A novel prospective descriptive analysis of nausea and vomiting among patients receiving gastrointestinal radiation therapy

Purpose

Nausea and vomiting are common side effects from radiotherapy that can interfere with gastrointestinal (GI) cancer patients’ quality of life (QOL). This study described the subjective experience of patients with radiation-induced nausea and vomiting (RINV) and its relation to QOL.

Methods

Forty-eight patients treated with abdominal radiotherapy alone or with concomitant chemoradiotherapy were followed in a prospective study. All episodes of nausea, vomiting, and antiemetic use were recorded daily for the treatment period and the week following completion of therapy. QOL was assessed weekly using the Functional Living Index—Emesis QOL Tool (FLIE) and the EORTC QLQ-C30 core questionnaire (C30).

Results

In total, 351 episodes of nausea severity, duration, onset time, and 154 outcomes of vomiting onset times and contents were documented. The median nausea severity experienced per episode was 5 (on a scale from 1 to 10), and the most common durations of nausea were 30 min or less and constant nausea all day and night. The most common location of nausea was the abdomen. Longer nausea duration, great nausea severities, and the location of nausea experienced had significant adverse relationships to multiple QOL items on both the FLIE and the C30. In addition, the onset timing and number of vomiting episodes were related to the majority of all FLIE and QOL scores.

Conclusion

Patient’s subjective experiences of RINV directly correlated to the worsening of QOL outcomes. The identification and amelioration of these RINV experiences could improve QOL.

     

A prospective analysis of time to screen protocol ECGs in adult Emergency Department triage patients

BackgroundEarly identification of ST elevation MI (STEMI) in emergency departments (ED) via electrocardiogram (ECG) expedites intervention. While screening of all ED chest pain ECGs should be obtained within 10 minutes per the American Heart Association, 40% of all ECGs are software-analyzed as “Normal” or “Otherwise Normal.” However, the reliability of this analysis and the time for confirmation read are uncertain. This study investigates the time necessary for Patient Care Technicians (PCTs) to deliver ECGs to ED attendings to confirm automated interpretation.MethodsA prospective cohort study was conducted at a single academic ED. All patients ≥18 years who had a triage ECG were included. ECGs were obtained within 10 min of arrival, time-stamped, delivered for ED attending review and time-stamped upon PCT return to triage. Data were entered into REDCap and analyzed using StatPlus.ResultsDuring the 4-month study, 1768 ECGs were collected. Distribution of automated readings was: “Normal ECG” 33.7%; “Otherwise Normal ECG” 11.2%; and “borderline/abnormal” 55.1%. The median time necessary for PCTs to confirm a screening ECG was 2.8 min (IQR 2,4) with attending physicians interrupted an average of 14.6 times per day.ConclusionScreening of triage ECGs is time-intensive and compounds the frequency of physician interruptions. Although findings are not generalizable, the impact of these interruptions on patient care and safety is paramount and universal. Future directions include validating the reliability of “Normal” and “Otherwise Normal” ECG automated readings to obviate the need to interrupt ED physician for expedited screening confirmation.     

Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: a preliminary prospective study.

There is accumulating evidence that opioid therapy might not only be associated with the development of tolerance but also with an increased sensitivity to pain, a condition referred to as opioid-induced hyperalgesia (OIH). However, there are no prospective studies documenting the development of opioid tolerance or OIH in patients with chronic pain. This preliminary study in 6 patients with chronic low back pain prospectively evaluated the development of tolerance and OIH. Patients were assessed before and 1 month after initiating oral morphine therapy. The cold pressor test and experimental heat pain were used to measure pain sensitivity before and during a target-controlled infusion with the short-acting mu opioid agonist remifentanil. In the cold pressor test, all patients became hyperalgesic as well as tolerant after 1 month of oral morphine therapy. In a model of heat pain, patients exhibited no hyperalgesia, although tolerance could not be evaluated. These results provide the first prospective evidence for the development of analgesic tolerance and OIH by using experimental pain in patients with chronic back pain. This study also validated methodology for prospectively studying these phenomena in larger populations of pain patients. PERSPECTIVE: Experimental evidence suggests that opioid tolerance and opioid-induced hyperalgesia might limit the clinical utility of opioids in controlling chronic pain. This study validates a pharmacologic approach to study these phenomena prospectively in chronic pain patients and suggests that both conditions do occur within 1 month of initiating opioid therapy.     

A prospective descriptive study exploring hope, spiritual well-being, and quality of life in hospitalized patients

A study evaluating relationships among interventions and outcomes of hope, spiritual well-being, quality of life and length of stay in hospitalized patients at admission, discharge, and 6 weeks after discharge is described. The findings highlight the importance of presence, listening; and other caring behaviors in the patient experience.     

Fatigue in cancer patients. A descriptive study

The purpose of this study was to examine relationships between fatigue and various physical and psychological factors in women undergoing chemotherapy for ovarian cancer. The Rhoten Fatigue Scale (RFS) and the Beck Depression Inventory (BDI) were used to evaluate levels of fatigue and depression in the patient sample. The sample was composed of 12 adult ovarian cancer patients who were receiving chemotherapy and 12 apparently healthy adult women. The patients' responses to the instruments used in this study indicated no significant relationship between fatigue and age, stage of disease, course of treatment, or depression. Weak-to-moderate relationships were found between levels of fatigue and CA 125 levels. A moderately strong (r = 0.68, p less than 0.01) relationship was found between ratings on the RFS and fatigue items on the BDI. A fatigue trajectory was found to peak at day 7 and to slowly decline during the remainder of the 28-day treatment course.     

A randomized trial of empirical antibiotic therapy with one of four beta-lactam antibiotics in combination with netilmicin in febrile neutropenic patients

Over a two year period 174 evaluable episodes of fever in neutropenic patients were treated in a randomized study comparing four beta-lactam antibiotics, each given in combination with netilmicin. Exclusions included episodes due to viral or fungal infection, and trial violations. Most patients were receiving treatment for leukaemia, including 18% undergoing bone marrow transplantation. The overall response rate (EORTC criteria) was 66%, ranging from 56% for cefoperazone to 76% for mezlocillin. Microbial documentation was obtained in 31% of episodes; Gram-positive isolates were most frequent but Pseudomonas aeruginosa was found in 18 patients. In patients with microbiologically documented infection 70% improved, overall--from 40% with cefoperazone to 80% with piperacillin (P less than 0.05). Nephrotoxicity was seen in 6.7% and was associated with severe documented sepsis. Hypokalaemia was seen in 29% and was most marked in patients receiving ticarcillin. Rashes occurred in 6.6% overall, with no difference between the groups. Ototoxicity, shown by serial audiograms, was seen in 4.7% of patients. No evidence of vestibular dysfunction was seen in 62 patients studied. Of thirteen deaths due to the primary infection, seven were caused by Ps. aeruginosa and five by fungi.     

Meanings and aspects of quality of life for cancer patients: a descriptive exploratory qualitative study

Given the importance of quality of life (QoL) for cancer patients, it is important to work out what this concept means not only for cancer patients, and for the nurses who care for them, but also the aspects of which it is composed. Therefore, an interpretive research study was conducted to explore in-depth meanings and aspects of QoL as expressed by cancer nurses. Participants were selected from different inpatient and outpatient oncology services and a palliative setting in Adelaide, South Australia. Results showed that many aspects contribute to an individual's QoL. These include the physical, the psychological, the spiritual, and both environmental and social interactions. More importantly, participants stated that spirituality is multifaceted and that there may be aspects in life that may be taken for granted. The meaning of patients' QoL was viewed by nurses as a patient's overall happiness and satisfaction. Also, nurses identified that providing choices to patients made an important contribution to a patient's QoL. Therefore, this exploration into the in-depth meanings and aspects of QoL for cancer patients from nurses' perspectives identified that, in addition to the aspects related to QoL that have been identified previously in the literature, aspects related to spirituality would need to be extensively covered, and providing choices to patients would be important in patients' QoL in an Australian setting.