Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer

PurposeThe relationship between radiation treatment and adverse effects resulting in changes in appetite was studied in patients with head and neck (H&N) cancer.Methods and samplePath analysis was used to evaluate the following factors in 117 patients receiving radiation therapy for H&N cancer: daily fluctuations in saliva production, analgesic use, frequency of oral care, subject characteristics, and appetite.ResultsAt 20 Gy of radiation, appetite was affected by Brinkman index value, age, and sensitivity to taste (R² = 0.48, p < 0.001); at 30 Gy of radiation, appetite was affected by frequency of oral care, xerostomia symptoms, age, sensitivity to taste, and oral mucositis (R² = 0.52, p < 0.001); and at 50 Gy of radiation, appetite was affected by low saliva production in the morning, frequency of oral care, xerostomia symptoms, sensitivity to taste, analgesic use, and oral mucositis (R² = 0.62, p < 0.001).ConclusionsThe results of this study suggest that care taken to avoid a decrease in appetite due to adverse effects of radiation therapy should differ according to the dosage and schedule of radiation therapy. These findings represent important data for health care professionals to understand and support appropriate dietary intake and improved quality of life for H&N cancer patients receiving radiation therapy.     

Effectiveness of oxygen nebulization at preventing radiotherapy-induced mucositis in patients with nasopharyngeal cancer

PurposeTo evaluate the effectiveness of oxygen nebulization at preventing radiotherapy-induced mucositis in patients with nasopharyngeal cancer.MethodsSixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups; treatment was once daily for 20 minutes. All patients received routine oral care. We compared saliva pH and volume, food intake, and change in oral mucosa during radiotherapy, and dry mouth and sore throat after radiotherapy between the two groups.ResultsThere were significant differences in the incidence of grade III or IV mucositis, saliva volume and pH, and dry mouth and sore throat between the two groups when the total dose was 33 Gy (p < 0.05 or p < 0.01).ConclusionOxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.     

Evaluation of the effect of cryotherapy in preventing oral mucositis associated with chemotherapy – A randomized controlled trial

Purpose of the researchThe goal of this study was to assess the effect of oral cryotherapy on the development of oral mucositis related to infusion of 5-fluorouracil (5-FU) with leucovorin.MethodThis study, a randomized controlled trial with random assignments to the experimental and control groups, was conducted with cancer patients. The study included 60 patients; 30 patients in the study group were instructed to hold ice cubes in their mouth shortly before, during, and shortly after infusion of 5-FU with leucovorin, the 30 patients in the control group received routine care. Oral mucositis in the patients was evaluated at 7, 14, and 21 days after chemotherapy. For analysis of data, chi-square, Fisher’s tests were used; p < 0.05 was accepted as statistically significant.ResultsIn the majority of patients receiving cryotherapy, oral mucositis was not observed (Grade 0) at 7 and 14 days. Similarly, incidence of Grades 1, 2, and 3 oral mucositis in the experimental group was quite a bit lower when compared to the control group (p < 0.05). On day 21, no statistically significant difference between the experimental and control groups was determined based on the development of oral mucositis (p > 0.05).ConclusionsWe found that oral cryotherapy has a significant contribution to the protection of oral health by reducing mucositis score according to the WHO mucositis scale, especially on the 7th and 14th days. Nurses’ awareness of how cryotherapy can affect patients and options for resolving problems will enable them to provide a higher standard of individualized care.     

Development and psychometric evaluation of the Relocation Stress Syndrome Scale-Short Form for patients transferred from adult intensive care units to general wards

ObjectiveThis study aimed to develop the Relocation Stress Syndrome Scale-Short Form as an assessment tool for relocation stress experienced by intensive care unit patients after transfer to general wards.MethodsThis study included 535 intensive care unit patients at two tertiary care hospitals in South Korea from May to December 2018. Data were collected through face-to-face interview, using a structured questionnaire. Study 1 was conducted to estimate the factorial structure, and reliability of the scale. Study 2 was conducted to confirm the factorial structure of the scale.Main outcomesStudy 1 found that the new instrument had a good reliability (α = 0.92) and validity. In study 2, confirmatory factor analysis supported a three-factor structure and the scale continued to demonstrate good psychometric properties. The criterion validity showed that a low level of relocation stress syndrome was associated with higher satisfaction with the transfer process (r = −0.58, p < .001) and good general health status (r = −0.51, p < .001).ConclusionThe 10-item Relocation Stress Syndrome Scale was developed with appropriate validity and reliability. This scale can be used to assess relocation stress of patients in transition periods. This new scale requires cross-cultural validation.     

Development and psychometric testing of the attitude and confidence with oral healthcare among nursing students (ACORN) scale

AimTo develop and test the psychometric properties of the attitude and confidence with oral healthcare among nursing students (ACORN) scale.BackgroundDelivering oral healthcare is an essential component of care, which is often overlooked and omitted. A nurse’s attitude or confidence may influence how oral healthcare is prioritised. To date, there are no scales that assess both attitude and confidence for nurses when undertaking oral healthcare and thus the ACORN scale was developed.MethodsThe 24-item scale was developed following a three-stage process, which included concept identification and item construction, pilot testing, factorial and discriminant validity and reliability testing. The survey was distributed to nursing students to assess their attitude and confidence in providing oral healthcare. This study has been registered with the Registry of Efficacy and Effectiveness Studies (12940.1v1).ResultsUsing a before and after intervention survey design, the psychometric properties of the ACORN scale were examined with data collected from two student groups. Exploratory Factor Analysis yielded a two-factor structure, which was verified using Confirmatory Factor Analysis. Importantly, aggregated scale scores were able to detect differences in attitude and confidence following oral healthcare education (4.95 versus 5.66, p < 0.01). The Cronbach’s alpha for the 24-item scale was 0.94.ConclusionThe ACORN scale is a valid and reliable tool that can be used to assess differences in attitude and confidence of students following oral health education. Further research is recommended to test the utility of this scale using other educational interventions with different groups of healthcare providers.     

The Spanish Version of the Edmonton Symptom Assessment System-Revised (ESAS-r): First Psychometric Analysis Involving Patients With Advanced Cancer

ContextThe Edmonton Symptom Assessment System (ESAS) is a measure widely used in palliative care for the assessment of symptoms in patients with advanced cancer. The tool has been validated in different languages, including Spanish. A revised version (ESAS-r) was developed by Watanabe et al. in 2010.ObjectivesTo develop the Spanish version of the ESAS-r and examine its psychometric properties.MethodsBased on the original English version, a group of experts created a Spanish version of the ESAS-r and administered it to a group of advanced cancer patients. Patients completed the ESAS and ESAS-r and were asked for their perceptions of the tool. The psychometric properties of the ESAS-r that were analyzed were equivalence, internal consistency, and discriminant validity.ResultsSixty-six patients from Spain and Guatemala participated in the survey. Patients perceived the ESAS-r to be significantly easier to understand and easier to complete than the ESAS. Significantly, patients preferred the ESAS-r (47%) to the ESAS (15%; P < 0.0007). As to reliability, we found good internal consistency (Cronbach's alpha 0.86), and the equivalence of the two versions was between 0.71 and 0.94. The ESAS-r discriminates between inpatients and outpatients (Mann-Whitney U test; P = 0.02) and among those with different palliative performance status (Spearman's rho for pain, tiredness, drowsiness, lack of appetite, well-being; P < 0.01).ConclusionThe ESAS-r is a valid instrument with adequate psychometric characteristics. This version is preferred by patients with advanced cancer. The Spanish version of the ESAS-r can, therefore, replace the use of the ESAS.     

Development of Knowledge and Attitudes Survey on Pain Management for Korean Long-term Care Professionals

PurposeInappropriate knowledge and attitude toward pain management of professionals has been pointed to be major obstacles to effective pain management in long-term care setting. The purpose of this study was to develop the knowledge and attitudes survey on pain management for Korean long-term care (LTC) professionals (KASP-K).MethodsTo develop the KASP-K, the knowledge and attitudes survey regarding pain developed by Ferrell and McCaffery in 2014 was amended after a review of broad literature and the latest pain management standards. A rigorous validation process of the KASP-K was performed by testing the content validity, item difficulty and discrimination index, construct validity, test–retest reliability, and internal consistency.ResultsThe KASP-K consisted of 22 items and showed a content validity index of >0.7. The average difficulty of the KASP-K was 0.56 and the discrimination index was >0.2. The construct validity of the KASP-K was verified because of the differences in the sum scores depending on pain education (t = 2.30, p = .024). The test–retest reliability was r = .79 (p < .001) and the Cronbach's alpha was 0.73.ConclusionThis preliminary evaluation of the KASP-K demonstrated acceptable validity and reliability. The KASP-K will be able to provide scientific and empirical data regarding the knowledge of and attitude toward pain management by LTC professionals.     

Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury

BackgroundPain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience.AimsTo investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury.MethodsThis was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury.ResultsThe BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001).ConclusionsOur results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients.     

Development and psychometric testing of the 10-item satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment scale

The Objective Structured Clinical Examination (OSCE) or Assessment (OSCA) has traditionally been used in disciplines such as medicine and nursing, to assess students' competence to perform clinical skills safely in a simulated hospital environment. Despite its accepted use, a validated and reliable tool has yet to be developed and tested to assess students' perception of and satisfaction with this mode of assessment. This study developed and tested the psychometric properties of a brief Objective Structured Clinical Examination tool for assessing student perception that could have transferability across health education settings. The study used a cross-sectional survey design. Final year students (n = 727) enrolled in an undergraduate nursing program in Western Sydney completed the 10-item Satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment (SINE-OSCA) Scale in 2017. Exploratory factor analysis uncovered a one-component structure with component loading that ranged from 0.45 to 0.86. Cronbach's alpha of the SINE-OSCA was 0.91. Socio-demographic group comparisons revealed that respondents who were: i) male (p = 0.003); ii) non-native-born (p < 0.001); iii) non-English-speaking (p < 0.001); and iv) International (p = 0.001), reported higher satisfaction with clinical assessments, as measured by the SINE-OSCA scale. The SINE-OSCA scale demonstrates validity and reliability in identifying students who may have difficulty with this mode of clinical skill assessment.     

Turkish Translation of the Patterns of Activity Measure-Pain in Patients with Chronic Low Back and Neck Pain: Validity and Reliability

ObjectiveTo translate the Patterns of Activity Measure-Pain (POAM-P) into Turkish and test its validity and reliability.MethodsA total of 252 patients with chronic low back and neck pain were included. The Turkish translation of the POAM-P (POAMP/T), which has subgroups of Avoidance, Overdoing, and Pacing, was performed in accordance with international recommendations. The POAMP/T was administered twice. Physical activity level was assessed with the International Physical Activity Questionnaire-7 (IPAQ-7), and psychologic status was assessed with the Hospital Anxiety (HADS-A) and Depression Scales (HADS-D). The internal and external construct validity, internal consistency, and test-retest reliability were analyzed.ResultsThree related factorial structures were defined in Confirmatory Factor Analysis. Indexes and factor loads were found to be sufficient. A negative relationship was observed between avoidance and IPAQ-7 (rho = –0.328, p < .001), HADS-D (ρ = ?0.163, p = .009), and HADS-A scores (ρ = ?0.164, p = .009); whereas, a positive relationship was observed between overdoing and IPAQ-7 (ρ = 0.362, p < .001), HADS-D (ρ = 0.309, p < .001), and HADS-A scores (ρ = 0.325, p < .001). A negative correlation was found between pacing and IPAQ-7 (ρ = ?0.200, p = .001), HADS-D (ρ = ?0.507, p < .001), and HADS-A scores (ρ = ?0.509, p < .001). The Cronbach alpha values for avoidance, overdoing, and pacing were obtained as 0.941, 0.917, and 0.940, respectively. The intraclass correlation coefficient for avoidance, overdoing, and pacing was found as 0.972, 0.973, and 0.972, respectively. Test and retest scores were similar (p > .05).ConclusionsThe Turkish version of the POAM-P is a valid and reliable scale for the assessment of pain-related activity patterns in patients with chronic low back or neck pain.     

The effect of oral care using honey as an additional topical agent on oral health status of intubated patients in the intensive care unit

BackgroundPatients using endotracheal tubes are at high risk of oral health status dysfunction due to impaired natural airway defence, oral flora composition changes and protective substances of the teeth, medication causing xerostomia. Oral care has not been enough to manage oral mucosal dryness, so an additional topical agent is needed to protect oral mucosa to maintain oral health. Honey is one of the recommended topical agents.ObjectiveThis study aims to identify the effect of oral care with honey as topical agents on the oral health status of patients using endotracheal tube in the Intensive Care Unit.MethodsThis was an experimental study with a randomized pretest and posttest design. The sample was adult intubated patients, consisting of 36 patients. The data were analysed using the parametric test, and dependent and independent t-test.ResultsThe oral health score in the control group was found to be pre & post mean score11.94 and 13.28 (p = .004) respectively, while in the intervention group 11.89 and 8.33 (p < .001). Mean differences in both groups were 4.95 (p < .001) and the BOAS subscale differences were seen on the lips, gums & mucosa, and tongue (p < .05).ConclusionOral care with honey as a topical agent can improve the oral health status of intubated patients on the lips, gum, mucosa, and tongue subscale. Therefore, honey as an additional topical agent can be a moisturizer to maintain the oral mucosa for intubated patients in the Intensive Care Unit. Furthermore, good mucosal health will help prevent the infection and colonization of microorganisms.     

Development and validation of the Nurse’s Workplace Mental Health Questionnaire

ObjectivesThis study aimed to develop and validate the Nurse’s Workplace Mental Health Questionnaire (NWMHQ).MethodsThe questionnaire was developed based on the two continua model of mental illness and health proposed by Keyes. The initial questionnaire was generated through literature review, two rounds of Delphi expert consultation, followed by a pilot survey. Finally, the reliability and validity of the questionnaire were validated through an online survey of 2,815 registered nurses selected from the public hospitals in 11 provinces from June to July 2020.ResultsThe item-content validity index (I-CVI) of the questionnaire ranged from 0.750 to 1.000 and the average scale-level content validity index (S-CVI/Ave) was 0.906. Cronbach’s α coefficient was 0.948 and test-retest reliability was 0.850. The self-rating depression scale score was negatively related to the NWMHQ score (r = −0.664, P < 0.01). The exploratory factor analysis (EFA) yielded six factors (emotional status, psychological security, positive relationship, resilience, self-efficacy, and subjective well-being), consisting of 32 items. The cumulative variance contribution rate was 65.58%. Confirmatory factor analysis (CFA) showed an acceptable fit.ConclusionThe NWMHQ developed in this study showed good reliability and validity. This questionnaire may help assess the mental health status of nurses and help nursing managers to develop appropriate targeted psychological interventions.     

Validity and reliability of the modified John Hopkins Fall Risk Assessment Tool for elderly patients in home health care

This prospective cohort study was conducted to evaluate the validity and reliability of the modified Johns Hopkins Fall Risk Assessment Tool (mJH-FRAT) among elderly patients receiving home health care visits. Out of 107 patients, 33 (30.8%) had one or more falls and seven (6.5%) experienced falls with injury. Receiver Operating Characteristics of the tool in predicting falls showed an Area Under Curve (AUC) of 0.66 (p = 0.011) with sensitivity and specificity of 72.5% and 52.2% at the cutoff score of 14. For predicting falls with injury, the AUC was 0.82 (p = 0.016) with sensitivity and specificity of 100% and 65.9% at the cutoff score of 17. Inter-rater reliability of the tool was 85.7% agreement with Cohen's kappa of 0.714 (p < 0.001). The mJH-FRAT is a simple and easy-to-use multi-factor fall risk assessment tool with promising sensitivity, specificity and inter-rater reliability for prospectively identifying patients at risk of falls with injury among community-dwelling elderly populations.     

Reliability and validity of the Modified Functional Ambulation Classification in patients with hip fracture

A psychometrically sound and easily applicable mobility outcome measure is crucial for evaluating patient performance and efficacy of rehabilitative treatment. The Modified Functional Ambulation Classification (MFAC) is an assessment tool designed to categorize functional ambulation ability. This study aimed to evaluate the reliability and concurrent validity of the MFAC in patients with hip fracture in a rehabilitation hospital setting. A total of 122 patients with hip fracture, aged 81.3 ± 6.5 years, were evaluated using the MFAC and Elderly Mobility Scale (EMS). Inter-rater reliability was assessed by administering the MFAC to the same patients by two independent raters. Intraclass correlation (2,1) was used to calculate inter-rater reliability, and the Spearmen correlation was used to assess the correlation between MFAC and EMS scores (i.e., concurrent validity). The results revealed that the MFAC categories provided by the two raters were highly reliable (intraclass correlation coefficient (ICC) = 0.960, 95% confidence interval: 0.942-0.972, p < 0.001). The MFAC scores were also significantly correlated with the EMS scores (ρ = 0.814, p < 0.001). In conclusion, the MFAC demonstrated good reliability and concurrent validity in patients with hip fracture.     

Nurses’ knowledge and perception of delirium screening and assessment in the intensive care unit: Long-term effectiveness of an education-based knowledge translation intervention

ObjectivesTo determine the impact of education on nurses’ knowledge of delirium, knowledge and perception of a validated screening tool, and delirium screening in the ICU.MethodsA quasi-experimental single group pretest-post-test design.SettingA 16 bed ICU in a Canadian urban tertiary care centre.Main outcome measuresNursing knowledge and perception were measured at baseline, 3-month and 18-month periods. Delirium screening was then assessed over 24-months.ResultsDuring the study period, 197 surveys were returned; 84 at baseline, 53 at 3-months post education, and 60 at the final assessment period 18-months post intervention. The significant improvements in mean knowledge scores at 3-months post intervention (7.2, SD 1.3) were not maintained at 18-months (5.3, SD 1.1). Screening tool perception scores remained unchanged. Improvements in the perception of utility were significant at both time periods (p = 0.03, 0.02 respectively). Physician value significantly improved at 18-months (p = 0.01). Delirium screening frequency improved after education (p < 0.001) demonstrating a positive correlation over time (p < 0.01).ConclusionMultifaceted education is effective in improving delirium knowledge and screening; however, without sustained effort, progress is transient. Education improved perceived tool utility and over time utility perception and physician value improved.     

Validation of a simple screening test for elementary visuo-spatial perception deficit

ObjectiveThe reliability and validity of a screening test for a deficit in elementary visuo-spatial perception (EVSP) were evaluated.MethodThis prospective study collected performance from 210 typically developing individuals and evaluated the internal consistency of the EVSP screening test. Test–retest reliability was examined with 25 individuals. Validity also involved retrospective clinical data collected from 223 non-typically developing children coming to the hospital for outpatient consultation. Since EVSP matures through childhood, we standardized the EVSP screening test scores by age category and performed Pearson correlations with standardized clinical tests scores.ResultsTest–retest reliability (intraclass correlation coefficient = 0.76) and internal consistency (Cronbach's alpha = 0.76) were satisfactory. Construct validity included correlation with the subtests of the Wechsler Intelligence Scale IV (WISC-IV) involving visuo-spatial analysis (Matrix Reasoning and Block Design, P < 0.01; Symbol Search and Coding, P < 0.05) and was reinforced by the expected non-correlation between the Verbal Comprehension Index and EVSP scoring class. The EVSP scoring class was correlated with Manual dexterity of the M-ABC (P < 0.05) and the Working Memory Index (P < 0.05) of the WISC-IV including the subtest Arithmetic (P < 0.01).ConclusionThis screening test is reliable and valid to evaluate EVSP before more complex cognitive or motor assessment.     

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university

ObjectiveAlthough guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students.DesignPre-test post-test study (2015–2017).SettingAn undergraduate midwifery program within an Australian university.ParticipantsAll first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56).MethodsOral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion.Results44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module.ConclusionsThe module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.     

The development and psychometric testing of a Disaster Response Self-Efficacy Scale among undergraduate nursing students

BackgroundDisaster nurse education has received increasing importance in China. Knowing the abilities of disaster response in undergraduate nursing students is beneficial to promote teaching and learning. However, there are few valid and reliable tools that measure the abilities of disaster response in undergraduate nursing students.ObjectivesTo develop a self-report scale of self-efficacy in disaster response for Chinese undergraduate nursing students and test its psychometric properties.Participants and SettingsNursing students (N = 318) from two medical colleges were chosen by purposive sampling.MethodsThe Disaster Response Self-Efficacy Scale (DRSES) was developed and psychometrically tested. Reliability and content validity were studied. Construct validity was tested by exploratory and confirmatory factor analysis. Reliability was tested by internal consistency and test-retest reliability.ResultsThe DRSES consisted of 3 factors and 19 items with a 5-point rating. The content validity was 0.91, Cronbach's alpha coefficient was 0.912, and the intraclass correlation coefficient for test-retest reliability was 0.953. The construct validity was good (χ²/df = 2.440, RMSEA = 0.068, NFI = 0.907, CFI = 0.942, IFI = 0.430, p < 0.001).ConclusionsThe newly developed DRSES has proven good reliability and validity. It could therefore be used as an assessment tool to evaluate self-efficacy in disaster response for Chinese undergraduate nursing students.