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OBJECTIVE: The purpose of this study was to examine the use of a nurse-driven plan to describe factors associated with delays in the 1st case on time start within the operating room. METHODS: A posttest-only quasi-experiment was conducted to examine the effect of designating specific time periods for steps in the preoperative process on 1st case operating delays. Rationale for delays was also examined. Using an audit form, data on target time, time met, delay in minutes, and reasons for delay were collected by an observer. RESULTS: Thirty-one percent (n = 31) of patient/participants (N = 99) were late to the operating room. Controllable factors, such as caregivers being late, and uncontrollable factors, such as patients' needing to use the restroom just prior to surgery, were identified. CONCLUSIONS: Results of this study support the identification and examination of steps in the preoperative process to prevent delays by adjusting activities as needed. Identifying controllable and uncontrollable factors can help in preparing to prevent delays.
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Salas Cirúrgicas , Humanos , Fatores de Tempo , Masculino , Feminino , Adulto , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Our objective was to determine whether early detection of undiagnosed psoriatic arthritis (PsA) in a primary care psoriasis population improves outcome in physical function at 24 months post-registration. METHODS: A multicentre, prospective, parallel group cluster randomised controlled trial in patients with psoriasis was conducted. Participants with suspected inflammatory arthritis on screening were referred for an assessment of PsA (enhanced surveillance (ES) arm: at baseline, 12 and 24 months; standard care (SC) arm: at 24 months). The primary outcome measure was the Health Assessment Questionnaire Disability Index (HAQ-DI) at 24 months post registration in participants diagnosed with PsA. RESULTS: A total of 2225 participants across 135 GP practices registered: 1123 allocated to ES and 1102 to SC. The primary analysis population consisted of 87 participants with a positive diagnosis of PsA: 64 in ES, 23 in SC. The adjusted odds ratio (OR) for achieving a HAQ-DI score of 0 at 24 months post registration in ES compared with SC was 0.64 (95% CI (0.17, 2.38)), and the adjusted OR of achieving a higher (non-zero) HAQ-DI score at 24 months post registration in ES relative to SC arm was 1.12 (95% CI: 0.67, 1.86), indicating no evidence of a difference between the two treatment groups (p= 0.66). CONCLUSION: The trial was underpowered for demonstrating the prespecified treatment effect; in patients with psoriasis there was no evidence that early diagnosis of PsA by ES in primary care changes physical function at 24 months compared with SC. CLINICAL TRIAL REGISTRATION: The TUDOR trial is registered as ISRCTN38877516.
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OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging cause of liver disease in HIV. Transient elastography (TE) with controlled attenuation parameter (CAP) measures liver stiffness as a marker of liver fibrosis and CAP as a measure of hepatic steatosis. Our aim was to evaluate longitudinal CAP and liver stiffness in children with perinatally acquired HIV (PHIV) on antiretroviral therapy (ART) from early life compared to children without HIV (HU). DESIGN: Prospective cohort study. METHODS: PHIV and HU were followed annually for two years. During the study, 60% of PHIV switched from older ART regimens to tenofovir disoproxil, lamivudine and dolutegravir (TLD). Longitudinal evolution of CAP and liver stiffness were investigated in two PHIV groups - on older ART and on TLD - compared to HU children using linear mixed effects models. RESULTS: 263 children and adolescents (112 PHIV, 151 HU) aged 7-20âyears were followed. PHIV on older ART had CAP 8.61% (95% CI 4.42-12.97, P â<â0.001) greater than HU and no significant difference in CAP between PHIV on TLD and HU. No significant difference in liver stiffness was found between PHIV on older ART regimens and PHIV on TLD compared to HU. CONCLUSION: PHIV on older ART had higher CAP than HU, whereas in PHIV switched to TLD there was no difference in CAP compared to HU. There was no difference in liver stiffness between either PHIV group and HU. This suggests starting ART early in life might protect PHIV from developing hepatic fibrosis.
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Técnicas de Imagem por Elasticidade , Infecções por HIV , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Feminino , Criança , África do Sul , Estudos Prospectivos , Masculino , Adolescente , Estudos Longitudinais , Adulto Jovem , Fígado/patologia , Antirretrovirais/uso terapêutico , Cirrose HepáticaRESUMO
OBJECTIVE: To investigate mode of birth in relation to onset of labor and Bishop score. DESIGN: Retrospective observational cohort design. SETTING: A 434-bed Magnet redesignated community hospital. PARTICIPANTS: Nulliparous women, 18 years of age or older, who gave birth at 37 to 41 weeks gestation to live, singleton fetuses in the vertex presentation (N = 701). METHODS: We conducted a retrospective chart review and used chi-square analysis to measure the associations among mode of birth, onset of labor, and Bishop score. We used logistic regression to test the probability of cesarean birth for women undergoing elective induction of labor. RESULTS: Most participants (n = 531, 75.7%) gave birth vaginally. Significant findings included the following relationships: spontaneous onset of labor and vaginal birth (χ2 = 22.2, Ø = 0.18, p < .001) and Bishop score of greater than or equal to 8 and vaginal birth (χ2 = 4.9, Ø = .14, p = .028). Induction of labor was a significant predictor in cesarean birth when controlling for age and body mass index (OR = 2.1, 95% confidence interval [1.5, 3.1], p < .001). CONCLUSION: Reducing elective induction of labor in women with low-risk pregnancies may help lower the risk of cesarean birth. Clinically, Bishop score and mode of birth have a weak association, particularly when induction includes cervical ripening.
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OBJECTIVE: To estimate the relative rate of all-cause mortality amongst those on antiretroviral treatment (ART) with a history of interruptions compared with those with no previous interruptions in care. DESIGN: Retrospective cohort study. METHODS: We used data from four South African cohorts participating in the International epidemiology Databases to Evaluate AIDS Southern Africa collaboration. We included adults who started ART between 2004 and 2019. We defined a care interruption as a gap in contact longer than 180âdays. Observation time prior to interruption was allocated to a 'no interruption' group. Observation time after interruption was allocated to one of two groups based on whether the first interruption started before 6âmonths of ART ('early interruption') or later ('late interruption'). We used Cox regression to estimate hazard ratios. RESULTS: Sixty-three thousand six hundred and ninety-two participants contributed 162â916 person-years of observation. There were 3469 deaths. Most participants were female individuals (67.4%) and the median age at ART initiation was 33.3âyears (interquartile range: 27.5-40.7). Seventeen thousand and eleven (26.7%) participants experienced care interruptions. Those resuming ART experienced increased mortality compared with those with no interruptions: early interrupters had a hazard ratio of 4.37 (95% confidence interval (CI) 3.87-4.95) and late interrupters had a hazard ratio of 2.74 (95% CI 2.39-3.15). In sensitivity analyses, effect sizes were found to be proportional to the length of time used to define interruptions. CONCLUSION: Our findings highlight the need to improve retention in care, regardless of treatment duration. Programmes to encourage return to care also need to be strengthened.
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Infecções por HIV , Humanos , Feminino , Masculino , Estudos Retrospectivos , Adulto , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , África do Sul/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Pessoa de Meia-Idade , Antirretrovirais/uso terapêuticoRESUMO
Signal transducers and activators of transcription (STAT) proteins regulate mammary development. Here we investigate the expression of phosphorylated STAT3 (pSTAT3) in the mouse and cow around the day of birth. We present localised colocation analysis, applicable to other mammary studies requiring identification of spatially congregated events. We demonstrate that pSTAT3-positive events are multifocally clustered in a non-random and statistically significant fashion. Arginase-1 expressing cells, consistent with macrophages, exhibit distinct clustering within the periparturient mammary gland. These findings represent a new facet of mammary STAT3 biology, and point to the presence of mammary sub-microenvironments.
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Células Epiteliais , Glândulas Mamárias Animais , Fator de Transcrição STAT3 , Animais , Feminino , Bovinos , Glândulas Mamárias Animais/metabolismo , Glândulas Mamárias Animais/citologia , Glândulas Mamárias Animais/crescimento & desenvolvimento , Camundongos , Células Epiteliais/metabolismo , Fator de Transcrição STAT3/metabolismo , Fosforilação , Gravidez , Parto/fisiologia , Parto/metabolismo , Transdução de SinaisRESUMO
OBJECTIVE: The aim of this study was to examine the effect of an educational intervention on nurses' knowledge defined as understanding, beliefs, and actions to be taken, regarding nurse suicide. BACKGROUND: Between 2007 and 2018, nurses were 18% more likely to die by suicide than the general public. As a result, an assessment of nurses' knowledge regarding suicide has become an important issue for nursing administration. METHODS: A quasi-experiment (N = 225) was conducted. Variables of interest were assessed pre and post an educational intervention on 3 domains related to suicide. RESULTS: Significant and meaningful differences were found regarding 2 domains of interest in nurses' understanding related to nurse suicide, and actions to be taken, pre and post intervention. A significant change occurred regarding beliefs; however, the difference was small and therefore not meaningful. CONCLUSIONS: Finding demonstrate that educational interventions focused on issues related to suicide can enhance nurses' knowledge of the challenges implicit when one considers taking one's own life.
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OBJECTIVE: The aim of this study was to assess nurse preceptor burnout and examine related factors. BACKGROUND: Nurse preceptors are essential to the provision of optimal hospital-based care. Preceptors guide and support nurses' transition from professional training to practice as well as movement within practice roles. METHODS: As a component of the DevelopYou database, nurse preceptors (N = 210) were surveyed electronically using the BHLex Preceptor Role Questionnaire. Data retrieved from this data set were analyzed. RESULTS: Twenty-eight percent (n = 60) of participants experienced burnout. Most (n = 203, 96.7%) enjoyed their role. Reasons for becoming a preceptor included a love for teaching, a desire to help others, and feelings of responsibility to the profession and the institution. Strategies to enable perceived value of the role focused on activities involving person-to-person interactions. CONCLUSIONS: On the basis of the results of this analysis, it is apparent that nurse preceptors want to feel valued and supported by administration and have opportunities to interact regularly with colleagues.
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Esgotamento Profissional , Preceptoria , Humanos , Emoções , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The length of time from diagnosis of breast cancer to surgery has steadily increased. Consultations and tests, in addition to a lack of available counseling programs, contribute to delays. Evidence suggests that delays between diagnosis and surgery may adversely affect patients. OBJECTIVES: This article examines the effect of time from diagnosis of breast cancer to surgery by requiring nurse navigators to contact the genetic counseling office within 48 hours of the diagnosis to schedule an appointment for the patient as soon as possible. METHODS: Using a quasiexperimental design, data of time from diagnosis to surgery among patients with breast cancer were collected retrospectively preintervention (N = 30) and prospectively postintervention (N = 30). FINDINGS: Time from diagnosis to surgery decreased significantly from pre- (mean = 50.3 days, SD = 22 days) to postintervention (mean = 39 days, SD = 16 days) (t = 2.25, p = 0.03).
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Neoplasias da Mama , Aconselhamento Genético , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Estudos Retrospectivos , Aconselhamento , Encaminhamento e ConsultaRESUMO
BACKGROUND: Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care. AIMS: We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities. METHODS: A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality. RESULTS: Respondents (n = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with 'Is a GI chemotherapy regimen better than an ovarian regimen?' the most highly ranked option, followed by 'Should stage 1C patients receive chemotherapy?' CONCLUSIONS: Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC.
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Neoplasias Ovarianas , Padrões de Prática Médica , Humanos , Feminino , Nova Zelândia , Austrália , Neoplasias Ovarianas/terapia , Padrões de Prática Médica/estatística & dados numéricos , Adenocarcinoma Mucinoso/terapia , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/cirurgia , Inquéritos e Questionários , Estadiamento de Neoplasias , Oncologistas , Oncologia , GinecologiaRESUMO
Extensive farming systems form an integral part of sheep production systems across Europe. However, with innate production handicaps, declining sheep numbers and narrow economic margins, production is becoming increasingly challenging threatening the future sustainability of the industry. Gastrointestinal nematodes (GINs) are a significant cause of production losses to the global sheep industry, with well-established resistance to the major anthelmintic groups. Traditionally, extensive farming systems are not thought to have a significant parasite challenge compared with intensive farms, but there is a need to identify the scale and importance of GINs on extensive farms to inform the need for sustainable control strategies. In this study, a questionnaire of extensive farmers (n=34) was conducted and parasitological data were collected from nine study farms to investigate the perceived versus actual GIN and anthelmintic resistance challenge faced by extensive farms. The results showed a production-limiting challenge on most farms, with a higher GIN challenge observed on improved pastures. Furthermore, over half of the extensive farmers perceived anthelmintic resistance to be a greater problem for intensive farmers, with only 20% of respondents reporting known anthelmintic resistance. However, all study farms had evidence of resistance to at least one group of anthelmintics. Consequently, this study has demonstrated that despite the traditional perception of parasitism on extensive farms, there is a need to increasingly consider its impact and take a proactive approach to sustainable control, with solutions tailored to their unique management.
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Anti-Helmínticos , Nematoides , Infecções por Nematoides , Doenças dos Ovinos , Animais , Ovinos , Fazendas , Infecções por Nematoides/prevenção & controle , Infecções por Nematoides/veterinária , Infecções por Nematoides/tratamento farmacológico , Doenças dos Ovinos/parasitologia , Anti-Helmínticos/uso terapêutico , Anti-Helmínticos/farmacologia , Resistência a MedicamentosRESUMO
OBJECTIVES: The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients. BACKGROUND: Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats. METHODS: Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI. RESULTS: Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment. CONCLUSIONS: Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.
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Úlcera por Pressão , Adulto , Humanos , Estudos Retrospectivos , Protestantismo , Doença Iatrogênica , Medição de Risco , Fatores de RiscoRESUMO
INTRODUCTION: Lung disease remains a frequent complication in children with perinatal HIV infection (CHIV) and exposure without infection (CHEU), resulting in diminished lung function. In CHIV, early antiretroviral therapy (ART) initiation improves survival and extrapulmonary outcomes. However, it is unknown if there is benefit to lung function. METHODS: Cohorts of CHIV (ART initiated at median 4.0 months), CHEU and HIV-unexposed children (CHU) prospectively performed pulmonary function testing (PFT) consisting of spirometry, plethysmography and diffusing capacity from 2013 to 2020. We determined lung function trajectories for PFT outcomes comparing CHIV to CHU and CHEU to CHU, using linear mixed effects models with multiple imputation. Potential confounders included sex, age, height, weight, body mass index z-score, urine cotinine and Tanner stage. RESULTS: 328 participants (122 CHIV, 126 CHEU, 80 CHU) performed PFT (ages 6.6-15.6 years). Spirometry (forced expiratory volume in 1 s, FEV1, forced vital capacity (FVC), FEV1/FVC) outcomes were similar between groups. In plethysmography, the mean residual volume (RV) z-score was 17% greater in CHIV than CHU (95% CI 1% to 33%, p=0.042). There was no difference in total lung capacity (TLC) or RV/TLC z-scores between groups. Diffusing capacity for carbon monoxide was similar in all groups, while alveolar volume (VA) differed between HIV groups by sex. CONCLUSION: Our study indicates that early ART initiation can mitigate the loss of lung function in CHIV with lasting benefit through childhood; however, there remains concern of small airway disease. CHEU does not appear to disrupt childhood lung function trajectory.
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Infecções por HIV , Doença Pulmonar Obstrutiva Crônica , Feminino , Gravidez , Humanos , Criança , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Capacidade Vital , Medidas de Volume Pulmonar , Volume Expiratório Forçado , Espirometria , PulmãoRESUMO
Many organisms live in fragmented populations, which has profound consequences on the dynamics of associated parasites. Metapopulation theory offers a canonical framework for predicting the effects of fragmentation on spatiotemporal hostparasite dynamics. However, empirical studies of parasites in classical metapopulations remain rare, particularly for vector-borne parasites. Here, we quantify spatiotemporal patterns and possible drivers of infection probability for several ectoparasites (fleas, Ixodes trianguliceps and Ixodes ricinus) and vector-borne microparasites (Babesia microti, Bartonella spp., Hepatozoon spp.) in a classically functioning metapopulation of water vole hosts. Results suggest that the relative importance of vector or host dynamics on microparasite infection probabilities is related to parasite life-histories. Bartonella, a microparasite with a fast life-history, was positively associated with both host and vector abundances at several spatial and temporal scales. In contrast, B. microti, a tick-borne parasite with a slow life-history, was only associated with vector dynamics. Further, we provide evidence that life-history shaped parasite dynamics, including occupancy and colonization rates, in the metapopulation. Lastly, our findings were consistent with the hypothesis that landscape connectivity was determined by distance-based dispersal of the focal hosts. We provide essential empirical evidence that contributes to the development of a comprehensive theory of metapopulation processes of vector-borne parasites.
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Bartonella , Infestações por Pulgas , Ixodes , Sifonápteros , AnimaisRESUMO
INTRODUCTION: HIV is associated with accelerated cardiovascular disease, due to HIV-associated metabolic abnormalities, antiretroviral therapy (ART), and HIV itself. Carotid-femoral pulse wave velocity (PWV) is the noninvasive gold standard measurement of arterial stiffness, and associated with incident vascular events in adults. It is unclear if arterial stiffness is accelerated in children living with perinatal HIV (CHIV) who initiate ART early in life. We compared the longitudinal trajectory of PWV in CHIV to children unexposed to HIV. A secondary comparison compared HIV exposed uninfected children (CHEU) to unexposed children. METHODS: Four hundred and sixty-five children (141 CHIV, 160 CHEU, 164 unexposed) previously in the children with HIV early antiretroviral therapy (ART) (CHER) and P1060 trials were followed annually at Tygerberg Children's Hospital, South Africa between 2014 and 2020. CHIV initiated ART in infancy or early childhood, with excellent ART adherence and largely sustained viral suppression. The primary outcome was PWV, measured using the Vicorder system, and evaluated using linear mixed effects models. RESULTS: Median (interquartile range) age at first PWV measurement was 8.64 (7.7-9.1) years, and median follow-up time 2.9 (1.6-4.0) years. Adjusted analyses showed no significant mean difference in PWV in CHIV and CHEU compared to unexposed [CHIV: 0.101âm/s, 95% confidence interval (CI) -0.012 to 0.214; CHEU: 0.068âm/s, 95% CI -0.047 to 0.183], after adjusting for gender, age, ethnicity, mean arterial pressure, resting average heart rate and family history of cardiovascular disease. CONCLUSIONS: Early-treated CHIV with sustained viral suppression have similar PWV to unexposed children. Excellent adherence and early ART initiation may protect against cardiovascular disease.
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Doenças Cardiovasculares , Infecções por HIV , Rigidez Vascular , Adulto , Gravidez , Feminino , Humanos , Criança , Pré-Escolar , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Análise de Onda de Pulso , Doenças Cardiovasculares/complicações , Antirretrovirais/uso terapêutico , CogniçãoRESUMO
Stent thrombosis (ST) has significant morbidity and mortality following percutaneous coronary intervention (PCI). ST is uncommon making the identification of nonprocedural predictors challenging. Numerous case reports of ST in both benign and malignant hematological conditions exist. Given ST could be a Herald event of an undiagnosed condition and condition-specific treatment may be available, it is important to consider specialist testing in an unexplained ST. This review included a case presentation of ST in previously undiagnosed paroxysmal nocturnal hemoglobinuria (PNH) and a literature review of ST in other acquired thrombophilias including myeloproliferative disorders (MPNs), antiphospholipid syndrome, hematological malignancies, and heparin-induced thrombocytopenia (HIT). Inherited thrombophilias and common pitfalls in thrombophilia and coagulation testing are also discussed. The cardiac-hematology landscape is becoming increasingly complex and there is a paucity of how to best manage ST in these patients. There is clear variability in practice and the use of multidisciplinary input between cardiologists and hematologists is essential.
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Neoplasias da Mama , Mastectomia , Humanos , Feminino , Satisfação do Paciente , Neoplasias da Mama/cirurgiaRESUMO
INTRODUCTION: HIV infection is associated with insulin resistance and dyslipidaemia driven by HIV-associated immune dysregulation and antiretroviral therapy (ART). Children living with perinatally acquired HIV (CHIV) face many decades of exposure to these factors. We evaluated the longitudinal trajectory of insulin resistance and dyslipidaemia in CHIV and HIV-exposed uninfected children (CHEU), compared with children HIV-unexposed (CHU). METHODS: Four hundred and eighty-five children (141 CHIV, 169 CHEU, 175 CHU) aged 5-16âyears, previously part of CHER and P1060 trials, were followed annually at Tygerberg Children's Hospital, South Africa. The primary outcome was Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Secondary outcomes included low-density lipoprotein (LDL) cholesterol, triglyceride-to-HDL ratio, android fat mass and SBP. Outcomes were evaluated using linear mixed effects models, adjusting for potential confounders. RESULTS: CHIV had 73% greater HOMA-IR than CHU in ages 6-8âyears (95% CI 15.9-158.2%, Pâ<â0.001), and 24.7% greater HOMA-IR than CHU in ages 9-10âyears (0.3-55.1%, Pâ=â0.04). By 10-11âyears, the difference was not significant (Pâ=â0.161). Longitudinally, triglyceride-to-HDL was 47.94% (34.50-62.73%, Pâ<â0.001) higher in CHIV vs. CHU; LDL was 0.25âmmol/l (0.10-0.39, Pâ=â0.001) higher in CHIV vs. CHU; android fat mass was 11.57% (-21.11 to -0.87%, Pâ=â0.035) lower in CHIV than CHU. No significant difference in SBP was found. CHEU and CHU had similar outcomes. CONCLUSION: Early-treated CHIV have elevated insulin resistance, which resolves with time. Triglyceride-to-HDL ratio and LDL cholesterol were elevated into puberty. CHIV should be monitored for insulin resistance, dyslipidaemia and subclinical cardiovascular disease.
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Dislipidemias , Infecções por HIV , Resistência à Insulina , Feminino , Gravidez , Humanos , Criança , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , África do Sul/epidemiologia , Triglicerídeos/uso terapêutico , Dislipidemias/epidemiologia , Dislipidemias/complicaçõesRESUMO
PURPOSE: The aim was to identify the impact of the (a) components of breast cancer-related lymphedema (BCRL) educational content, (b) modes of education, and (c) timing of education on arm volume, quality of life, function, complications associated with BCRL, adherence to interventions, and knowledge acquisition in individuals diagnosed with breast cancer (BC). METHODS: This review followed the Preferred Reported Items for Systematic Review and Meta-analysis (PRISMA) guidelines (PROSPERO CRD42021253084). Databases searched included PubMed, CINAHL, Web of Science, Google Scholar, and Scopus from January 2010 to December 2021. Study quality and bias were assessed using the American Physical Therapy Association's Critical Appraisal Tool for Experimental Intervention Studies. RESULTS: Forty-five studies were eligible, and 15 met the inclusion criteria (4 acceptable and 11 low quality). This review was unable to determine the optimal content, mode, and timing for BCRL education across survivorship. Content included a brief overview of BCRL, early signs and symptoms, risk reduction practices, and a point of contact. Delivery was multi-modal, and knowledge acquisition was rarely assessed. Education was provided pre/post operatively and after BCRL developed. CONCLUSIONS: Individualized BCRL education via a multi-modal approach, repeated at multiple time points, and assessment of survivors' knowledge acquisition is recommended. Consideration of the survivors' phase of treatment, content volume, and time required to complete the program is advised when developing the educational intervention. IMPLICATIONS FOR CANCER SURVIVORS: Survivors of BC may need to advocate for BCRL education based on their individual risk and needs, request a point of contact for questions/follow up, and express their preferred style of learning.