bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Implications of Histologic Abnormalities in Ileocolonic Biopsies of Patients With Crohn’s Disease in Remission
Authors: Brennan Gregory T. , Melton Shelby D. , Spechler Stuart J. , Feagins Linda A. 
Published: February 2016

Background:
For patients with Crohn’s disease (CD) who have colonoscopy during periods of clinical remission, the utility of taking ileocolonic biopsy specimens to assess disease activity is disputed.

Goals:
We explored the clinical implications of histologic disease activity in such patients.

Study:
We reviewed medical records of CD patients who underwent elective colonoscopy while in clinical remission at our VA Medical Center from 2000 to 2013, and who had at least 6 months of follow-up. We correlated endoscopic and histologic disease activity with the subsequent development of flares.

Results:
We identified 62 CD patients who had a total of 103 colonoscopies during clinical remission; 55 colonoscopies revealed complete endoscopic healing and 48 showed active disease. Flares within 6, 12, and 24 months of colonoscopy were not more common in patients with endoscopic activity than those with complete endoscopic healing. In contrast, patients with any of 5 histologic features of active inflammation (erosions, cryptitis, crypt abscess, increased neutrophils, or increased eosinophils in the lamina propria) had more flares than patients without those changes (P<0.05). Among the individual histologic features, an increase in eosinophils or neutrophils in the lamina propria and cryptitis were associated with higher flare rates (P<0.05).

Conclusions:
For CD patients who have a colonoscopy while in clinical remission, biopsy seems to provide important prognostic information beyond that provided by endoscopic assessment of disease activity alone. In particular, increased eosinophils or neutrophils in the lamina propria and cryptitis are strongly associated with an increased risk of clinical flares within 1 to 2 years.
Factors associated with anxiety and depressive symptoms in colorectal cancer survivors
Authors: Braamse Annemarie M.J. , van Turenhout Sietze T. , Terhaar sive Droste Jochim S. , de Groot Gerrit H. , van der Hulst René W.M. , Klemt-Kropp Michael , Kuiken Sjoerd D. , Loffeld Ruud J.L.F. , Uiterwaal M. Tessa , Mulder Chris J.J. , Dekker Joost 
Published: February 2016

Background
Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity.

Methods
In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity.

Results
The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity.

Conclusion
From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.
Usefulness of a multiplying factor in predicting the final number of victims during a mass casualty incident
Authors: Maurin Olga , Bignand Michel , Jost Daniel , Travers Stéphane , Raclot Stéphane , Trichereau Julie , Bon Olivier , Frattini Benoit , Loeb Thomas , Lecarpentier Eric , Noto René , Poncelin de Raucourt Gaëtan , Tourtier Jean-Pierre 
Published: February 2016

Objective
Whenever a mass casualty incident (MCI) occurs, it is essential to anticipate the final number of victims to dispatch the adequate number of ambulances. In France, the custom is to multiply the initial number of prehospital victims by 2–4 to predict the final number. However, no one has yet validated this multiplying factor (MF) as a predictive tool. We aimed to build a statistical model to predict the final number of victims from their initial count.

Methods
We observed retrospectively over 30 years of MCIs triggered in a large urban area. We considered three types of events: explosions, fires, and road traffic accidents. We collected the initial and final numbers of victims, with distinction between deaths, critical victims (T1), and delayed or minimal victims (T2–T3). The MF was calculated for each category of victims according to each type of event. Using a Poisson multivariate regression, we calculated the incidence risk ratio (IRR) of the final number of T1 as a function of the initial deaths and the initial T2–T3 counts, while controlling for potential confounding variables.

Results
Sixty-eight MCIs were included. The final number of T1 increased with the initial incidence of deaths [IRR: 1.8 (1.4–2.2)], the initial number of T2–T3 being greater than 12 [IRR: 1.6 (1.3–2.1)], and the presence of one or more explosion [IRR: 1.4 (1.1–1.8)].

Conclusion
The MF seems to be an appealing decision-making tool to anticipate the need for ambulance resources. In explosive MCIs, we recommend multiplying T1 by 1.4 to estimate final count and the need for supplementary advanced life support teams.
TIER competency-based training course for the first receivers of CBRN casualties: a European perspective
Authors: Djalali Ahmadreza , Della Corte Francesco , Segond Frederique , Metzger Marie-Helene , Gabilly Laurent , Grieger Fiene , Larrucea Xabier , Violi Christian , Lopez Cédric , Arnod-Prin Philippe , Ingrassia Pier L. 
Published: February 2016

Introduction
Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events.

Objective
The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method.

Methods
This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts’ consensus, core competencies for hospital staff – as CBRN casualty receivers – were determined, and training curricula and delivery methods were defined.

Results
The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen.

Conclusion
By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.
Using Healthcare Failure Mode and Effect Analysis to Reduce Intravenous Chemotherapy Errors in Chinese Hospitalized Patients
Authors: Li Gui , Xu Bo , He Rui-xian , Zhang Shu-xiang 
Published: February 2016

Background:
Intravenous chemotherapy administration is a high-risk process; attention must be paid to preventing errors that might occur during the administration of chemotherapy.

Objective:
The aim of this study is to investigate whether the healthcare failure mode and effect analysis (HFMEA) is a valid proactive method to apply to chemotherapy administration in the Chinese oncology inpatient setting.

Methods:
A multidisciplinary team created a flow diagram of the chemotherapy administration process and potential failure modes were identified and evaluated using a hazard-scoring matrix. Using a decision tree, failure mode recommendations were made. Chemotherapy error rates before and after the HFMEA were compared.

Results:
A total of 5 failure modes were identified with high hazard scores, and 15 recommendations were made. After the intervention, the chemotherapy error rate decreased significantly from 2.05% to 0.17%.

Conclusions:
The complexity of intravenous chemotherapy makes it vulnerable to error, and with serious consequences. Multiple errors can occur during ordering, preparing, compounding, dispensing, and administering the chemotherapy. The process of HFMEA helped reduce the chemotherapy error rate in Chinese hospitalized patients.

Implications for Practice:
Clinicians in oncology can take effective measures to avoid chemotherapy errors using the HFMEA.
Development of a Symptom Management Intervention
Authors: Mosher Catherine E. , Ott Mary A. , Hanna Nasser , Jalal Shadia I. , Champion Victoria L. 
Published: February 2016

Background:
Little is known about cancer patient and family caregiver preferences for the content and format of nonpharmacologic interventions. Revising interventions based on patient and caregiver feedback before implementation may improve intervention feasibility and acceptability, especially in the context of advanced-stage cancer.

Objectives:
The aim of the study was to obtain feedback from patients with advanced-stage, symptomatic lung cancer and their family caregivers on the content and format of a nonpharmacologic symptom management intervention under development. The intervention blended evidence-based cognitive-behavioral and emotion-focused strategies to reduce physical and psychological symptoms.

Methods:
Semistructured qualitative interviews were conducted with 21 patients with advanced-stage, symptomatic lung cancer and caregivers. Participants reviewed handouts regarding intervention components and provided feedback.

Results:
Patients and caregivers desired intervention components that addressed the patient’s high symptom burden such as education regarding treatment adverse effects and the provision of various coping tools. Offering interventions with a brief or flexible length and delivering them via telephone were other suggestions for enhancing intervention acceptability. Participants also preferred an equal focus on patient and caregiver concerns and a more positive intervention framework.

Conclusions:
Intervention preferences of patients with advanced-stage lung cancer and caregivers underscore the severity of the disease and treatment process and the need to adapt interventions to patients with high symptom burden. These preferences may be incorporated into future intervention trials to improve participant recruitment and retention.

Implications for Practice:
Nurses can modify interventions to meet the needs of patients with advanced-stage, symptomatic lung cancer and caregivers. For example, flexibility regarding intervention content and length may accommodate those with significant symptoms.
Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia
Authors: Miladinia Mojtaba , Baraz Shahram , Shariati Abdolali , Malehi Amal Saki 
Published: February 2016

Background:Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia.Objective:The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy.Methods:In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests ofχ2,ttest, and the repeated-measure analysis of variance were used for data analysis.Results:Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time.Conclusions:Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients.Implications for Practice:Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.
The Efficacy of Couple-Based Interventions on Health-Related Quality of Life in Cancer Patients and Their Spouses: A Meta-analysis of 12 Randomized Controlled Trials
Authors: Wang FuZhi , Luo Dan , Fu Lianguo , Zhang Hao , Wu Shuyin , Zhang Min , Zhou Huan , Sun Ting , Chen Xingzhi 
Published: February 2016

Background:Couple-based interventions on health-related quality of life (HRQoL) of cancer patients and their spouses have received increasing attention in recent years, but the findings of previous studies are inconsistent.Objective:The aim of this study was to investigate the effects of couple-based interventions on the HRQoL of cancer patients and their spouses using a meta-analysis approach.Method:English- and Chinese-language publications were collected from PubMed, EBSCO, EMBASE, CMB, and CNKI. The outcome measures included physical health, depression, anxiety, hopelessness, and marital satisfaction (MS). Pooled, weighted mean differences and 95% confidence intervals were estimated using fixed- and random-effects models. Publication bias and sensitivity analyses were performed.Results:Twelve randomized controlled trials were included in this study. Compared with the control groups, the weighted mean differences of depression, anxiety, and MS were significantly improved in the intervention groups. However, improvements in the measures of physical health and hopelessness were nonsignificant. Psychoeducational interventions yielded a larger effect size than did skill training and blending interventions. Publication bias was not significant, and a sensitivity analysis indicated that the results were robust.Conclusions:Couple-based interventions can improve anxiety, depression, and MS among cancer patients and their spouses, and psychoeducational interventions may be an effective approach. Given the small number of studies utilized in this analysis, the results should be considered preliminary and interpreted with caution.Implications for Practice:Couple-based interventions may be an adjunctive method for cancer patients and their spouses to improve HRQoL. Further study concerning couple-based skill training and blending intervention are needed to better understand intervention effects.
Incidence and Determinants of Port Occlusions in Cancer Outpatients
Authors: Milani Alessandra , Mazzocco Ketti , Gandini Sara , Pravettoni Gabriella , Libutti Livio , Zencovich Claudia , Sbriglia Ada , Pari Chiara , Magon Giorgio , Saiani Luisa 
Published: February 2016

Background:
Normal saline is considered a safe alternative for heparin as a locking solution in totally implantable venous access devices. The incidence rate of partial occlusion with the use of normal saline (easy injection, impossible aspiration) is estimated at 4%.

Objective:
The aim of this study was to investigate determinants of partial occlusions with the use of normal saline solution and the maintenance of positive pressure in the catheter.

Methods:
We enrolled 218 patients with different solid tumors who underwent pharmacologic treatment through the port with different frequencies: from once every week to at least once every month. The port was flushed with normal saline solution keeping a positive pressure in the catheter.

Results:
We performed 4111 observations and documented normal port functioning in 99% of observations (n = 4057) and partial occlusions in 1% of observations (n = 54). Partial occlusions were significantly associated with frequency of port flushing (P < .05), chemotherapy (P < .001), and blood sample collection (P < .001).

Conclusions:
The use of positive pressure in addition to normal saline reduces the incidence rate of partial occlusions. The type of treatment, blood sample collection, and treatment schedule are important determinants of partial occlusions.

Implications for Practice:
Nurses play a key role in maintaining a functioning port using positive pressure during the flushing techniques. Certain risk factors must be monitored to prevent partial occlusions, and certain patients are more likely to present with port-related problems.
Adolescents’ Perspectives of Living With a Parent’s Cancer
Authors: Bartfai Jansson Katrin , Anderzén-Carlsson Agneta 
Published: February 2016

Background:
By the age of 21 years, 1 in 15 children will have had a parent with a diagnosis of cancer. A parent’s cancer affects the whole family. Adolescent children of cancer patients seek information about their parents’ condition and support in reciprocal relations.

Objective:
The aims of this study were to explore adolescents’ views on support and information when a parent has cancer and to describe the impact a parent’s illness has on adolescents’ everyday lives.

Interventions/Methods:
Interviews with 11 participants, conducted individually or in a focus group, were processed using qualitative content analysis.

Results:
Participants gained understanding about their parent’s illness mainly through their experience. They looked for support primarily in their own social circles and often found their needs met. Sometimes a fear of appearing vulnerable stood in the way of asking for support and left the adolescents feeling alone.

Conclusions:
Participants dealt with the situation in ways that reflected their adolescence. They were connected to their parents emotionally, but strived for independence. The adolescents shared an ideal of handling difficulties on their own and looking after the people who were important to them.

Implications for Practice:
Making parents feel more secure in supporting their adolescent child is important. The task of balancing respect for the adolescent’s integrity and providing them an opportunity to let their guard down requires trust. Inviting the adolescents to the hospital gives them a chance to learn what is happening there and to get to know healthcare personnel who may be able to help them.
“Cancer Put My Life on Hold”
Authors: McGrath Catherine , Mihala Gabor , Beesley Vanessa L. , Lynch Brigid M. , Graves Nicholas , Gordon Louisa G. 
Published: February 2016

Background:
Colorectal cancer affects a wide range of working-age people. Little is known about the consequent work limitations.

Objective:
The aim of this study was to understand the extent and changing nature of work-related limitations of middle-aged (45-64 years) people over the first 12 months of colorectal cancer.

Methods:
Surveys were administered to participants recruited via the Queensland Cancer Registry, at 6 and 12 months after diagnosis. Among those who returned to work, the Work Limitations Questionnaire measured 4 job performance domains (time management, physical, mental-interpersonal, and output demands) and an overall productivity score. Open-ended questions supplemented the Work Limitations Questionnaire, and responses were thematically analyzed.

Results:
Of 239 participants, 8% did not continue in the study, and 20% left employment by 12 months, leaving 171 participants eligible for this analysis. Open-ended responses for why participants stopped work included bowel problems and stoma, loss of strength, and medication adverse effects. At 12 months, 22% to 39% of participants reported work limitations, but there was no overall significant change in work limitations between 6 and 12 months. Qualitative data highlighted the key work-related issues were changes in work functioning, attitudes of employers and colleagues, financial pressures, and emotional responses.

Conclusions:
While a significant proportion left work because of treatment-related problems, and the majority of participants did not experience workplace limitations, some reported considerable work-related challenges.

Implications for Practice:
Discussions with health professionals about the possible impact of treatment adverse effects on employment, good communication with employers, and workplace flexibility may facilitate return to work for this population.
A Systematic Review of Emergency Department Use Among Cancer Patients
Authors: Lash Rebecca S. , Bell Janice F. , Reed Sarah C. , Poghosyan Hermine , Rodgers James , Kim Katherine K. , Bold Richard J. , Joseph Jill G. 
Published: February 2016

Background:
Recent reports call for reductions in costly and potentially avoidable services such as emergency department (ED) visits. Providing high-quality and safe care for oncology patients remains challenging for ED providers given the diversity of patients seeking care and the unpredictable clinical environment. While ED use by oncology patients is appropriate for acute health concerns, some ED visits may be preventable with well-coordinated care and adequate symptom management.

Objective:
The aim of this study was to summarize available evidence regarding the incidence, predictors of, and reasons for ED visits among oncology patients.

Methods:
Keyword/MeSH term searches were conducted using 4 online databases. Inclusion criteria were publication date between April 1, 2003, and December 5, 2014; sample size of 50 or more; and report of the incidence or predictors of ED use among oncology patients.

Results:
The 15 studies that met criteria varied in study aim, design, and time frames for calculating ED utilization rates. The incidence of ED visits among oncology patients ranged from 1% to 83%. The 30-day standardized visit rate incidence ranged from 1% to 12%. Collectively, the studies lack population-based estimates for all cancers combined.

Conclusions:
The studies included in this review suggest that rates of ED use among cancer patients exceed those of the general population. However, the extent of ED use by oncology patients and the reasons for ED visits remain understudied.

Implications for Practice:
Nurses are involved in the treatment of cancer, patient education, and symptom management. Nurses are well positioned to develop patient-centered treatment and care coordination plans to improve quality of care and reduce ED visits.