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How do three components of professional commitment influence nurse‐reported patient‐centred care and care quality?

Abstract

Aims and Objectives

To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse-reported patient-centred care and care quality.

Background

Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap.

Design

This study adopted a two-wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan.

Methods

Proportionate random sampling was used. Full-time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient-Centered Care Scale of Laird-Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist.

Results

Affective professional commitment was positively associated with nurse-reported patient-centred care (β = .18, p = .002 and .01), which was positively associated with nurse-reported care quality (β = .85, p < .001). Affective and normative professional commitment were also positively associated with nurse-reported care quality (β = .17, p < .001).

Conclusions

Our findings offer insights for nursing managers that nurses’ affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce.

Relevance to clinical practice

Nursing managers could publicise reports documenting nurses’ significant contributions to public health. This could strengthen affective professional commitment among nurses.

Indigenous Māori experiences of fundamental care delivery in an acute inpatient setting: A qualitative analysis of feedback survey data

Abstract

Aim and Objectives

This study aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well-being.

Background

Bi-annual Fundamentals of Care audits at the study site have shown that Māori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups.

Design

Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach.

Methods

Three hundred and fifty-four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Māori concepts of health and well-being. The research complies with the SRQR guidelines for reporting qualitative research.

Results

Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care.

Conclusion

The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples.

Relevance to clinical practice

Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people.

Patients' needs regarding rehabilitation services delivered via mobile applications after arthroplasty: A qualitative study

Abstract

Aims and Objectives

To obtain an in-depth understanding of the specific needs of patients for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty.

Background

Due to increased demand for arthroplasty, the provision of face-to-face rehabilitation services for patients is becoming challenging. New approaches using digital technologies are being developed, such as mobile applications to deliver rehabilitation services. However, the perspectives of patients on the delivery of these services via mobile applications after total hip or knee arthroplasty have not been explored extensively.

Design

A qualitative descriptive study.

Methods

Twenty patients who had been discharged from the hospital after a total hip or knee arthroplasty were interviewed via telephone about their needs regarding the future use of mobile applications to conduct arthroplasty rehabilitation. Interview records were transcribed verbatim and analysed using inductive content analysis. Reporting of the findings complies with the COREQ checklist for qualitative studies.

Results

Four categories emerged from the data collected from the participants: (1) assisting rehabilitation self-management, (2) facilitating peer support, (3) facilitating contact with healthcare professionals and (4) supporting emotional well-being.

Conclusions

The study provided an in-depth understanding of the specific needs of patients for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty. The findings of the study could be used in the development or revision of mobile application rehabilitation programmes to better support the rehabilitation of patients. Future studies are needed to evaluate the effectiveness of such programmes, especially including the self-efficacy of patients as an outcome measure.

Relevance to clinical practice

From the perspective of patients who have undergone arthroplasty, a mobile application rehabilitation programme should encourage patients in rehabilitation self-management, assist them to contact healthcare professionals and other patients and support their postoperative emotional well-being. The study findings will assist nurses with the preparation and delivery of telerehabilitation programmes after arthroplasty.

Quality Evaluation of Visual Display Terminal Syndrome Videos Shared on YouTube

imageVisual display terminal syndrome is a health problem that occurs when an individual looks at a visual display terminal for a long time. This study aimed to evaluate the quality of YouTube videos on visual display terminal syndrome. YouTube was searched using the keywords “visual display terminal syndrome” and “a prolonged user of a computer or smartphone” on October 16, 2019. A total of 45 videos were evaluated using DISCERN and the Journal of the American Medical Association scoring systems. The variables extracted from the videos were the uploading agency; content; presentation format; days since upload; the number of views, likes, dislikes, and comments; and the video power index. The mean DISCERN and Journal of the American Medical Association scores were 35.64 and 3.08 points, respectively, indicating that the information on visual display terminal syndrome in YouTube videos was inaccurate and unreliable. The major reason for the low quality of the videos was that the sources of information presented in the videos were not provided. The DISCERN and Journal of the American Medical Association scores showed significant differences in the uploading agency and presentation format variables. Nurses must be familiar with evaluating the quality of videos presenting health information. Guidelines informing patients that YouTube might provide misinformation about health need to be developed.

Quality of Online Information Regarding High-Risk Pregnancies

imageHealth information on the Internet can have a direct effect on healthcare decision-making. However, the quality of information online has seldom been evaluated. This study aimed to assess the quality of online information on high-risk pregnancies provided by English and Korean Web sites. Through a Google search, 30 English and 30 Korean Web sites were selected on January 2 and 3, 2020, respectively, and assessed using DISCERN, a Journal of the American Medical Association, and Health On the Net Foundation code questionnaires. The data assessed were analyzed using descriptive and nonparametric statistical tests. Overall, the information provided by the English Web sites presented higher-quality information than the Korean Web sites. Most Web sites did not provide the sources of the information presented on their Web sites, meet the Journal of the American Medical Association criteria, or provide information on complementarity. Based on our results, nurses need to be competent in assessing the quality of Web sites and the health information presented there, and nursing students need to be prepared to do so as well. Nurses are responsible for educating their patients about the possibility of incorrect information provided by Internet Web sites and informing their patients about reliable Web sites, thus assisting them to make informed decisions regarding their health.

Association Between Symptoms of Patients With Heart Failure and Patient Outcomes Based on Electronic Nursing Records

imageWe examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients' average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients' symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients' symptom and utilizing big data.

Unintended Consequences and Workarounds of Electronic Medical Record Implementation in Clinical Nursing Practice

imageNurses have experienced unintended consequences and workarounds associated with health information technology implementation. However, examination of this occurrence is rare. This study aimed to examine the unintended consequences and workarounds produced by the implementation of electronic medical record systems in clinical nursing practice. A total of 143 nurses participated in a survey using statistically tested instruments. The data were analyzed using descriptive statistics and a nonparametric test. The descriptive data were analyzed by meaning. The participants experienced unintended consequences and workarounds related to electronic medical record implementation at moderate or high levels based on the responses to questions scored on 5-point Likert scales. The unintended consequences were closely associated with workarounds. The degree of experience with unintended consequences and the use of workarounds differed significantly according to the level of education, job position, and years in nursing practice. The nursing examples of unintended consequences and workarounds were organized into four categories of unintended consequences. By presenting unintended consequences and workarounds together, this study enhances the understanding of the problems encountered in EMR implementation and the action of nurses. Nurses' needs should be considered as an important resource in developing, redesigning, or purchasing and implementing health information technology in healthcare settings.

Capacity of nurses working in long‐term care: A systematic review qualitative synthesis

Abstract

Background

The United Nations calculates there were 703 million adults 65 years and older globally as of 2019 with this number projected to double by 2050. A significant number of older adults live with comorbid health conditions, making the role of a nurse in long-term care (LTC) complex. Our objective was to identify the challenges, facilitators, workload, professional development and clinical environment issues that influence nurses and nursing students to seek work and continue to work in LTC settings.

Methods

Eligibility criteria included being a nurse in a LTC setting and research with a substantial qualitative component. Multiple databases (including Medline and CINAHL) were searched between 2013 and 2019 along with grey literature. Covidence was used to organise a team of 10 into a paired review of titles and abstracts to the final full text screening, extraction and appraisal with the CASP Qualitative Studies Checklist. Analysis involved a thematic synthesis approach. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist informed the writing of the review.

Results

The search resulted in 18 articles and dissertations. Areas investigated included recruitment, resilience, employment and retention, how nurses perceived their professional work, rewards and difficulties, supervision, student preceptorship and career aspiration, nurses' perceptions of occupational status, along with leadership, education and development needs, and intentions to manage resident deteriorating health. The five themes were (1) perspectives of nursing influenced by the organisation, (2) pride in, and capacity to build relationships, (3) stretching beyond the technical skills, (4) autonomy, and (5) taking on the challenge of societal perceptions.

Discussion

This review revealed what is required to recruit nursing students to careers in LTC and retain nurses. To be explored is how staff can work to their full scope of practice and the resultant impact on resident care, including how to maximise a meaningful life for residents and their families.

Registration

National Institute for Health Research UK (Prospero ID: CRD42019125214).

Major limb amputation and mortality in patients with neuro‐ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both

Abstract

A majority of lower extremities neuro-ischaemic wounds (NIU) are related to: (a) only diabetes (DM); (b) only peripheral artery disease (PAD); (c) co-existing diabetes and peripheral artery disease (DM-PAD). This study aims to characterise the major clinical outcomes of forementioned three groups of lower extremity wound patients in Singapore. Patients hospitalised for lower extremity NIU between January 2014 and October 2017 in a tertiary hospital in Singapore were analysed. Patients' major limb amputation and mortality were assessed using Cox regression models. Cumulative survival and amputation-free survival among the three classified groups were calculated using Kaplan-Meier analysis. Compared with patients with only DM, those in the PAD group and the DM-PAD group had higher risk of major limb amputation (adjusted hazard ratio: 2.47, 95% CI: 1.65-3.70; adjusted hazard ratio: 2.01, 95% CI: 1.53-2.65 respectively) and mortality (adjusted hazard ratio: 2.36, 95% CI: 1.57-3.55; adjusted hazard ratio: 2.46, 95% CI: 1.86-3.26 respectively). The 3-year survival and amputation-free survival were lowest in the DM-PAD group (52.1% and 41.5% respectively), followed by the PAD group (53.3% and 44.6% respectively) and the DM group (74.2% and 68.5% respectively). Lower extremity NIU patients with PAD or DM-PAD were found to have poorer clinical prognosis than those with DM only.

Dynamics of patient adherence with their cardiovascular treatment plans

Por: Al ZadJali · S. · Lee · A. J.

Commentary on: Rashidi, A., Kaistha, P., Whitehead, L. et al. (2020) Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: A review of published qualitative research studies. International Journal of Nursing Studies, 110, 103727.

Implications for practice and research

  • Following treatment plans is essential for best outcomes—nurses must understand how and why patients choose to conform with treatment so they can support adherence.

  • Further research is needed to highlight factors from both healthcare professional and patient/relatives’ perspectives to encourage concordance.

  • Context

    Adherence to cardioprotective treatment and lifestyle modification are crucial to reduce future cardiovascular complications, rehospitalisation and death; as well as to improve patient quality of life.1 Numerous studies have reviewed medication adherence, while research on factors that influence medication adherence and treatment plans is scarce. This systematic review collates evidence on factors which influence cardiovascular patient adherence...

    Enriching outcomes for persons with intellectual disabilities: choice, individuality and collaboration are key to effective eHealth

    Por: Fewings · H. · Lee · A. J.

    Commentary on: Oudshoorn CEM, Frielink N, Nijs SLP, Embregts PJCM. eHealth in the support of people with mild intellectual disability in daily life: a systematic review. J Appl Res Intellect Disabil 2019;00:1–22.

    Implications for practice and research

  • This review highlights a need for more individualised, planned and collaborative approaches when using eHealth to assist persons with mild intellectual disabilities.

  • Further research is required to tackle the significant lack of rigorous evidence on eHealth interventions for people with mild intellectual disabilities.

  • Context

    eHealth can be used to support daily functioning and independence for people with intellectual disabilities.1 Yet there is a distinct lack of evidence to support how we can use services most effectively. This is most important in today’s post COVID-19 environment, as healthcare increasingly needs to embrace technology to support our most vulnerable citizens, as we reduce onsite care provision. This...

    Developing a multicomponent implementation strategy for mental health interventions within the Nurse‐Family Partnership: An application of the EPIS framework

    Abstract

    Purpose

    The purpose of this article is to describe the process used to create the Mental Health Innovation (MHI), a multicomponent implementation strategy that integrates evidence-based mental health interventions into the Nurse-Family Partnership (NFP), a national home visiting program delivered by nurses to low-income mothers.

    Organizing construct

    The Exploration, Preparation, Implementation, Sustainment (EPIS) framework outlines the multistep, stakeholder-engaged process used to develop the MHI.

    Conclusion

    Engaging stakeholders provided an in-depth understanding of NFP infrastructure and the needs of NFP nurses and their clients. This understanding was key to designing a multicomponent implementation strategy to integrate mental health interventions within national and local NFP infrastructure and existing care processes.

    Clinical relevance

    Application of implementation frameworks such as EPIS provides a guide to integrating evidence-based interventions in a systematic, intentional, and rigorous manner, which in turn may promote their wide scale use and long-term sustainability.

    Effects of nurse‐led nonpharmacological pain interventions for patients with cancer: A systematic review and meta‐analysis

    Abstract

    Purpose

    The purposes of this study were to review the types of nurse-led nonpharmacological pain interventions (NPI) offered to cancer patients and/or family caregivers, and to determine a comprehensive and robust estimate of the effect size of nurse-led NPI for cancer patients on various pain-related outcomes.

    Design

    Systematic review and meta-analysis. Studies assessing nurse-led NPIs targeting cancer patients and published between January 2008 and December 2020 were identified by searching multiple literature databases, including MEDLINE®, EMBASE, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®.

    Methods

    This review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-analyses guidelines. The selected randomized clinical trials were independently assessed for methodological quality. The effect sizes (ESs) of treatment were presented as standardized mean differences (Hedges’ g) and 95% confidence intervals (CIs).

    Findings

    A meta-analysis was performed to analyze data from 22 randomized clinical trials. Three types of nurse-led NPI were offered, mainly to cancer patients but also to some caregivers: music, physical, and psycho-educational interventions. The dose and duration of nonpharmacological interventions varied widely. The study participants ranged in age from 44.1 to 67.3 years. Meta-analysis indicated that, although these interventions had small effects in long-term (g = 0.24, 95% CI: 0.06–0.43, p = 0.011) to medium effects in short-term (g = 0.43, 95% CI: 0.32–0.53, p < 0.001), they significantly reduced patients’ pain, increased their knowledge of pain management, reduced barriers to pain management and pain coping, and improved other physical and emotional symptoms. The significance of the ES differed according to the type of intervention, with psycho-educational and physical NPIs having a significant but medium short-term ES, whereas music NPI had a significant but large short-term ES. Only psycho-educational NPIs had significant long-term effects.

    Conclusion

    The combined ES showed that these nurse-led NPIs were significantly effective in both the short and long-term. Types of intervention as a potential moderator were associated with short-term and long-term effects of nonpharmacological interventions on patient outcomes.

    Clinical relevance

    Research-tested interventions should be provided to help patients cope effectively with pain.

    Predictors for psychological distress of young burn survivors across three years: A cohort study of a burn disaster in Taiwan

    Abstract

    Purpose

    The study aims to investigate long-term psychological distress and its risk factors in the burn survivors.

    Design

    A longitudinal study with follow-up interviews was conducted from November 2015–June 2018. A post-burn baseline interview was conducted 6 months after the event, followed by annual surveys for three years.

    Methods

    The burn survivors received structured assessment through telephone in the four-wave interviews, including the five-item Brief Symptom Rating Scale (BSRS-5); two-item Patient Health Questionnaire (PHQ-2); four-item Startle, Physiological Arousal, Anger, and Numbness Scale (SPAN-4); and six-item Impact of Event Scale (IES-6) alongside demographic data and other health-related assessment.

    Findings

    A total of 180 respondents with the mean age of 23 years old completed the four waves of interview. Using the BSRS-5 as the outcome, each variable had different input in psychological distress during the follow-up years. The main finding was that the SPAN-4 score could predict more than 62% of psychological distress between 6 months and 3 years after the disaster. The generalized estimating equation demonstrated that SPAN-4, IES-6, family functioning impairment, hypnotics use, adaptation to the event, and PHQ-2 could predict psychological distress. However, the variable of follow-up year did not exemplify significant estimation in the model.

    Conclusions

    The results indicated that different factors had various influences on psychological distress across the four follow-up stages. PTSD-like symptoms, depression, and anxiety were the most common psychological problems experienced by the young burn cohort in the longitudinal post-traumatic period.

    Clinical relevance

    Healthcare providers should be aware of psychological consequences of traumatic events within up to a 3-year post-burn period, particularly post-traumatic stress, depression, and anxiety symptoms.

    Nurse editors’ roles and practices

    Abstract

    Purpose

    While nurse editors carry great responsibility for the scientific literature in the nursing profession, little has been published about this unique role. The purpose of this study was to examine contemporary nurse editors’ roles and practices.

    Design

    In early 2019, a sample of 129 nurse editors participated in a cross-sectional study using survey methods.

    Methods

    The online survey was based on an instrument used in a prior study and included 43 primarily multiple-choice questions. Findings were analyzed using descriptive statistics.

    Findings

    Beyond the expected roles of journal management, editorial decision making, leadership for the profession, and specific journal focus, some aspects of the nurse editor role have remained unchanged. The role continues to be learned mostly on the job and nurse editors still find satisfaction in helping other nurses publish and disseminate their work. Nurse editors are older and better educated. They also are receiving more manuscripts submitted to their journals and perceive this role as hard work but worth it. This is also the first study to report on the role of other levels of editors.

    Conclusion

    This study provides a description of the current roles and practices of nurse editors. Nurse editors can bring more attention to the role and encourage more nurses to consider this role as an attainable and a satisfying one.

    Clinical relevance

    Being a nurse editor is a leadership role and one that many nurses may not consider as a career goal. Nurse editors can increase the visibility of this role and engage, encourage, and support nurses who are interested in this role.

    Alertness during working hours among eight‐hour rotating‐shift nurses: An observational study

    Abstract

    Purpose

    The aim of this study was to identify the patterns of the decline in the alertness of rotating-shift nurses during working hours across different shift types (day, evening, and night) using an objective measure.

    Design

    An observational study using ReadiBand wrist actigraphs was conducted.

    Methods

    Data were collected from June 2019 to February 2020. Participants were rotating-shift nurses (N = 82) who provided direct nursing care for patients in acute care hospitals in South Korea. Nurses wore actigraphs continuously for 14 days on their non-dominant hand to identify sleep–wake cycles and predict their alertness scores hourly. All participants completed a sleep diary.

    Findings

    Nurses working during night shifts had lower average alertness scores (mean = 77.12) than nurses working during day (mean = 79.05) and evening (mean = 91.21). Overall, alertness showed a declining trend and the specific patterns of decline differed across shifts. Participants with alertness scores less than 70 or 80 demonstrated a significant decline in alertness across all shifts.

    Conclusions

    Distinct patterns of decline in alertness per nursing shift were revealed. Each shift feature should be considered when developing interventions to increase nurses’ alertness, promote high-quality care provision, and ensure patient safety.

    Clinical relevance

    The implementation of interventions to increase alertness among shift nurses is needed at the organizational level, and the cooperation of nursing managers and administrators is required.

    Multidimensional factors affecting homebound older adults: A systematic review

    Abstract

    Purpose

    To systematically identify the multidimensional factors affecting homebound older adults.

    Design

    Systematic review.

    Methods

    We searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment.

    Findings

    Nineteen studies met the review criteria; the studies were either cross-sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health-related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%.

    Conclusions

    The prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses.

    Clinical relevance

    This research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.

    Possible Bioenergetic Biomarker for Chronic Cancer-Related Fatigue

    imageBackground Cancer-related fatigue (CRF) is a highly prevalent, debilitating, and persistent symptom experienced by patients receiving cancer treatments. Up to 71% of men with prostate cancer receiving radiation therapy experience acute and persistent CRF. There is neither an effective therapy nor a diagnostic biomarker for CRF. This pilot study aimed to discover potential biomarkers associated with chronic CRF in men with prostate cancer receiving radiation therapy. Methods We used a longitudinal repeated-measures research design. Twenty men with prostate cancer undergoing radiation therapy completed all study visits. CRF was evaluated by a well-established and validated questionnaire, the Patient-Reported Outcomes Measurement Information System for Fatigue (PROMIS-F) Short Form. In addition, peripheral blood mononuclear cells were harvested to quantify ribonucleic acid (RNA) gene expression of mitochondria-related genes. Data were collected before, during, on completion, and 24 months postradiation therapy and analyzed using paired t-tests and repeated-measures analysis of variance. Results The mean of the PROMIS-F T score was significantly increased over time in patients with prostate cancer, remaining elevated at 24 months postradiation therapy compared to baseline. A significant downregulated BC1 ubiquinol-cytochrome c reductase synthesis-like (BCS1L) was observed over time during radiation therapy and at 24 months postradiation therapy. An increased PROMIS-F score was trended with downregulated BCS1L in patients 24 months after completing radiation therapy. Discussion This is the first evidence to describe altered messenger RNA for BCS1L in chronic CRF using the PROMIS-F measure with men receiving radiation therapy for prostate cancer. Conclusion Our results suggest that peripheral blood mononuclear cell messenger RNA for BCS1L is a potential biomarker and therapeutic target for radiation therapy-induced chronic CRF in this clinical population.

    Non‐pharmacological interventions using information and communication technology for behavioral and psychological symptoms of dementia: A systematic review and meta‐analysis protocol

    Abstract

    Aim

    To review and examine the effectiveness of non-pharmacological interventions on behavioural and psychological symptoms of dementia using information and communication technology.

    Design

    This is a systematic review and meta-analysis.

    Methods

    The databases including PubMed, CINAHL with Full Text (EBSCOhost), PsycINFO, Embase, and the Cochrane Library will be searched for all published studies. Studies will be screened and selected with criteria described in PICOS format. Risk of bias will be assessed by the National Institute for Health and Clinical Excellence checklist. Data will be extracted from eligible studies and used to perform a meta-analysis examining the overall effects and effects on individual outcomes. Additionally, we will conduct meta-regression to examine the association between explanatory variables and behavioural and psychological symptoms. This study has been funded since June 2020.

    Discussion

    This study will be the first to reveal the effects of non-pharmacological interventions using information and communication technology on behavioural and psychological symptoms of dementia. Furthermore, this study will provide updated and valid evidence of interventions using this for managing behavioural and psychological symptoms of dementia.

    Impact

    Although non-pharmacological interventions using information and communication technology for older adults living with dementia are continuously developing, their direct effect remains unclear. This study will evaluate the effectiveness of these interventions on behavioural and psychological symptoms of dementia and provide the evidence to implement these interventions among older adults living with dementia. Thus, caregivers and nursing staff can manage behavioural and psychological symptoms of dementia more effectively by incorporating information and communication technology.

    Prospective pilot study protocol evaluating the safety and feasibility of robot-assisted nipple-sparing mastectomy (RNSM)

    Por: Park · K. U. · Lee · S. · Sarna · A. · Chetta · M. · Schulz · S. · Agnese · D. · Grignol · V. · Carson · W. · Skoracki · R. J.
    Introduction

    Nipple-sparing mastectomy (NSM) can be performed for the treatment of breast cancer and risk reduction, but total mammary glandular excision in NSM can be technically challenging. Minimally invasive robot-assisted NSM (RNSM) has the potential to improve the ergonomic challenges of open NSM. Recent studies in RNSM demonstrate the feasibility and safety of the procedure, but this technique is still novel in the USA.

    Methods and analysis

    This is a single-arm prospective pilot study to determine the safety, efficacy and potential risks of RNSM. Up to 12 RNSM will be performed to assess the safety and feasibility of the procedure. Routine follow-up visits and study assessments will occur at 14 days, 30 days, 6 weeks, 6 months and 12 months. The primary outcome is to assess the feasibility of removing the breast gland en bloc using the RNSM technique. To assess safety, postoperative complication information will be collected. Secondary outcomes include defining benefits and challenges of RNSM for both surgeons and patients using surveys, as well as defining the breast and nipple-areolar complex sensation recovery following RNSM. Mainly, descriptive analysis will be used to report the findings.

    Ethics and dissemination

    The RNSM protocol was reviewed and approved by the US Food and Drug Administration using the Investigational Device Exemption mechanism (reference number G200096). In addition, the protocol was registered with ClinicalTrials.gov (NCT04537312) and approved by The Ohio State University Institutional Review Board, reference number 2020C0094 (18 August 2020). The results of this study will be distributed through peer-reviewed journals and presented at surgical conferences.

    Trial registration number

    NCT04537312.

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