Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer.

PURPOSE/OBJECTIVES: To evaluate quality of life (QOL) and cost outcomes of advanced practice nurses' (APNs') interventions with women diagnosed with breast cancer. DESIGN: Randomized clinical trial. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 210 women with newly diagnosed breast cancer with an age range of 30-85 years. METHODS: The control group (n = 104) received standard medical care. The intervention group (n = 106) received standard care plus APN interventions based on Brooten's cost-quality model and the Oncology Nursing Society's standards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years. Information about costs (charges and reimbursement) was collected through billing systems. MAIN RESEARCH VARIABLES: Uncertainty, mood states, well-being, charges, and reimbursement. FINDINGS: Uncertainty decreased significantly more from baseline in the intervention versus control group at one, three, and six months after diagnosis (p = 0.001, 0.026, and 0.011, respectively), with the strongest effect on subscales of complexity, inconsistency, and unpredictability. Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being. No significant cost differences were found. CONCLUSIONS: APN interventions improved some QOL indicators but did not raise or lower costs. IMPLICATIONS FOR NURSING PRACTICE: The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes. More research is necessary to define cost-effective interventions.

Using a process action team to improve patient education.

To develop an effective, coordinated, and integrated process for patient education in primary care, the Department of Veterans Affairs, Western New York Healthcare System, launched a process action team. The interdisciplinary team utilized a variety of methods, including flowcharts, cause-and-effect diagrams, and variance matrices. The team developed, implemented, and analyzed a data collection plan involving chart reviews, staff interviews, and patient-staff surveys. An improvement plan was initiated in collaboration with staff. The results highlight the importance of using a data collection plan to understand the causes of problems as well as the need for staff involvement.

A critical pathway for patients undergoing one-day breast cancer surgery.

As the trend of surgical procedures shifting from inpatient to outpatient settings continues, outpatient-focused standardized care processes will become more of a necessity. A multidisciplinary critical pathway (CP) for breast cancer surgery can assist care providers in meeting patients' educational and psychosocial needs. The CP document discussed in this article takes into account the expedient nature of outpatient surgery and spans the continuum of care from the surgical clinic to the postoperative homecare visit. Integrating homecare nursing improves the quality and consistency of care.

Reduced offspring production in bark beetleTomicus piniperda in pine bolts baited with ethanol and α-pinene, which attract antagonistic insects.

Bolts of Scots pine,Pinus sylvestris L., attacked by the bark beetleTomicus piniperda (L.) were baited with ethanol and α-pinene to attract antagonistic insects and thereby enhance their detrimental effects on the production of bark beetle progeny. Unbaited and caged bolts were included in the experiments as controls. Attraction of beetles to the bolts and subsequent emergence were estimated using traps. Six phloem-feeding species (potential competitors ofT. piniperda) and four predatory species were caught in significantly higher numbers at the baited bolts than at the unbaited ones. The number of offspring and the productivity ofT. piniperda were four to seven times higher in unbaited bolts than in baited bolts. Exclusion of other insects, by using cages, resulted in a nine-fold increase in the number ofT. piniperda offspring per square meter and productivity (offspring per egg gallery) compared with unbaited, exposed bolts.Hylurgops palliatus (Gyll.) (Scolytidae) andRhagium inquisitor (L.) (Cerambycidae) attacked both the baited and unbaited bolts, whereasAcanthocinus aedilis (L.) (Cerambycidae) andPytho depressus (L.) (Pythidae) reproduced almost exclusively in the baited ones. Large numbers of larvae ofThanasimus (Cleridae) andRhizophagus (Rhizophagidae) emerged from both the baited and unbaited bolts. Adults ofPlegaderus vulneratus (Panzer) andCylister linearis (Er.) (Histeridae) emerged almost exclusively from the baited bolts. The low progeny production ofT. piniperda in the baited bolts was attributed largely to the influence of adults ofRhizophagus andEpuraea (Nitidulidae), and larvae ofThanasimus andA. aedilis.

Olfactory recognition of nonhosts aspen and birch by conifer bark beetlesTomicus piniperda andHylurgops palliatus.

The field response ofTomicus piniperda (L.) andHylurgops palliatus (Gyll.) (Coleoptera: Scolytidae) to the attractant ethanol in combination with volatile wood constituents released from the nonhost tree speciesPopulus tremula L. (Salicaceae) andBetula pendula Roth (Betulaceae) was studied using flight barrier traps. The attraction of both species decreased when aspen or birch wood was added to the ethanol bait. The same was true forRhizophagus depressus (F.) (Coleoptera: Rhizophagidae), a predatory species associated with conifer bark beetles.Glischrochilus quadripunctatus (L-),Epuraea bickhardti St.-Claire Deville,E. unicolor (Oliv.) (Coleoptera: Nitidulidae), andRhizophagus parvutus (Payk.) (Coleoptera: Rhizophagidae) were caught in higher numbers in traps baited with both ethanol and wood of aspen or birch than in traps baited with ethanol alone. In a separate experiment, landings ofT. piniperda andH. palliatus on nonhosts (black plastic tubes) were demonstrated with sticky traps.

Attraction of scolytids and associated beetles by different absolute amounts and proportions of α-pinene and ethanol.

The attraction of bark and ambrosia beetles as well as associated beetles to α-pinene and ethanol was studied in field experiments with flight barrier traps. α-Pinene and ethanol were released individually and as combinations in approximately 1∶1 or 1∶10 ratios and at four different release rates. Ethanol attractedTomicus piniperda (L.),Hylurgops palliatus (Gyll.),Trypodendron lineatum (Oliv.),Hylastes cunicularius Er.,H. brunneus Er.,H. opacus Er., andAnisandrus dispar (F.) (Scolytidae);Glischrochilus quadripunctatus (L.) andEpuraea spp. (Nitidulidae);Thanasimus formicarius (L.) (Cleridae); andRhizophagus depressus (F.) (Rhizophagidae). α-Pinene attracted all these species with the exception ofT. lineatum, H. cunicularius, andA. dispar. Combinations of a-pinene and ethanol resulted in synergistically increased attraction of all species with the exception ofH. opacus andA. dispar. A. dispar, the only hardwood-associated species in the study, was repelled by α-pinene. Both the release rates and the ratio at which the two substances were released influenced the response of the beetles. The differences in response between the beetle species seem to reflect dissimilarities in the release of the two substances among the various types of breeding material to which the species are adapted.

Gallery initiation byTomicus piniperda (Coleoptera: Scolytidae) on scots pine trees baited with host volatiles.

In a trapping experiment, wood chips from freshly cut Scots pine trees attracted flying adults of the bark beetleTomicus piniperda (L.) Healthy Scots pine trees, which usually are not attacked byT. piniperda, were baited with chips from freshly cut trees. In other experiments trees were baited with a mixture of (-)-α-pinene, (+)-3-carene, and terpinolene; the individual monoterpenes; or with ethanol alone. All baited treatments were attacked byT. piniperda. Most of the attacks resulted in short egg galleries and in larval galleries which were only a few millimeters in length. In trees from which a new generation of beetles emerged, net reproduction was well below 1.0. Unbaited control trees remained unattacked or received a few isolated attacks.