Reproducibility of F18-FDG PET radiomic features for different cervical tumor segmentation methods, gray-level discretization, and reconstruction algorithms.

Site-specific investigations of the role of radiomics in cancer diagnosis and therapy are emerging. We evaluated the reproducibility of radiomic features extracted from 18 Flourine-fluorodeoxyglucose (18 F-FDG) PET images for three parameters: manual versus computer-aided segmentation methods, gray-level discretization, and PET image reconstruction algorithms. Our cohort consisted of pretreatment PET/CT scans from 88 cervical cancer patients. Two board-certified radiation oncologists manually segmented the metabolic tumor volume (MTV1 and MTV2 ) for each patient. For comparison, we used a graphical-based method to generate semiautomated segmented volumes (GBSV). To address any perturbations in radiomic feature values, we down-sampled the tumor volumes into three gray-levels: 32, 64, and 128 from the original gray-level of 256. Finally, we analyzed the effect on radiomic features on PET images of eight patients due to four PET 3D-reconstruction algorithms: maximum likelihood-ordered subset expectation maximization (OSEM) iterative reconstruction (IR) method, fourier rebinning-ML-OSEM (FOREIR), FORE-filtered back projection (FOREFBP), and 3D-Reprojection (3DRP) analytical method. We extracted 79 features from all segmentation method, gray-levels of down-sampled volumes, and PET reconstruction algorithms. The features were extracted using gray-level co-occurrence matrices (GLCM), gray-level size zone matrices (GLSZM), gray-level run-length matrices (GLRLM), neighborhood gray-tone difference matrices (NGTDM), shape-based features (SF), and intensity histogram features (IHF). We computed the Dice coefficient between each MTV and GBSV to measure segmentation accuracy. Coefficient values close to one indicate high agreement, and values close to zero indicate low agreement. We evaluated the effect on radiomic features by calculating the mean percentage differences (d¯) between feature values measured from each pair of parameter elements (i.e. segmentation methods: MTV1 -MTV2 , MTV1 -GBSV, MTV2 -GBSV; gray-levels: 64-32, 64-128, and 64-256; reconstruction algorithms: OSEM-FORE-OSEM, OSEM-FOREFBP, and OSEM-3DRP). We used |d¯| as a measure of radiomic feature reproducibility level, where any feature scored |d¯| ±SD ≤ |25|% ± 35% was considered reproducible. We used Bland-Altman analysis to evaluate the mean, standard deviation (SD), and upper/lower reproducibility limits (U/LRL) for radiomic features in response to variation in each testing parameter. Furthermore, we proposed U/LRL as a method to classify the level of reproducibility: High- ±1% ≤ U/LRL ≤ ±30%; Intermediate- ±30% < U/LRL ≤ ±45%; Low- ±45 < U/LRL ≤ ±50%. We considered any feature below the low level as nonreproducible (NR). Finally, we calculated the interclass correlation coefficient (ICC) to evaluate the reliability of radiomic feature measurements for each parameter. The segmented volumes of 65 patients (81.3%) scored Dice coefficient >0.75 for all three volumes. The result outcomes revealed a tendency of higher radiomic feature reproducibility among segmentation pair MTV1 -GBSV than MTV2 -GBSV, gray-level pairs of 64-32 and 64-128 than 64-256, and reconstruction algorithm pairs of OSEM-FOREIR and OSEM-FOREFBP than OSEM-3DRP. Although the choice of cervical tumor segmentation method, gray-level value, and reconstruction algorithm may affect radiomic features, some features were characterized by high reproducibility through all testing parameters. The number of radiomic features that showed insensitivity to variations in segmentation methods, gray-level discretization, and reconstruction algorithms was 10 (13%), 4 (5%), and 1 (1%), respectively. These results suggest that a careful analysis of the effects of these parameters is essential prior to any radiomics clinical application.

Improved class preparation and learning through immediate feedback in group testing for undergraduate nursing students.

PURPOSE: A mixed-method educational evaluation project to increase learning through testing was conducted in a required senior nursing course. METHOD: The Immediate Feedback Assessment Technique (IF-AT) was used to motivate preparation for optimal final examination performance. Students took multiple-choice final exams in small groups, used critical thinking and collaboration to select best answers, and then used scratch-off answer sheets indicating correct answers. A causal-comparative evaluation design was used to assess effectiveness of the IF-AT technique in improving learning as measured by final exam scores compared with results of traditional individual multiple-choice final exams. FINDINGS: Results indicated that the IF-AT format was significantly more effective than traditional testing in enhancing learning. CONCLUSION: Descriptive and qualitative evaluation data from students indicated students increased their learning, engaged in critical thinking, and prepared adequately for the exam. Students evaluated the test method as superior to standard testing. Implementation information is included.

Health promotion through forgiveness intervention.

The purpose of this article is to offer evidence-based forgiveness interventions clinically useful to nurses in holistic health promotion for individuals, families, and communities. Forgiveness interventions are developed and described within four approaches inspired by midrange nursing theorists who have adapted their theories from Bandura's Social Learning Theory and Frankl's Theory of Meaning. Interventions are also assimilated from a comprehensive review of theoretical and research literature. The four interventional approaches include persuasive information, vicarious experience, awareness of physiological reactions, and enactive attainment. Barriers to implementation are discussed as well as ways to individualize the interventions.

Toward a trajectory of adjustment in women with end-stage renal disease on haemodialysis.

AIMS: To examine the lived experiences of community-dwelling women with end-stage renal disease undergoing haemodialysis treatment. BACKGROUND: End-stage renal disease is a chronic progressive disease with renal transplantation as a major treatment option. However, the majority of patients choose haemodialysis as their primary treatment. In this disease, many changes occur in the body that demand adjustment in every aspect of these patients' lives. The turbulent trajectory of adjusting to this disease and treatment has been under-researched. Given the increased number of patients requiring haemodialysis, a fuller understanding of the experienced disease course is essential in guiding clinical efforts. METHOD: Descriptive phenomenology was used as it suited the purpose of this study. DESIGN: Sixteen adult women from two large haemodialysis centres in a large Midwestern city in the USA were interviewed. All data were analysed using Colaizzi's methodological interpretation. FINDINGS: Three major themes emerged supporting a possible adjustment trajectory: initiation-the initial phase of adjustment; appreciation-the middle phase of appreciating haemodialysis treatment; and grappling-the later phase of dealing with adverse effects from haemodialysis. The findings, however, suggest that experiences in the adjustment trajectory are interwoven, circular and ongoing, rather than linear. CONCLUSION: More research is needed in this under-researched area to guide practice for meeting the demands of this growing patient population. RELEVANCE TO CLINICAL PRACTICE: These results provide knowledge that can assist nurses to implement care that is tailored to support adjustment, thus minimizing setbacks and improving patients' well-being.

Women's experience of spirituality within end-stage renal disease and hemodialysis.

The purpose of this descriptive, phenomenological qualitative study is to describe women's lived experiences of spirituality within end-stage renal disease (ESRD) and hemodialysis. The purposive volunteer sample of 16 women regularly attended two outpatient dialysis centers in a large Midwestern city. Audiotaped, transcribed interviews were analyzed using Colaizzi's method. These women affirmed that spirituality was extremely important in living with their illness and necessary treatment regime. Four major clusters of themes pertaining to the women's spiritual experience within their illness emerged: acceptance, understanding, fortification, and emotion modulation. Findings show that spirituality is of great importance in living with ESRD while receiving hemodialysis and suggest that spirituality may be a significant consideration in nursing and interdisciplinary health care. These findings may be used to improve holistic nursing practice and education in related areas.

Concept analysis of forgiveness with a multi-cultural emphasis.

AIM: This paper is a report of a concept analysis of forgiveness. BACKGROUND: Worldwide interest in and funding for forgiveness research has brought about a body of knowledge from many disciplines that could be clinically useful to nursing. At this time, nurse scholars are beginning to challenge one another to focus on this important area of inquiry. To date, however, most scholarship on forgiveness has been conducted in related disciplines, rather than in nursing. Conceptual and theoretical work is needed in nursing to promote knowledge development in this area. METHOD: The CINAHL, Medline and PsycInfo databases were searched for papers published between 1990 and 2007 using the keywords, forgiveness, forgive, or reconciliation in the title or abstract. The non-linear evolutionary process of concept analysis was used to identify the concept of interest, its origins, realm, attributes and context, characteristics, and implications. Forgiveness was also explored from an international multi-cultural perspective. An exemplar is included to illuminate the concept. A total of 34 scholarly works from a variety of disciplines were included in the analysis. FINDINGS: A definition of forgiveness emerged from the analysis, as well as a multi-cultural understanding of the concept. Three important attributes of forgiveness are that it is the relinquishing of a negative response, replacing the negative response with a benevolent response, and a process that occurs over time. Multi-cultural attributes centre on group harmony, re-establishing harmonious connections between people, and the morality of considering others as worthy of love and understanding. CONCLUSION: A multi-cultural understanding of forgiveness may provide the impetus for further theory development and research in nursing, and could be used to educate nurses on beginning interventions in this area.

Spirituality in African American and Caucasian women with end-stage renal disease on hemodialysis treatment.

This reanalysis of data from a previous investigation in the United States was conducted to compare spiritual well-being scores of African American (n = 31) and Caucasian (n = 27) women on hemodialysis for end-stage renal disease (ESRD). Women, aged 24 to 79, completed the spiritual well-being (SWB) scale and other instruments. Results indicated a strong trend for African American women to score higher on religious well-being than Caucasian women. Comparisons of SWB item scores indicated areas of spiritual strengths for African American women: perceptions of God's concern for them, God's help with loneliness, fulfilling relationship with God, satisfaction with life, and sense of life's purpose. These findings have multidisciplinary implications for factors that may mitigate the illeffects of ESRD.

Perceptions of incorporating spirituality into their care: a phenomenological study of female patients on hemodialysis.

This phenomenological study was aimed at understanding how women with end stage renal disease undergoing hemodialysis want nurses to address their spirituality. Interviews were conducted with 16 women from outpatient hemodialysis centers in a large Midwestern city. Eighty-three significant statements yielded meanings representing four theme clusters, highlighting how these women prefer nurses to incorporate spirituality into their care: (a) displaying genuine caring, (b) building relationships and connectedness, (c) initiating spiritual dialogue, and (d) mobilizing spiritual resources. Participants expressed that nephrology nurses are uniquely positioned to understand their individualized spiritual needs and implement spiritual care.

Coming to the cultural "in-between": nursing insights from a Hmong birth case study.

This article discusses the historical background and traditional beliefs of the Hmong. Cultural conflict occurs when traditional Hmong beliefs and Western health care ideologies are misunderstood. A specific case study focuses on care of a Hmong woman and her husband after a precipitous birth, hemorrhage, and surgical intervention. Nursing insights are identified from "in-between" the cultures. Establishing cultural awareness is an essential first step toward cultural competence.

Adjustment, spirituality, and health in women on hemodialysis.

End stage renal disease (ESRD) is progressive, requiring adjustment. This descriptive correlational study examined levels of and relationships between adjustment, spiritual well-being, and self-perceived health in women with ESRD. The sample included 65 women aged 24 to 82 receiving hemodialysis at five outpatient centers in a large metropolitan area. Frequencies, central tendencies, and correlations were used for analyses. Overall, these women were fairly well adjusted as measured by the Psychosocial Adjustment to Illness Scale-Self-Report. They demonstrated fairly high levels of religious, existential, and overall spiritual well-being. Self-perceived health was good Spiritual well-being variables were all positively and significantly related to overall psychosocial adjustment and psychological distress adjustment. Self-perceived health variables were all positively and significantly related to overall psychosocial adjustment. Few significant relationships were found between spiritual well-being and other adjustment domains and between self-perceived health and other types of adjustment.