Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer

PURPOSE/OBJECTIVES: To test the efficacy of structured symptom assessment on level and rate of change in symptom distress over time. DESIGN: Prospective six-month randomized control trial. SETTING: Outpatient oncology offices and clinics in California. SAMPLE: 48 subjects newly diagnosed with advanced lung cancer, predominantly non-small cell. Most subjects received chemotherapy, 50% were women, and their average age was 62 years. 190 observations were analyzed. METHODS: Subjects were assigned randomly to structured assessment or usual care. Both groups completed the Symptom Distress Scale (SDS) monthly. After bivariate screening of potential predictors, a multivariate regression model for level and rate of change in SDS scores was created. MAIN RESEARCH VARIABLES: Symptom distress, functional status, and emotional distress. FINDINGS: Fatigue was the most common severely distressing symptom. In a multivariate model, chemotherapy and systematic assessment were associated with less symptom distress over time. Higher scores in depression and more functional limitations were related to higher levels of overall distress. Weight loss had a small impact. CONCLUSIONS: Systematic use of structured symptom assessment forestalled increased symptom distress over time. Chemotherapy lessened symptom distress, but the impact diminished with time. Subjects with more depression and greater functional limitations had greater symptom distress. IMPLICATIONS FOR NURSING PRACTICE: During the course of advanced lung cancer, systematic ongoing nursing assessment of symptoms may be the first step in enhancing interventions to decrease distress. Patients at highest risk for symptom distress are those who experience emotional distress and functional limitations.     

Effects of extensive oral surgery and hemorrhage on coagulation and fibrinolysis

The changes in coagulation and fibrinolytic activity in 22 patients with oral cancer undergoing extensive surgical procedures were studied. The patients were divided into two groups: group I patients suffered blood loss of less than 2,000 mL and group II patients had blood loss of more than 2,000 mL. The platelet count decreased significantly during surgery, at the end of surgery and on the 1st postoperative day in both groups. Fibrinogen was decreased during and at the end of surgery in both groups, but increased significantly on the 3rd postoperative day and reached about two times the preoperative levels on the 7th postoperative day. Fibrin degradation products increased significantly after surgery and reached the maximum value on the 1st postoperative day in both groups. Plasmin inhibitor complex and plasminogen increased significantly on the 3rd and 7th postoperative days. There was no clear evidence regarding the influence of blood loss on coagulation and fibrinolytic factors except for platelets. It was concluded that coagulation and fibrinolysis are enhanced between the 3rd and 7th postoperative days.     

Preoperative preparation for cardiac surgery facilitates recovery, reduces psychological distress, and reduces the incidence of acute postoperative hypertension.

This study evaluated whether preoperative preparations for cardiac surgery (a) reduced psychological distress and facilitated physical recovery, (b) reduced preoperative anxiety by making patients feel well-informed or by increasing their sense of control over recovery, and (c) reduced the incidence of sympathetically mediated, acute postoperative hypertension. Information-only and information-plus-coping preparations were compared with a contact-control preparation. Preoperatively (1 day after preparation), both experimental groups were significantly less anxious and fearful than the control group. The experimental groups did not differ from each other. Both experimental preparations increased patients' belief in control over recovery. Consistent with Lazarus's theory of stress, belief in control over recovery best predicted preoperative anxiety. Regression analyses indicated that information reduced anxiety by increasing feelings of control. Postoperatively, both experimental groups (a) reported less emotional distress, (b) were judged by nurses as making better physical and psychological recoveries, and (c) had a 32.5% lower incidence of postoperative hypertension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pre- and postoperative radiotherapy to prevent heterotopic ossification of the hip joint

BACKGROUND: In-vivo experimental data indicate that both pre- and postoperative radiotherapy can prevent heterotopic ossification after hip surgery. This comparison was clinically tested in a randomized study. PATIENTS AND METHODS: From June 1992 to September 1993, 84 patients with high risk for the development of heterotopic ossification were randomized. The treatment concept consisted either of preoperative radiotherapy within four hours prior to surgery (arm A) or postoperative radiotherapy within 72 hours following hip surgery (arm B). Preoperative radiotherapy was given in one fraction of 7 Gy, while the postoperative radiotherapy was delivered in five fractions of each 3.5 Gy (total 17.5 Gy). All patient variables (age, sex, prior surgery) and predisposing risk factors were comparable in both treatment arms. For the radiological assessment of heterotopic ossification according to (Brooker-Score) X-rays of the pelvis or hip were evaluated which had been taken immediately pre- and postoperatively as well as at least six months following surgery and prophylactic irradiation. The functional hip status was evaluated pre- and postoperatively using the Harris-Score. Cases in which the Brooker- and/or Harris-Score worsened during the postoperative follow-up as compared to the pre- and immediate postoperative situations were considered as treatment failures. RESULTS: Of 44 patients with at least six months follow-up 41 (93%) experienced a successful prophylaxis. Two failures were observed in the preoperative and one in the postoperative group. The prophylactic efficacy was not influenced if the pre- or postoperative interval was longer than prescribed. All intra- and postoperative complications were comparable for both treatment groups. The mean interval to partial strain (50% body weight) of the operated hip was longer in the preoperative group (mean 19 +/- 27 days) as compared to the postoperative group (mean 8 +/- 13 days). With respect to full strain (100% body weight), the results were equal in both groups. The functional hip status decreased in two patients. Again the mean overall improvement in the postoperative group was larger (mean 42.7 +/- 17.1 points) as compared to the preoperative group (mean 34.3 +/- 13.7 points). CONCLUSIONS: Preoperative and postoperative radiotherapy have equal prophylactic efficacy to prevent heterotopic ossification following hip surgery. The main advantage of preoperative radiotherapy are the simple management of the patient, the reduction of possible complications associated with transport and positioning of the patient in the postoperative period as well as excellent acceptance of this treatment concept by patients, nurses and staff.     

Cardiovascular surgery in the patients with liver dysfunction

Under the current situations we have increasing opportunities to manage the patients with posthepatitis and/or congestive liver dysfunction. In order to prevent postoperative hepatic failure we described perioperative management for those patients. For this purpose, the major point is the selection of appropriate operative methods which reduce operative invasions and have sure efficacy. In order to decide operative methods, we have to grasp the functional reserve of dysfunctional liver. We have no effective methods to estimate the functional reserve, but our data suggested that serum cholinesterase level at the preoperative states might demonstrate prognostic significance. The others are managements of postoperative cardiopulmonary distress and infection. It goes without saying that preoperative improvement of anemia and poor nutrition.     

Laser-Doppler flowmetry in neurosurgery

It is theorized that persons with strong sense of coherence are likely to define an event as less stressful and be able to manage a problem more successfully than those with weak sense of coherence. The study investigated the relationship among coherence and personal and environmental concerns, appraisal of threat, emotional distress, and high-risk behaviors in minority women at risk for human immunodeficiency (HIV) infection. As predicted, a significant negative relationship was seen between level of coherence and concerns. Moreover, women strong in coherence reported less negative appraisals of threat, less emotional distress, and fewer high-risk behaviors than those with weak coherence. Results of tests of a path model investigating the impact of coherence and appraisal on distress and risk revealed coherence to be significantly and negatively associated with appraisal, distress, and risk, both directly and indirectly through its association with appraisal. The path model accounted for 45% of the variance in distress, 10% of the variance in appraisal, and 4% of risk behavior. Continuing investigation of factors such as coherence that can lessen the seriousness of environmental stressors is imperative as it relates to women at risk for HIV infection.     

Impaired recovery of strength in older patients after major abdominal surgery

OBJECTIVE: This study compared changes in muscle strength after major elective abdominal surgery in young and old patients, and related these changes to body composition and nitrogen balance. SUMMARY BACKGROUND DATA: The breakdown of muscle protein, erosion of lean tissue, and negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands. METHODS: Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol. RESULTS: The young (age, 36 +/- 9 years [mean +/- standard deviation]; n = 20) and old groups (age, 77 +/- 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and postoperative urine cortisol values. Age group, time after operation, and interaction effects were significant for each strength variable (all p < 0.005 by analysis of variance). Older patients had lower preoperative strength (29% to 41%) and mean 24-hour urine creatinine (27%). Postoperative strength was decreased most markedly on postoperative day 2, with similar proportional changes in the two age groups but lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration. CONCLUSIONS: Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.     

Links from emotional distress to adolescent drug use: A path model.

Administered anonymous surveys asking about drug use, emotional distress, and peer drug associations to 11th and 12th grade high school students (N?=?563). Emotional distress variables accounted for only 4.8% of the variance in drug use. The addition of peer drug associations as a predictor variable increased the variance accounted for to 43.4%. A path model of adolescent drug use based on peer cluster theory was tested using LISREL, and this provided a good fit with the data. As predicted, peer drug associations dominated the prediction of drug use and mediated the effect of emotional distress on drug use, with the exception of a small residual path directly from anger to drug use. The hypothesis that young people take drugs to alleviate emotional distress does not hold up well; emotional distress variables, with the exception of anger, produced only very small and indirect links to drug use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low dose heparin in major surgery: clinical relevance of plasma heparin concentrations

56 patients undergoing elective major surgery received low dose heparin prophylaxis, 5,000 IU 2 h before surgery and every 8 h for 7 days. The patients were tested by the 125I-fibrinogen uptake test, which, if positive, was controlled by venography. The heparin concentrations were measured by the method of DENSON and BONNAR and by the chromogenic method of TEIEN et al. in blood samples drained immediately before and after surgery and on the 1st and 5th postoperative day 2 and 4h after the injection of heparin. The values were found higher when estimated by the method of DENSON and BONNAR than by the chromogenic method. Deep vein thrombosis (DVT) developed in 11 patients, and in 10 of them within the first 48 after the operative procedure, in 1 after 4 days. The preoperative values were not lower in the patients who developed DVT, and the heparin concentrations found on the 1st and 5th postoperative day were at the same level as in those who did not develop DVT.     

Systemic liberation of interleukin-1 beta and interleukin-1 receptor antagonist in the perioperative phase of liver transplantation

We measured systemic serum levels of interleukin-1 receptor antagonist (IL-1ra), interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF-alpha), and interleukin-6 (IL-6) during the preoperative, anhepatic, and postreperfusional phases up to the 7th postoperative day in 60 patients undergoing orthotopic liver transplantation (LTx). In contrast to IL-1 beta, IL-1ra, TNF-alpha, and IL-6 showed a significant elevation in relation to the early phase after reperfusion, while TNF-alpha displayed a high grade of scatter. In addition, IL-1ra levels were significantly elevated during the anhepatic phase. Maximum serum levels were found at 15 min after reperfusion, 120 min after reperfusion, and on the 1st postoperative day, respectively. Serum levels decreased considerably at 24 h and 7 days after reperfusion. The comparative monitoring of systemic cytokine and cytokine antagonist levels, in particular the liberation of IL-1ra and IL-6 may provide useful parameters for the development of new liver preservation theories for LTx.     

Significance of the peroral phenolsulfonphthalein test in hepatic resection: a possible predictor of bacterial translocation

BACKGROUND/AIMS: The aim of this study was to evaluate the perioperative changes in intestinal permeability by using the phenolsulfonphthalein (PSP) test and to also to clarify the significance of the peroral PSP test in hepatic resection. METHODOLOGY: Fifty patients, all of whom underwent hepatic resection, were prospectively studied. Postoperative complications occurred in 16 patients, and 10 of these complications were infectious. A peroral PSP test, which was scheduled before operation and on postoperative days 3, 7, and 14, was performed as follows: after the administration of 30 mg of PSP, a 24-hour urine was collected, and the urinary PSP was measured by colorimetric assay. The correlation between the preoperative PSP value and various clinical variables, such as perioperative changes in urinary PSP excretion, and the relationship between the postoperative PSP value and postoperative complications, were investigated. RESULTS: Preoperative urinary PSP excretion was found to increase in proportion to the degree of liver dysfunction. In contrast, urinary PSP excretion did not significantly change during the perioperative period. However, urinary PSP excretion on postoperative day 3 in patients with postoperative infectious complications (27.3%) was significantly greater than that in those without infectious complications (17.4%; p < 0.05). Furthermore, PSP excretion on postoperative day 3 in those with infectious complications was also significantly greater as compared to the preoperative level. The patients with a urinary PSP excretion level on postoperative day 3 of greater than 25%, exhibited infectious complications more frequently than patients with a level under 25% (60% versus 10.3%, respectively; p < 0.05). CONCLUSIONS: The peroral PSP test is thus suggested to be a possible predictor of bacterial translocation after hepatic resection.     

Predictors of posttraumatic distress 1 year after exposure to community violence: The importance of acute symptom severity.

In this longitudinal study of 333 primarily male, Hispanic survivors of community violence, the authors investigated the effects of 4 categories of risk factors on posttraumatic stress disorder (PTSD) symptom severity: demographic characteristics, pretraumatic psychological factors, characteristics of the trauma, and reactions to the trauma. Replicating past research, exemplars from all 4 categories predicted PTSD symptom severity at 12-month follow-up. Acute symptom severity, measured approximately 5 days posttrauma, accounted for the largest proportion of variance among all the predictors included. No other predictors remained significant after 5-day distress was included in the model. These findings suggest that the effects of several purported risk factors for chronic posttraumatic distress may already be reflected in acute distress following trauma exposure. These results bear on current conceptions of the fundamental nature of PTSD and suggest that initial distress during the immediate aftermath of the trauma may be an important target for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early inpatient rehabilitation after elective hip and knee arthroplasty

CONTEXT: Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who cannot function at home soon after surgery, but how soon after surgery inpatient rehabilitation can be initiated has not been studied. OBJECTIVE: To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7, without adverse consequences to the patients. DESIGN: Randomized controlled trial conducted from 1994 to 1996. SETTING: Tertiary care center. PARTICIPANTS: A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk: 70 years of age or older and living alone, 70 years of age or older with 2 or more comorbid conditions, or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed the study. INTERVENTIONS: Random assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7. MAIN OUTCOME MEASURES: Total length of stay and cost from orthopedic and rehabilitation hospital admissions, functional performance in hospitals using a subset of the functional independence measure, and 4-month follow-up assessment using the RAND 36-item health survey I and the functional status index. RESULTS: Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean (+/-SD) total length of stay (11.7+/-2.3 days vs 14.5+/-1.9, P<.001), lower mean (+/-SD) total cost ($25891+/-$3648 vs $27762+/-$3626, P<.03), more rapid attainment of short-term functional milestones between days 6 and 10 (36.2+/-14.4 m ambulated vs 21.4+/-13.3 m, P<.001; 4.8+/-0.8 mean transfer functional independence measure score vs 4.3+/-0.7, P<.01), and equivalent functional outcome at 4-month follow-up. CONCLUSION: These data showed that high-risk individuals were able to tolerate early intensive rehabilitation, and this intervention yielded faster attainment of short-term functional milestones in fewer days using less total cost.     

Mucosa-associated bacterial flora of the human colon

Little is known about factors that predict return to work following carpal tunnel release. Patients enrolled in a prospective, community-based study of carpal tunnel syndrome in Maine were evaluated with standardized questionnaires preoperatively and 6 months following carpal tunnel release. Univariate and multivariate analyses were performed to identify baseline factors associated with work disability 6 months following surgery. Thirty-one of 135 patients (23%) were out of work because of CTS 6 months following surgery. The predominant preoperative variables associated with work absence due to CTS 6 months postoperatively in logistic regression analyses were Workers' Compensation, work absence preoperatively, and worse mental health status (p < or = 0.01 for each). In analyses that considered postoperative as well as preoperative variables, persistence of symptoms following surgery was the most striking predictor of failure to return to work due to CTS (p < 0.0001). Preoperative correlates of less complete relief of symptoms in multivariate models included involvement of an attorney, milder preoperative symptom severity, preoperative work absence (p < 0.005 for each) and exposure to hand intensive work (p = 0.04). These data indicate that economic and psychosocial variables have a strong influence upon both return to work and the extent of symptom relief 6 months following surgery for carpal tunnel syndrome.     

Minimally invasive esophageal surgery

OBJECTIVE: This study aimed to assess patient satisfaction and change in functional status after surgery for epiretinal membrane (ERM), rhegmatogenous retinal detachment (RRD), and complex retinal detachment (CRD). This study also aimed to determine whether objective measures of vision are predictive of subjective improvement after surgery. DESIGN: The study design included patient interviews and retrospective chart review. PARTICIPANTS: Participants were those patients who underwent surgery for ERM, RRD, or CRD by one surgeon at the Bascom Palmer Eye Institute between January 1, 1993, and December 31, 1994. INTERVENTION: Patient satisfaction and patients' perceptions of the impact of surgery on their functional status were assessed by telephone interviews conducted by one interviewer at least 6 months after surgery. MAIN OUTCOME MEASURES: Responses to patient satisfaction survey and subjective change in patients' functional status were measured. RESULTS: Of 187 eligible patients, 146 (78.1%) could be contacted and all agreed to participate. Ninety patients (61.6%) reported improved functioning after surgery in 2 or more of the 5 activities investigated. Twenty-one patients (14.4%) reported worse postoperative vision than expected, but only 5 patients (3.4%) thought surgery had not been worthwhile. One hundred forty-three patients (97.9%) reported adequate explanation of surgery and its expected results. Patients with preoperative study eye visual acuity between 20/40 and 20/200 were most likely to improve in two or more activities. Lower preoperative worse eye vision and better final study eye vision were associated with a greater likelihood of satisfaction after surgery. Diagnostic category was not predictive of change in functional status or patient satisfaction. CONCLUSIONS: There is a high rate of patient satisfaction and improved functional status after surgery for ERM, RRD, and CRD, even among patients with good fellow eye vision.     

Using a memory handbook to improve everyday memory in community-dwelling older adults with memory complaints

This article summarizes the importance of preoperative and postoperative conditioning for lung transplantation and volume reduction surgery. Assessment of exercise tolerance and functional status and identification of the primary limitations to exercise conditioning will enhance preoperative and postoperative exercise conditioning. Exercise conditioning can be implemented in a pyramidal manner with emphasis on the most needed and appropriate mode of exercise and the manipulation of exercise frequency, duration, and intensity. Several important adjuncts to exercise conditioning can improve exercise conditioning efforts before and after lung transplantation and volume reduction surgery, including ventilatory muscle training, optimal use of supplemental oxygen and pulmonary medications, and different methods to prescribe aerobic exercise.     

Influence of different fat emulsions with 10 or 20% MCT/LCT or LCT on lipoproteins in plasma of patients after abdominal surgery

In patients after elective abdominal surgery, different fat emulsions were used to compare their efficacy in total parenteral nutrition and in normalizing plasma lipoprotein levels. In five different groups with 5 patients each, half of the nonprotein calories were given as medium-chain triglycerides/long-chain triglycerides (1:1) or as long-chain triglycerides alone in 10 or 20% fat emulsions or as glucose alone in a control group for 7 days. After surgery, an initial decrease of all plasma lipoprotein components was followed by a different behavior of glyceride-glycerol, cholesterol, phospholipids, and apolipoproteins. Glyceride-glycerol in very-low-density lipoproteins and high-density lipoproteins is increasing during infusion of fat emulsions and decreasing during overnight interruption of infusions. After the 7-day infusion period, there was no significant difference in very-low-density lipoprotein glyceride-glycerol as compared with the values before different infusions. Low-density lipoprotein cholesterol is reaching and exceeding preoperative concentrations between the 4th and the 7th day, most during infusion of 10% fat emulsion and especially due to an increase of free cholesterol. High-density lipoprotein cholesterol and apolipoprotein A-I reach preoperative levels during infusion of fat emulsions but not with glucose alone. Higher than preoperative values are reached in phospholipids with all fat infusions already on day 4. Abnormal lipoprotein X occurred least with the medium-chain/long-chain triglyceride 20% fat-infusion. This fat emulsion is suggested as having the best normalizing effect on plasma lipoproteins and best tolerance in patients after surgery.     

Phobic children one and two years posttreatment.

Evaluated progress of 62 phobic children 1 and 2 yrs after termination of treatment or waiting period. 80% were either symptom free or significantly improved; only 7% still had a severe phobia. Successfully treated Ss tended to remain symptom free and to be free from other deviant behaviors as well. 60% of the failures at termination continued to receive treatment and most were symptom free 2 yrs later. After 2 yrs, the effects of the original psychotherapy and reciprocal inhibition therapy no longer were related to outcome. However, age, status at the end of treatment, and time were related to outcome. Results are discussed in terms of the nature of child phobia and implications for research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial predictors of children's postoperative pain

The purpose of this study was to investigate the influence of psychosocial variables in the prediction of children's pain intensity following surgery. Forty-two children, ages 7 to 17 years (M = 12.26, SD = 3.06), completed an interview 1 week prior to surgery assessing anticipatory distress related to their forthcoming surgery and history of coping strategy use. Following surgery, children reported the intensity of their pain using visual analog scales. Findings demonstrated that the majority of children experienced moderate to severe postoperative pain. Hierarchical multiple regression analyses revealed that psychosocial variables added to the prediction of children's postoperative pain after controlling for the influence of surgery-related and demographic variables. These findings lend initial support for the inclusion of psychosocial assessment measures (e.g., anticipatory surgery distress) in the preoperative assessment of pediatric patients who may be at risk for excessive postsurgical pain.