Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents.

BACKGROUND: In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance. METHODS: A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual-spatial ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A). RESULTS: After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better (p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test). CONCLUSION: The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training.

Barriers to tobacco cessation in clinical practice: report from a National Survey of Oncology Nurses.

This study describes the survey results of a national random sample of members of the Oncology Nursing Society who reported the greatest number of barriers to delivering a tobacco cessation intervention with their patients. Nurses who perceived the greatest number of barriers were more likely to be current smokers and to be young and were less likely to have an advanced degree, to be a nurse practitioner, or to have administrative responsibilities. Those with greater barriers were less likely to deliver tobacco cessation interventions.

Physical activity and fatigue during radiation therapy: a pilot study using actigraph monitors.

PURPOSE/OBJECTIVES: To describe the relationship of patterns of physical activity and fatigue during radiation therapy. DESIGN: Prospective, descriptive, repeated measures, pilot study. SETTING: Outpatient radiation oncology clinic at a large medical center. SAMPLE: Seven adult subjects with cancer who received a six-week course of external beam radiation therapy to the trunk (including breast, chest, or abdomen). METHODS: Wrist actigraphs were used to measure physical activity for 72 hours during the second and fifth weeks of therapy. The Fatigue-Inertia and Vigor-Activity subscales of the Profile of Mood States (POMS) and the Linear Analogue Scale-Fatigue (LAS-F) were used to measure perceptions of fatigue at the beginning and the end of the week of the two collection periods. The Symptom Distress Scale (SDS) assessed symptom severity. Subjects recorded their physical activities in a five-day diary. MAIN RESEARCH VARIABLES: Physical activity, fatigue, and six-week course of external beam radiation therapy. FINDINGS: Physical activity levels were highest at the end of the week at both week two and week five. As measured by POMS and LAS-F, perception of fatigue decreased at the end of the week. SDS showed minimal change in symptom distress. CONCLUSIONS: Contrary to expectations, activity increased during treatment and fatigue decreased. This agrees with current work supporting the benefits of exercise during cancer treatment. IMPLICATIONS FOR NURSING PRACTICE: Physical activity during treatment, as compared to inactivity, may help to reduce fatigue.

Quality of life in patients with heart failure: do gender differences exist?

OBJECTIVE: The purpose of this study was to evaluate gender differences in quality of life (QOL) in a large sample of age-matched and ejection fraction (EF)-matched patients with heart failure. DESIGN: Matched comparisons of secondary data were used. SETTING: The setting consisted of multicenter Studies of Left Ventricular Dysfunction trials. SAMPLE: The sample included 1382 patients (691 men and 691 women) who were age-matched and EF-matched. OUTCOME MEASURES: Global QOL and the QOL dimensions of physical function, emotional distress, social health, and general health were measured using the Ladder of Life, items from the Profile of Mood States Inventory, the Functional Status Questionnaire, the beta-Blocker Heart Attack Trial instrument, and an item from the RAND Medical Outcomes Study instrument. RESULTS: Women had significantly worse general life satisfaction, physical function, and social and general health scores than men. There were no significant differences found between gender groups for current life situation or emotional distress. After controlling for New York Heart Association classification, women still had significantly worse ratings for intermediate activities of daily living (a sub-dimension of physical functioning) and social activity. CONCLUSIONS: Despite controlling for age, EF, and New York Heart Association classification, women had worse QOL ratings than did men for intermediate activities of daily living and social activity. Research should focus on identifying why differences exist and developing measures to improve QOL, particularly physical functioning, in women with heart failure.

Mammography screening behavior in older women caregivers.

The purposes of this study are to explore older caregivers' mammography participation and the facilitators and barriers to mammography screening. Of the 52 older female caregivers with a mean age of 65 years (range 50-90) interviewed by telephone, 80.8% had had a mammogram within 12 months. Significant facilitators included health care provider recommendation and beliefs in the efficacy of treatment. Significant barriers included health care providers' failure to recommend mammograms, caregiver procrastination, fear of pain, and lack of symptoms. Caregivers with higher burden reported less frequent self- and provider-conducted breast examinations.

Cancer screening among Korean Americans.

PURPOSE: Cancer is a leading cause of death among Korean Americans (KAs), one of the most rapidly growing ethnic minority communities in the United States. An understanding about cancer screening practices among Koreans (Ks) living in Korea can be useful in designing culturally sensitive health promotion programs in the United States. The purpose of this study was to describe the cancer screening knowledge and behaviors of a sample of KAs in Los Angeles, California, compared with a similar sample of Ks in Korea. DESCRIPTION OF STUDY: This descriptive survey used a convenience sample of 140 KAs age 40 and older, living in Los Angeles, California, in 1998. A random sample of 149 Ks from Pusan, Korea, in 1995 to 1996 was used as a comparison group. KAs had lived in the United States for an average of 15 years. A Korean and English language 58-item self-administered questionnaire assessed knowledge of cancer screening tests and personal cancer screening practices. RESULTS: The findings demonstrate that both KAs and Ks had low participation in cancer screening. Breast cancer screening was significantly more likely among KA women than among Ks; screening rates for cervical cancer and gastrointestinal malignancies were not significantly different between the two groups. CLINICAL IMPLICATIONS: These data can be used to assist healthcare professionals in the development of educational tools and strategies for promoting cancer screening programs for KAs. The unique contribution of this study was the opportunity to compare findings from an immigrant Korean population with a similar population in the country of origin.

Tobacco-control attitudes, advocacy, and smoking behaviors of oncology nurses.

PURPOSE/OBJECTIVES: To describe oncology nurses' attitudes, smoking behaviors, and involvement in tobacco-control policy and legislation. DESIGN: Descriptive, cross-sectional survey. SAMPLE: Responses from 1,508 (38% return) of 4,000 randomly selected members of the Oncology Nursing Society (ONS). The typical respondent was female, age 44, a staff nurse, had practiced as an oncology nurse for 12 years, and was certified as an OCN. METHODS: A mailed survey with specific questions about smoking status and the importance of nursing involvement in healthcare policy and legislation for tobacco control. MAIN RESEARCH CONCEPTS: Attitudes about tobacco-control policies and legislation; sociodemographic, professional, and institutional variables; and tobacco use. FINDINGS: The majority (85%) of members stated that nursing involvement in tobacco-control healthcare policy and legislation was important. More than 90% of respondents supported prevention of youth access to tobacco and providing information about health effects of tobacco and cessation. Seven percent (n = 106) were current smokers. Significantly fewer smokers valued involvement in tobacco-control activities. Respondents with personal experience of tobacco-related illnesses were more likely to value involvement in advocacy activities. Educational programs to prevent tobacco use among youth and to help patients stop smoking received the most support (80%). IMPLICATIONS FOR NURSING PRACTICE: This sample of ONS members strongly supported involvement in tobacco-control policies and legislation. Smoking was associated with more negative attitudes about the importance of actively engaging in tobacco control. These oncology nurses recognized the need for additional educational programs to prevent tobacco initiation by youth.

Tobacco interventions by oncology nurses in clinical practice: report from a national survey.

BACKGROUND: Tobacco use is an important risk factor in cancer, cancer recurrence, and increased treatment morbidity, but limited information is available about interventions for tobacco cessation used in oncology clinical practice. In 1996, the Agency for Health Care Policy Research (AHCPR) published the first evidence-based smoking cessation guideline for use by health professionals. Using the AHCPR guideline as a framework, the authors describe the frequency of tobacco interventions provided by oncology nurses. METHODS: A questionnaire was mailed to 4000 randomly selected members of the Oncology Nursing Society in winter of 1998. Of those who were mailed questionnaires, 1508 respondents (38%) were available for analysis. RESULTS: The typical respondent was female, 44 years of age, and had practiced as an oncology nurse for 12 years. Seven percent were current smokers, and 30% were former smokers. Most (86%) encountered smokers on a weekly basis, but only 10% had heard of the AHCPR guideline. The majority (64%) assessed and documented tobacco status, 38% assessed readiness to quit. Few went on to provide interventions: 36% provided counseling, 32% provided cessation advice, 24% recommended nicotine replacement, and 16% taught skills to prevent relapse. Common barriers included perceived lack of patient motivation (74%) and the nurse's lack of time (52%) and skills (53%). The majority stated that they wanted to help patients stop smoking (88%) but needed additional training (92%). CONCLUSIONS: Documentation of tobacco status alone is not adequate in assisting patients with smoking cessation. Greater efforts are needed to educate oncology nurses about the range of tobacco interventions available and to facilitate their use in clinical settings.

Colon cancer screening among older women caregivers.

UNLABELLED: Colorectal cancers are common causes of morbidity and mortality among women in the United States. Many of these deaths are unnecessary because of the availability of effective early detection methods. The demands of caregiving may limit older women's participation in screening. The purposes of this exploratory study were to describe the participation in colorectal cancer screening of older women (n = 52; mean age 65 years) who were the primary caregivers for an ill spouse or parent, and to investigate the relationship of the caregiving burden and perceptions of health to participation in recommended colorectal cancer screening tests. RESULTS: Only 36% of the older women (n = 16) had been screened with both fecal occult blood testing (FOBT) and sigmoidoscopy. A number of women had never participated in colorectal cancer screening: 10 (21%) had never undergone FOBT and 22 (47%) had never undergone sigmoidoscopy. Only 20% (n = 9) had received all of the recommended cancer screening tests: mammogram, Papanicalaou smear, FOBT, and sigmoidoscopy. Those who did not participate in cancer screening with sigmoidoscopy had significantly worse health perceptions than those who did participate. Caregiver burden was not significantly associated with differences in cancer screening participation. Only 14 of these older women felt that they would have a good chance of survival if they received a diagnosis of colon cancer. Further research is needed to investigate strategies to increase participation of older women in colon cancer screening.

Pulmonary toxicities of cancer therapy.

Toxicity of the pulmonary region in persons with cancer can have singular or multidimensional causes. The seven distinct pulmonary toxicities are embolism, edema, pleural effusion, fibrosis, alveolitis, bronchiolitis obliterans, and radiation-induced pneumonitis. Although difficult to diagnose, all of these toxicities can be minimized by early assessment and immediate interventions. Astute nursing assessments and comprehensive treatment can make a difference in quality and quantity of life.

Influence of adjuvant chemotherapy on skeletal muscle and fatigue in women with breast cancer.

The purpose of this pilot study was to investigate the changes in skeletal muscle size and strength and perception of fatigue in women undergoing adjuvant chemotherapy for breast cancer. The findings of this pilot study suggest that changes in muscle size and strength can occur during chemotherapy. Quadricep muscle size increased for two subjects. These subjects also experienced an increase in muscle strength. This is the first known study to address change in muscle size and fatigue in women during adjuvant chemotherapy for breast cancer from an integrated biobehavioral perspective. Our findings may indicate that muscle size can increase during chemotherapy, but this may not diminish the subjective experiences of fatigue. As the potential for causing serious damage to striated muscle exists, further research into muscle changes and activity during chemotherapy and its role in fatigue is crucial.

Quality of life in women with symptomatic HIV/AIDS.

Despite the increasing incidence of cases of human immune deficiency virus (HIV) infection and of acquired immune deficiency syndrome (AIDS) in women, there is a serious lack of information about those women's quality of life (QoL). The purpose of this exploratory descriptive study was to describe QoL using an HIV-specific instrument (the HOPES) every 2 months over a 4-month period in a convenience sample of 44 women with symptomatic HIV/AIDS. Changes in physical, psychological, social, sexual dimensions, and overall QoL were evaluated along with the frequency of the most prevalent distressing items. The mean scores of the global QoL, physical and psycho-social summary scales were significantly different over the 4-month data collection period: quality of life improved. The most prevalent disruptions were in the psycho-social domain, including financial problems, worry about the family, distress about losing others from HIV, and worry about disease progression. The most prevalent physical disruptions included reduction in energy, difficulties with daily activities and frequent pain. Married women appeared to be more vulnerable to disruptions in QoL over time. In addition to the use of conventional disease-specific parameters for the ongoing follow-up of women with HIV/AIDS, the systematic use of a QoL assessment can provide a focused approach to monitoring problems and targeting interventions. Such an approach is especially important for nurses who assist women living with the symptoms of HIV/AIDS.

Prevention: tobacco control and cancer nursing.

In the next century, tobacco will become the number-one cause of preventable death throughout the world, resulting in half a billion deaths. As global patterns of tobacco use change, tobacco-related morbidity and mortality will shift from developed countries to developing countries. Internationally, lung cancer will become the fifth leading cause of preventable death, affecting an increasing number of women. Tobacco cessation after a diagnosis of cancer may decrease treatment-related morbidity and increase survival. With the increasing number of cancer survivors, tobacco cessation becomes an important part of rehabilitation. This article aims to provide a foundation for developing strategies to involve cancer nurses throughout the world in an international campaign to prevent tobacco-related morbidity and mortality. The devastating health impacts of tobacco are reviewed, and highlights of new scientific findings about nicotine addiction are presented. New approaches to tobacco prevention, legislation, and regulatory policies are discussed. Tobacco assessment strategies and treatment interventions for use in cancer nursing clinical practice are reviewed, and global strategies for nursing action in tobacco control are offered.

Developing a team for multicultural, multi-institutional research on fatigue and quality of life.

PURPOSE/OBJECTIVES: To describe the process of establishing a multisite team to conduct research with a multicultural focus on fatigue. DATA SOURCES: Articles, book chapters, personal experience. DATA SYNTHESIS: Teamwork facilitated development of a productive professional working group, sharing of resources, and data collection culminating in a research proposal for studying cancer-related fatigue in a multicultural population. CONCLUSIONS: Establishing a common goal by investing time, committing to the process, and establishing trust was the secret to effective team functioning. IMPLICATIONS FOR NURSING PRACTICE: The prospect of multi-institutional collaboration has implications for oncology nurses in the areas of research and practice. Goals that could not be achieved easily in the setting of a single institution are reached more easily with multisite collaboration and teamwork.

Women with HIV: living with symptoms.

This exploratory study used a semistructured interview to describe women's experiences coping with HIV-symptoms, their descriptors of their worst and best days, and their attempts to control symptoms. A convenience sample of 44 women, largely women of color, of lower socioeconomic status, unemployed, seeking treatment in one of six outpatient clinics in Los Angeles, were interviewed. Fatigue, the most frequently reported worst symptom, was present in 98% of these women. Feeling physically sick and having negative mood were mentioned most often in descriptions of worst days; being active, feeling physically healthy, and having positive mood were descriptors of best days. Of the total, 59% used rest/sleep to control symptoms, and this often was used in conjunction with healthy diet. The results of this study reveal aspects of women's day-to-day experiences with HIV-related symptoms.

Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer.

PURPOSE/OBJECTIVES: To test the efficacy of structured symptom assessment on level and rate of change in symptom distress over time. DESIGN: Prospective six-month randomized control trial. SETTING: Outpatient oncology offices and clinics in California. SAMPLE: 48 subjects newly diagnosed with advanced lung cancer, predominantly non-small cell. Most subjects received chemotherapy, 50% were women, and their average age was 62 years. 190 observations were analyzed. METHODS: Subjects were assigned randomly to structured assessment or usual care. Both groups completed the Symptom Distress Scale (SDS) monthly. After bivariate screening of potential predictors, a multivariate regression model for level and rate of change in SDS scores was created. MAIN RESEARCH VARIABLES: Symptom distress, functional status, and emotional distress. FINDINGS: Fatigue was the most common severely distressing symptom. In a multivariate model, chemotherapy and systematic assessment were associated with less symptom distress over time. Higher scores in depression and more functional limitations were related to higher levels of overall distress. Weight loss had a small impact. CONCLUSIONS: Systematic use of structured symptom assessment forestalled increased symptom distress over time. Chemotherapy lessened symptom distress, but the impact diminished with time. Subjects with more depression and greater functional limitations had greater symptom distress. IMPLICATIONS FOR NURSING PRACTICE: During the course of advanced lung cancer, systematic ongoing nursing assessment of symptoms may be the first step in enhancing interventions to decrease distress. Patients at highest risk for symptom distress are those who experience emotional distress and functional limitations.