摘要 :
This integrative review explored and described published research findings focused on the experiences of pediatric sibling hematopoietic stem cell donors. After a comprehensive search, nine studies met the inclusion criteria of th...
展开
This integrative review explored and described published research findings focused on the experiences of pediatric sibling hematopoietic stem cell donors. After a comprehensive search, nine studies met the inclusion criteria of the study. There was no evidence of coordinated programs of research to effectively advance and build knowledge about the experiences of pediatric sibling donors. The limited descriptive evidence revealed that differences in the experiences of sibling donors vary by age and developmental stages; however, the use of small or repeated samples and qualitative methods limited the generalizability of study findings. Collaborative research using prospective, longitudinal designs will build and advance the evidence base for the design of developmentally appropriate interventions for pediatric sibling donors and their families.
收起
摘要 :
Constipation is an all too common symptom in palliative care patients and may be associated with a range of severe issues and experiences. Its effects on patients contribute to both physical and psychological scarring during a ver...
展开
Constipation is an all too common symptom in palliative care patients and may be associated with a range of severe issues and experiences. Its effects on patients contribute to both physical and psychological scarring during a very distressing stage of life not only for the patient but also for their caregivers. It is during this time that, too often, the complexity of managing the condition moves the locus of control away from the patient toward the health professionals. This article considers a number of different treatment options and facets of individual management that may enable patients to move the locus of control back to a position of joint management by patients, caregivers, and health professionals.
收起
摘要 :
Introduction: Dysregulation of the hedgehog signaling pathway has been linked to the development and progression of a variety of different human tumors including cancers of the skin, brain, colon, prostate, blood, and pancreas. We...
展开
Introduction: Dysregulation of the hedgehog signaling pathway has been linked to the development and progression of a variety of different human tumors including cancers of the skin, brain, colon, prostate, blood, and pancreas. We assessed the clinicopathological factors that are potentially related to expression of Gli1, the transcription factor that is thought to be the most reliable marker of hedgehog pathway activation in bladder cancer. Methods: Bladder cancer cases were identified from the New Hampshire State Cancer Registry as histologically confirmed primary bladder cancer diagnosed between January 1, 2002, and July 31, 2004. Immunohistochemical analysis was performed on a tissue microarray to detect Gli1and p53 expression in these bladder tumors. We computed odds ratios (ORs) and their 95% CIs for Gli1 positivity for pathological category using T category (from TNM), invasiveness, and grade with both the World Health Organization 1973 and World Health Organization International Society of Urological Pathology criteria. We calculated hazard ratios and their 95% CI for Gli1 positivity and recurrence for both Ta-category and invasive bladder tumors (T1+). Results: A total of 194 men and 67 women, whose tumors were assessable for Gli1 staining, were included in the study. No appreciable differences in Gli1 staining were noted by sex, age, smoking status, or high-risk occupation. Ta-category tumors were more likely to stain for Gli1 as compared with T1-category tumors (adjusted OR = 0.38, CI: 0.17-0.87). Similarly, low-grade (grades 1-2) tumors were more likely to stain for Gli1 as compared with high-grade tumors (grade 3) (adjusted OR = 0.44, CI: 0.21-0.93). In a Cox proportional hazards regression analysis, non-muscle-invasive bladder tumors expressing Gli1 were less likely to recur (adjusted hazard ratio = 0.48; CI: 0.28-0.82; P<0.05) than those in which Gli1 was absent. Conclusion: Our findings indicate that Gli1 expression may be a marker of low-stage, low-grade bladder tumors and an indicator of a reduced risk of recurrence in this group.
收起
摘要 :
Purpose: A recently-developed assistive technology nicknamed "the Hummer" was investigated as a potential powered wheelchair controller for individuals with severe and multiple disabilities. System performance in a noisy environme...
展开
Purpose: A recently-developed assistive technology nicknamed "the Hummer" was investigated as a potential powered wheelchair controller for individuals with severe and multiple disabilities. System performance in a noisy environment was compared to that obtained with a commercial automatic speech recognition (ASR) system. Method: A bi-hum driving protocol was developed to allow the Hummer to serve as a powered wheelchair controller. Participants performed several virtual wheelchair driving tasks of increasing difficulty using the two systems. Custom-written software recorded task execution time, number of commands issued and wall collisions, speed, and trajectory. Results: The bi-hum protocol was shown to be non-intuitive and required user training. Overall, the Hummer achieved lower performance relative to ASR. Once users became accustomed to the protocol, the difference in performance between the two systems became insignificant, particularly for the higher-difficulty task. Conclusions: The Hummer provides a promising new alternative for powered wheelchair control in everyday environments for individuals with severe and multiple disabilities who are able to hum, particularly for those with severe dysarthria which precludes ASR usage. A more intuitive driving protocol is still needed to reduce user frustration and mitigate user-generated errors; recommendations on how this can be achieved are given herein. Implications for Rehabilitation The "Hummer" allows for noise-insensitive powered wheelchair control in everyday environments The "Hummer" accommodates individuals without functional speech or those with severe dysarthria to gain mobility independence, thus improving their quality of life.
收起
摘要 :
Sparse information exists on the nutrition intake of U.S. military service members in a garrison setting. The purpose of this study was to assess the eating habits of a small group of service members who had not deployed in the pr...
展开
Sparse information exists on the nutrition intake of U.S. military service members in a garrison setting. The purpose of this study was to assess the eating habits of a small group of service members who had not deployed in the preceding 12 months. Nutrition intake was measured using an online food frequency questionnaire and anthropo-metric measurements taken. Correlations were used to assess relationships between total caloric intake and sex, age, weight, waist circumference, body mass index, rank, marital status, history in a service-specific weight control program, and time in service. There were 39 subjects (18 males, 21 females) enrolled. There was a significant difference in total caloric intake between males and females (p = 0.040). The relationships of total caloric intake to both weight and waist circumference were significant (r = 0.425, p = 0.007 and r = 0.393, p = 0.013). There was a modest relationship between total caloric intake and sex (r = 0.331, p = 0.040) and history in a weight control program (r = -0.313, p = 0.052). There was no significant correlation between body mass index, age, rank, marital status, time in service, and total caloric intake. These relationships may partially explain the eating habits of service members in garrison. Future studies should further assess intake and influential additional factors, such as deployments.
收起
摘要 :
Constipation is a common symptom in palliative care patients that can generate considerable suffering owing to both the inherent physical discomfort and the attendant psychological issues such as embarrassment. This article consid...
展开
Constipation is a common symptom in palliative care patients that can generate considerable suffering owing to both the inherent physical discomfort and the attendant psychological issues such as embarrassment. This article considers the management of constipation for palliative care patients, including the importance of the patient's own definition of their problem, the need for thorough and frequent assessment, established treatment options, and the challenges that nurses may face. It provides a simple algorithm to assist in the management process, and also looks at the current strength of the evidence base for two more recent therapies. Finally, it examines the potential of the independent nurse prescriber (INP) for constipation management in the UK, using a brief case study to illustrate a commonly experienced constipation management scenario for the INP in the community setting.
收起
摘要 :
Objective: To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland. Design: This is a descriptive study. Data on demographical and clinical factors were retrieved from...
展开
Objective: To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland. Design: This is a descriptive study. Data on demographical and clinical factors were retrieved from the teleoncology database of Townsville Hospital and review of medical records for the period between May 2007 and May 2011. Setting and Participants: The medical oncologists at the Townsville Cancer Centre, a regional cancer centre in North Queensland, have been providing their services to rural hospitals in Townsville and Mt Isa districts via videoconferencing since 2007. Intervention: Cancer care delivery to rural sites via Townsville teleoncology model. Main Outcome Measures: The ability of the teleoncology model to provide the following services to rural towns: (i) specialist consultations; (ii) urgent specialist medical care; (iii) care for Indigenous patients; and (iv) remote supervision of chemotherapy administration. Results: Between May 2007 and May 2011, 158 patients from 18 rural towns received a total of 745 consultations. Ten of these patients were consulted urgently and treatment plans initiated locally, avoiding interhospital transfers. Eighteen Indigenous patients received consultative services, being accompanied by more than four to six family members. Eighty-three patients received a range of intravenous and oral chemotherapy regimens in Mt Isa and oral agents in other towns through remote supervision by medical oncologists from Townsville. Conclusion: Teleoncology model of care allows rural and Indigenous cancer patients to receive specialist consultations and chemotherapy treatments closer to home, thus minimising the access difficulties faced by the rural sector.
收起
摘要 :
In England (UK) the discharge of patients from hospital is a source of constant scrutiny from primary care trusts in order to reduce the patient length of stay in Hospital. To support nurses in practice a part time, post registrat...
展开
In England (UK) the discharge of patients from hospital is a source of constant scrutiny from primary care trusts in order to reduce the patient length of stay in Hospital. To support nurses in practice a part time, post registration discharge practice education module was developed entitled Facilitating Timely Patient Discharge. It was the first of its kind to be accredited at degree level (level 6) during 2006. University evaluation of the module involved an academic assignment based on a 3000 word case study. Projects in practice were integrated to enable the students to apply theories to clinical practice. This aspect was driven by an organisational impetus to demonstrate learning back in practice to the benefit of Heart of England Foundation Trust (HEFT). Students self assessed their individual ability pre and post the discharge module using questionnaires citing 17 areas of discharge practice analysing knowledge and ability. They demonstrated an increase in knowledge and ability in key areas such as; 'understanding complex discharge' and 'teaching discharge practice to peers'. Although these were not formally included in the outcomes or evaluations they may inform future module development and design of delivery. The questionnaires were designed and developed with support for projects in practice from the Foundation of Nursing Studies in London.
收起
摘要 :
BACKGROUND: Recent studies report an increasing incidence of Clostridium difficile infections (CDIs) in children and suggest that CDIs may occur outside known populations at risk. OBJECTIVE: To identify clinical factors associated...
展开
BACKGROUND: Recent studies report an increasing incidence of Clostridium difficile infections (CDIs) in children and suggest that CDIs may occur outside known populations at risk. OBJECTIVE: To identify clinical factors associated with CDI in a hospitalized pediatric population. METHODS: A retrospective case-control study was conducted with C difficile cases (CD) and controls (CTLs) in hospitalized children over a 2-year period. CDs (N = 134) and 2:1 age-matched CTLs (N = 274) with diarrheal illness were evaluated. RESULTS: CDs and CTLs were similar in gender and race. Watery diarrhea was the most common type of diarrhea in CDs and CTLs. Immunodeficiency (46% vs 6%; P < 0.001), gastrointestinal (GI) disease (31% vs 18%; P = 0.005), and proton pump inhibitor (PPI) use (22% vs 7%; P < 0.001) were more frequent in CDs. Of CDs, 30% were defined as community acquired. Bloody diarrhea was more frequent in community-acquired CD (28% vs 4% P < 0.001); however, other clinical variables were not statistically different. No antibiotic exposure, recent hospitalization, prolonged hospitalization, or past history of CDI existed in 8% of CDs. Multivariate logistic regression demonstrated that antibiotic use (odds ratio [OR]: 2.80, P = 0.001), recent hospitalization (OR: 2.33, P = 0.007), and immunodeficiency (OR: 6.02, P < 0.001) were significantly associated with cases when controlling for PPI use, having GI disease, and history of abdominal surgery. CONCLUSIONS: Clinical history is of greater value than symptoms in distinguishing CD, with immunodeficiency having the strongest association. An important percentage of CDs did not have any risk factors, confirming concerns that CDIs do occur in otherwise low-risk pediatric populations.
收起
摘要 :
Aims Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with i...
展开
Aims Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with incontinence or constipation and overflow soiling. Methods Following ethical approval, a review of children with incontinence or constipation on a bowel management program with Peristeen? transanal colonic irrigation treated between 2007 and 2012 was performed. Irrigations were performed with a volume of 10-20 ml/kg of water with schedules depending on patient response. Data are reported as median (range). Results Twenty-three patients were reviewed. Median age at commencement of irrigations was 7 (2-15) years. Median follow-up is 2 (0.7-3.4) years. Diagnoses include the following: spina bifida (n = 11), anorectal anomaly (n = 6), Hirschsprung's (n = 1), and other complex anomalies (n = 5). Sixteen (70%) patients had associated anomalies. Twelve (52%) had constipation and overflow soiling, and 11 (48%) had fecal incontinence. Twenty (87%) had associated urinary wetting. Sixteen (70%) children used alternate-day irrigations, 4 (17%) daily irrigations, and 3 (13%) every third-day irrigations. Nine (39%) patients were taking oral laxatives. Sixteen (70%) reported to be clean and 3 (13%) reported a significant improvement, although were having occasional soiling. Four patients (17%) did not tolerate the irrigations and underwent subsequent colostomy formation for intractable soiling. Conclusions In our experience, Peristeen? transanal colonic irrigation is an effective method of managing patients with focal soiling in childhood. Majority (83%) of children achieve social fecal continence or a significant improvement with occasional soiling. This was accompanied by high parental satisfaction. Peristeen? transanal colonic irrigation is a valid alternative to invasive surgical procedures and should be considered the first line of treatment for bowel management in children with soiling where simple pharmacological maneuvers failed to be effective.
收起
原文获取