Consideration of the Self-Care Supporting Program Including Simple Exercise for Patients with Early Stages of Secondary Lower-Limb Lymphedema

Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.

Supportive care in transplantation: A patient-centered care model to better support kidney transplant candidates and recipients

Kidney transplantation(KT),although the best treatment option for eligible patients,entails maintaining and adhering to a life-long treatment regimen of medications,lifestyle changes,self-care,and appointments.Many patients experience uncertain outcome trajectories increasing their vulnerability and symptom burden and generating complex care needs.Even when transplants are successful,for some patients the adjustment to life post-transplant can be challenging and psychological difficulties,economic challenges and social isola-tion have been reported.About 50%of patients lose their transplant within 10 years and must return to dialysis or pursue another transplant or conservative care.This paper documents the complicated journey patients undertake before and after KT and outlines some initiatives aimed at improving patient-centered care in transplantation.A more cohesive approach to care that borrows its philosophical approach from the established field of supportive oncology may improve patient experiences and outcomes.We propose the"supportive care in transplantation"care model to operationalize a patient-centered approach in transplantation.This model can build on other ongoing initiatives of other scholars and researchers and can help advance patient-centered care through the entire care continuum of kidney transplant recipients and candidates.Multi-dimensionality,multi-disciplinarity and evidence-based approaches are proposed as other key tenets of this care model.We conclude by proposing the potential advantages of this approach to patients and healthcare systems.Core Tip:Kidney transplant recipients and candidates face several uncertainties in their care journey and have several expressed unmet healthcare needs.We recommend a structured and comprehensive approach to transplant care across the entire continuum of a transplant patient’s journey similar to what has been developed in the field of oncology.The supportive care in transplantation model can operationalize patient-centered care and build on the efforts of other researchers in the field.We postulate that such a model would significantly improve care delivery and patients’experiences and outcomes and potentially decrease healthcare utilization and cost.INTRODUCTION Patients with kidney failure benefit from(KT)[1,2],and experience improved survival rates when compared with dialysis[3-6].KT studies,using validated instruments,have also consistently demonstrated that kidney transplant recipients(KTRs)experience better health-related quality of life and several improvements in other disease-specific domains when compared with dialysis[7].In countries where dialysis is out of reach for many,the diagnosis of kidney failure would be futile without KT[8].Thus,increasing KT has been a priority for the nephrology and transplant communities.This priority has been reflected in recent global trends:Of the 79 countries where data were available,the International Society of Nephrology’s Global Kidney Atlas reported that the prevalence of KTRs in 2023 was 279 per million population which represented an increase of 9.4%from the data published four years prior[8].Despite this growth,KT can be a challenging journey for many patients and it is sometimes regarded as a‘cure’,which does not conform with the reality that many patients experience[9-13].KTRs must maintain a life-long treatment regimen of medications,lifestyle changes,self-care and medical appointments[14-17].As poignantly stated by a young female transplant recipient,“I thought everything would change once I got my kidney.I thought I would be healthy again”but after experiencing multiple side effects of immunosuppressive medications and graft loss,she stated,“I am just a different kind of patient now”[18].Indeed,a significant proportion of patients experience graft failure and return to dialysis;it is estimated that over 50%return to dialysis within 10 years of KT[19-23].Patients are often not prepared for this outcome and report several psychosocial and physical ramifications of graft failure[24,25].Overall,high symptom burden,adverse effects of immunosuppressants,risk of graft rejection or failure and mortality,contribute to complex needs,vulnerability and uncertainties for patients,increasing their care needs and treatment burden[26-30].In this paper,we highlight the complex journey that KTRs and candidates undertake that can generate varied outcome trajectories and complex healthcare needs.We highlight the need for a comprehensive patient-centered approach to care and conclude with a proposal for a“supportive care in transplantation”care model.

Supportive care needs of women with gynecologic cancer and factors affecting in Turkiye: a cross sectional study

Background:Identifying and managing patients'supportive care needs is an essential component of health care.The cancer patients'needs are multidimensional and it is important to identify these needs.This study was conducted to assess supportive care needs of women with gynecologic cancer and affecting factors.Methods:This cross-sectional study consisted of 98 women with gynecologic cancer.The data of the study was gathered using“Personal Information Form”and the“James Supportive Care Screening”.Results:The most frequently reported unmet needs of gynecologic cancer patients were emotional issues,including uncertainty(87.6%),fears(85.7%),feeling down(86.7%),worry(87.6%),loss of interest in usual activities(73.3%)and physical symptoms including fatigue/lack of energy(81.9%),weakness(81.9%),lack of appetite(76.2%).The most frequently reported social/practical problems was transportation problems(50%).The mean scores for JSCS was 29.72±15.57.There were a statistically significant difference was found only between family type,stage of the disease,and time of diagnosis,and the total mean scores of the JSCS(p<0.05).Conclusion:It has been determined that patients with gynecological cancer mostly experience emotional and physical problems.Health professionals working in the oncology unit should be aware of unmet needs.Certain programs and services to address the identified unmet needs should be provided.

Nursing Care of 10 Patients with Vasovagal Reflex Caused by Artificial Liver Support System Treatment

This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.

Supportive care needs and health-related quality of life among Chinese lung cancer survivors

Purpose: The purpose of this study was to explore the supportive care needs and health-related quality of life (HRQoL) of lung cancer survivors, and to identify the association between patient characteristics, HRQoL and supportive care needs. Method: This was a sub-study of a larger scale survey of cancer survivors’ supportive care needs. A total of 48 lung cancer survivors were recruited from a regional teaching hospital, and a three-part structured questionnaire was used to collect 1) socio-demographic and clinical characteristics, 2) supportive care needs and 3) health-related quality of life data. Results: The three most commonly reported unmet needs were all in the health-system information domain: 1) being informed about your results as soon as possible (58%), 2) being informed about cancer which is under control or diminishing (50%), and 3) being informed about things you can do to help yourself get well (46%). The second most common unmet need domain was access to healthcare and ancillary support services. The survivors generally reported satisfactory HRQoL. However, household income and unmet physical and psychological needs were independently associated with HRQoL among these survivors. Conclusion: The high unmet needs in the health-system information area call for a review of the content and amount of information provided to lung cancer survivors. In addition, more attention should be given to lung cancer survivors with low incomes but high physical and psychological unmet needs, who require appropriate follow-up and long-term care of a physical, social and psychological kind.

What is New in Supportive Care in Cancer？

The Annual Symposium of the Multinational Association of Supportive Care in Cancer （MASCC）/International Society of Oral Oncology （ISOO） was held in Vancouver, Canada,June 24-26, 2010. The symposium brought together health care professionals from many countries and many fields of expertise for an excellent forum of ideas, lectures and collegial interactions,and discussed methods to minimize cancer-induced side effects, the symptoms and complications of its treatment, and psychosocial issues facing cancer patients and their families. Some ideas and studies selected from the presentations of different fields of supportive care in cancer presented in this symposium are introduced in this paper.

Offering Smoking Cessation Support to Cancer Patients:The Role of Associations Providing Supportive Care in Cancer.Example of the Ligue Contre le Cancer Gironde

Aims:This article aims to explore the interventional and contextual components of smoking cessation support for cancer patients in the context of supportive care in cancer provided by an association,that is viable and effective in the French context,and to describe the partnership research process in which they were developed.Procedure:The intervention was developed from a dataset collected during a viability study for the development of a smoking cessation intervention carried out at the Ligue Contre le Cancer Gironde,a scoping review of evidence-based interventions and two narrative reviews on the determinants and ethical issues of smoking cessation in cancer.Results:The results confirmed a tangible opportunity to develop smoking cessation services within the relevant case because of the obstacles that can be overcome,the facilitators that can be mobilized,and the gaps existing in this field.In addition,they enabled the design of an intervention adapted to the context,guided by a voluntarist,multidisciplinary approach,and focused on patients’well-being.Conclusion:The associations providing supportive care in cancer can initiate and participate in the process of smoking cessation.They can play a key role in mediating between oncology and addictology.

Care and Support Programmes for Orphans and Vulnerable Children: Achievements and Implications of HIV/AIDS Funded Project in Osun State, Nigeria

Orphans and Vulnerable Children (OVC) and their families face many challenges but there are opportunities to provide care and support programmes for them in their communities. This paper presents the achievements and implications of HIV Programme Development Project (HPDP) funded by World Bank on care and support services for OVC in Osun State, Nigeria. Eight Civil Society Organisations (CSOs) were engaged by Osun State Agency for the Control of AIDS (OSACA) as part of HPDP to provide care and support services for OVC between year 2013 and 2015. Using reporting tools, data collected by the CSOs were entered into District Health Information System 2 (DHIS2) platform and analysed using Microsoft Excel. In addition, Key Informant Interviews (KII) were conducted among the selected CSOs, OVC and the caregivers who were beneficiaries of HPDP in Osun State, Nigeria. A total of 12,353 OVC were reached and about half of them were female. There was an increase in the trends of number of OVC seen and the support services provided from the year 2013 to 2015. Of the 12,353 OVC that benefitted from this programme, 1905 (15.4%) received health care services, 5383 (43.6%) received nutritional services, 5317 (43.0%) received educational services and 9861 (79.8%) were provided with psychosocial support services. About 503 (4.1%) of the OVC received economic strengthening services while 270 (2.2%) of household heads were provided with economic support. However, 3 OVC were lost to follow-up, 14 OVC voluntarily withdrew from the project and 6 OVC died. The FGD and KII revealed that the project was very impactful in transforming the lives of the OVC. Programmes for children orphaned and made vulnerable by HIV/AIDS will contribute to the achievement of HIV/ AIDS prevention and control efforts. The HIV/AIDS free generation can be built by responding to the physical, social and mental needs of these children and their families in their communities. There is a need to scale-up this programme.

How the Health Care Nurse Supports and Enhances the Child’s Attachment to Their Parents

Objective: The aim of this study was to provide insight into how the Child Healthcare Clinic (BVC) nurse supports and encourages the child’s bonding to their parents during the regularly scheduled checkups at the healthcare clinics. Method: The study was done using a qualitative approach. The data was collected from the interviews of four focus groups which were comprised of a total of eighteen BVC nurses who work solely for the BVC. The resulting data was analyzed using qualitative content analysis. Results: The following theme emerged from the research material: Empower the parents in order to enable the child to have a healthy connection to the parents. This is accomplished by the BVC nurse building and creating a trusting relationship with the parents and providing support for them in their new roles as parents. The BVC nurses must have comprehensive knowledge about the needs and development of children and they need to have exceptional communication skills as well. It is also mandatory that the BVC nurse have access to cooperation and support from their colleagues and the support of other related professions. Conclusion: Providing support to parents during the bonding period of their infant children is a most important function for BVC nurses because there is much to be determined about children’s development and future possibilities during this formative period.

Relationship of Job Satisfaction with Perceived Organizational Support and Quality of Care among Saudi Nurses

Background: Both, job satisfaction with quality of provided health care is considered the main issue which directly influences the health care field because if nurses do not give the quality care to their patients then the patient dissatisfaction increased. Job satisfaction is defined as the extent of workers’ contentedness with their job, either they like the job or individual aspects or facets of jobs, such as type of work or regulation. Objective: To assess nurses’ job satisfaction and perceived organizational support with their effect on quality of provided health care in Saudi Arabia. Methods: Nurses in Saudi Arabia governmental hospitals during the period from 1st March to 30th April 2020 were invited and consecutively included. Data were collected using online questionnaire. Results: The study included 355 nurses with their ages ranged from 25 to 55 years old. Females were 216 (60.8%) of the total participants. Exact of 267 (75.2%) nurses reported that they like the type of work they do, 245 (69%) provided with satisfactory equipment to accomplish my task. There was a significant relation between organizational support and job satisfaction with their effect on quality of care. Conclusion: Organizational support positively affected nonsatisfaction which in turn positively affected quality of delivered care.

Literature Review on Support for Children and Families Experiencing Parental Bereavement

Purpose: This study aimed to understand the actual nursing support in a wide perspective by reviewing overseas literature on support for children who have experienced parental bereavement and their families. The goal was to identify future challenges in nursing support in clinical practice in Japan. Method: Literature searchable as of May 2023 was retrieved using PubMed, resulting in 11 relevant articles. Result: The results revealed the following: 1) For support provided to children, 13 codes were condensed into 5 subcategories and 4 categories. 2) For support provided to families, 36 codes were condensed into 11 subcategories and 4 categories. Conclusion: Open communication was found to be essential for supporting children and their families who have experienced parental bereavement. Moreover, involvement of multiple professions facilitated the provision of specialized support to address diverse needs of children and families, playing a crucial role in overcoming grief. Additionally, the effectiveness of support systems for bereaved families highlighted the need for nursing professionals in Japan to gain knowledge through learning opportunities and to establish a multi-disciplinary approach to support, thus indicating future challenges in nursing support.

Computerized decision support in adult and pediatric critical care

Computerized decision support(CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization ofmeaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.

Support from Healthcare Professionals for Couples/Partners Undergoing Assisted Reproductive Technology in Japan: A Literature Review

Background and Purpose: A growing number of couples/partners have been undergoing assisted reproductive technology (ART) in Japan. The purpose of this study was to clarify the support from healthcare professionals based on the support vectors in the Family Care/Caring Theory proposed by Hohashi (2015) through a literature review. Methods: Using Ichushi-Web, we searched for original articles using the keywords “assisted reproductive technology”, “infertility”, “family”, “couple”, “nursing”, “care”, and “support”. Thirteen articles suitable for the purpose of this study were subjected to content analysis. Family support was encoded and grouped into subcategories and categories, and classified according to support vectors. Results: A total of 21 categories of support from healthcare professionals was extracted. Intervention for family internal environment included seven categories, such as “Nursing professionals stay close to females”. Intervention for family system unit included five categories, such as “Nursing professionals adjust couple/partner relationships”. Intervention for micro system only included “Nursing professionals provide opportunities for peer support to the couples/partners” and intervention for macro system only included “Nursing professionals encourage medical doctors to relate to females”. Intervention for family chrono environment included seven categories, such as “Healthcare professionals resolve female’s anxieties”. Conclusion: The support from healthcare professionals could be organized by the support vectors of Family Care/Caring Theory, but intervention for supra system (culture, religion, etc.) was lacking. Moreover, because most support was directed toward females or couples/partners, male-focused direct and/or indirect support are also needed. .

Culturally Sensitive Medical Care and Nursing Support: A Study of the Concerns of Foreign Visitors to Japan

Background: Considering the development of international transportation in modern societies, nursing care needs to be sensitive to the cultures and customs of patients from other countries. The purpose of this study is to determine, from the perspective of culturally sensitive nursing support, the cultural practices that foreigners consider important when they visit a Japanese hospital for check-ups or hospitalization. Methods: A survey was completed by 110 foreign participants at a shrine in Kyoto City. The purpose of the survey was to evaluate the concerns of foreign visitors regarding Japanese medical providers, caused by cultural differences such as customs of daily life. The statistical analyses were performed using descriptive statistics as well as cross-tabulation, chi-square, and Fisher’s exact tests. Results: After grouping participants by continent, the top concerns observed in all groups about visiting a Japanese hospital were accessibility to and cost of medical care. First, as for medical facilities, participants from North and South America (North and South American) and Europe (Europeans) were significantly more concerned than those in Asia (Asians) (P P P P P Conclusion: Nurses need opportunities to learn and understand differences in cultures. If nurses have opportunities to learn cultural differences as well as to experience caring for foreign patients, their competencies in culturally sensitive nursing support will improve over time. It can be said that this is an issue not only in Japan but also in all other countries.

闭环通气模式适应性支持通气与智能化脱机Smart Care/PS对COPD患者机械通气脱机的疗效对比研究

目的比较闭环通气模式适应性支持通气与智能化脱机Smart Care/PS对慢性阻塞性肺疾病(COPD)患者机械通气脱机的疗效。方法选取接受有创机械通气的70例COPD患者随机分为A组和B组各35例,A组适应性支持通气脱机法,B组智能化脱机Smart Care/PS脱机,比较疗效。结果 A组脱机时间、总机械通气时间明显短于B组(P<0.01),1次脱机成功率高于B组(P<0.05),脱机后无创通气率、住院期间患者病死率两组比较差异无统计学意义(P>0.05)。结论闭环通气模式下对机械通气的COPD患者脱机,适应性支持通气脱机较智能化脱机Smart Care/PS脱机时间更短、脱机成功率更高。

Enteral nutrition administration in a surgical intensive care unit:Achieving goals with better strategies

AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on enteral nutrition(EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol(pre-intervention) and six months after implementation(post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were preintervention and 51 post-intervention.RESULTS: Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate(pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase(3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showeda non-significant decline in the post-intervention phase(P = 0.24) and the overall volume administered daily was higher in the post-intervention phase(61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions(interruptions for unknown reasons) were lower in the post-intervention phase(pre = 23/124, post = 9/96; P = 0.06).CONCLUSION: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.

CICARE需求评估联合支持性照护对手部烧伤病人瘢痕整形术后应对方式及心理弹性的影响

目的:探讨CICARE需求评估联合支持性照护对手部烧伤病人瘢痕整形术后应对方式及心理弹性的影响。方法:将2016年3月—2019年3月收治的94例手部烧伤瘢痕整形术病人随机分为对照组、观察组各47例,对照组采用常规护理,观察组在常规护理基础上给予CICARE需求评估联合支持性照护。干预1周后采用简易应对方式量表、中文版心理弹性水平量表(CD-RISC)评价病人应对方式、心理弹性。结果:观察组病人积极应对评分高于对照组,消极应对评分低于对照组(P<0.05);观察组病人CD-RISC量表中坚韧控制、力量、乐观维度评分高于对照组(P<0.05)。结论:CICARE需求评估联合支持性照护在手部烧伤瘢痕整形术病人中的应用,能转变其术后应对方式,提升心理弹性水平。

Checklist for early recognition and treatment of acute illness:International collaboration to improve critica care practice

Processes to ensure world-wide best-practice for critical care delivery is likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit(ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness(CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources(included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices(as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.

Relationship between Self-Care and Hand Foot Syndrome Specific Quality of Life in Cancer Patients

Purpose: The purpose of this study was to describe adherence to self-care for hand-foot syndrome (HFS) and the relationship between self-care and health-related quality of life (QOL). Methods: A cross-sectional study was conducted on 105 consecutive outpatients with HFS. To assess self-care for HFS and QOL, the participants were asked to complete self-care and HFS-14 (hand-foot syndrome specific QOL) questionnaires, respectively. Multiple regression models were used to identify the relationship between self-care and QOL. Results: Adherence to self-care for HFS was low, less than 50% for most of the items. Multivariate analysis revealed that poorer self-care (βs = -0.19;P = 0.03), depressive symptoms (βs = 0.43;P βs = 0.20;P = 0.04) were independent predictors of poorer QOL scores. Conclusions: We have identified a need for further research to develop effective programs of self-care in HFS.

社会支持视角下农村老年人互助养老行为及影响因素研究

老龄化“城乡倒置”、养老资源“分布倒挂”现象加剧,互助养老成为解决我国农村养老问题的新途径。基于社会支持理论,运用CHARLS2018年数据,考察社会支持对农村老年人互助养老行为的影响,研究发现:正式社会支持中助推型公共政策能通过“减少策略”和重构互助环境显著发挥促进作用;非正式社会支持中隔代照料正向作用显著;与农村老年人经济条件相关的变量均起到负向作用,互助养老行为的根本驱动与经济困境有关;非正式社会支持与正式社会支持存在交互效应,助推政策与照料孙子女具有互补性;低龄、无配偶且受教育水平较高的农村老年女性互助养老行为更强。研究结论有助于揭示互助养老行为影响因素以及柔性助推在其中的作用。