pain (F = 10.524 p < 0.001) and dysphagia (F = 4.525 p = 0.033). CONCLUSION: The study has demonstrated the safety and efficacy findings of Thyme honey in head and neck cancer patients for the management of treatment induced xerostomia.

The quality of oncology nursing care: A cross sectional survey in three countries in Europe.

PURPOSE: The increase in patients diagnosed with and living with cancer calls for the provision of quality nursing care within this paradigm, one that can reflect the complex needs of the patient that cancer and its treatments induce. The study aimed to evaluate the quality of oncology nursing care, as perceived, by hospitalized cancer patients in three European countries. METHODS: This was a cross-sectional descriptive study. In-patients diagnosed with cancer were selected based on explicit inclusion and exclusion criteria. Data was collected with the Quality of Oncology Nursing Care Scale- QONCS, comprising of 34 items grouped in 5 domains. Sociodemographic data was also retrieved. RESULTS: The sample included 610 patients receiving care in 2 hospitals in Cyprus (n = 274), 1 hospital in Greece (n = 144) and 2 hospitals in the Czech Republic (n = 192). Statistically significant differences were found between the three countries and across all domains of the QONCS, with the exception of the spiritual and religious care (p = 0.136). Age and days of treatment produced statistically significant differences across all the domains of the QONCS, whilst gender did not produced any statistically significant differences (p ranged from (0.136-0.369). CONCLUSION: This is one of the first studies that provide evidence on the Quality of Nursing Care delivered to patients diagnosed with cancer in various European countries. Discrepancies were found between the participating countries. However, the provision of spiritual and religious care by the nurses received the lowest scores across the three participating countries.

"I Lost My Image, the Image Others Know Me By": Findings From a Hermeneutic Phenomenological Study of Patients Living With Treatment-Induced Cutaneous Toxicities.

Cancer patients receiving targeted therapies often develop persistent cutaneous adverse effects, such as papulopustular eruption (rash), xerosis cutis (dry skin), pruritus (itch), and hair and nail changes. These can be dose-limiting or a cause for therapy discontinuation but also can be wearing on patients, negatively influencing their self-image and relationships with others. In a Ricoeurian hermeneutic phenomenological study, we aimed to explore the lived experiences of colorectal, pancreatic, and non-small cell lung cancer patients living with cutaneous toxicities following treatment with targeted agents. Narratives were used to elicit the experiences of 22 cancer patients. Data were analyzed in three steps informed by Ricoeur's interpretation theory: naïve understanding, structural analyses, and comprehensive understanding. Three themes were identified: "Ashamed of what I have become," "Surrender to cancer," and "Mourning for the loss of my body," with nine sub-themes revealing the multidimensional impact of the adverse effects on the patients' lives. The comprehensive understanding produced in analysis revealed a new contextualized interpretation of being in the world while living with cutaneous toxicities. Treatment-induced cutaneous toxicities distorted patients' daily living in ways that led to negative manifestations and effects on their self-image, social engagement, and intimate relationships. Although the dose-limiting and treatment-interrupting effects of these toxicities have been reported, this study sheds light on their existential impact, touching on physical, psychological, and social issues. © 2016 Wiley Periodicals, Inc.