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1.
Appl Nurs Res ; 43: 36-41, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30220361

RESUMO

BACKGROUND: Health information technology (HIT), such as electronic health records (EHRs), is a growing part of the clinical landscape. Recent studies among physicians suggest that HIT is associated with a higher prevalence of burnout. Few studies have investigated the workflow and practice-level predictors of burnout among advanced practice registered nurses (APRNs). AIM: Characterize HIT use and measure associations between EHR-related stress and burnout among APRNs. METHODS: An electronic survey was administered to all APRNs licensed in Rhode Island, United States (N = 1197) in May-June 2017. The dependent variable was burnout, measured with the validated Mini z burnout survey. The main independent variables were three EHR-related stress measures: time spent on the EHR at home, daily frustration with the EHR, and time for documentation. Logistic regression was used to measure the association between EHR-related stress and burnout before and after adjusting for demographics, practice-level characteristics, and the other EHR-related stress measures. RESULTS: Of the 371 participants, 73 (19.8%) reported at least one symptom of burnout. Among participants with an EHR (N = 333), 165 (50.3%) agreed or strongly agreed that the EHR added to their daily frustration and 97 (32.8%) reported an insufficient amount of time for documentation. After adjustment, insufficient time for documentation (AOR = 3.72 (1.78-7.80)) and the EHR adding to daily frustration (AOR = 2.17 (1.02-4.65)) remained predictors of burnout. CONCLUSIONS: Results from the present study revealed several EHR-related environmental factors are associated with burnout among APRNs. Future studies may explore the impact of addressing these EHR-related factors to mitigate burnout among this population.


Assuntos
Prática Avançada de Enfermagem , Esgotamento Profissional , Registros Eletrônicos de Saúde , Recursos Humanos de Enfermagem/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
J Cell Mol Med ; 12(1): 343-50, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18366457

RESUMO

Angiogenesis, the development and recruitment of new blood vessels, plays an important role in tumour growth and metastasis. Vascular endothelial growth factor (VEGF) is an important stimulator of angiogenesis. Circulating and urinary VEGF levels have been suggested as clinically useful predictors of tumour behaviour, and investigations into these associations are ongoing. Despite recent interest in measuring VEGF levels in patients, little is known about the factors that influence VEGF levels in biospecimens. To begin to address this question, urine samples were collected from patients with solid tumours undergoing radiotherapy and healthy volunteers. Four factors were examined for their effects on VEGF concentrations as measured by chemiluminescent immunoassay: time from sample collection to freezing, number of specimen freeze-thaw cycles, specimen storage tube type and the inclusion or exclusion of urinary sediment. The results of this study indicate that time to freeze up to 4 hrs, number of freeze-thaw cycles between one and five, and different types of polypropylene tubes did not have statistically significant effects on measured urinary VEGF levels. Urinary sediment had higher VEGF levels than supernatant in five of six samples from healthy patients. It is not clear whether there is an active agent in the sediment causing this increase or if the sediment particles themselves are affecting the accuracy of the assay.Therefore, we recommend centrifuging urine, isolating the supernatant, and freezing the sample in polypropylene microcentrifuge tubes or cryogenic vials within 4 hrs of collection.In addition, we recommend the use of samples within five freeze-thaw cycles.


Assuntos
Biomarcadores Tumorais/urina , Neoplasias/urina , Manejo de Espécimes , Fator A de Crescimento do Endotélio Vascular/urina , Congelamento , Humanos , Neoplasias/radioterapia , Polipropilenos/química
3.
Int J Radiat Oncol Biol Phys ; 70(1): 90-5, 2008 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-17855015

RESUMO

PURPOSE: To test whether intrarectal amifostine limits symptoms of radiation proctitis, measured by using the Radiation Therapy Oncology Group (RTOG) gastrointestinal (GI) toxicity score and the Expanded Prostate Cancer Index Composite (EPIC) score. METHODS AND MATERIALS: Patients with localized prostate cancer received amifostine as a rectal suspension 30-45 minutes before daily three-dimensional conformal radiation therapy. The first 18 patients received 1 g of amifostine, and the next 12 patients received 2 g. Toxicity was assessed at baseline, during treatment, and at follow-up visits by using RTOG grading and the EPIC Quality of Life (QoL) 50-item questionnaire. The Bowel Function subset of the bowel domain (EPIC-BF), which targets symptom severity, and the Bowel Bother subset of the bowel domain (EPIC-BB), which assesses QoL, were evaluated and compared with the RTOG GI toxicity score. RESULTS: Median follow-up was 30 months (range, 18-36 months). Overall, EPIC-BF and EPIC-BB scores both tracked closely with the RTOG GI toxicity score. Seven weeks after the start of radiation therapy, the incidence of RTOG Grade 2 toxicity was 33% in the 1-g group (6/18 patients) compared with 0% (0/12 patients) in the 2-g group and tended toward statistical significance (p = 0.06). A significant difference between amifostine groups was observed using the EPIC-BF score at 7 weeks (p = 0.04). A difference in EPIC-BB scores between dose groups was evident at 7 weeks (p = 0.07) and was significant at 12 months (p = 0.04). CONCLUSIONS: Higher doses of amifostine produced significant improvements in acute and late bowel QoL (up to 1 year after therapy), measured using the EPIC score.


Assuntos
Amifostina/administração & dosagem , Proctite/prevenção & controle , Neoplasias da Próstata/radioterapia , Qualidade de Vida , Protetores contra Radiação/administração & dosagem , Radioterapia Conformacional/efeitos adversos , Adenocarcinoma/radioterapia , Administração Retal , Idoso , Relação Dose-Resposta a Droga , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/prevenção & controle , Reto/efeitos da radiação , Índice de Gravidade de Doença , Inquéritos e Questionários
4.
Radiat Oncol ; 2: 36, 2007 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-17877821

RESUMO

BACKGROUND: To assess the feasibility and early toxicity of selective, IMRT-based dose escalation (simultaneous integrated boost) to biopsy proven dominant intra-prostatic lesions visible on MRI. METHODS: Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible. All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality. Gold fiducial markers were also placed. Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan. This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion. A 3 mm expansion was performed on the intra-prostatic lesions, defined as a separate volume within the prostate. The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray (Gy) respectively in 42 fractions. Daily seed position was verified to be within 3 mm. RESULTS: Three patients were treated. Follow-up was 18, 6, and 3 months respectively. Two patients had a single intra-prostatic lesion. One patient had 2 intra-prostatic lesions. All four intra-prostatic lesions, with margin, were successfully targeted and treated to 94.5 Gy. Two patients experienced acute RTOG grade 2 genitourinary (GU) toxicity. One had grade 1 gastrointestinal (GI) toxicity. All symptoms completely resolved by 3 months. One patient had no acute toxicity. CONCLUSION: These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI. The treatment was well tolerated.


Assuntos
Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Biópsia , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , National Cancer Institute (U.S.) , Seleção de Pacientes , Neoplasias da Próstata/epidemiologia , Dosagem Radioterapêutica , Inquéritos e Questionários , Estados Unidos/epidemiologia
5.
Radiat Oncol ; 1: 28, 2006 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-16914054

RESUMO

PURPOSE: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. MATERIALS AND METHODS: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise >35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. RESULTS: Median follow-up was 24 months (range 18-36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. CONCLUSION: We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive.


Assuntos
Braquiterapia/métodos , Imagem por Ressonância Magnética/métodos , Antígeno Prostático Específico/biossíntese , Neoplasias da Próstata/radioterapia , Radioterapia/métodos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica , Risco , Resultado do Tratamento
6.
Int J Radiat Oncol Biol Phys ; 65(4): 1008-13, 2006 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-16730138

RESUMO

PURPOSE: Our goal was to test the ability of intrarectal amifostine to limit symptoms of radiation proctitis. METHODS AND MATERIALS: The first 18 patients received 1 g of intrarectal amifostine suspension placed 30-45 min before each radiation treatment. The following 12 patients received 2 g of amifostine. Total dose prescribed ranged from 66 to 76 Gy. All patients were treated with three-dimensional conformal radiation therapy. The suspension remained intrarectal during treatment and was expelled after treatment. For gastrointestinal symptoms, during treatment and follow-up, all patients had a Radiation Therapy Oncology Group (RTOG) grade recorded. RESULTS: Median follow-up was 18 months (range, 6-24 months). With 2 g vs. 1 g amifostine, there was a nearly significant decrease in RTOG Grade 2 acute rectal toxicity. Seven weeks after the start of radiation therapy, the incidence of Grade 2 toxicity was 33% in the 1-g group (6/18) compared with 0% (0/12) in the 2-g group (p=0.06). No Grade 3 toxicity or greater occurred in this study. CONCLUSION: This trial suggests greater rectal radioprotection from acute effects with 2 g vs. 1 g amifostine suspension. Further studies should be conducted in populations at higher risk for developing symptomatic acute and late proctitis.


Assuntos
Amifostina/administração & dosagem , Proctite/prevenção & controle , Neoplasias da Próstata/radioterapia , Lesões por Radiação/prevenção & controle , Protetores contra Radiação/administração & dosagem , Reto/efeitos da radiação , Administração Retal , Idoso , Humanos , Masculino , Projetos Piloto , Proctite/etiologia , Radioterapia Conformacional , Estatísticas não Paramétricas
7.
Int J Radiat Oncol Biol Phys ; 62(5): 1316-21, 2005 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-16029787

RESUMO

PURPOSE: This study strives to compare early measures of bowel toxicity in patients with prostate cancer receiving definitive or adjuvant 3D conformal external beam radiation therapy and concurrent daily endorectal application of amifostine. METHODS: Eighteen patients were enrolled in the clinical study with a median follow-up of 12 months. Prescription doses ranged from 66 Gy to 76 Gy with a daily fractionation of 2 Gy. Acute bowel toxicity was measured at baseline, at Weeks 5 and 7 of radiotherapy, and at 1 and 3 months after the completion of therapy. Measures of acute bowel toxicity included the Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring criteria, Expanded Prostate Cancer Index Composite (EPIC) self-assessment questionnaires, and proctoscopic examinations. RESULTS: The mean EPIC bowel scores changed significantly through the course of therapy and follow-up (p < 0.0001), with a progressive decrease in scores at Weeks 5 and 7 of treatment, a partial recovery at 3 months, and a correlation to the gold standard RTOG grade (p = 0.004). Proctoscopic toxicity scores were low, did not vary over time, and did not correlate with either EPIC or RTOG scores. CONCLUSION: The EPIC questionnaire measurements are most sensitive to changes in acute bowel toxicity through a course of radiotherapy and correlate with RTOG acute toxicity scores. Endoscopic examination of the rectal mucosa at the end and immediate follow-up of a course of therapy does not seem to be informative or reproducible between observers in the acute setting.


Assuntos
Amifostina/uso terapêutico , Neoplasias da Próstata/radioterapia , Lesões por Radiação/patologia , Protetores contra Radiação/uso terapêutico , Reto/efeitos da radiação , Idoso , Distribuição de Qui-Quadrado , Humanos , Masculino , Pessoa de Meia-Idade , Proctoscopia , Qualidade de Vida , Dosagem Radioterapêutica , Radioterapia Conformacional , Estatísticas não Paramétricas , Inquéritos e Questionários
8.
Int J Radiat Oncol Biol Phys ; 59(5): 1414-23, 2004 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-15275727

RESUMO

PURPOSE: Magnetic resonance imaging (MRI) provides superior visualization of the prostate and surrounding anatomy, making it the modality of choice for imaging the prostate gland. This pilot study was performed to determine the feasibility and dosimetric quality achieved when placing high-dose-rate prostate brachytherapy catheters under MRI guidance in a standard "closed-bore" 1.5T scanner. METHODS AND MATERIALS: Patients with intermediate-risk and high-risk localized prostate cancer received MRI-guided high-dose-rate brachytherapy boosts before and after a course of external beam radiotherapy. Using a custom visualization and targeting program, the brachytherapy catheters were placed and adjusted under MRI guidance until satisfactory implant geometry was achieved. Inverse treatment planning was performed using high-resolution T(2)-weighted MRI. RESULTS: Ten brachytherapy procedures were performed on 5 patients. The median percentage of volume receiving 100% of prescribed minimal peripheral dose (V(100)) achieved was 94% (mean, 92%; 95% confidence interval, 89-95%). The urethral V(125) ranged from 0% to 18% (median, 5%), and the rectal V(75) ranged from 0% to 3.1% (median, 0.3%). In all cases, lesions highly suspicious for malignancy could be visualized on the procedural MRI, and extracapsular disease was identified in 2 patients. CONCLUSION: High-dose-rate prostate brachytherapy in a standard 1.5T MRI scanner is feasible and achieves favorable dosimetry within a reasonable period with high-quality image guidance. Although the procedure was well tolerated in the acute setting, additional follow-up is required to determine the long-term safety and efficacy of this approach.


Assuntos
Braquiterapia/métodos , Imagem por Ressonância Magnética , Neoplasias da Próstata/radioterapia , Idoso , Intervalos de Confiança , Estudos de Viabilidade , Humanos , Imagem por Ressonância Magnética/instrumentação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Neoplasias da Próstata/diagnóstico , Dosagem Radioterapêutica , Cateterismo Urinário/métodos
9.
Semin Oncol ; 30(6 Suppl 18): 63-7, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14727242

RESUMO

Tolerance of the normal rectal mucosa to radiation injury limits the dose that can be safely delivered to the prostate gland with definitive external beam radiation therapy. The radioprotective agent amifostine (Ethyol; MedImmune, Inc, Gaithersburg, MD) is approved for intravenous use. Laboratory studies indicate that rectal administration results in preferential accumulation of amifostine in the rectal mucosa, and in clinical studies, neither free parent compound nor free active metabolite has been detected in the systemic circulation. This trial evaluates the rates of early and late rectal toxicities in patients with prostate cancer receiving definitive or adjuvant three-dimensional conformal external beam radiation therapy and concurrent daily endorectal applications of amifostine. Endpoints include Radiation Therapy Oncology Group acute and late toxicity gradings, Expanded Prostate Cancer Index Composite self-assessment questionnaires, and proctoscopic examinations with scoring of mucosal damage measured before, during, and after treatment. Eleven patients have been enrolled to date; 10 have completed radiotherapy and three have been followed-up to 6 months. Two patients received 66 Gy to the prostatic bed post-prostatectomy; five patients received 74 Gy and three received 76 Gy to the prostate gland. In all patients, daily fractionation was 2 Gy, and 1 g of amifostine (50 mg/mL in 20 mL reconstituted saline) was administered endorectally 40 minutes before radiation delivery. Daily endorectal administration was well tolerated. To date, six patients have experienced grade 2 (Radiation Therapy Oncology Group) acute toxicities, all but one because of frequent bowel movements relieved by loperamide. The initial trial will proceed until 18 patients are accrued, at which time an interval evaluation of both early and late toxicity endpoints will be conducted.


Assuntos
Adenocarcinoma/radioterapia , Amifostina/administração & dosagem , Neoplasias da Próstata/radioterapia , Protetores contra Radiação/administração & dosagem , Administração Retal , Idoso , Amifostina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/prevenção & controle , Protetores contra Radiação/uso terapêutico , Dosagem Radioterapêutica , Radioterapia Conformacional
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