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1.
Rehabil Nurs ; 47(2): 50-59, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35234405

RESUMEN

PURPOSE: The aim of this study was to examine a fatigue model for older individuals based on the theory of unpleasant symptoms. RESEARCH DESIGN: The research design used was a secondary data analysis of the "Patient-Reported Outcomes Measurement Information System Profiles-Health Utilities Index" data set. METHODS: Multiple regression analysis and path analyses were used to examine hypothesized model paths. RESULTS: A number of comorbidities, pain, sleep, depression, anxiety, education, and sensory impairment were significant predictors of fatigue. Higher fatigue scores predicted lower physical, social, and cognitive performances, as well as worse perceived health and quality of life (QOL). In addition, the identified fatigue outcomes mediated the relationship between fatigue and QOL. CONCLUSIONS: Future research should be directed toward exploring other risk factors of fatigue and examining feedback loops depicted in the theory of unpleasant symptoms. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses should closely monitor and manage the identified fatigue-influencing factors to improve older individuals' performance, perceived health, and QOL.


Asunto(s)
Fatiga , Calidad de Vida , Anciano , Ansiedad/etiología , Depresión/complicaciones , Depresión/psicología , Fatiga/complicaciones , Humanos , Dolor , Sueño
2.
Cancer Res Treat ; 2022 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-35287254

RESUMEN

Purpose: In the treatment of concurrent chemoradiotherapy (CCRT) in limited-stage small cell lung cancer, the optimal once-daily radiotherapy (RT) dose/fractionation remain unclear although it is the most frequently used. Therefore, this study aimed to compare the treatment outcomes and toxicities of modest dose RT (≤54 Gy) with those of standard dose RT (>54 Gy) and investigate the benefit of the high dose based on patient factors. Materials and Methods: Since 2004, our institution has gradually increased the thoracic RT dose. Among the 225 patients who underwent CCRT, 84 patients (37.3%) received >54 Gy. Because the patients treated with RT > 54 Gy were not randomly assigned, propensity score matching (PSM) was performed. Results: The proportion of patients treated with >54 Gy increased over time (p=0.014). Multivariate analysis revealed that the overall tumor stage and dose > 54 Gy (hazard ratio 0.65, p=0.029) were independent prognostic factors for overall survival (OS). PSM confirmed that thoracic RT doses of >54 Gy showed significantly improved progression-free survival (3-year 42.7% vs 24.0%, p < 0.001) and OS (3-year 56.2% vs 38.5%, p=0.003). Sensitivity analysis also showed that 60 Gy resulted in better survival than 54 Gy. However, in patients with underlying lung disease, OS benefit from >54 Gy was not observed but considerable rates of severe pulmonary toxicities were observed (p=0.001). Conclusion: Our analysis supports that the 60 Gy RT dose should be considered in the once-daily regimen of CCRT for limited-stage small cell lung cancer without underlying lung disease, but RT dose > 54 Gy did not seem to benefit for patients with chronic obstructive pulmonary disease or interstitial lung disease. Further study is needed to validate these results.

3.
Issues Ment Health Nurs ; : 1-8, 2022 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-35025714

RESUMEN

Psychiatric boarding in an emergency department (ED) has personal and social consequences that can increase healthcare expenditure through a variety of inter-related mechanisms. This study aimed to compare health outcomes (e.g., length of stays, the severity of illness) between patients who stayed in an emergency department and those who did not visit an emergency department before the hospitalization. With the National Inpatient Sample dataset in the United States, we compared psychiatric inpatient service utilization outcomes between those who had stated in an emergency department and those who had not. Results: Among those with ED visits, the in-hospital mortality was 0.80 times lower (95% CI: 0.79-0.81). The length of hospital stays and the total charges were not significantly different from those without ED visits. The integration of primary care with psychiatric inpatient services can improve the management of psychiatric prevention and treatment, with the reduction of ED visits. This study provides an essential value in reducing emergency visits as the plan for psychiatric inpatient utilization to achieve more cost-effective and adequate healthcare outcomes.

4.
Cancer Nurs ; 44(6): E414-E428, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34694086

RESUMEN

BACKGROUND: Physical activity (PA) has been shown to improve total mortality and colorectal-specific mortality risk; however, colorectal cancer (CRC) survivors have lower rates of PA compared with survivors with other types of cancers. OBJECTIVE: To examine the effect of PA interventions on CRC survivors. METHODS: A systematic review and meta-analysis were conducted to identify randomized controlled trials that met the inclusion criteria, which included an intervention designed to increase PA and more than 1 outcome of interest. Random effects of the meta-analyses were performed using Review Manager 5.3. RESULTS: Eight publications representing 7 randomized controlled trials of 803 participants were identified. All studies used a combination of behavioral change methods. Physical activity interventions significantly improved disease-specific quality of life, PA level, and maximum amount of oxygen and did not show significant improvements for fatigue and body mass index among CRC survivors. CONCLUSIONS: We provided evidence that PA interventions were effective in improving disease-specific quality of life, PA level, and maximum amount of oxygen; however, they did not improve fatigue and body mass index. Further randomized controlled trials are needed to determine the optimal mode of delivering PA intervention for CRC survivors. IMPLICATIONS FOR PRACTICE: As the survival rate of patients with CRC increases, survivors of CRC need to increase PA in a community setting after completing primary treatments. Effective and efficient modes of PA intervention delivery could improve health-related outcomes and address specific barriers for CRC survivors.


Asunto(s)
Neoplasias Colorrectales , Calidad de Vida , Ejercicio Físico , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sobrevivientes
5.
Artículo en Inglés | MEDLINE | ID: mdl-34639657

RESUMEN

Marijuana is the most common illicit substance globally. The rate of marijuana use is increasing in young adults in the US. The current environment of legalizing marijuana use is further contributing to an increase of users. The purpose of this study was to explore the characteristics of adults who abuse marijuana (20-49 years old) and analyze behavior and social relation variables related to depression and suicide risk using machine-learning algorithms. A total of 698 participants were identified from the 2019 National Survey on Drug Use and Health survey as marijuana dependent in the previous year. Principal Component Analysis and Chi-square were used to select features (variables) and mean imputation method was applied for missing data. Logistic regression, Random Forest, and K-Nearest Neighbor machine-learning algorithms were used to build depression and suicide risk prediction models. The results showed unique characteristics of the group and well-performing prediction models with influential risk variables. Identified risk variables were aligned with previous studies and suggested the development of marijuana abuse prevention programs targeting 20-29 year olds with a regular depression and suicide screening. Further study is suggested for identifying specific barriers to receiving timely treatment for depression and suicide risk.


Asunto(s)
Cannabis , Abuso de Marihuana , Fumar Marihuana , Uso de la Marihuana , Adulto , Humanos , Aprendizaje Automático , Abuso de Marihuana/epidemiología , Uso de la Marihuana/epidemiología , Persona de Mediana Edad , Adulto Joven
6.
Nurs Educ Perspect ; 42(5): 315-317, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34310479

RESUMEN

ABSTRACT: Successful transition to an academic nurse educator role is challenging; it is necessary to identify facilitators and barriers that aide or hinder this process. This study used an autoethnographic qualitative design to explore the lived experiences of a cohort of faculty during their transition into a tenure-track role. Three facilitators (noncompetitive environment, resource sharing, and cohort approach) and two barriers (work-life balance and intrusion of old habits) emerged as themes. A cohort model can be a valuable facilitator for a successful transition. Multitiered mentoring further aided in the transition.


Asunto(s)
Tutoría , Logro , Estudios de Cohortes , Docentes de Enfermería , Humanos , Mentores
7.
Nurse Educ Today ; 103: 104961, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34049121

RESUMEN

BACKGROUND: Exam wrapper, a structured self-regulated learning strategy, assists students to review study habits and performance on an exam with the goal of improving future study habits. Little is known about the use of this strategy in nursing students, particularly associate degree students. OBJECTIVES: To describe and compare demographic characteristics, study habits, reasons for getting content wrong on an exam and future study plans between associate degree and baccalaureate nursing students. DESIGN: A cross sectional, descriptive comparative study of exam wrapper use in associate degree and baccalaureate nursing students. SETTINGS: A medium-sized public university and small private college in the northeastern United States. PARTICIPANTS: A convenience sample 102 prelicensure baccalaureate (n = 63) and associate degree (n = 39) nursing students. Mean age of 21.9 ± 5.6, GPA of 3.46 ± 0.38, 7% male, 57% commuter students, 75% employed an average of 14 ± 11.4 h per week. METHODS: Data were collected by course faculty during an in-class exam review following a multiple-choice examination. Students completed a demographic form and exam wrapper that assessed pre-exam study habits, reasons for getting items wrong on an exam and future study habits. RESULTS: Associate degree students had lower GPAs (3.19 vs 3.57, p = .000), were older (27 vs 19.2, p = .000), more often commuted (100% vs 31%, p = .000), were employed (95% vs 65%, p < .001), were more likely to study at home (39.5% vs 13.1%, p = .000) and spent significantly longer on each study activity (p = .000) than baccalaureate students. When comparing reasons for getting a question wrong and intended study habits, baccalaureate and associate degree students did not differ. CONCLUSIONS: Use of the exam wrapper strategy allows nursing students at all levels of prelicensure education to actively reflect upon their learning with the goal of improving future learning.


Asunto(s)
Bachillerato en Enfermería , Estudiantes de Enfermería , Estudios Transversales , Graduación en Auxiliar de Enfermería , Femenino , Humanos , Masculino , New England
8.
J Appl Clin Med Phys ; 22(3): 86-93, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33522671

RESUMEN

INTRODUCTION: We investigated the correlation between optical surface imaging using a three-dimensional (3D) scanner and magnetic resonance imaging (MRI) for suggesting feasibility in the clinical process of tracking volume changes in head and neck patients during radiation treatment. METHODS: Ten patients were divided into two groups depending on the location of their tumor (i.e., right or left side). With weekly imaging data, the change in volume based on MRI was evaluated during the treatment course. Four volumes of interest (VOIs) were calculated on the 3D surface image of the facial and cervical areas using an optical 3D scanner, and the correlation between volumetric parameters were analyzed. RESULTS: The target volume changed significantly overall for both groups. The changes parotid volume reduced by up to 3.8% and 28.0% for groups A (right side) and B (left side), respectively. In Group A, VOI 1 on the facial area and VOI 3 on the cervical area decreased gradually during the treatment course by up to 3.3% and 10.7%, respectively. In Group B, only VOI 4 decreased gradually during the treatment course and reduced by up to 9.2%. In group A, the change in target volume correlated strongly with right-side parotid, VOI 1, and VOI 3, respectively. The parotid also showed strong correlations with VOIs (P < 0.01). The weight loss was strongly correlated with either PTV or parotid without statistical significance (P > 0.05). In group B (left side), the change in target volume correlated strongly with each volumetric parameter, including weight loss. For individual patient, PTV showed more correlation with VOIs on the cervical area than VOIs on the facial area. CONCLUSIONS: An optical 3D scanner can be applied to track changes in volume without radiation exposure during treatment and the optical surface image correlated with MRI.


Asunto(s)
Neoplasias de Cabeza y Cuello , Imagenología Tridimensional , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Imagen por Resonancia Magnética , Cuello , Glándula Parótida
9.
In Vivo ; 34(5): 2955-2965, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32871838

RESUMEN

BACKGROUND/AIM: A noninvasive method for predicting a patient's response to neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer would be useful because this would help determine the subsequent treatment strategy. Two types of noninvasive biomarkers have previously been studied, based on radiomics and based on blood test parameters. We hypothesized that a combination of both types would provide a better predictive power, and this has not previously been investigated. PATIENTS AND METHODS: Data from 135 patients with locally advanced rectal cancer who underwent nCRT were retrospectively allocated into training and validation cohorts in a 2:1 ratio. Sixty-five radiomics features were extracted from tumors segmented on T2-weighted magnetic resonance images. An elastic net was applied to generate four models for discerning the patients with good responses to nCRT based on radiomics features (model R), blood biomarkers (model B), both (model RB), and a linear combination of models R and B (model R+B). RESULTS: Among 65 radiomics features, 17 were selected as robust features for model development. The AUC values of model R, model B, model RB, and model R+B achieved 0.751, 0.627, 0.785, and 0.711 in the training cohort (n=90), and 0.705, 0.603, 0.679, and 0.705 in validation cohort (n=45), respectively. In the entire cohort, models RB and R+B demonstrated a significantly better performance than model B but not R. There was no correlation between the scores of models R and B (p=0.76). Radiomics features had a greater influence than blood biomarkers on models RB and R+B. CONCLUSION: A non-redundancy between radiomics features and blood-based biomarkers was observed. Furthermore, radiomics features are more valuable in terms of predicting response to nCRT. The importance of combining non-invasive biomarkers in future investigations is highlighted.


Asunto(s)
Neoplasias del Recto , Biomarcadores , Pruebas Hematológicas , Humanos , Curva ROC , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/terapia , Estudios Retrospectivos
10.
Br J Radiol ; 93(1110): 20200047, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32187503

RESUMEN

OBJECTIVE: To analyze the effect of intra- and interfractional motion during breast intensity modulated radiation therapy (IMRT) by calculating dose distribution based on four-dimensional computed tomography (4DCT). METHODS: 20 patients diagnosed with left breast cancer were enrolled. Three-dimensional CT (3DCT) along with 10 phases of 4DCT were collected for each patient, with target volumes independently delineated on both 3DCT and all phases of 4DCT. IMRT plans were generated based on 3DCT (43.2 Gy in 16 fractions). The plan parameters for each segment were split into phases based on time duration estimates for each respiratory phase, with phase-specific dose distributions calculated and summated (4D-calculated dose). The procedure is repeated for 16 fractionations by randomly allocating starting phase using random-number generation to simulate interfractional discrepancy caused by different starting phase. Comparisons of plan quality between the original and 4D-calculated doses were analyzed. RESULTS: There was a significant distortion in 4D-calculated dose induced by respiratory motion in terms of conformity and homogeneity index compared to those of the original 3D plan. Mean doses of the heart and the ipsilateral lung were significantly higher in the 4D-calculated doses compared to those of the original 3D plan (0.34 Gy, p = 0.010 and 0.59 Gy, p < 0.001), respectively). The mean internal mammary lymph node (IMN) dose was significantly greater in the 4D-calculated plan, compared to the original 3D plan (1.42 Gy, p < 0.001). CONCLUSIONS: IMN doses should be optimized during the dose-calculation for the free-breathing left breast IMRT. ADVANCES IN KNOWLEDGE: The interplay effect between respiratory motion and multileaf collimator modulation caused discrepancies in dose distribution, particularly in IMN.


Asunto(s)
Tomografía Computarizada Cuatridimensional , Imagenología Tridimensional/métodos , Radioterapia de Intensidad Modulada , Neoplasias de Mama Unilaterales/diagnóstico por imagen , Neoplasias de Mama Unilaterales/radioterapia , Fraccionamiento de la Dosis de Radiación , Femenino , Corazón , Humanos , Pulmón , Irradiación Linfática/métodos , Movimientos de los Órganos , Planificación de la Radioterapia Asistida por Computador , Radioterapia Ayuvante/métodos , Respiración , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Neoplasias de Mama Unilaterales/cirugía
12.
Radiother Oncol ; 143: 81-87, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32044172

RESUMEN

PURPOSE: To identify risk factors for developing symptomatic brain metastases and evaluate the impact of prophylactic cranial irradiation (PCI) on brain metastasis-free survival (BMFS) and overall survival (OS) in extensive disease small cell lung cancer (ED-SCLC). MATERIALS AND METHODS: Among 190 patients diagnosed with ED-SCLC who underwent FDG PET/CT and brain Magnetic Resonance Imaging (MRI) prior to treatment, 53 (27.9%) received PCI while 137 (72.1%) did not. Prognostic index predicting a high risk of symptomatic brain metastases was calculated for the group without receiving PCI (observation group, n = 137) with Cox regression model. RESULTS: Median follow-up time was 10.6 months. Multivariate Cox regression showed that the following three factors were associated with a high risk of symptomatic brain metastases: the presence of extrathoracic metastases (p = 0.004), hypermetabolism of bone marrow or spleen on FDG PET (p < 0.001), and high neutrophil-to-lymphocyte ratio (p = 0.018). PCI significantly improved BMFS in high-risk patients (1-year rate: 94.7% vs. 62.1%, p = 0.001), but not in low-risk patients (1-year rate: 100.0% vs. 87.7%, p = 0.943). However, PCI did not improve OS in patients at high risk for symptomatic brain metastases (1-year rate: 65.2% vs. 50.0%, p = 0.123). CONCLUSION: Three prognostic factors (the presence of extrathoracic metastases, hypermetabolism of bone marrow or spleen on FDG PET, and high neutrophil-to-lymphocyte ratio) were associated with a high risk of symptomatic brain metastases in ED-SCLC. PCI was beneficial for patients at a high risk of symptomatic brain metastases in terms of BMFS, but not OS. Thus, selective use of PCI in ED-SCLC according to the risk stratification is recommended.


Asunto(s)
Neoplasias Encefálicas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células Pequeñas , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/radioterapia , Irradiación Craneana , Fluorodesoxiglucosa F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/radioterapia , Tomografía Computarizada por Tomografía de Emisión de Positrones , Medición de Riesgo , Carcinoma Pulmonar de Células Pequeñas/diagnóstico por imagen , Carcinoma Pulmonar de Células Pequeñas/radioterapia
13.
Nurse Educ Today ; 85: 104303, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31785574

RESUMEN

BACKGROUND AND PURPOSE: Despite the rapid growth in offering online RN-to-BSN programs, limited information is available on student perception of online courses. The aims were to develop and to evaluate Student Perceptions of an Online Course (SPOC) scale. METHODS: A quantitative study using a two-phase methodological design was applied. A convenience sample of 201 RN-to-BSN students was used to establish internal consistency and evidence of validity including exploratory factor analyses. RESULTS: Three factors of student engagement, organization, and resources were verified. The overall SPOC had high reliability with Cronbach's alpha =0.98. CONCLUSIONS: The SPOC is valid and reliable. It can be used in research and quality assurance/improvement work on the delivery of online nursing education.


Asunto(s)
Educación a Distancia/normas , Percepción , Estudiantes de Enfermería/psicología , Estudios Transversales , Educación a Distancia/métodos , Educación a Distancia/estadística & datos numéricos , Educación en Enfermería/métodos , Educación en Enfermería/normas , Educación en Enfermería/estadística & datos numéricos , Humanos , Medio Oeste de Estados Unidos , Proyectos Piloto , Psicometría/instrumentación , Psicometría/métodos , Estudiantes de Enfermería/estadística & datos numéricos
14.
J Appl Res Intellect Disabil ; 32(6): 1501-1513, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31318122

RESUMEN

BACKGROUND: Negative healthcare provider attitudes may contribute to healthcare disparities in adults with intellectual disabilities. This study identified predictors of nurses' attitudes and emotions toward caring for adults with intellectual disabilities in the United States. METHOD: A convenience sample of 248 nurses was used to collect nurses' attitudes and emotions toward caring for adults with intellectual disabilities (Adapted Caring for Adults with Disabilities Questionnaire) and quality of life beliefs (Prognostic Beliefs Scale). RESULTS: Overall, nurses held less positive attitudes toward caring for an adult with intellectual disability versus a physical disability. Intellectual disability nurses held more positive attitudes and emotions and less negative emotions than non-intellectual disability nurses. Quality of life beliefs predicted nurse attitude, positive emotions and negative emotions. The number of adults with intellectual disabilities cared for during the nurse's career predicted negative emotions. CONCLUSIONS: Future interventions should focus on improving nurses' understanding of the quality of life of adults with intellectual disabilities.


Asunto(s)
Actitud del Personal de Salud , Emociones , Discapacidad Intelectual/enfermería , Enfermeras y Enfermeros/psicología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Especialidades de Enfermería , Adulto Joven
15.
J Nurs Educ ; 58(7): 417-421, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31242311

RESUMEN

BACKGROUND: An exam wrapper is a structured debriefing questionnaire designed to help students understand examination performance and develop improvement strategies. This mixed-methods pilot study sought to examine its impact on students' metacognitive skills in a fundamentals nursing class and to assess student perceptions of its usefulness. METHOD: Metacognition was assessed using the Metacognitive Inventory for Nursing Students. Quantitative data were analyzed using the nonparametric Friedman test. Qualitative data were taken from four focus groups. RESULTS: Students who used the exam wrapper throughout the semester demonstrated significant improvement in metacognition over time (p = .014). Focus group data revealed that students did not find the exam wrapper to be helpful. The analysis revealed three themes: Reliance on Faculty, Overlap With Established Self-Regulated Learning Strategies, and Difficulty in Answering Exam Wrapper Questions. CONCLUSION: Although students may not perceive this tool as useful, those who repeatedly used it over time had increased metacognition. [J Nurs Educ. 2019;58(7):417-421.].


Asunto(s)
Actitud , Educación en Enfermería/métodos , Evaluación Educacional/métodos , Metacognición , Estudiantes de Enfermería/psicología , Femenino , Humanos , Masculino , Proyectos Piloto , Adulto Joven
16.
Radiat Oncol ; 14(1): 43, 2019 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-30866965

RESUMEN

BACKGROUND: To develop and compare delta-radiomics signatures from 2- (2D) and 3-dimensional (3D) features that predict treatment outcomes following preoperative chemoradiotherapy (CCRT) and surgery for locally advanced rectal cancer. METHODS: In total, 101 patients (training cohort, n = 67; validation cohort, n = 34) with locally advanced rectal adenocarcinoma between 2008 and 2015 were included. We extracted 55 features from T2-weighted magnetic resonance imaging (MRI) scans. Delta-radiomics feature was defined as the difference in radiomics feature before and after CCRT. Signatures were developed to predict local recurrence (LR), distant metastasis (DM), and disease-free survival (DFS) from 2D and 3D features. The least absolute shrinkage and selection operator regression was used to select features and build signatures. The delta-radiomics signatures and clinical factors were integrated into Cox regression analysis to determine if the signatures were independent prognostic factors. RESULTS: The radiomics signatures for LR, DM, and DFS were developed and validated using both 2D and 3D features. Outcomes were significantly different in the low- and high-risk patients dichotomized by optimal cutoff in both the training and validation cohorts. In multivariate analysis, the signatures were independent prognostic factors even when considering the clinical parameters. There were no significant differences in C-index from 2D vs. 3D signatures. CONCLUSIONS: This is the first study to develop delta-radiomics signatures for rectal cancer. The signatures successfully predicted the outcomes and were independent prognostic factors. External validation is warranted to ensure their performance.


Asunto(s)
Adenocarcinoma/secundario , Quimioradioterapia , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Recurrencia Local de Neoplasia/diagnóstico , Cuidados Preoperatorios , Neoplasias del Recto/patología , Adenocarcinoma/terapia , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Neoplasias del Recto/terapia , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
17.
J Psychosoc Nurs Ment Health Serv ; 57(7): 39-47, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-30888427

RESUMEN

An educational support group, The Lighten Your Life Program, was developed for adult patients who self-reported depressive symptoms and had one or more comorbid chronic pain condition. Using a mixed methods, pilot design, the purpose of the current study was to test the feasibility of The Lighten Your Life Program, which combined depression education with in-person group support every 2 weeks. The Lighten Your Life Program also encouraged the use of Pacifica, a mobile application (app), as a self-management tool. Another aim was to explore what effect The Lighten Your Life Program had on decreasing depression severity. Statistically significant differences in Patient Health Questionnaire-9 scores were noted over time. Educational support group programs and the use of mobile apps, such as Pacifica, could be beneficial in helping individuals self-manage their depressive symptoms and chronic pain condition. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 39-47.].


Asunto(s)
Dolor Crónico/terapia , Depresión/terapia , Aplicaciones Móviles , Grupos de Autoayuda , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Calidad de Vida , Autoinforme , Encuestas y Cuestionarios
18.
Cancers (Basel) ; 10(9)2018 Sep 07.
Artículo en Inglés | MEDLINE | ID: mdl-30205529

RESUMEN

There is ongoing debate regarding the significance of complete or near-complete response after neoadjuvant chemoradiotherapy (CRT) for rectal cancer. This study assessed the prognostic value of the Dworak tumor regression grade (TRG) following neoadjuvant CRT and surgery primarily in patients with pathological stage (ypStage) II and III rectal cancer. The records of 331 patients who underwent neoadjuvant CRT followed by total mesorectal excision between 2004 and 2015 were retrospectively reviewed. Patients were categorized as having a good response (GR, TRG 3/4, n = 122) or a poor response (PR, TRG 1/2, n = 209). At a median follow-up of 65 months, five-year disease-free survival (DFS) was higher in the GR group than in the PR group (91.3% vs. 66.6%, p < 0.001). Patients with a GR and ypStage II disease had a five-year DFS that was indistinguishable from that of patients with ypStage 0⁻I disease (92.3% vs. 90.7%, p = 0.885). Likewise, patients with a GR and ypStage III disease had a five-year DFS similar to those with ypStage II disease (76.0% vs. 75.9%, p = 0.789). A new modified staging system that incorporates grouped TRG (GR vs. PR) was developed. The prognostic performance of this modified stage and the ypStage was compared with the Harrell C statistic. C statistic of the modified stage was higher than that of the ypStage (0.784 vs. 0.757, p = 0.012). The results remained robust after multivariate Cox regression analyses. In conclusion, a GR to neoadjuvant CRT is an independent predictor of good DFS and overall survival and further stratifies patients so as to estimate the risk of recurrence and survival among patients with ypStage II and III rectal cancer.

19.
Int J Orthop Trauma Nurs ; 29: 10-15, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29409721

RESUMEN

BACKGROUND: It is vital that patients take an active role in self-management of their chronic knee pain condition. The Chronic Knee Pain Program was developed to assist patients in managing their chronic condition and to improve their overall well-being. PURPOSE: The purpose of this pilot study was to determine the feasibility of a six-week self-management program and to explore whether it may assist in decreasing body mass index (BMI) and depression symptom severity and increase physical activity levels in obese adults with chronic knee pain. DESIGN: A one group, pre-test/post-test pilot study. SETTING: A pain management clinic in the northeastern United States. SAMPLE: Convenience sample of twelve adult patients with chronic knee pain and a BMI of 30 or greater were recruited, however, six participants completed the full program. RESULTS: This type of intervention has potential value to improve the lifestyles of those individuals with chronic knee pain, including improvements in BMI, depression symptom severity and physical activity levels. In this study there was a decrease in mean BMI overtime; 41.2 (at week 1), 40.8 (at week 6), and 40.7 (at week 10). CONCLUSIONS: The Chronic Knee Pain Program had a small sample size and high attrition rate, though yielded positive outcomes for some participants. Future research could focus on depression management, using conservative measures to help manage pain, and increasing pain coping skills. Implementing this program with a larger sample size is recommended to see if BMI, depression symptom severity and physical activity levels reach statistical significance.


Asunto(s)
Adaptación Psicológica , Dolor Crónico/rehabilitación , Terapia por Ejercicio , Obesidad Mórbida , Osteoartritis de la Rodilla/rehabilitación , Autocuidado , Adulto , Anciano , Dolor Crónico/enfermería , Dolor Crónico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Enfermería , Osteoartritis de la Rodilla/enfermería , Osteoartritis de la Rodilla/psicología , Proyectos Piloto , Resultado del Tratamiento
20.
Radiat Oncol J ; 36(4): 332-340, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30630272

RESUMEN

PURPOSE: To retrospectively analyze dosimetric parameters of volumetric-modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3D-CRT) delivered to extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue in the stomach (gastric MALT lymphoma) to find out advantages of VMAT and conditions for definite benefits of VMAT. MATERIALS AND METHODS: Fifty patients with stage I-II gastric MALT lymphoma received VMAT (n = 14) or 3D-CRT (n = 36) between December 2005 and April 2018. Twenty-seven patients were categorized according to whether the planning target volume (PTV) overlaps kidney(s). Dosimetric parameters were analyzed by dose-volume histogram. RESULTS: Radiation dose to the liver was definitely lower with VMAT in terms of mean dose (p = 0.026) and V15 (p = 0.008). The V15 of the left kidney was lower with VMAT (p = 0.065). For those with PTV overlapping kidney(s), the left kidney V15 was significantly lower with VMAT. Furthermore, the closer the distance between the PTV and kidneys, the less the left kidney V15 with VMAT (p = 0.037). Delineation of kidney(s) by integrating all respiratory phases had no additional benefit. CONCLUSIONS: VMAT significantly increased monitor units, reduced treatment time and radiation dose to the liver and kidneys. The benefit of VMAT was definite in reducing the left kidney V15, especially in geometrically challenging conditions of overlap or close separation between PTV and kidney(s).

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