Trauma Versus Nontrauma Intensive Care Unit Nursing: A Workload Comparison.

BACKGROUND: Trauma centers with dedicated trauma intensive care units (TICUs) have recently been developed in South Korea. It is hypothesized that TICU nurse staffing is driven not only by the number of patients but also by the work intensity. This study aims to compare nursing workload characteristics between TICUs and non-TICUs. METHODS: A 1-year retrospective study was performed in one TICU and five non-TICUs in a single trauma center from September 2014 to August 2015. Demographic data were collected along with nursing workload characteristics using the Workload Management System of Critical Care Nurses (WMSCN) score. RESULTS: A total of 332 trauma patients in the TICU and 2,346 nontrauma patients in non-TICUs were studied. TICU patients were younger (49.27 vs. 60.44, p < .001) and more frequently male (75.6% vs. 24.4%, p < .001). The most common admission reasons were motor vehicle crash (38.6%) and cardiovascular conditions (24.9%). Both intensive care unit and hospital length of stay were longer in TICU patients (12.72 vs. 5.43, p < .001; and 35.61 vs. 18.16, p < .001), whereas the mortality rates in the TICU were lower (11.1% vs. 15.1%, p < .001). Total WMSCN scores were significantly higher in the TICU (115.99 vs. 110.19; p < .001). CONCLUSIONS: This study found that nursing workload or work intensity was significantly higher in the TICU than in non-TICUs. Further multicenter studies using objective medical severity scores are warranted.

Oncologic outcome after cessation or dose reduction of capecitabine in patients with colon cancer.

PURPOSE: Oral capecitabine has been used as adjuvant therapy for colorectal cancer patients since the 1990s. Patient-initiated cessation or reduced use of capecitabine occurs widely for various reasons, yet the consequences of these actions are unclear. The present study sought to clarify treatment outcomes in such patients. METHODS: The study included 173 patients who had been diagnosed with stage II or III colon cancer according to the pathologic report after radical surgery at Samsung Medical Center from May 2005 to June 2007 and who had received capecitabine as adjuvant therapy. The patients were divided into groups according to whether the dose was reduced (I, dose maintenance; II, dose reduction) or stopped (A, cycle completion; B, cycle cessation). Recurrence and disease-free survival rates between the two groups each were analyzed. RESULTS: Of the 173 patients, 128 (74.6%) experienced complications, most frequently hand-foot syndrome (n = 114). Reduction (n = 35) or cessation (n = 18) of medication was most commonly due to complications. Concerning reduced dosage, both groups displayed no statistically significant differences in recurrence rate and 3-year disease-free survival rate. Concerning discontinued medication use, the cycle completion group showed an improved recurrence rate (P = 0.048) and 3-year disease-free survival rate (P = 0.028). CONCLUSION: The results demonstrate that maintaining compliance with capecitabine as an adjuvant treatment for colon cancer to preventing complications positively affects patient prognosis.

Compliance and effective management of the hand-foot syndrome in colon cancer patients receiving capecitabine as adjuvant chemotherapy.

PURPOSE: Physicians and oncology nurses must continue to update their knowledge on treatment and treatment-related side effects, while searching for effective methods to prevent or manage side effects. The objective of our study was to describe the incidence and response to treatment of the hand-foot syndrome (HFS) and the compliance with treatment of patients with stage IIB, IIIA, IIIB, and IIIC colon cancer that were treated with capecitabine alone as adjuvant therapy. MATERIALS AND METHODS: Between September 2005 and September 2006, 84 patients fulfilled the inclusion criteria and were included in this retrospective analysis of prospectively collected data. RESULTS: The treatment compliance rate was 90.5% (76 out of the 84 patients). The HFS developed in 65 patients (77.4%). Thirty-three patients (50.7%) had grade 1 HFS, 22 patients (33.8%) had grade 2 HFS and 10 patients (15.5%) had grade 3 HFS, as their most severe episode. For Grade 1 patients, the dose was maintained, and skin barrier cream and moist exposed burn ointment (MEBO) were applied. For Grade 2 patients, either the dose was maintained or 25% of the dose was reduced; MEBO and supportive care were provided. For Grade 3 patients, one cycle of chemotherapy was interrupted followed by dose adjustment; MEBO and supportive care were provided. CONCLUSION: HFS is manageable if both patients and oncology care teams are educated about HFS associated with capecitabine. The HFS is treated by patient education, preventive management, ointment application, conservative management, dose reduction, and interruption of chemotherapy administration.