Outcomes of scholarly inquiry: an analysis of Master's of Nursing students' projects/theses.

This study examined the first scholarly projects/theses of 112 graduates of a newly formed Master of Nursing (MN) program. The purpose of the analysis was to determine whether MN graduates' scholarly projects/theses addressed the American Association Colleges of Nursing's (1996) Essentials of Master's Education for Advanced Practice Nursing, met program outcomes, and adhered to campus and program values. Other specific questions were formulated to ascertain the method of inquiry most used, the population group most examined, and the outcomes of the inquiry. The sample of 106 scholarly projects and six theses were categorized according to method of inquiry, population group, population type, and scholarly outcomes and then entered into a database software program. The findings showed the method of inquiry most used was literature review, followed by program critique, community assessment, and secondary analysis. The community was the most frequently examined population group, with patient, children, provider, minority, and elderly the most used population type. The most frequent scholarly outcomes were recommendations, study reports, educational materials, and program development. Findings supported the campus's and program's mission statement that values community partnership and diversity, improved health care outcomes, as well as an outcome objective of master's-level proficiencies in research competencies.     

Effects of experimentally-induced anterior knee pain on knee joint position sense in healthy individuals.

PURPOSE: The ability to sense the position of limb segments is a highly specialised proprioceptive function important for control of movement. Abnormal knee proprioception has been found in association with several musculoskeletal pathologies but whether nociceptive stimulation can produce these proprioceptive changes is unclear. This study evaluated the effect of experimentally induced knee pain on knee joint position sense (JPS) in healthy individuals. STUDY DESIGN: Repeated measures, within-subject design. METHODS: Knee JPS was tested in 16 individuals with no history of knee pathology under three experimental conditions: baseline control, a distraction task and knee pain induced by injection of hypertonic saline into the infrapatellar fat pad. Knee JPS was measured using active ipsilateral limb matching responses at 20 degrees and 60 degrees flexion whilst non-weightbearing (NWB) and 20 degrees flexion single leg stance. During the tasks, the subjective perception of distraction and severity of pain were measured using 11-point numerical rating scales. RESULTS: Knee JPS was not altered by acute knee pain in any of the positions tested. The distraction task resulted in poorer concentration, greater JPS absolute errors at 20 degrees NWB, and greater variability in errors during the WB tests. There were no significant correlations between levels of pain and changes in JPS errors. Changes in JPS with pain and distraction were inversely related to baseline knee JPS variable error in all test positions (r=-0.56 to -0.91) but less related to baseline absolute error. CONCLUSION: Knee JPS is reduced by an attention-demanding task but not by experimentally induced pain.     

Results of a multidisciplinary pain management program: a 6- and 12-month follow-up study.

The aim of this study was to evaluate an 8-week multidisciplinary pain management program offered to patients suffering from chronic pain. The study initially included 88 participants, and 61 of the sample completed a follow-up program conducted at 6 and 12 months after the initial programs. The pain management program was based on a cognitive behavioral approach with active patient participation in learning new coping skills. The intervention consisted of supervised dialog, physical activity, and education. The main goals were change of focus from pain and disability to resources and functional coping strategies. It was hypothesized that the positive changes gained at posttest registration after an 8-week program on coping, health-related quality of life, and pain intensity would be maintained during follow-up sessions. The results indicated that these hypotheses were mainly supported and further pain reduction, decreased emotion-focused coping, better social functioning, and overall physical and mental health gains were observed. The participants who did not complete the follow-up program did not differ from the patients who completed the program on background variables investigated. The study also supported the claim that professional nurses are competent to lead such programs and to evaluate treatment results. Clinical and research implications are discussed.     

Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes.

PURPOSE: Colorectal cancer is the second leading cause of cancer deaths in the United States, with poor survival predicted by regional lymph node (LN) metastasis. The impact of LN ratio (LNR) on survival is unknown in this disease. PATIENTS AND METHODS: We analyzed data from Intergroup trial 0089 of adjuvant chemotherapy for stage II and III patients with colon cancer, in which all patients received fluorouracil-based therapy. Survival was similar for all arms of the study, allowing us to evaluate all patients together. End points included overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Multivariate analyses were performed on all patients and on groups according to LNR quartiles (LNR: < 0.05, 0.05 to 0.19, 0.2 to 0.39, and 0.4 to 1.0). Covariates included in the models were age, sex, tumor stage, grade, histology, number of positive LNs, number of LNs removed, and LNR. RESULTS: The median age was 63.7 years, and the median number of LNs removed was 11. In the multivariate analysis, LNR was a significant factor for OS, DFS, and CSS in patients with 10 to 15 LN and more than 15 LN removed but not for patients with less than 10 LN removed. Using quartiles, LNR maintained its significance for all three end points when patients were grouped by node status. CONCLUSION: After curative resection for colorectal cancer, the LNR is an important prognostic factor and should be used in stratification schemes for future clinical trials investigating adjuvant treatments.     

A Phase I study of CHS 828 in patients with solid tumor malignancy.

CHS 828 is a cyanoguanidine, which has demonstrated potent antitumor activity in preclinical tumor models. The activity of CHS 828 in vitro showed only low to moderate correlation to other antineoplastic agents suggesting a unique mechanism of action. Ten females and 6 males (median age 58 years) with solid tumors refractory to standard therapy were included in this Phase I study. The study drug was administered to fasting patients as a single oral dose on days 1-5 of each treatment cycle. Patients received one to six cycles of treatment. The doses ranged from 30 mg to 200 mg (total dose within a cycle). Hematological toxicity was generally mild and dominated by transient thrombocytopenia and lymphocytopenia. Nonhematological toxicity most frequently consisted of nausea, vomiting, diarrhea, fatigue, and localized genital mucositis. The dose-limiting toxicities were thrombocytopenia, thrombosis, esophagitis, diarrhea, and constipation. The recommended Phase II dose of CHS 828 was 20 mg once daily for 5 days in cycles of 28 days duration. The extent of systemic exposure of CHS 828 across patients was approximately dose proportional. The time at which the highest drug concentration occurs was 2.2 +/- 1.3 h and half-life was 2.1 +/- 0.52 h (mean +/- SD). Large intra- and interindividual variation in dose level-adjusted maximum plasma concentration and the area under the curve from time 0 h to infinity were observed. There was an apparent inverse relationship between systemic exposure of CHS 828, and thrombocyte and lymphocyte nadir levels. No objective tumor responses were observed, and 7 patients showed stable disease after two courses of therapy.     

Estimation of X-ray beam quality by electron paramagnetic resonance (EPR) spectroscopy

A novel dosimetry-based technique using EPR spectroscopy to determine X-ray beam quality is proposed. The radiation-sensitive material is made of a mixture of two polycrystalline substances with different X-ray absorption properties.

The composite samples, consisting of polycrystalline lithium formate monohydrate and calcium formate, were prepared as pellets, X-irradiated, and analyzed with EPR spectroscopy. The ratio of the EPR signal amplitudes of the two constituents can serve as a measure of the X-ray beam quality given by the equivalent photon energy. The calculation of the signal amplitude ratio involves a reconstruction of the composite EPR spectrum. The logarithm of the signal amplitude ratio appears to be linearly correlated with the logarithm of the equivalent photon energy. The linear relationship can be used as a calibration for estimating the equivalent photon energy from the composite EPR spectrum.

The composite material was used to investigate the changes in the equivalent photon energy in a Perspex phantom with increasing depth. When a 220 kV X-ray beam with an equivalent photon energy of about 100 keV was used, changes in the EPR signal amplitude ratio revealed a buildup of scattered photons with increasing depth in the phantom. This change could be related to the equivalent photon energy using the logarithmic calibration curve. It was found that the equivalent photon energy at the depth of 13 cm in the phantom was 25% lower than on its surface.

The proposed method can be used for estimating equivalent photon energy in both standardized and non-standardized situations, the latter corresponding to beam setups where use of filters and ionization chambers is difficult or impossible. Also, the system can provide a means for measuring photon energy in X-irradiated phantoms.     

Evaluation of a Nutrition Care Process‐based audit instrument,the Diet‐NCP‐Audit,for documentation of dietetic care in medical records

Adequate documentation in medical records is important for high‐quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four‐step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0–1 or 0–2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet‐NCP‐Audit. Firstly, the content validity of the Diet‐NCP‐Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter‐rater agreement with Krippendorff's α = 0.65–0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra‐rater reliability test–retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic care.     

Parenting stress among parents of children with congenital diaphragmatic hernia

Purpose

The aim of this study was to examine parental stress among parents of children with congenital diaphragmatic hernia (CDH).

Methods

Between 2005 and 2009, a total of 51 children with CDH were treated at Astrid Lindgren Children’s Hospital. The survival rate at discharge was 86% and long-term survival rate 80%. One parent each of the long-term survivors (41 children) was included in the present study, and 34 parents (83%) agreed to participate. Participants received the Swedish Parenthood Stress Questionnaire (SPSQ). The questionnaire was supplemented by data from case records.

Results

Parents of children with CDH, who had been supported by ECMO or had a long hospital stay, showed significantly higher overall parental stress. Mothers scored an overall higher parental stress compared with fathers. A prenatal diagnosis of CDH or lower parental educational level resulted in significantly higher parental stress in some of the factors.

Conclusions

Parental stress in parents of children with CDH seems to increase with the severity of the child’s malformation. Mothers tend to score higher parental stress than fathers.