Nurses' knowledge of and attitude toward postoperative patient-controlled analgesia (PCA) and the associated factors.

BACKGROUND: Postoperative pain control is pivotal for surgical care; it facilitates patient recovery. Although patient-controlled analgesia (PCA) has been available for decades, inadequate pain control remains. Nurses' knowledge of and attitude toward PCA may influence the efficacy on clinic application. PURPOSE: The purpose of this study is to evaluate nurses' knowledge of and attitude toward postoperative PCA and investigate the associated factors. METHODS: This is a cross-sectional study. We enrolled registered nurses from a 2200-bed medical center in northern Taiwan within one year. The participants completed an anonymous self-reported PCA knowledge inventory and PCA attitude inventory. Data were analyzed descriptively and associated were tested using logistic regression. RESULTS: With 303 participants enrolled, we discovered that nurses had limited knowledge of and a negative attitude toward PCA. Under half of the participants know how to set up a bolus dose and lockout intervals. The majority held misconceptions regarding side effect management for opioids. The minority agree to increase the dose when a patient experienced persistent pain or suggested the use of PCA. Surprisingly, participants with a bachelor's or master's degree had lower knowledge scores than those with a junior college degree. Those with 6-10 years of work experience also are lower than those with under 5 years of experience. However, the participants with experience of using PCA for patient care had higher knowledge scores and a more positive attitude. CONCLUSIONS: Although postoperative PCA has been available for decades and education programs are routinely provided, nurses had limited knowledge of and a negative attitude toward PCA. A higher education level and longer work experience were not associated with more knowledge. The current education programs on PCA should be revised to enhance their efficacy in delivering up-to-date knowledge and situation training which may convey supportive attitude toward clinical application of PCA.

Validation of the prophylactic efficacy of urea-based creams on sorafenib-induced hand-foot skin reaction in patients with advanced hepatocellular carcinoma: A randomised experiment study.

BACKGROUND: Hand-foot skin reaction may influence the effectiveness of patients' treatment, patient quality of life, and the economics of health care. An effective prophylactic dermatological cream for preventing sorafenib-induced hand-foot skin reaction (HFSR) is yet to be identified. AIM: The aim of this study is validated the prophylactic efficacy of urea-based creams on sorafenib-induced hand-foot skin reaction in patients with advanced hepatocellular carcinoma. METHODS: This was a randomised double-blind experimental study. A total of 129 patients with advanced HCC were randomly assigned to three groups. The comparison group received best supportive care (BSC), group A received BSC plus a moisturising cream, and group B received BSC plus a 10% urea-based cream. Incidence of HFSR and cutaneous wetness were assessed 3 days before starting sorafenib and each week after starting sorafenib for 8 weeks. RESULTS: No significant difference was observed in the incidence density of sorafenib-induced HFSK (comparison group/A group, p > .05; comparison group/B group, p > .05). Group B reported significantly better cutaneous wetness of hands in the seventh week after starting sorafenib (p < .05) and of feet during the first 6 weeks (p < .05-.001). CONCLUSION: This study found a nut size amount of a 10% urea-based cream applied twice a day can maintain patients' cutaneous wetness in the first 6 weeks after starting sorafenib than moisturising-alone cream. But it cannot reduce the occurrence of HFSR. Thus, the result supports nut-size dose of the 10% urea-based cream three times a day may be an appropriate dose to prevent HFSR. Clinical Trail Registration Number: NCT04568330.

Daily activity, mood, and quality of life in colorectal cancer patients with chemotherapy-induced peripheral neuropathy: A mediation effect analysis.

Chemotherapy-induced peripheral neuropathy (CIPN) with restriction of daily activity (RDA) was common consequence of oxaliplatin-based chemotherapy in colorectal cancer patients. CIPN with RDA and negative mood may impact the quality of life (QoL). However, the relationships among RDA, mood, and QoL remain unclear. This was a cross-sectional relative study in which four instruments were used: the Neuropathic Pain Symptom Inventory was used to measure the severity of CIPN; the Screening of Activity Limitation and Safety Awareness scale was used to evaluate RDA; the Profile of Mood States Short Form was used to assess negative mood; and the Functional Assessment Cancer Center Therapy-Colorectal scale version 4 was used to evaluate QoL. Relationships among the variables were analyzed by bivariate correlation, hierarchical multiple linear regression, and Baron and Kenny's mediation testing. One hundred three colorectal adenocarcinoma patients with CIPN after receiving oxaliplatin-based chemotherapy were enrolled. Patients had mild-to-moderate CIPN and mild RDA. Significant correlations were found between CIPN and mood (r = 0.425, P < 0.001), between RDA and mood (r = 0.343, P < 0.001), and between RDA and QoL (r = 0.285, P < 0.01). RDA and mood may impact QoL. Under mediation effect analysis, mood mediated 38.48% of the effect of RDA on QoL (P < 0.001). Negative mood is the major factor impacting QoL in colorectal cancer patients with CIPN. Although the management of CIPN and RDA can prevent irreversible functional problems, enhancing the adaption of mood disturbance can strongly promote their QoL.

Reliability and validity of the Chinese version neuropathic pain symptom inventory in patients with colorectal cancer.

BACKGROUND/PURPOSE: Chemotherapy-induced peripheral neuropathy is a common consequence of chemotherapeutic treatments in patients with cancer. This study evaluated the validity and reliability of a Chinese version of the Neuropathic Pain Symptom Inventory (C-NPSI) in patients with colorectal cancer and chemotherapy-induced peripheral neuropathy. METHODS: This cross-sectional study recruited 106 patients from a cancer center in Northern Taiwan. The C-NPSI was obtained through the translation and back-translation of the original NPSI. Content validity was evaluated by 10 experts. Internal consistency reliability was assessed through Pearson correlation analysis. Construct validity was conducted by confirmed factor analysis. Convergent validity was examined using the Chinese version of Profile of Mood States-Short Form (POMS-SF). RESULTS: The item-level and average scale-level content validity indices were 0.80 and 0.90, respectively. Internal consistency reliability was acceptable (Cronbach's α coefficient = 0.9). A parsimonious goodness-of-fit model was supported by the normed chi-square (x2/df = 2.74), root mean square error of approximation (RMSEA; 0.10) and root mean square error with respect to the mean (RMSEM; 0.126, 90% confidence interval [CI], 0.093-0.16); partial indices were acceptable (goodness-of-fit index [GFI] = 0.90; comparative fit index [CFI] = 0.89; incremental fit index [IFI] = 0.90). Additional model modifications demonstrated goodness of fit (x2/df = 1.78; RMSEA = 0.08; RMSEM = 0.085, 90% CI, 0.041-0.12; GFI = 0.92; CFI = 0.96; IFI = 0.96). Convergent validity showed most coefficients between the C-NPSI and POMS-SF Chinese version have a significant positive correlation (p < 0.05-0.005). CONCLUSION: The C-NPSI has satisfactory reliability and validity. Clinicians and physician can use it to evaluate and manage oxaliplatin-induced peripheral neuropathy.

The lived experiences of patients with post-operative rectal cancer who suffer from altered bowel function: A phenomenological study.

PURPOSE: Altered bowel function is a common consequence of anal sphincter-saving surgery in rectal cancer patients, and bowel symptoms influence patients' daily life and psychosocial status. Patients have inadequate professional support because care specialists fail do fully appreciate the impact of the patients' symptoms. In-depth exploration of the individual's experience is essential to improve the quality of patient care. The purpose of this study was to explore the lived experiences of post-operative rectal cancer patients with altered bowel function. METHODS: This Husserlian descriptive phenomenological study recruited 16 post-operative rectal cancer patients with altered bowel function. Data was collected through purposive sampling and one-on-one in-depth, semi-structured interviews. Narratives were analyzed thematically using Colaizzi's seven-step method. RESULTS: Three themes emerged, namely: "living in the restroom", "never backward", and "rebalancing on a new road". "Living in the restroom" described how patients frequent the restroom due to post-operative physical changes. "Never backward" outlined that such changes disturbed their mood, interrupted their daily activities, and affected their family life. "Rebalancing on a new road" described the patients' coping strategies, which included spiritual reconstruction, a new excrement model, an adjusted lifestyle, and peer support. CONCLUSIONS: Post-operative rectal cancer patients with altered bowel function frequent the restroom for prolonged periods, which disturbs their psychosocial status. However, they are forced to develop coping methods by themselves. Specialists can offer effective early post-operative interventions by thoroughly understanding each patient's symptomatic experience, symptom-related interferences, and primary concerns.

Difference in blood pressure between supine and sitting positions in diabetic and non-diabetic subjects.

BACKGROUND: This study was designed to investigate whether there was any difference in blood pressure (BP) readings between sitting and supine positions in diabetic and non-diabetic subjects. MATERIAL/METHODS: BP in sitting and supine position was measured in 356 patients with type 2 diabetes (study group) and in 356 age- and sex-matched non-diabetic subjects (control group). RESULTS: The systolic and diastolic BP in the supine position was significantly higher than in the sitting position in both groups (P<0.001). The BP increment in the supine position was similar in the study and control groups (P>0.05). Multivariate logistic regression analysis of the study group showed that age was an independent predictor for the systolic pressure increment (P=0.001), whereas body mass index was an independent predictor for the increment in diastolic BP (P=0.04). The levels of sitting BP were inversely correlated with the pressure increments in the supine position in the diabetic patients (P<0.001). CONCLUSIONS: In diabetic and non-diabetic subjects, BP in a supine position is higher than in the sitting position. In diabetic patients, age, body mass index and the levels of sitting BP seem to have significant impact on the pressure increment from a sitting to the supine position.

Differences in blood pressure readings between supine and sitting positions in hypertensive patients.

OBJECTIVE: The objective of this study was to investigate the impact of postures on blood pressure (BP) readings in patients with hypertension. METHODS AND RESULTS: BP was measured in 1,487 hypertensive patients in sitting and supine positions. The systolic (SBP) and diastolic (DBP) BP in supine position was 2.9 +/- 7.8mmHg and 0.9 +/- 5.4 mmHg higher, respectively, than in the sitting position (P <0.001). The greatest difference between supine and sitting SBP was found in those aged between 30 and 39 years (3.6 +/- 6.8 mmHg), and in those who were older than 80 years (5.3 +/- 7.9 mmHg).A greater difference between the supine and sitting DBP was identified in the groups > 60-years of age. Multivariate regression analysis showed that age and sex were independent predictors for the increment of BP in the supine position. CONCLUSION: There is a significant difference between supine and sitting SBP and DBP, with age and sex being the most important predicting factors.