Lifestyle behaviours and weight among hospital-based nurses

Aims  The purpose of this study was to (i) describe the weight, weight-related perceptions and lifestyle behaviours of hospital-based nurses, and (ii) explore the relationship of demographic, health, weight and job characteristics with lifestyle behaviours.
Background  The obesity epidemic is widely documented. Worksite initiatives have been advocated. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients.
Methods  A sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys.
Results  The majority of nurses were overweight and obese, and some were not actively involved in weight management behaviours. Self-reported health, diet and physical activity behaviours were low, although variable by gender, age and shift. Reports of co-worker norms supported low levels of healthy behaviours.
Conclusions  Findings reinforce the need to address the hospital environment and culture as well as individual behaviours for obesity control.
Implications for nursing management  Nurse managers have an opportunity to consider interventions that promote a climate favourable to improved health habits by facilitating and supporting healthy lifestyle choices (nutrition and physical activity) and environmental changes. Such efforts have the potential to increase productivity and morale and decrease work-related disabilities and improve quality of life.     

Poststroke Shoulder Pain: Inevitable or Preventable?

Cerebral vascular accident or stroke is recognized as the leading cause of disability in the United States; consequently, it is important that all healthcare professionals working with this population develop competency of care to promote functional recovery. One of the most profound effects of stroke is upper‐extremity dysfunction. With correct handling, proper positioning, and ongoing patient‐caregiver education, healthcare professionals can positively influence upper‐extremity recovery and prevention of poststroke shoulder pain. In doing so, they will help patients avoid the mass effect that pain can impart on daily routines. The purposes of this article are to describe poststroke shoulder pain, discuss possible causes of shoulder pain, and detail best practices nurses can use to prevent or minimize poststroke shoulder pain.     

Delayed hepatic CT scanning: increased confidence and improved detection of hepatic metastases

Fifty oncologic patients with suspected hepatic metastases were prospectively evaluated by dynamic sequential hepatic computed tomography (DSHCT) and by delayed iodine hepatic computed tomography (DICT) scanning. DICT scanning was performed 4-6 hours following administration of 60 g of intravenous iodine. Both techniques were evaluated for lesion definition relative to the adjacent hepatic parenchyma and for numbers of metastases detected. Metastases were detected by both techniques in 26 patients. Fifteen patients (58%) had lesions better defined by DICT. DICT scanning detected more metastases in seven of these 15 patients. In eight patients (31%), there was no difference between the two techniques in numbers of masses detected or lesion definition. In three cases (11%), metastases were more confidently identified on the initial or DSHCT scan. DICT scanning, as described, is useful in defining and detecting hepatic metastases, especially where there is questionable hepatic involvement or better quantification of size is necessary.     

Survival of patients in a Phase 1 clinic

BACKGROUND:

Patients with advanced malignancies for whom standard therapy is ineffective may participate in phase 1 trials. To gain a better understanding of the clinical features that could influence benefit versus risk, the authors of this report assessed prognostic factors and survival for patients who were referred to a phase 1 clinic focused primarily on targeted agents.

METHODS:

The medical records of 200 sequential patients who presented to the Phase 1 Clinic at The University of Texas M. D. Anderson Cancer Center were reviewed, and their characteristics and survival were analyzed.

RESULTS:

The median patient age was 58 years (range, 12‐85 years), and 57% of patients were men. The median number of prior therapies was 4. Of 200 patients, 182 were treated on at least 1 phase 1 clinical trial. The median follow‐up of surviving patients was 21 months, and the median overall survival was 9 months (95% confidence interval [CI], 7.4‐10.8). In univariate analysis, the factors that predicted shorter survival were primary tumor in the gastrointestinal tract; a history of thrombosis, liver metastases, and elevated levels of serum lactate dehydrogenase; platelet count; carbohydrate antigen 9 (Ca19‐9) and Ca‐125 levels; aspartate aminotransferase levels, and alkaline phosphatase levels (P < .05 for each). In multivariate analysis, independent factors that predicted shorter survival were a history of thromboembolism (hazard ratio [HR], 2.38; 95% CI, 1.29‐4.39; P = .005), platelets ≥440 × 10⁹/L (HR, 1.72; 95% CI, 1.12‐2.65; P = .014), and the presence of liver metastases (HR, 1.51; 95% CI, 1.09‐2.09; P = .013).

CONCLUSIONS:

Patients who were referred to phase 1 studies had a short median survival (9 months). Patients with thrombocytosis, liver metastases, and a history of thromboembolism had worse outcomes. A prognostic score is proposed. Cancer 2009. © 2009 American Cancer Society.     

Assessment of FMR1 Gene Mutation at-Risk Status in Young Children

Fragile X syndrome (FXS), caused by a mutation of the FMR1 gene, is the most commonly inherited cause of developmental disability. Fragile X syndrome occurs relatively equally in all racial and ethnic groups and is one of the few disorders affecting child behavior for which the exact gene is identified. Furthermore, from infancy, both males and females with this syndrome are predisposed for manifesting characteristic cognitive, emotional, and behavioral challenges. The purpose of this article is to illuminate the multisystemic and multifaceted phenotype of the FMR1 gene mutation by means of the parent response Biopsychosocial Screening Inventory for Fragile X, for which preliminary studies show promise.