| 1. |
- Altena, Renske, et al.
(författare)
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Evidence-based prediction and prevention of cardiovascular morbidity in adults treated for cancer
- 2021
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Ingår i: Cardio-Oncology. - : BMC. - 2057-3804. ; 7:1
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Forskningsöversikt (refereegranskat)abstract
- Background Cancer treatment-related morbidity relevantly compromises health status in cancer survivors, and efforts to optimise health-related outcomes in this population are vital to maximising healthy survivorship. A pre-treatment assessment - and possibly preventive management strategies - of cancer patients at increased risk for cardiovascular disease (CVD) seems a rational approach in this regard. Definitive evidence for such strategies is largely lacking, thereby impeding the formulation of firm recommendations. Results The current scoping review aims to summarise and grade the evidence regarding strategies for prediction and prevention of CVD in adults in relation to oncological treatments. We conducted a scoping literature search for different strategies for primary prevention, such as medical and lifestyle interventions, as well as the use of predictive risk scores. We identified studies with moderate to good strength and up to now limited evidence to recommend primary preventive strategies in unselected patients treated with potentially cardiotoxic oncologic therapies. Conclusion Efforts to minimize the CVD burden in cancer survivors are needed to accomplish healthy survivorship. This can be done by means of robust models predictive for CVD events or application of interventions during or after oncological treatments. Up to now there is insufficient evidence to implement preventive strategies in an unselected group of patients treated with potential cardiotoxic oncological treatments. We conclude that randomised controlled trials are needed that evaluate medical and lifestyle interventions in groups at increased risk for complications, in order to be able to influence chronic illness risks, such as cardiovascular complications, for cancer survivors.
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| 2. |
- Forsberg, Anna, et al.
(författare)
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Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
- 2022
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Ingår i: The Lancet Gastroenterology & Hepatology. - : ELSEVIER INC. - 2468-1253. ; 7:6, s. 513-521
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Tidskriftsartikel (refereegranskat)abstract
- Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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| 4. |
- Heiwe, Susanne, et al.
(författare)
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Evidence-based practice : attitudes, knowledge and behaviour among allied health care professionals
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:2, s. 198-209
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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| 5. |
- Holm, Maja, et al.
(författare)
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Recruiting participants to a randomized controlled trial testing an intervention in palliative cancer care - The perspectives of health care professionals
- 2017
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Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 31, s. 6-11
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The recruitment of participants to randomized controlled trials (RCTs) in palliative cancer care by health care professionals is often unsuccessful, which could result in failure to achieve study power. The purpose of this paper is to describe how health care professionals experienced recruiting patients and family caregivers to an RCT in palliative cancer care. Methods: The study had a qualitative explorative design. Ten palliative home care settings were involved in the RCT and data were generated through focus group discussions and interviews with health care professionals who were responsible for the recruitment. The transcripts were analyzed with interpretive descriptive principles. Results: The experiences of the health care professionals reveal that communicating the RCT-design to patients and family caregivers was a challenging part of the recruitment but was considered a process of learning over time. The delicate situation that participants were living under added to the challenge and health care professionals believed that the randomized design was contrary to their normal approach to always offer the best possible support. Conclusions: The results contribute valuable knowledge for future trials in palliative cancer care. To promote successful recruitment, health care professionals may be in need of more training to improve their communication skills and it may be necessary to consider other research designs than the RCT. (C) 2017 Elsevier Ltd. All rights reserved.
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| 6. |
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| 7. |
- Kearney, Nora, et al.
(författare)
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WISECARE plus : results of a European study of a nursing intervention for the management of chemotherapy-related symptoms
- 2008
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 12:5, s. 443-448
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Tidskriftsartikel (refereegranskat)abstract
- While the use of chemotherapy has significantly improved survival rates, the symptoms associated with chemotherapy remain a major burden for patients. Preventing or appropriately managing side effects significantly improves patients' functional status and quality of life, ultimately leading to greater patient acceptance of chemotherapy. However, symptom assessment and management are fraught with difficulties such as poor patient recall, retrospective assessment conducted by clinicians and lack of appropriate, clinically relevant and patient friendly symptom assessment and management tools. Furthermore the differences between clinician and patient perceptions of stresses and distress during chemotherapy are well recognised. This study aimed to evaluate the impact of a nursing intervention incorporating structured symptom assessment and management, facilitated by information technology, on chemotherapy-related symptoms, nausea, vomiting, fatigue and mucositis. This pan-European study, involved 8 clinical sites from Belgium, Denmark, England, Ireland and Scotland. Adults (n = 249) receiving first line chemotherapy for breast, lung, ovarian or colorectal cancer, osteosarcoma, acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL) or lymphoma were recruited to the study. Patients completed daily symptom assessment questionnaires for 14 days following consecutive cycles of chemotherapy. Symptom outcomes were compared before and after the introduction of the intervention with positive impact on patients' experiences of nausea, vomiting and oral problems. Fatigue was not significantly improved. (C) 2008 Elsevier Ltd. All rights reserved.
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| 10. |
- Orton, Marie-Louise, et al.
(författare)
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Roles and functions in clinical care for registered nurses with a PhD-A systematic literature review
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : WILEY. - 0283-9318 .- 1471-6712. ; 36:1, s. 16-26
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Forskningsöversikt (refereegranskat)abstract
- Background Nurses are responsible for nursing care and their expertise is crucial for quality of care. One factor important to successful delivery of evidence-based care is availability of staff with the expertise to support their colleagues in this endeavour. RN/PhDs versed in scientific research with a thorough knowledge of their disciplines have the potential to help narrow the gap between theory and practice. The roles and functions of RN/PhDs involved in clinical care have not yet been well defined. Aim To explore publications concerning clinical contributions from registered nurses who hold a PhD (RN/PhDs) regarding impact on quality and improvement of care. Method A systematic literature review was conducted and qualitative content analysis was applied to the data obtained from the included studies. Findings The leadership role is considered essential for RN/PhDs, where the focus is on the pursuit of evidence-based practice and the improvement of nursing practices. The opportunity to combine the clinical and academic aspects of nursing is considered crucial in order for RN/PhDs to influence and improve care, yet few such positions are currently available. RN/PhDs cited limited career opportunities as one important reason for not combining clinical and academic work. Conclusions In order for nursing practice to reach full potential, clinical positions with clearly defined job descriptions for RN/PhDs are needed. To fully leverage their expertise, it is important to allocate sufficient time to conduct relevant research, as well as to support colleagues and students in the improvement of clinical practice.
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| 11. |
- Tengvall, Oili M., et al.
(författare)
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Differences in pain patterns for infected and noninfected patients with burn injuries
- 2006
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Ingår i: Pain Management Nursing. - : Elsevier BV. - 1524-9042 .- 1532-8635. ; 7:4, s. 176-182
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Tidskriftsartikel (refereegranskat)abstract
- The management of pain is a primary issue in burn care. Patients hospitalized for burn injuries experience severe pain on a daily basis, immediately after the injury and during the healing of the burn wound. Our clinical experience is that the intensity of pain is increased by wound infection. The purpose of this study was to investigate retrospectively whether patients experience increased pain intensity in conjunction with wound infection. A total of 165 patients with burn injuries were included, 60 of whom were diagnosed with infection. The results of this study showed a significant increase in pain intensity in association with infection. An increase in pain is one of the factors to be considered among the many assessments, tests, and treatments for patients with burn injuries.
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| 12. |
- Wengstrom, Yvonne, 1959-, et al.
(författare)
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Assessing nursing problems of importance for the development of nursing care in a radiation therapy department
- 1998
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Ingår i: Cancer Nursing. - : Lippincott Williams & Wilkins. - 0162-220X .- 1538-9804. ; 21:1, s. 50-56
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Tidskriftsartikel (refereegranskat)abstract
- The challenges to nurses working in the rapidly changing milieu of radiotherapy in cancer care are great. New treatment regimens continually require reexamination of old assumptions about patients' needs and communication between colleagues. In order to continue the development of the nursing care in the radiation therapy department, the purpose of this study was to assess the nursing problems experienced in the care of the cancer patients and the nursing problems experienced in work with other professionals from the nurse's perspective. Eighteen of the 38 nurses in the radiation therapy department were invited to participate in the study. The mean age of the nurses was 39 years (range 25-57 years). The study was carried out by using a three-phase, structured, communication-process method according to the Delphi technique. The nurses reported "poor follow-up of patients who have completed radiation therapy," closely followed by "finding time to document the nursing care" and "finding time to treat the scheduled patients" as the most problematic areas of importance for the development of nursing care. The nursing problems considered to be the most difficult in the work with other professionals were "lack of communication," "lack of knowledge of our work and competence," and "lack of comprehension of each other's professions." With the present trend in the health care system toward smaller financial resources, it is necessary to find new ways of organizing nursing care in order to find time to take care of the patient's problems during and after the radiation therapy. This study constituted the base for organizing a nursing care clinic in the department with sufficient time to assess and monitor side effects, patient education, sexual counselling, and coping assistance.
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| 13. |
- Wengstrom, Yvonne, 1959-, et al.
(författare)
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European Oncology Nursing Society breakthrough cancer pain guidelines
- 2014
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 18:2, s. 127-131
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The overall aim of the project was to update and inform nurses of current best practice based on previously published literature to enable nurses to assess and manage breakthrough cancer pain (BTCP) and thereby to provide optimal management of BTCP. Methods: The EONS started a project in 2010 by recruiting a working group and a multidisciplinary advisory board to develop guidelines with the purpose of helping oncology nurses understand and recognise BTCP. Results: This paper presents and overview of the guideline. Key recommendations include; using an algorithm for assessment of BTCP, individualise treatment interventions, optimization of analgesia and reassessment of outcomes of interventions. Conclusions: By implementing the EONS guidelines nurses will utilise the latest available knowledge in clinical practice and the understanding and management of BTCP will improve assessment and overall management of breakthrough pain in cancer patients. (C) 2013 Elsevier Ltd. All rights reserved.
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