Caregivers of persons with a brain tumor: a conceptual model

Researchers have documented negative physical and emotional consequences for both family caregivers of persons with cancer as well as caregivers of persons with a neurologic disorder. However, there is a unique subset of caregivers who must provide care for someone who may suffer from both a short, terminal trajectory of disease, as well as neurological and neuropsychiatric sequelae - the caregiver of a person with a primary malignant brain tumor. The purpose of this article was to describe a conceptual framework for providing care for a person with a primary malignant brain tumor. The demands of this particular care situation are described, as well as potential resources available to the caregiver to meet those demands. Finally, the stress response that results from the balance between care demands and caregiver resources is illustrated. Development of a conceptual framework for this caregiving population is the first step in assisting nurses to identify factors that place caregivers of persons with a primary malignant brain tumor at risk for negative consequences, and to design interventions to improve caregiver health.     

Predictors of psychological distress in family caregivers of persons with psychiatric disabilities

The purpose of the study was to determine the relationships of primary and secondary stressors, and informal and formal supports, to psychological distress in 154 family caregivers of persons with psychiatric disabilities. All caregivers were members of self-help groups located in the Province of Quebec in Canada. Psychological distress was significantly lower among older caregivers, those working full time, and those experiencing lower objective and subjective burdens. Contrary to the hypotheses, caregivers who perceived more support from friends and had more contacts with their relatives' primary mental health providers experienced a higher level of psychological distress.     

Understanding persons with psychological distress in primary health care

The purpose of this study was to gain more knowledge and a deeper understanding of experiences of persons living with psychological distress who seek help in primary care. Psychological distress is a state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life. The lack of effective care for and difficulty in identifying psychological distress is frustrating for patients and health professionals alike. The aim was therefore to gain more knowledge about the experience of living with psychological distress. Twelve persons (nine women and three men) aged 23–51 years were interviewed. Analyses were based on a phenomenological hermeneutic method and indicated that psychological distress may be seen as an imbalance (incongruence) between the self and the ideal self, which slowly breaks down a person's self‐esteem. This imbalance was described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one's grip on life. It seems to be associated with a gradual depletion of existential capacities and lead to dissatisfaction, suffering, poor self‐esteem and lack of control. As psychological distress may be a forerunner to mental, physical and emotional exhaustion, there is a need to initiate preventive or early interventions to avoid mental, physical and emotional chaos in such patients. Patients' with psychological distress need to be involved in a person‐centred salutogenic dialogue with health professionals to become aware of and strengthen their own capacities to regain health and well‐being.     

恶性肿瘤患者心理痛苦与营养不良的相关性分析

目的 探讨恶性肿瘤患者心理痛苦与营养不良之间的关系,为肿瘤患者营养不良的预防及干预提供参考依据。方法 采用方便抽样法,选择352例肿瘤住院患者,应用一般情况调查表、心理痛苦温度计(DT)及患者主观整体评估量表(PG-SGA)进行问卷调查,了解肿瘤患者心理痛苦与营养不良的现状,采用Pearson相关分析探讨两者相关性,采用非条件多因素Logistic回归分析。结果 患者心理痛苦得分为(3.49±2.57)分,显著痛苦(DT≥4分)检出率为41.45%;营养评估得分为(6.64±5.12)分,存在营养不良(PG-SGA B+C)的有255例, 总体营养不良发生率为73.92%;心理痛苦与营养不良程度呈显著正相关(r=0.533,P＜0.001);年龄≥60岁、消化道肿瘤、BMI＜18.5和存在心理痛苦是营养不良的危险因素。结论 恶性肿瘤患者心理痛苦及营养不良发生率均较高,存在心理痛苦的患者发生营养不良的风险更高。因此,医护人员在临床工作中对存在营养不良的肿瘤患者除了开展营养干预外,还应重视其心理状况的评估与干预。     

原发性颅内肿瘤患者脑囊液细胞学检查

目的：对脑囊液进行细胞学检查，以提高颅内占位病变的定性准确率。方法：对12例原发性颅内肿瘤患者脑囊液的检查结果进行分析。结果：其定性阳性率66．6％（s／12），虽比手术病理报告的90％（9／10）为低，但比头颅CT或MR定性阳性率33．3％（4／12）为高。结论：初步探讨了脑囊液的特点，并可作为术前颅内肿瘤影像学定性诊断的重要补充，亦可为病理诊断手段之一。     

VEGF在小鼠活体移植脑肿瘤生长过程中的表达研究

目的通过连续测定血管内皮生长因子（ⅥⅪF）在小鼠Lewis肺癌活体移植脑肿瘤生长过程中的表达变化，分析其变化的规律和特点，探讨这些规律和特性与肿瘤生长的相互作用。方法采用小鼠kwis肺癌皮下移植肿瘤组织悬液，经直接穿破颅骨注入法建立小鼠脑移植瘤模型。荷瘤鼠分别选取实施肿瘤移植手术后第6，7，8，9，10，11，12,13日时处死，取脑。对各日龄组标本进行以下测定：（1）HE染色和免疫组织化学染色检测VEGF的表达：（2）逆转录-聚合酶链方法（RT-PCR）与定量PCR检测VEGFmRNA的表达；（3）测定VEGF的蛋白含量。结果10日龄前区间VEGF的表达符合肿瘤血管形成期的生长特点，10日龄后区间VEGF的表达符合肿瘤血管生长期的生长特点。10日龄可以作为肿瘤血管形成期和生长期的分界点。10日龄前区间内VEGF的表达呈缓慢上升趋势。自10日龄始，VEGF的表达显著上调，并伴随肿瘤的生长呈爆发性指数增长趋势。结论VEGF的表达强度和蛋白含量作为肿瘤新生血管多少的判定指标与肿瘤生长的时间存在密切关联性和规律性。其表达伴随肿瘤的生长逐渐增强，且存在一个显著上调的分界点。此分界点对肿瘤生长阶段的诊断判定具有重大的意义。     

Problems of new caregivers of persons with stroke.

Nine adult caregivers new to the role of caring for persons with stroke, upon discharge from rehabilitation centers in Ohio and Michigan and living farther away from formalized support services than urban caregivers, were enrolled for 3 months in a Web-based intervention project that examined the feasibility of the intervention and described the experience of caring. This article is an analysis of qualitative data from the intervention project that used a rigorous protocol to examine 68 perceived problems reported in caring. Problem themes in order of most to least frequent were 1) having independence issues, 2) dealing with emotions, 3) living with physical limitations, 4) managing co-morbid conditions, 5) balancing it all, 6) participating in physical therapy, and 7) having sleeping issues. These problems were related to four of Orem's universal self-care requisites. Although the total number of problems decreased over time, "balancing it all" was the only problem that increased. This may be due to the resumption of the caregivers' regular activities or increased caregiving responsibilities. Nurses could use these findings to identify and focus on self-care needs of caregivers and to implement problem-resolution strategies.     

脑转移瘤射波刀治疗的临床护理

目的探讨射波刀治疗脑转移瘤的有效的护理措施。方法对23例脑转移瘤患者实施射波刀治疗前的宣教、治疗中护理、治疗后的并发症的观察与相应的护理。结果23例患者均顺利完成治疗,经过治疗后第1周J临床症状改善率95．6％：治疗后第3个月的治疗有效率为74．3％,局部控制率为88．6％。无护理并发症的出现。结论精心的护理为射波刀成功治疗提供了有效的支持和保汪。     

Delineation of brain tumor margins using intraoperative sononavigation: implications for tumor resection

PURPOSE: Sonography has been employed for real-time intraoperative delineation of tumor boundaries during resection of brain tumors. However, the variably hyperechoic appearance of brain edema or gliosis surrounding the brain may interfere with accurate depiction of tumor margins. The goal of the present study was to use sononavigation, which provides coregistration between real-time sonograms and MRI scans, to assess the accuracy of sonographic determination of tumor margins. METHODS: Sononavigation was performed on 12 brain tumors (7 metastatic brain tumors, 2 meningiomas, 1 anaplastic oligodendroglioma, 1 anaplastic pilocytic astrocytoma, and 1 anaplastic astrocytoma). Sonograms of tumor margins were categorized into 1 of 3 types: in type 1, the tumor margin was clearly visualized and corresponded to the margin of the enhanced lesion on MR scan in all areas; in type 2, the tumor margin was clearly seen in some areas but was obscure in others due to hyperechoic edema; and in type 3, the tumor margin was indistinguishable from surrounding tissues in all areas. RESULTS: Three metastatic brain tumors and 1 meningioma were categorized as type 1. Three metastatic brain tumors, 1 meningioma, and 1 anaplastic oligodendroglioma were categorized as type 2. The anaplastic pilocytic astrocytoma, 1 metastatic brain tumor (which consisted mainly of necrotic tissue), and the anaplastic astrocytoma were categorized as type 3. These data assist in determining whether the sonographic appearance of tumor margins is accurate and whether to rely on information from either sonography (type 1) or the sononavigation system when resecting tumor types 1, 2, and 3. CONCLUSIONS: Sononavigation can help categorize the sonographic tumor margins into 3 different patterns, and this categorization can assist in determining which imaging modalities are needed to better delineate the tumor margins for subsequent resection.     

Predictors of psychological distress in chronic pain patients

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self-report assessment questionnaire which included a 12-item, 5-point semantic differential measure of psychological well-being/distress, together with a range of single-item measures of pain and psychosocial factors measured using 5-point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.     

Quality of life among primary caregivers of Taiwanese children with brain tumor

This study evaluated the quality of life among primary caregivers of Taiwanese children with brain tumors and examined the factors associated with their quality of life. Data were obtained from the Impact of Childhood Cancer on the Chinese Family survey conducted by the Taiwan Childhood Cancer Foundation in 2001. This analysis included 30 families. Quality of life among primary caregivers was measured by the World Health Organization Questionnaire on Quality of Life: BREF-Taiwan version. Quality-of-life scores for various subgroups were compared using the Mann-Whitney U test or the Kruskal-Wallis test. The scores in the physical health and psychological domains for caregivers of children with brain tumors were lower than the norm scores for healthy adults. Caregivers of boys had higher scores in social relationships. Caregivers of children within 5 years of the brain tumor diagnosis had higher scores in the physical health domain. The child's treatment stage was associated with caregiver scores in the physical health and psychological domains. The caregiver's psychological domain was negatively affected by a low education level. The health status of caregivers was positively associated with their quality of life in physical health, psychological status, social relationships, and environment domains. The lower quality of life among caregivers indicates the need for promoting an awareness in healthcare providers of the impact that having a child with brain tumor has on the quality of life. Family-centered interventions are implicated. Healthcare providers should elicit information regarding the caregiver's perceived physical health and intervene early. This may help to improve the quality of life among caregivers of children with brain tumors.     

Predictors of distress and depression in elders with arthritic pain

AIM: The aim of this paper is to report the findings of a study testing a theory of chronic pain, with financial hardship added as a contextual stimulus. BACKGROUND: Arthritis is highly prevalent among older people, resulting in severe pain and suffering. A previous study testing a theory of chronic pain in elders with arthritis found that pain, disability and social support explained only 35% of the variance in their emotional distress. It is possible that demands, other than chronic pain, such as financial hardship, also contribute to these elders' stress and depression. METHOD: The theory was tested with 235 elders with arthritis using a secondary data analysis strategy. Data were obtained from the study of Ageing, Status, and Sense of Control carried out in 1998 in the United States of America. Variables were constructed from original questionnaires. RESULTS: The hypothesized model fitted the data only moderately well (chi2 = 40.04, d.f = 6, P < 0.0001; CFI = 0.88; NFI = 0.88). Disability and financial hardship positively predicted distress, while social support and age had a reverse impact on distress, which explained 24% of the variance in distress. This means that elders with higher levels of disability, more financial hardship, less social support or younger age are likely to have higher levels of distress. Distress alone explained 33% of the variance in depressive symptoms. A data-derived model was created with excellent fit (chi2 = 3; d.f. = 4; P = 0.56; CFI = 1.00; NFI = 0.99), showing that disability, social support, financial hardship and age predicted distress (R2 = 0.24). Pain, disability and distress predicted depression (R2 = 0.44). CONCLUSIONS: The results partially supported the theory. Exploring the possibility of using depression as part of the control process and removing gender as a residual stimulus may lead to further refinement of the theory. The findings allow nurses to have a better understanding of the experiences of elders with arthritis, and thus to offer appropriate care to meet their needs.