Application of a tungsten apron for occupational radiation exposure in nursing care of children with neuroblastoma during 131I-meta-iodo-benzyl-guanidine therapy.

The use of effective shielding materials against radiation is important among medical staff in nuclear medicine. Hence, the current study investigated the shielding effects of a commercially available tungsten apron using gamma ray measuring instruments. Further, the occupational radiation exposure of nurses during 131I-meta-iodo-benzyl-guanidine (131I-MIBG) therapy for children with high-risk neuroblastoma was evaluated. Attachable tungsten shields in commercial tungsten aprons were set on a surface-ray source with 131I, which emit gamma rays. The mean shielding rate value was 0.1 ± 0.006 for 131I. The shielding effects of tungsten and lead aprons were evaluated using a scintillation detector. The shielding effect rates of lead and tungsten aprons against 131I was 6.3% ± 0.3% and 42.1% ± 0.2% at 50 cm; 6.1% ± 0.5% and 43.3% ± 0.3% at 1 m; and 6.4% ± 0.9% and 42.6% ± 0.6% at 2 m, respectively. Next, we assessed the occupational radiation exposure during 131I-MIBG therapy (administration dose: 666 MBq/kg, median age: 4 years). The total occupational radiation exposure dose per patient care per 131I-MIBG therapy session among nurses was 0.12 ± 0.07 mSv. The average daily radiation exposure dose per patient care among nurses was 0.03 ± 0.03 mSv. Tungsten aprons had efficient shielding effects against gamma rays and would be beneficial to reduce radiation exposures per patient care per 131I-MIBG therapy session.

Exploring National Nursing Readiness for a Radiological or Nuclear Incident: A Cross-Sectional Study.

INTRODUCTION: As the largest component of the United States health care workforce, nurses will play a critical role in radiological or nuclear disaster medical response. Despite this, the United States' schools of nursing are not currently providing radiation content (75% teach zero or <1 hour), and much of the current nursing workforce may not have received adequate response education and training. Nurses working in emergency departments and those who work at hospitals within the Radiation Injury Treatment Network will be relied on heavily, but little is known about whether these nurses possess the knowledge and skills needed to care for and protect patients after a radiation emergency. Current federal and state radiological/nuclear preparedness plans may be built on false assumptions of readiness, which would have serious implications for national preparedness and the National Health Security Strategy. The purpose of this study was to assess nurses' knowledge and skill in emergency radiological or nuclear response and determine their willingness to use mobile technology for education and training in response to a large-scale radiation event. METHODS: Descriptive cross-sectional survey of registered nurse members of the Emergency Nurses Association and/or those employed at Radiation Injury Treatment Network centers. RESULTS: Knowledge scores were low for all respondents. Prior attendance at a Radiation Emergency Medical Management course, use of online resources, and having a preparedness plan were associated with higher scores. Experience with a radiation emergency was associated with the highest score. Nurses are willing to use mobile technology during a radiological or nuclear disaster response. DISCUSSION: Key nurses may not possess adequate knowledge or clinical competence to participate in radiation response activities. The results of this assessment identified educational gaps and areas to strengthen nursing education and clinical skills.

Experiences of xerostomia after radiotherapy in patients with head and neck cancer: A qualitative study.

AIMS AND OBJECTIVES: To describe the experiences of radiation-induced xerostomia in patients with head and neck cancer. BACKGROUND: Xerostomia is the most commonly occurring complication during and following radiotherapy. It can persist for several months or years and can have a significant impact on patients' quality of life. DESIGN: This was a qualitative descriptive study. METHODS: Semi-structured interviews were conducted with a sample of 20 participants. Inductive content analysis was used to analyse the qualitative data. RESULTS: Analysis of the manifest content identified five categories: communication problems, physical problems, psychosocial problems, treatment problems and relief strategies. The latent content was formulated into a theme: due to lack of information from professionals, the patients had to find their own solutions for their problems. CONCLUSIONS: Xerostomia is not only a biophysical symptom but also has a profound effect on the emotional, intellectual and sociocultural dimensions of life. The majority of patients continued to suffer from xerostomia and its associated symptoms after radiotherapy, in part, because of a lack of professional support, including the inability of nurses to provide oral health care. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be knowledgeable about the effects of radiotherapy on oral mucosa and about appropriate interventions. The healthcare system requires a symptom management platform for radiation-induced complications, to help patients, their families and healthcare professionals obtain information about self-care, treatments and relief strategies.

[Nursing care of prostate cancer patients against radiative proctitisinduced by CyberKnife treatment].

OBJECTIVE: To investigate the nursing care of prostate cancer (PCa) patients againstradioactive proctitisinduced byCyberKnifetreatment. METHODS: Sixty-eightPCapatients undergoingCyberKnife treatment in the observation group receivedspecialnursing care againstradioactive proctitis. The nursing measures includedthoserelevant toCyberKnife treatment, prevention ofradioactive proctitis, skin care, and discharge guidance. Meanwhile, another 54 prostate cancer patients received traditional nursing care as controls. We compared the incidence rate and severity of radioactive proctitis between the two groups of patients. RESULTS: The incidence rate of radioactive proctitiswas markedly lower in the observation group than in the control (2.9% vs 13.0%, P<0.05), but no statistically significant difference was observed in the severity of radioactive proctitis between the two groups of patients. CONCLUSIONS: The special nursing care againstCyberKnife-induced radioactiveproctitiscan significantlyreduce the incidence of radioactive proctitis andimprove the effect of CyberKnife treatment of prostate cancer, which therefore deserves wide clinical application.

A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer.

PURPOSE: Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. METHODS: Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). RESULTS: Twenty participants were 26-71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. CONCLUSIONS: According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.

Predictors of adverse cosmetic outcome in the RAPID trial: an exploratory analysis.

PURPOSE: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. METHODS AND MATERIALS: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. RESULTS: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. CONCLUSION: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment volume was not independently associated with an adverse cosmetic outcome, and a useful clinical threshold could not be identified.

Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial.

BACKGROUND: Chronic gastrointestinal symptoms after pelvic radiotherapy are common, multifactorial in cause, and affect patients' quality of life. We assessed whether such patients could be helped if a practitioner followed an investigative and management algorithm, and whether outcomes differed by whether a nurse or a gastroenterologist led this algorithm-based care. METHODS: For this three-arm randomised controlled trial we recruited patients (aged ≥18 years) from clinics in London, UK, with new-onset gastrointestinal symptoms persisting 6 months after pelvic radiotherapy. Using a computer-generated randomisation sequence, we randomly allocated patients to one of three groups (1:1:1; stratified by tumour site [urological, gynaecological, or gastrointestinal], and degree of bowel dysfunction [IBDQ-B score <60 vs 60-70]): usual care (a detailed self-help booklet), gastroenterologist-led algorithm-based treatment, or nurse-led algorithm-based treatment. The primary endpoint was change in Inflammatory Bowel Disease Questionnaire-Bowel subset score (IBDQ-B) at 6 months, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00737230. FINDINGS: Between Nov 26, 2007, and Dec 12, 2011, we enrolled and randomly allocated 218 patients to treatment: 80 to the nurse group, 70 to the gastroenterologist group, and 68 to the booklet group (figure). Most had a baseline IBDQ-B score indicating moderate-to-severe symptoms. We recorded the following pair-wise mean difference in change in IBDQ-B score between groups: nurse versus booklet 4·12 (95% CI 0·04-8·19; p=0·04), gastroenterologist versus booklet 5·47 (1·14-9·81; p=0·01). Outcomes in the nurse group were not inferior to outcomes in the gastroenterologist group (mean difference 1·36, one sided 95% CI -1·48). INTERPRETATION: Patients given targeted intervention following a detailed clinical algorithm had better improvements in radiotherapy-induced gastrointestinal symptoms than did patients given usual care. Our findings suggest that, for most patients, this algorithm-based care can be given by a trained nurse. FUNDING: The National Institute for Health Research.

Evidence-based oral care for oral mucositis.

Nurses must intervene to provide evidence-based supportive care and symptom management for cancer patients. Oral mucositis, a distressing side effect of cancer treatment, is both a research and clinical priority. Nurses can lead improvements with evidence-based oral mucositis interventions. This article describes application of evidence-based clinical recommendations for oral mucositis across diverse patient populations.

Supporting patients following pelvic radiotherapy for endometrial cancer.

Endometrial cancer is the commonest gynaecological cancer in the UK. Affected women often live with long-term complex and debilitating side-effects of radiotherapy treatment, such as bowel toxicity, fatigue and psychosexual problems. Women also experience negative feelings around self-image and sexuality, which contribute to a decline in their quality of life. A review of the literature and national policy showed that women had unmet needs after completing radiotherapy treatment for endometrial cancers, and that cancer nurse specialists are in a prime position to deliver a holistic package of personalized care. Staff at a nurse-led gynaecology oncology clinic performed an audit that found the clinic was not meeting the longer-term needs of most women after radiotherapy for endometrial cancers, and that women were attending multiple appointments to access different services. The clinical nurse specialist reviewed local and national policy, carried out situational analysis and engaged with service users to identify where change was needed and to examine whether a new model of service provision, where patients could consult different professionals at one appointment, would help the move forward in life after treatment.

Role of nurses in a nuclear disaster: experience in the Fukushima Dai-ichi nuclear power plant accident.

BACKGROUND: A severe earthquake occurred in Japan on 11 March 2011. The giant tsunami devastated many coastal communities in eastern Japan and caused the Fukushima Dai-ichi nuclear power plant incident. The Japanese government conducted a large-scale survey of residents affected by the nuclear and natural disasters in Fukushima prefecture and in response to the government's request, H University dispatched a Radiation Exposure Research Team to Fukushima. PURPOSE: This article explains the activities of the Radiation Exposure Research Team and the role of nurses in a nuclear disaster. CONCLUSION: As a nurse in the field of radiation medicine, our role is to protect the health of those affected and to reduce their anxiety. In addition, as the persons responsible for implementing these projects, it is also necessary that we educate and foster the development of medical care personnel with the appropriate knowledge and skills to carry out the measures required.

Courage and selflessness in professional actions: but are they enough?

BACKGROUND: The Great East Japan Earthquake on 11 March 2011 caused considerable loss of life, destruction of livelihood and infrastructure. Linked to this event but not its cause, was the meltdown and radioactive contamination of the environment from Fukishima Dai-ichi power plant. This disaster, in turn, led to the enforced evacuation of populations at risk. Japanese nurses, physicians, paramedical staff and faculty from nearby universities all volunteered to staff decontamination centres for evacuees and survivors. AIM: This commentary critically reflects on the insights provided in this issue by Noto, Kitamiya, Itaki, Urushizaka & Yamabe (pp. 196-200) on the role of nurses in the Fukishima Dai-ichi disaster, extending that critique to evidence that has emerged through official and unofficial sources. DISCUSSION: Disaster planning is not a popular subject for societies in general nor is it a finite art or process. Civil authorities often work under restricted or reducing budgets and resources while serving increasing demands. Disaster planning requires multidisciplinary skills sets to be able to work across the many different departments, agencies, interest groups and budgets. Planners need to think outside the box, allocate resources and training to a level that justifies known and/or projected threats in preparing first responders with the correct tools, training and time to practise skills they may never be called upon to use. CONCLUSION: Disasters will always happen be they natural or man-made. To rely on the courage and selflessness of professionals is not enough. Training and learning from previous disasters can help in responsible planning.

Taste dysfunction in head and neck cancer survivors.

PURPOSE/OBJECTIVES: To describe the prevalence of issues with taste function in survivors of head and neck cancer. DESIGN: Exploratory, cross-sectional. SETTING: Outpatients from Saint Louis University Cancer Center in Missouri. SAMPLE: 92 adult head and neck cancer survivors, heterogeneous in cancer site, treatment type, and time post-treatment, ranging from three months to more than 28 years after completion of therapy. METHODS: Taste discrimination was assessed using high, medium, and low concentrations of sweet, salty, sour, and bitter tasting solutions. MAIN RESEARCH VARIABLES: Taste, percentage of weight change, tumor site and stage, treatment type, and time since completion of therapy. FINDINGS: Eighty-five of 92 participants had some measurable taste dysfunction. Confusion between bitter and sour and the inability to discriminate among the different concentrations of the sweet solutions were common. Statistically significant weight loss was associated with dysgeusia. CONCLUSIONS: Taste dysfunction was a persistent problem across all categories of head and neck cancer treatments, sites, and stages. Participants who reported the loss of one or more specific taste modality performed poorly on the taste test. However, participants could not accurately predict which taste was most severely impaired. IMPLICATIONS FOR NURSING: Taste dysfunction is a long-term treatment-related side effect for head and neck cancer survivors. Assessing for taste changes and dysgeusia are important nursing considerations, as taste loss is distressing and associated with decreased appetite. Future studies are needed to identify interventions to help patients better manage and adapt to this long-term complication of cancer therapy. KNOWLEDGE TRANSLATION: Flavors are recognized by taste, texture, aroma, thermal quality, and visual cues. A disruption of one or more of those sensory experiences alters flavor recognition. Having intact taste sense but impaired flavor recognition is possible. Finally, taste is not accurately self-reported because it is commonly confused with flavor recognition.

Cuidados domiciliarios de enfermería a una mujer con una herida neoplásica en el ámbito de la atención primaria de la salud / Home nursing care of a woman with a malignant wound in a primary health care setting

El progresivo aumento de la esperanza de vida en la población española comporta un aumento de episodios oncológicos, que suponen la segunda causa de mortalidad de los españoles, y un aumento en las heridas de etiología neoplásica, las cuales tienen un tiempo de cicatrización diferente del de otro tipo de heridas. En este artículo se describe el caso de una mujer de 85 años, con una herida neoplásica, consecuencia de un linfangiosarcoma cutáneo recidivante así como su inclusión en el programa de atención domiciliaria en atención primaria y la coordinación del equipo de atención primaria con el equipo de apoyo de la atención domiciliaria (PADES). La valoración global de la persona y no solo de «su» herida, con un plan de cuidados de enfermería individualizado permitió controlar el dolor, lograr la epitelización de la herida y prevenir posibles complicaciones (estreñimiento, empeoramiento de la lesión). El cuidado de la herida tumoral siguiendo el proceso de cura en ambiente húmedo ha sido eficaz incluso en un tejido tan frágil. El seguimiento y cuidados de la piel perilesional ha sido fundamental para que la herida no se deteriorara más. Además, se evitó el ingreso hospitalario de la paciente con las repercusiones negativas que podría suponer tanto para la calidad de vida de la paciente como de su familia (AU)

The gradual increase in life expectancy in the Spanish population has led to an increase cancer episodes (the second leading cause of mortality in Spain), and an increase in wounds of neoplastic origin, which have a different healing time from other wounds. This article describes the case of an 85 year-old woman with a malignant wound, due to a recurrent skin lymphangiosarcoma, and her inclusion in the Primary Care home care program with the home care support team (PADES). The overall assessment of the person and not just "the wound", and an individualised nursing care plan led to pain control, wound healing and prevention of complications (constipation, worsening of the injury). Tumour wound care using the process of moist wound healing has been effective even in a fragile tissue. Monitoring and surrounding skin care is essential for the wound not to deteriorate further. In addition, hospitalisation of the patient, with the negative impact it could have on the quality of life of both the patient and her family, was avoided (AU)

Nurse-led care for the management of side effects of pelvic radiotherapy: what does it achieve?

PURPOSE OF REVIEW: To describe what a nurse-led clinic can achieve, focusing on gastrointestinal side effects after pelvic radiotherapy. This article illustrates how a structured approach for management and treatment of late gastrointestinal symptoms after pelvic radiotherapy can be used as a model for other nurse-led clinics. RECENT FINDINGS: A large majority of cancer survivors treated for gynaecological, rectal and anal cancer suffer from physical symptoms from the bowels, the urinary bladder and the genitals. These long-term side effects lead to impairment of social functioning, sexual dysfunction and lowered quality of life. A structured model for the comprehensive management of cancer survivors can help care givers to offer patients treated with pelvic radiotherapy, methods that could help them to more fully restore physical health. SUMMARY: Nurses play an important role in the rehabilitation of cancer patients, improving patients' quality of life and psychosocial well being, and they are in the best position to provide continuity during the tailoring of rehabilitation care.

Can nurses manage gastrointestinal symptoms arising from pelvic radiation disease?

AIMS: About 17,000 patients receive radiotherapy for pelvic cancer in the UK annually. Up to 50% are left with altered bowel function affecting quality of life. The UK National Cancer Survivorship Initiative Vision acknowledges that the needs of cancer survivors are not being met and challenges professionals to develop new models of care. MATERIALS AND METHODS: A prospective, observational qualitative study was carried out to assess whether nurse-delivered care is feasible for patients with radiotherapy-induced bowel dysfunction. The experience of a senior nurse, directed by an algorithm of investigation with a comprehensive treatment pathway, is reported. RESULTS: Over 12 months, 59 new and 103 follow-up appointments were managed by the nurse. In total, 37 women and 73 men, with a median age of 69 years, were seen; 9 had been treated for gastrointestinal, 33 for gynaecological and 68 for urological cancers, 26 months (median) previously. Sixty minutes (new consultations) (median, range 35-80) and 40 minutes (follow-up consultations) (range 20-85) were required. Ordering investigations, treatment initiation, long-term care planning and discharge seemed to be manageable in 83% of patients. CONCLUSION: An experienced nurse, working within a defined scope of practice, with medical support can manage care in patients with mild or moderate symptoms arising after pelvic radiotherapy. An ongoing randomised controlled trial is assessing patient outcomes.

Nurse led electronic toxicity scoring in head and neck radiotherapy.

PURPOSE OF THE STUDY: In order to improve 'adherence' to a course of treatment for head and neck radiotherapy, patients need to be managed frequently. In order to achieve this in a busy clinical environment streamlined electronic tools must be utilised. By providing nursing teams with the capacity to conduct electronic toxicity scoring on a bi-weekly basis, adherence can be improved and closer attention paid to head and neck radiotherapy toxicities. METHODS AND MATERIALS: A convenience sample of 20 patients undergoing head and neck radiotherapy was analysed. Each of these patients had electronic toxicity data recorded on a bi-weekly basis for dysphagia, mucositis, skin reaction and weight loss. This information was then extracted from the ARIA™ patient information system and analysed. Additionally the time taken for the nursing team to undertake each patient review was also extracted from ARIA™. RESULTS: The efficiencies offered by an electronic medical record allow comprehensive toxicity data to be recorded and analysed effortlessly. The average time taken to review these patients on a bi-weekly basis was 6.97 min and contained on average 60 words of toxicity description and action. CONCLUSION: Electronic toxicity scoring offers many advantages to the radiation oncology nurse, increased efficiency allows more frequent patient interaction which will in turn aid adherence. In order to better manage the treatment course of head and neck radiotherapy patients, nurses must be provided with streamlined and efficient electronic means of recording data. In this way it is possible to review head and neck radiotherapy patients bi-weekly.

A nursing guide to surviving a radiological dispersal device.

A radiological dispersion device, or 'dirty bomb', is created by combining radioactive material and conventional explosives with the aim of causing both blast injuries and the psychological fear of lingering radiation. Future use of such a device by terrorist organizations operating in the UK is not unlikely. Both surgical and accident and emergency nursing staff may become involved in the management of patients involved in this type of disaster. This article summarizes the likely sequence of events, defines the nursing tasks emergency department personnel can expect to become involved with, and highlights specific issues of personal safety for this disaster scenario. Up-to-date, accurate information, and skills and training in this type of event can not be underestimated. Nursing teams equipped with the appropriate safety and procedural skills are more likely to respond positively to this type of event.

Factors affecting hospital-based nurses' willingness to respond to a radiation emergency.

BACKGROUND: Despite increased government and public awareness of the threat of a radiological emergency resulting from a terrorist attack or industrial accident, limited emphasis has been placed on preparing the US health care workforce for such an event. The purpose of this study was to develop and apply a rapid survey to evaluate hospital-based nurses' baseline knowledge, self-assessed clinical competence, perception of personal safety, and willingness to respond in the event of a radiological emergency. METHODS: The study was conducted in 2 phases, the first targeting nursing units likely to respond in the event of a radiological emergency and the second focusing more generally on members of the New York State Emergency Nurses Association currently employed as hospital-based nurses. RESULTS: Among the 668 nurses surveyed, baseline knowledge was found to be inadequate. Although baseline knowledge, clinical competence, and perception of personal safety were all positively associated with willingness to respond, perception of safety appeared to be the primary determinant. Furthermore, baseline knowledge did not appear to be strongly associated with perception of personal safety. CONCLUSIONS: Based on these results, the investigators recommend further clinical training to enhance preparedness and a more detailed exploration of the determinants of perceived personal safety.