Risk factors for fatigue severity in primary brain tumor patients

BACKGROUND:

In addition to neurologic symptoms, fatigue is commonly reported in patients with primary brain tumors during radiation therapy and in long–term survivors of low–grade brain tumors. Other factors have not been explored. The aim of this study was to identify demographic and clinical factors that predict fatigue severity and to evaluate the association of fatigue with other symptoms throughout the disease trajectory.

METHODS:

Two hundred one patients with primary brain tumors completed the M. D. Anderson Symptom Inventory–Brain Tumor Module and a demographic checklist. Clinical data, including treatment, tumor grade, and performance status, were also collected. Correlations among fatigue and other recorded symptoms were evaluated. Logistic regression modeling was performed to evaluate factors associated with fatigue severity.

RESULTS:

Fatigue severity was associated with symptoms including pain, drowsiness, distress, difficulty sleeping, and weakness as well as overall symptom severity and interference. Poor performance status (Karnofsky scale) (odds ratio [OR], 5.73; P = .001), female sex (OR, 2.48; P = .005), and disease status (OR, 2.20; P = .013) were the strongest predictors of fatigue. Severity of fatigue for women was primarily predicted by disease status (OR, 3.33; P = .01) For men, antidepressant use (OR, 4.43; P = .013) in addition to opioids (OR, 3.46; P = .017) and performance status (OR, 12.47; P = .0001) predicted fatigue severity.

CONCLUSIONS:

Fatigue should not be considered a solitary symptom with 1 root cause, but a complex symptom related to the severity of other symptoms and potentially having various etiologies. Future studies should consider these factors in planning interventions and assessing response. Cancer 2010. © 2010 American Cancer Society.     

"Leaving the Comfort of the Familiar": Fostering Workplace Cultural Awareness Through Short-Term Global Experiences

PROBLEM.  Facilitating the development of student nurses' cultural competence and translating these experiences into the clinical setting.
METHODS.  Qualitative methods.
FINDINGS.  A short-term global immersion experience informs student nurses' cultural awareness, education, and future clinical practice.
CONCLUSIONS.  Participation in a short-term global health experience contributes to students' personal growth and broadens their insight into multicultural care.     

Social Implications of Obstetric Fistula: An Integrative Review

Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub‐Saharan Africa.