Feasibility and Impact of an Online Simulation Focusing on Nursing Communication About Sexual Health in Gynecologic Oncology.

Nurses' communication regarding the sexual health of women with gynecologic cancer is suboptimal and may be attributed to their lack of sexual health training and knowledge. Our study aims to document the learning experience, impacts, and feasibility of an online educational intervention activity between oncology nurses and a simulated participant on communication with patients regarding oncological sexual health. Using a qualitative approach, we conducted a feasibility study, which included 11 oncology nurses, and performed semi-structured individual interviews after our simulation exercise. We then conducted an iterative thematic data analysis. The participating nurses found the learning experience positive and satisfactory, despite issues with discussions between learners via Zoom™. Study nurse participants reported positive outcomes in knowledge, beliefs, attitudes, communication skills, and nursing practices. Finally, the educational intervention was found to be feasible. The online educational intervention involving a simulated participant appears to be a satisfactory, feasible, and promising module to improve communication regarding the sexual health of gynecologic cancer patients among oncology nurses. However, further studies are needed to verify this type of intervention's effectiveness and optimize oncology nurses' continuing education in sexual health.

National survey of safe handling of hazardous drugs in hospital settings: Use of an innovative approach.

INTRODUCTION: Workers can reduce their risk of exposure to hazardous drugs by following safe handling guidelines. Healthcare centers need to dedicate time and resources in order to implement new safety recommendations. The objective was to present the results of a national survey about the safe handling of hazardous drugs in healthcare centers. METHODS: Quebec healthcare centers performed an auto-evaluation to the newly updated safe handling guidelines in 2021. Centers rated each criterion as compliant or non-compliant. The guidelines tailored recommendations according to three categories of hazards: G1, consisting mostly of carcinogenic drugs; G2, other hazardous drugs; and G3, those with reproductive toxicity. The questionnaire prompted participants to document their planned corrective measures for non-compliant criteria. RESULTS: Most centers participated (28/29, 97%). The overall compliance was 58% (8761/15,216 criteria). The conformity per theme was hygiene and sanitation (1290/1,878, 69%), laundry (221/367, 60%), pharmacy (2658/4,474, 59%), nursing (3436/6,017, 57%), spills and accidental exposure (353/649, 54%), and general measures (803/1,831, 44%). It was higher for recommendations regarding G1s (4226/6,115, 69%) than for G2s (1626/3557, 46%) and G3s (372/916, 41%). CONCLUSIONS: This project successfully used an innovative approach that combined a national auto-evaluation survey, an actionable report, and the involvement of a community of practice. Centers were able to benchmark their implementation of safe handling guidelines, and community of practices may help in sharing the best practices. The design of the questionnaire helped in targeting corrective measures. More work is needed for safe handling practices that relate to G2 and G3 drugs.

Educational interventions to improve communication about sexual health between nurses and gynecologic oncology patients: A narrative review.

Despite the desire of gynecologic oncology (GO) patients to speak openly about their sexual health experience with nurses, nurses often feel ill equipped to engage in these conversations. There are very few educational interventions available to GO nurses to improve sexual health communication with patients. The purpose of this narrative review is to identify and summarize existing educational interventions in this field. A literature search conducted in three databases, for the years 2010 through 2020, identified 11 papers. The results of the review indicate a mix of nurse training modalities and explore the potential for improving this communication. Existing training programs vary in terms of mode of delivery (online or in person), length, type of instructor, learning strategies and themes addressed. Overall, however, the results show a general lack of sexual health training for nurses caring for GO patients.

Continuous reduction in cerebral oxygenation during endurance exercise in patients with pulmonary arterial hypertension.

BACKGROUND: Patients with pulmonary arterial hypertension (PAH) have lower cerebral blood flow (CBF) and oxygenation compared to healthy sedentary subjects, the latter negatively correlating with exercise capacity during incremental cycling exercise. We hypothesized that patients would also exhibit altered CBF and oxygenation during endurance exercise, which would correlate with endurance time. METHODS: Resting and exercise cardiorespiratory parameters, blood velocity in the middle cerebral artery (MCAv; transcranial doppler) and cerebral oxygenation (relative changes in cerebral tissue oxygenation index (ΔcTOI) and cerebral deoxyhemoglobin (ΔcHHb); near-infrared spectroscopy) were continuously monitored in nine PAH patients and 10 healthy-matched controls throughout endurance exercise. Cardiac output (CO), systemic blood pressure (BP) and oxygen saturation (SpO2 ), ventilatory metrics and end-tidal CO2 pressure (PET CO2 ) were also assessed noninvasively. RESULTS: Despite a lower workload and endurance oxygen consumption, similar CO and systemic BP, ΔcTOI was lower in PAH patients compared to controls (p < .01 for interaction). As expected during exercise, patients were characterized by an altered MCAv response to exercise, a lower PET CO2 and SpO2 , as wells as a higher minute-ventilation/CO2 production ratio ( V˙E/V˙CO2 ratio). An uncoupling between changes in MCAv and PET CO2 during the cycling endurance exercise was also progressively apparent in PAH patients, but absent in healthy controls. Both cHHb and ΔcTOI correlated with V˙E/V˙CO2 ratio (r = 0.50 and r = -0.52; both p < .05 respectively), but not with endurance time. CONCLUSION: PAH patients present an abnormal cerebrovascular profile during endurance exercise with a lower cerebral oxygenation that correlate with hyperventilation but not endurance exercise time. These findings complement the physiological characterization of the cerebral vascular responses to exercise in PAH patients.

Analyse de minimisation de coût des fournitures utilisées pour la préparation et l'administration d'une dose d'antinéoplasique en établissement de santé.

BACKGROUND: Many strategies aim to reduce the risk of work-related exposure to hazardous drugs for health care workers; these strategies include the use of specific systems to prepare and administer these drugs. OBJECTIVE: To compare the cost of supplies used for preparing and administering one IV dose of antineoplastic in an adult health care facility in Canada between the traditional approach and one using a closed-system drug transfer device (CSTD). METHOD: This study was a cost reduction analysis conducted from the perspective of a typical university health care facility. The assessment focused only on the cost of supplies used to prepare and administer one IV dose of antineoplastic. It was not necessary to account for discounting. We developed 12 scenarios involving some of the 11 possible steps in preparing and administering one IV dose of antineoplastic. RESULTS: The cost of supplies used to prepare and administer one IV dose of antineoplastic ranged between $9.89 and $22.37 per dose with the classical system, and between $12.34 and $64.19 per dose for systems involving a CSTD. The annual average extra cost of systems involving a CSTD was 1.63 to 3.15 higher than the cost with the classical system and represents extra spending of between $363 566 and $1 238 072 each year for a typical adult health care institution. CONCLUSION: This cost reduction analysis presents original data relating to the preparation and administration of IV antineoplastics. Given the significant costs associated with preparing and administering antineoplastic drugs, decision-makers should perform a thorough analysis of costs and consequences to allow informed decisions to be made.

From theory to practice: implementing a standardized, interactive education session on oral anticancer medication (OAM) for patients and their caregivers.

PURPOSE: Self-administration at home and decreased visits to see health care professionals bring patients on oral anticancer medication (OAM) and their caregivers to become experts in handling medication, managing adverse events, and making sure that they adhere to treatment. This project aimed to implement a standardized education group session for patients starting an OAM regimen and their caregivers that would build new knowledge, validate comprehension of information, increase satisfaction, and empower participants in self-management. MATERIALS AND METHODS: A group session led by an oncology nurse was developed. The theoretical section consisted of short videos that include both verbal and visual explanations. The practical component consisted of quizzes with electronic recordings and instant answers. Turning Point technology was used to compile and analyze the data. RESULTS: Over a 2-year period, 124 patients and 79 caregivers participated in the group sessions. More than 111 h were saved by giving standardized group sessions instead of individual teachings. The participants' level of confidence regarding the essential concepts to master significantly increased following the group sessions. The results ranged from 18% of participants who answered 4 or 5 on a five-point Likert-type scale before the session to 100% who answered 4 or 5 after the group session. 94% of participants responded with a rating of 4 or 5 when asked if they were satisfied with the overall interactive group session. CONCLUSION: It is crucial that caregivers participate in the initial OAM teaching. The involvement of the interdisciplinary team was crucial in meeting the informational needs of patients. A standardized group session accessible for viewing and use by all health care professionals and patients simplifies the process of sharing high-quality learning materials in a technological society.

Compromised Cerebrovascular Regulation and Cerebral Oxygenation in Pulmonary Arterial Hypertension.

BACKGROUND: Functional cerebrovascular regulatory mechanisms are important for maintaining constant cerebral blood flow and oxygen supply in heathy individuals and are altered in heart failure. We aim to examine whether pulmonary arterial hypertension (PAH) is associated with abnormal cerebrovascular regulation and lower cerebral oxygenation and their physiological and clinical consequences. METHODS AND RESULTS: Resting mean flow velocity in the middle cerebral artery mean flow velocity in the middle cerebral artery (MCAvmean); transcranial Doppler), cerebral pressure-flow relationship (assessed at rest and during squat-stand maneuvers; analyzed using transfer function analysis), cerebrovascular reactivity to CO2, and central chemoreflex were assessed in 11 patients with PAH and 11 matched healthy controls. Both groups also completed an incremental ramp exercise protocol until exhaustion, during which MCAvmean, mean arterial pressure, cardiac output (photoplethysmography), end-tidal partial pressure of CO2, and cerebral oxygenation (near-infrared spectroscopy) were measured. Patients were characterized by a significant decrease in resting MCAvmean (P<0.01) and higher transfer function gain at rest and during squat-stand maneuvers (both P<0.05). Cerebrovascular reactivity to CO2 was reduced (P=0.03), whereas central chemoreceptor sensitivity was increased in PAH (P<0.01), the latter correlating with increased resting ventilation (R2=0.47; P<0.05) and the exercise ventilation/CO2 production slope (V˙E/V˙CO2 slope; R2=0.62; P<0.05) during exercise for patients. Exercise-induced increases in MCAvmean were limited in PAH (P<0.05). Reduced MCAvmean contributed to impaired cerebral oxygen delivery and oxygenation (both P<0.05), the latter correlating with exercise capacity in patients with PAH (R2=0.52; P=0.01). CONCLUSIONS: These findings provide comprehensive evidence for physiologically and clinically relevant impairments in cerebral hemodynamic regulation and oxygenation in PAH.

Impact of type 2 diabetes on cardiorespiratory function and exercise performance.

The aim of this study was to examine the impact of well-controlled uncomplicated type 2 diabetes (T2D) on exercise performance. Ten obese sedentary men with T2D and nine control participants without diabetes matched for age, sex, and body mass index were recruited. Anthropometric characteristics, blood samples, resting cardiac, and pulmonary functions and maximal oxygen uptake (VO2max) and ventilatory threshold were measured on a first visit. On the four subsequent visits, participants (diabetics: n = 6; controls: n = 7) performed step transitions (6 min) of moderate-intensity exercise on an upright cycle ergometer from unloaded pedaling to 80% of ventilatory threshold. VO2 (τVO2) and HR (τHR) kinetics were characterized with a mono-exponential model. VO2max (27.0 ± 3.4 vs. 26.7 ± 5.0 mL kg-1 min-1; P = 0.85), τVO2 (43 ± 6 vs. 43 ± 10 sec; P = 0.73), and τHR (42 ± 17 vs. 43 ± 13 sec; P = 0.94) were similar between diabetics and controls respectively. The remaining variables were also similar between groups, with the exception of lower maximal systolic blood pressure in diabetics (P = 0.047). These results suggest that well-controlled T2D is not associated with a reduction in VO2max or slower τVO2 and τHR.