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1.
Artigo em Inglês | MEDLINE | ID: mdl-31577665

RESUMO

Telehealth improves access to health care and has seen rapid expansion in recent years. Nurse practitioner (NP) students are expected to be able to use telehealth to provide health care on graduation; however, many programs of study do not include telehealth in the academic preparation of students. As a result, students feel unprepared to use telehealth to provide care to patients. To meet this need, a land-grant institution developed evidence-based competencies and curriculum to educate NP students in the area of telehealth. Curriculum included presentations, assignments, and simulation in the area of telehealth. Participants included 156 female and 15 male family nurse practitioner (FNP) students. Using a Likert scale from 1 (very unprepared) to 4 (very prepared), students indicated their knowledge and skill level for each telehealth competency area before and after the content delivery. Each competency demonstrated a significant increase in FNP student confidence and ability when comparing the pretest and posttest mean (p = .000). Outcomes of the project demonstrated the importance of including telehealth concepts into the curriculum for NP students to meet the needs and expectations of health care systems.

2.
S D Med ; 72(8): 354-360, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465640

RESUMO

INTRODUCTION: The Centers for Disease Control and Prevention updated recommendations for human papillomavirus (HPV) vaccine in 2016. National and statewide statistics indicate that HPV vaccination in the adolescent population is well below the administration rates for other vaccines. Because cancers associated with HPV infection are vaccine preventable, low administration rates are a cause for concern. METHODS: Through a two-year project funded by the South Dakota Department of Health, Sanford Health implemented a quality improvement project to address the low rate of HPV vaccine administration in their clinics in South Dakota. Evidence-based interventions included: implementation of a client reminder and recall system, vaccine education for providers and staff, a provider assessment and feedback system, and re-education on protocol (standing) orders. RESULTS: Implementation of this quality improvement project resulted in the following: 104,571 client reminders distributed, re-education on standing orders for vaccine administration, as well as feedback on missed opportunities for vaccination, and increased awareness for all providers and staff. In patients ages 11-26, HPV vaccine series completion rates increased by 13 percent in the two-year period. Zero-dose HPV vaccination dropped 22 percent in the seven pilot clinics over the two-year grant period, and by 10 percent overall when the additional clinics (n=32) were added in the second year. DISCUSSION: Implementation of the above practices provided a significant increase in awareness of the need to assess and administer HPV vaccine. The methods used are easily adaptable to any clinic system. These practices can increase HPV vaccination rates and ultimately decrease the number of HPV associated cancers.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Criança , Medicina de Família e Comunidade , Humanos , Infecções por Papillomavirus/prevenção & controle , Melhoria de Qualidade , South Dakota , Adulto Jovem
3.
Nurs Sci Q ; 27(1): 23-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24403032

RESUMO

End-of-life experiences are unique. Most can vividly recall feelings during those times. Governing boards in the United States attempt to guide nursing faculty regarding end of life curriculum. Yet, the beliefs of faculty members arising from those unique experiences can alter the tone and message of what students are actually taught--often surfacing as hidden curriculum. In this column the authors discuss hidden curriculum while presenting the beliefs regarding end of life, of four nursing faculty members from a single university. Heightened awareness and respect for the beliefs of all faculty members within any university setting is imperative in decreasing the development of hidden curriculum.


Assuntos
Currículo , Educação em Enfermagem/organização & administração , Doente Terminal , Docentes de Enfermagem , Humanos , Estados Unidos
4.
Cancer Nurs ; 37(3): 162-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23519042

RESUMO

BACKGROUND: Cancer treatments can lead to detriments in patients' health and declines in quality of life (QOL). Cancer rehabilitation programs may improve functional status, symptom control, and QOL. OBJECTIVE: The objective of this study was to determine if an outpatient, physical therapy-supervised Cancer Rehabilitation Strengthening and Conditioning (CRSC) program improved patients' conditioning level, functional status, QOL, and symptoms. METHODS: This was a prospective study of oncology patients participating in CRSC program. Measurements included conditioning level (6-minute walk test [SMWT], metabolic equivalent level, grip strength), functional status (Physical Component Summary of Short Form 36), QOL (Mental Component Summary of Short Form 36), and symptoms (M. D. Anderson Symptom Inventory). Paired t tests were conducted to determine significant changes between pre- and post-CRSC program measures, and regression methods identified predictors of change from baseline. RESULTS: One hundred fifteen patients with cancer were enrolled in the study; 75 patients completed pre- and post-CRSC program measures. Significant improvements were noted in SMWT by 186.4 ft, SMWT speed by 0.35 mph, treadmill time (3.5 minutes longer), metabolic equivalent level (by 0.87 units), QOL, symptom severity, symptom interference with daily life, fatigue, shortness of breath, and sadness. CONCLUSIONS: In a pretest-posttest design, significant improvements were noted in conditioning level, functional status, QOL, and symptoms. Greater improvements were noted in participants who were most deconditioned at baseline. IMPLICATIONS FOR PRACTICE: Further research should be conducted to provide additional support for CRSC programs. Cancer rehabilitation strengthening and condition programs may benefit patients across the continuum of care, including deconditioned patients.


Assuntos
Exercício , Neoplasias/enfermagem , Pacientes Ambulatoriais , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/reabilitação , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Caminhada
5.
Nurs Clin North Am ; 48(4): 661-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24295193

RESUMO

Rapid advances in knowledge and technology related to genomics cross health care disciplines and touch almost every aspect of patient care. The ability to sequence a genome holds the promise that health care can be personalized. Health care professionals are faced with a gap in the ability to use the rapidly expanding technology and knowledge related to genomics in practice. Yet, nurses are key to bridging the gap between genomic discoveries and the human experience of illness. This article presents a case study documenting the experience of five nursing schools/colleges of nursing as they work to integrate genetics and genomics into their curricula.


Assuntos
Bacharelado em Enfermagem/organização & administração , Educação em Enfermagem/métodos , Genética Médica/educação , Genômica/educação , Papel do Profissional de Enfermagem , Estudantes de Enfermagem , Adulto , Competência Clínica , Currículo , Feminino , Humanos , Masculino , Pesquisa em Educação de Enfermagem , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
6.
Oncol Nurs Forum ; 40(6): 549-57, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24161633

RESUMO

PURPOSE/OBJECTIVES: To estimate and compare responsiveness of standardized self-reported measures of musculoskeletal symptoms (MSSs) and physical functioning (PF) during treatment with aromatase inhibitors (AIs). DESIGN: Prospective, longitudinal study. SETTING: Park Nicollet Institute and North Memorial Cancer Center, both in Minneapolis, MN. SAMPLE: 122 postmenopausal women with hormone receptor-positive breast cancer. METHODS: MSSs and PF were assessed before starting AIs and at one, three, and six months using six self-reported MSSs measures and two PF tests. MAIN RESEARCH VARIABLES: MSSs and PF changes from baseline to six months. FINDINGS: Using the Breast Cancer Prevention Trial-Musculoskeletal Symptom (BCPT-MS) subscale, 54% of participants reported MSSs by six months. Scores from the BCPT-MS subscale and the physical function subscales of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) were most responsive to changes over six months. CONCLUSIONS: BCPT-MS, AUSCAN, and WOMAC were the most responsive instruments for measuring AI-associated MSSs. IMPLICATIONS FOR NURSING: Assessment and management of MSSs are important aspects of oncology care because MSSs can affect functional ability and AI adherence. KNOWLEDGE TRANSLATION: The three measures with the greatest sensitivity were the BCPT-MS, AUSCAN, and WOMAC questionnaires. These measures will be useful when conducting research on change in MSSs associated with AI treatment in women with breast cancer.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Artralgia/induzido quimicamente , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Estrogênios , Limitação da Mobilidade , Debilidade Muscular/induzido quimicamente , Mialgia/induzido quimicamente , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Índice de Gravidade de Doença , Atividades Cotidianas , Idoso , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/terapia , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Seguimentos , Humanos , Adesão à Medicação , Pessoa de Meia-Idade , Neoplasias Hormônio-Dependentes/terapia , Medição da Dor , Pós-Menopausa , Estudos Prospectivos , Inquéritos e Questionários , Avaliação de Sintomas , Resultado do Tratamento
7.
J Cancer Surviv ; 7(2): 211-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23417167

RESUMO

INTRODUCTION: Previous research has identified gaps in cancer survivors' knowledge of their diagnosis and treatment. This study assessed the effect of treatment summaries on survivors' accuracy in reporting details of diagnosis and treatment. METHODS: Written surveys were completed by 203 breast cancer survivors and 141 colorectal cancer survivors diagnosed between 1999 and 2008 at a cancer center in the Minneapolis, MN, area (78 % response rate). All completed the survey before and again 17 months after receiving a treatment summary, which was sent to them upon request. Accuracy of response at each assessment was compared to cancer registry and medical records. RESULTS: Both breast and colorectal cancer survivors showed significant improvement in accuracy on stage of disease, and breast cancer survivors showed significant improvement in accuracy on morphology, estrogen receptor status, progesterone receptor status, receipt of hormone therapy, and receipt of doxorubicin after receiving the treatment summary. Breast cancer survivors and older individuals were more likely than colorectal cancer survivors or younger individuals to indicate that they used the treatment summary in completing the second survey. Even for items on which accuracy improved significantly, however, patient knowledge remained incomplete. CONCLUSIONS: The provision of treatment summaries can improve cancer survivors' knowledge of details about their diagnosis and treatment. IMPLICATIONS FOR CANCER SURVIVORS: Treatment summaries can meet the specific goal of increasing patient knowledge. Their effectiveness might be greater if presented during a dedicated survivorship health care appointment.


Assuntos
Neoplasias da Mama/terapia , Neoplasias Colorretais/terapia , Conhecimento , Registros Médicos , Educação de Pacientes como Assunto , Sobreviventes/psicologia , Acesso à Informação , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/psicologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/psicologia , Comunicação , Coleta de Dados , Feminino , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
8.
J Cancer Educ ; 27(3): 566-72, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22467225

RESUMO

Radon is the second leading cause of lung cancer and it is recommended that all homes be tested for radon. Written surveys completed by 692 patients at two primary care clinics in the Minneapolis, MN, area revealed that only 24.7 % had ever tested their home. Testing rate was higher with greater income and education level and in homes without someone who smokes. Of participants whose homes had not been tested, 250 were enrolled in an intervention that included printed information on radon, a coupon for a discounted testing kit, and encouragement by their primary care provider to test. Follow-up indicated minimal effect of this intervention, with only 14.4 % of these participants testing during the ensuing year. Future studies should assess a stronger intervention, perhaps over multiple visits, and providing test kits on site. Targeting patients who smoke may be an effective use of resources.


Assuntos
Poluentes Radioativos do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/organização & administração , Radônio/análise , Adulto , Fatores Etários , Idoso , Monitoramento Ambiental/métodos , Feminino , Humanos , Neoplasias Pulmonares/prevenção & controle , Masculino , Pessoa de Meia-Idade , Minnesota , Fatores Sexuais , Fatores Socioeconômicos
9.
J Cancer Surviv ; 6(1): 20-32, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21735277

RESUMO

INTRODUCTION: Aspects of a personal cancer history can have implications for future decisions regarding screening, diagnosis, and treatment. Clinicians must sometimes rely on patients' self-report of their medical history. This study assessed knowledge of details of cancer diagnosis and treatment among breast and colorectal cancer survivors. METHODS: Written surveys were completed by 480 breast cancer survivors and 366 colorectal cancer survivors diagnosed between 1999 and 2008 at a large cancer center in the Minneapolis, MN, area (81% response rate). Responses were compared with cancer registry and medical records. RESULTS: Forty percent of breast cancer survivors and 65% of colorectal cancer survivors were unable to identify their stage of disease. Seven percent of breast cancer survivors and 21% of colorectal cancer survivors in whom regional nodes were examined did not know whether they had positive nodes. Accuracy of knowledge of estrogen and progesterone status among breast cancer survivors was 58% and 39%, respectively. Of breast cancer survivors treated with doxorubicin, 43% correctly identified it as a drug they had received. Their accuracy of identification of receipt of tamoxifen or specific aromatase inhibitors was >90%. Of colorectal cancer survivors treated with oxaliplatin, 52% correctly identified it as a drug they had received. Accuracy on many items decreased with patient age. CONCLUSIONS: This study identifies several gaps in adult cancer survivors' knowledge of details of their diagnosis and treatment that have implications for follow-up care. IMPLICATIONS FOR CANCER SURVIVORS: Provision of written treatment summaries to cancer survivors could help them obtain appropriate patient-centered long-term follow-up care.


Assuntos
Adenocarcinoma/psicologia , Neoplasias da Mama/psicologia , Neoplasias Colorretais/psicologia , Conhecimento , Sobreviventes/psicologia , Adenocarcinoma/classificação , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Adulto , Fatores Etários , Antineoplásicos/classificação , Antineoplásicos/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Feminino , Inquéritos Epidemiológicos , Humanos , Metástase Linfática , Masculino , Registros Médicos , Memória , Pessoa de Meia-Idade , Minnesota , Estadiamento de Neoplasias , Educação de Pacientes como Assunto , Receptores Estrogênicos/análise , Receptores de Progesterona/análise , Amostragem , Autorrelato , Inquéritos e Questionários , Adulto Jovem
10.
Clin Breast Cancer ; 11(1): 52-60, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21421523

RESUMO

PURPOSE: This study aimed to identify predictors of changes in weight and body composition among women receiving chemotherapy for breast cancer. PATIENTS AND METHODS: Data were from 49 women age 40-54 receiving chemotherapy for breast cancer. Weight, height, and body composition measurements from dual-energy x-ray absorptiometry (DEXA) scanning were completed at baseline (within 1 month of beginning chemotherapy) and 12 months. Caloric intake was assessed from food diaries at baseline, 6 and 12 months, and physical activity was measured by questionnaire at baseline, 3, 6, 9, and 12 months. RESULTS: Baseline body mass index (BMI) was inversely associated with gains in weight (P = .01) and fat mass in torso (P = .006). Women of normal weight gained an average of 4.3 pounds and increased fat mass in torso and arms. Overweight women lost 3.0 pounds, and obese women lost 4.1 pounds, and neither group increased body fat. Decreased physical activity was associated with weight gain (P = .047). Additional predictors of increased fat mass in torso were younger age (P = .023) and treatment with tamoxifen (P = .015). Predictors of loss of bone mineral content included older age (P = .004) and treatment with aromatase inhibitor (P = .024), whereas treatment with bisphosphonate prevented bone loss (P < .0001). CONCLUSION: Women receiving chemotherapy for breast cancer who are of normal weight at the time of breast cancer diagnosis are more likely to gain weight and body fat during the following year than overweight or obese women.


Assuntos
Antineoplásicos/efeitos adversos , Composição Corporal/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Neoplasias da Mama/tratamento farmacológico , Ganho de Peso/efeitos dos fármacos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Oncol Nurs Forum ; 37(3): 321-30, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20439216

RESUMO

PURPOSE/OBJECTIVES: To describe and predict adherence to a physical activity protocol for patients with breast cancer receiving chemotherapy. DESIGN: Longitudinal, observational study. SETTING: Cancer center in the upper Midwestern region of the United States. SAMPLE: 36 patients with breast cancer aged 40-55 years who were receiving adjuvant treatment. METHODS: A longitudinal study was conducted within a randomized clinical trial comparing the effects of physical activity versus bisphosphonates on bone mineral density. Participants randomized to physical activity were advised to walk 10,000 steps per day and received initial physical therapy consultation and ongoing motivational interviewing. Multilevel modeling was used to identify variables that predict adherence. MAIN RESEARCH VARIABLES: Adherence to the 10,000-step protocol was estimated with total steps and mean steps per day. FINDINGS: Thirty-six women were enrolled in the physical activity group; 29 provided step data. The mean total steps per participant for the first six weeks was 280,571 (SD = 111,992), which is 67% of the prescribed steps. Excluding days when no steps were recorded, the mean steps per day for the initial six-week period was 7,363 (SD = 2,421), a 74% adherence rate. A significant linear increase occurred in steps per day after chemotherapy in a treatment cycle (p < 0.0001). Baseline inactivity predicted adherence. CONCLUSIONS: Adherence to the walking program was compromised during chemotherapy but improved after chemotherapy completion. IMPLICATIONS FOR NURSING: Knowing that chemotherapy predicts adherence to a walking protocol is useful for selecting the type, timing, and intensity of physical activity interventions.


Assuntos
Neoplasias da Mama , Terapia por Exercício/psicologia , Cooperação do Paciente/psicologia , Caminhada/psicologia , Adulto , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/reabilitação , Fadiga/induzido quimicamente , Estudos de Viabilidade , Feminino , Humanos , Modelos Lineares , Estudos Longitudinais , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Motivação , Análise Multivariada , Pesquisa em Avaliação de Enfermagem , Enfermagem Oncológica , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Perimenopausa , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Support Oncol ; 7(3): 101-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19507458

RESUMO

Chemotherapy for breast cancer causes early-onset menopause for most women older than age 40 and is associated with accelerated bone loss. The primary objective of this study was to compare the effects of intravenous (IV) zoledronic acid versus prescribed physical activity (PA) on changes in bone mineral density (BMD) for women between the ages of 40 and 55 years receiving chemotherapy for breast cancer. A randomized controlled trial of 62 patients with breast cancer during chemotherapy compared IV zoledronic acid and oral calcium/vitamin D (ZO group) versus a PA program and oral calcium/vitamin D (PA group). ZO group participants received zoledronic acid IV every 3 months for 5 treatments. PA group participants were enrolled in a home-based exercise program and received motivational counseling, pedometers, and exercise tapes. BMD measurements from dual-energy x-ray absorptiometry (DEXA) scanning were completed at baseline and at 12 months. BMD significantly decreased in the PA group but not in the ZO group. Although spine, total hip, and total body BMD increased in the ZO group by 1.6%, 0.8%, and 0.8%, respectively, BMD decreased in the PA group by 6.0%, 3.4%, and 3.3%, respectively (P values < 0.0001 for all group comparisons). Zoledronic acid protected patients with breast cancer against bone loss during initial treatment, whereas home-based PA interventions were less effective in preventing bone loss.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea , Doenças Ósseas Metabólicas/prevenção & controle , Neoplasias da Mama/tratamento farmacológico , Difosfonatos/uso terapêutico , Exercício/fisiologia , Imidazóis/uso terapêutico , Absorciometria de Fóton , Adulto , Antineoplásicos/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/etiologia , Cálcio na Dieta/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Vitamina D/administração & dosagem , Ácido Zoledrônico
13.
Oncol Nurs Forum ; 36(2): 185-93, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19273407

RESUMO

PURPOSE/OBJECTIVES: To identify risk factors for lymphedema after breast cancer surgery. DESIGN: Multisite case-control study. SETTING: Lymphedema clinics in the upper midwestern region of the United States. SAMPLE: 94 patients with lymphedema and 94 controls without lymphedema, matched on type of axillary surgery and surgery date. METHODS: The Measure of Arm Symptom Survey, a patient-completed tool, assessed potential risk factors for lymphedema. Severity of lymphedema was measured by arm circumference, and disease and treatment factors were collected via chart review. MAIN RESEARCH VARIABLES: Risk factors for lymphedema after breast cancer surgery. FINDINGS: On univariate analysis, patients with lymphedema were more likely than controls to be overweight (body mass index >or= 25) (p = 0.009). They also were more likely to have had axillary radiation (p = 0.011), mastectomy (p = 0.008), chemotherapy (p = 0.033), more positive nodes (p = 0.009), fluid aspirations after surgery (p = 0.005), and active cancer status (p = 0.008). Strength training (p = 0.014) and air travel (p = 0.0005) were associated with less lymphedema occurrence. On multivariate analysis, the only factor significantly associated with lymphedema was being overweight (p = 0.022). CONCLUSIONS: Being overweight is an important modifiable risk factor for lymphedema. Axillary radiation, more extensive surgery, chemotherapy, and active cancer status also were predictive of lymphedema. IMPLICATIONS FOR NURSING: This study provides evidence that excess weight contributes to lymphedema; strength training and airline travel did not contribute to lymphedema.


Assuntos
Atitude Frente a Saúde , Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Linfedema/etiologia , Linfedema/psicologia , Mastectomia , Atividades Cotidianas/psicologia , Análise de Variância , Antropometria , Neoplasias da Mama/complicações , Estudos de Casos e Controles , Humanos , Incidência , Excisão de Linfonodo/métodos , Linfedema/diagnóstico , Linfedema/epidemiologia , Mastectomia/efeitos adversos , Mastectomia/métodos , Meio-Oeste dos Estados Unidos/epidemiologia , Minnesota/epidemiologia , Avaliação em Enfermagem , Pesquisa Metodológica em Enfermagem , Obesidade/complicações , Prevalência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários
14.
Fam Med ; 39(7): 477-82, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17602321

RESUMO

BACKGROUND AND OBJECTIVES: Primary care providers (PCPs) are often involved in the care of cancer survivors. This study asked PCPs about their role in the follow-up care of breast and colorectal cancer patients and elicited opinions on improving the transfer of care from oncologists to PCPs. METHODS: A total of 175 PCPs in a large health care system with an electronic medical record system were mailed a questionnaire that addressed (1) their comfort and confidence regarding surveillance for cancer recurrence, (2) when patients should be seen in primary care, (3) evaluation of the transfer of care, (4) potential problems with that process, and (5) suggestions for improving that process. RESULTS: The response rate was 75.4%. Overall, 52% were comfortable having responsibility for surveillance of cancer recurrence, and 43% were confident they are following standard guidelines for cancer recurrence. Both of the aforementioned measures increased with years of practice. More than half rated the current transfer of care from oncologist to PCP as fair or poor. The most common problems identified were uncertainty regarding the type (62.6% for breast, 56.5% for colorectal), frequency (72.5%, 66.4%), and duration (74.8%, 67.2%) of surveillance testing. CONCLUSIONS: Levels of comfort, confidence, and satisfaction were generally low. PCPs need more specific guidance regarding surveillance for cancer recurrence.


Assuntos
Continuidade da Assistência ao Paciente , Pessoal de Saúde/psicologia , Atenção Primária à Saúde , Atitude do Pessoal de Saúde , Neoplasias da Mama , Neoplasias Colorretais , Humanos , Minnesota , Inquéritos e Questionários
15.
Cancer ; 104(9): 1834-9, 2005 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-16161037

RESUMO

BACKGROUND: Surgical recommendation for early-stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early-stage breast carcinoma who underwent SLND without concomitant ALND. METHODS: A retrospective study was conducted using the oncology registry at Park Nicollet Health Services (Minneapolis, MN). Consecutive breast carcinoma cases with SLND only for axillary surgery, from January 28, 1999 to December 31, 2003, were included in the study. During this period, 700 patients with breast carcinoma were identified who had SLND alone. Fifty-two patients were excluded from the analysis because they had ductal carcinoma in situ. RESULTS: With a median follow-up of 33 months (range, 2-73 mos), axillary lymph node recurrence occurred in 4 of 647 (0.62%) patients overall. In these 4 patients, the axillary lymph node recurrences were isolated to the axillary lymph nodes and amenable to surgery. CONCLUSIONS: Data from the current study showed that axillary lymph node recurrence after SLND occurred very infrequently in early-stage breast carcinoma, and these results were comparable to other studies.


Assuntos
Axila , Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos
16.
Ann Surg Oncol ; 9(8): 745-53, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12374657

RESUMO

BACKGROUND: Axillary lymph node dissection (ALND) is often associated with permanent arm side effects. Side effects after sentinel lymph node dissection (SLND) should be less common, because the surgery is less extensive. METHODS: The study compared side effects and interference with daily life between 169 women who underwent an SLND and 78 who underwent an ALND for breast cancer. Patients rated symptom severity and interference with daily life caused by pain, numbness, limitation of arm range of motion (ROM), and arm swelling at 1, 6, and 12 months after surgery by using the Measure of Arm Symptom Survey. Repeated-measures and regression analyses for each time period were used to determine associations between symptoms and dissection type. RESULTS: At 1 month, SLND patients reported less pain, numbness, limitation in ROM, and seromas than ALND patients. At 6 months, SLND patients had less pain, numbness, and arm swelling, and at 12 months, SLND patients had less numbness, arm swelling, and limitation in ROM than ALND patients. At 1 month, pain, numbness, and limitation in ROM interfered significantly more with daily life for ALND patients. At 6 and 12 months, only numbness interfered more with daily life for ALND patients. CONCLUSIONS: SLND was associated with fewer side effects than ALND at all time points.


Assuntos
Neoplasias da Mama/cirurgia , Edema/etiologia , Hipestesia/etiologia , Excisão de Linfonodo/efeitos adversos , Dor/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/patologia , Feminino , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Qualidade de Vida , Análise de Regressão , Biópsia de Linfonodo Sentinela/efeitos adversos , Inquéritos e Questionários
17.
Cancer ; 94(11): 2830-5, 2002 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-12115369

RESUMO

BACKGROUND: A risk-based model was developed for recommendations for mammography screening of women in their 40s. We determined retrospectively the proportion of women already diagnosed in their 40s with breast cancer (BC) who would have been recommended for mammography screening by this model. METHODS: Information was obtained from 404 women who were diagnosed with BC in their 40s from 1990 to 1998 at a large midwestern hospital. Data on BC detection method, mammography history, and BC risk factors existing before diagnosis were obtained from 353 of these women by mailed questionnaires. Data for an additional 51 women who had died were obtained by chart review. Two algorithms, the Exact Age Procedure (EAP) and the Grouped Age Procedure (GAP), were used to calculate the proportion of women who would have been recommended for mammography screening based on age, race, and BC risk factors. RESULTS: Of women diagnosed with BC in their 40s, 74.5% would have been recommended for screening by the EAP and 70.5% by the GAP. The model would have recommended screening for approximately one half of the women who had no conventional risk factors (54% by EAP, 48% by GAP). CONCLUSION: Although use of the risk-based model could result in more recommendations for screening than individual recommendations based on patient-physician discussions about the woman's risk factors, one in four women diagnosed with breast cancer in their 40s would not have been recommended for mammography screening.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Programas de Rastreamento/métodos , Modelos Biológicos , Adulto , Fatores Etários , Algoritmos , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
18.
Oncol Nurs Forum ; 29(3): 547-53, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11979286

RESUMO

PURPOSE/OBJECTIVES: To explore women's expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction. DESIGN: Qualitative focus group study. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer. METHODS: An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization. FINDINGS: Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence. CONCLUSIONS: Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence. IMPLICATIONS FOR PRACTICE: Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.


Assuntos
Mamoplastia , Mastectomia , Qualidade de Vida , Feminino , Grupos Focais , Humanos , Mamoplastia/psicologia , Mastectomia/psicologia , Satisfação do Paciente
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