Oncology nursing--a challenge not to be taken lightly. 1977.
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History, 20th Century↗
Biomedical subjects
R McCorkle
Publications and source records attributed to R McCorkle.
The impact of posthospital home care on patients with cancer.
Symptom distress, mental health status, enforced social dependency and health perceptions were measured in two groups of cancer patients, one receiving home care services (n = 49) and the other receiving no such services (n = 11). Data were obtained at hospital discharge and 3 months later. Patients receiving home care demonstrated statistically significant improvement on mental health and social dependency; patients not receiving home care did not improve on any variable. After controlling for baseline scores, the home care group had significantly higher mental health status at the second interview than the no home care group.
Aftercare↗
Weight change and lung cancer: relationships with symptom distress, functional status, and smoking.
The pattern of weight change (at five 6-week intervals beginning 2 months after diagnosis of advanced disease) is described in adults with progressive lung cancer (N = 60). Weight loss of 10% or more at study entry occurred in 35% of subjects; 37% lost weight at three or more intervals; and 25% lost weight at only one interval. Pre-illness weight loss was moderately correlated with subsequent decreased functional status (Enforced Social Dependency Scale) at Times 1, 2, and 3 (r = -.49, r = -.43, r = -.48, p < .001). Weight loss correlated with subsequent increased symptom distress (Symptom Distress Scale, SDS) at three times (Times 2, 4, and 5: r = -.34, r = -.30, r = -.43, p < .05). Chemotherapy (50% of subjects) and smoking (25% at study entry) predicted weight loss from Time 1 to 5, explaining 28% of the variance.
Adenocarcinoma↗
Psychological distress in survivors of residential fires.
This paper presents preliminary findings from an ongoing study of survivors of residential fires. The purpose of this study was to examine psychological distress and extent of loss in order to provide a psychological profile of survivors overtime. The sample (N = 69) was drawn consecutively from the database of residential fires available through the Philadelphia Fire Department. Levels of psychological distress were measured as well as reports of symptoms consistent with the diagnostic criteria for Post-traumatic Stress Disorder. The major findings indicate that residential fires caused significant and sustained distress. An agenda for further research and for services to survivors of these fires is presented.
Adolescent↗
Detecting survival effects of socioeconomic status: problems in the use of aggregate measures.
Direct measures of SES are seldom included in medical records or large databases on disease incidence or survival, forcing researchers to infer the SES characteristics of individuals from aggregate data (e.g. census tract-level income, education, etc.). This paper assesses the degree of error that results from such inference and the impact this error may have on reported relationships between SES and survival. The authors obtained both individual and census tract-level data on 536 persons diagnosed with cancer between 1980 and 1982 and monitored their survival through 1992. Pearson correlations between individual-level and census tract-level SES variables ranged between 0.2 and 0.4. Statistically significant relationships between SES and survival were observed in the models based on individual-level but not census tract-level SES data. The authors computed the degree to which inference of individual-level from census tract-level SES reduces estimates of risk ratios across SES. It appears likely that much larger numbers of observations than have been used in published studies will be needed to better understand the relationship of SES to survival and other disease outcomes.
Age Factors↗
Production of bioactive and immunoreactive interleukin-6 (IL-6) and expression of IL-6 messenger ribonucleic acid by human pituitary adenomas.
Preliminary studies have demonstrated that some pituitary adenomas secrete immunoreactive interleukin-6 (irIL-6) when cultured in vitro. We have extended these studies by investigating 100 pituitary adenomas of different types measuring immunoreactive and bioactive IL-6. Tumors were cultured either as explants without fetal calf serum or as dispersed cells with 10% total calf serum. Fifty-three of the 100 (53%) pituitary cultures were found to release irIL-6 and in 44 adenomas examined, 32 (72.7%) secreted bioactive IL-6. In 61 explant cultures, 30 adenomas released IL-6, indicating autonomous secretion. The amount of IL-6 released by adenomas in cell culture was generally higher, although the incidence was similar to explant cultures. IrIL-6 was released by 7 of 14 prolactinomas, 15 of 27 somatotrophinomas, 5 of 7 corticotrophinomas (including 2 Nelson's adenomas), 1 of 1 thyrotrophinomas, 2 of 2 gonadotrophinomas, and 23 of 49 clinically non-functioning adenomas. Periadenomatous tissue removed from a patient with a corticotrophinoma was found to secrete IL-6 but in much lower concentration than from the adenoma tissue. Tumor necrosis factor-alpha and -gamma-interferon were not detected in the conditioned media. Four IL-6-secreting adenomas were examined by in situ hybridization for IL-6 messenger RNA, and three of these were positive with fluorescence present throughout the tissue examined. We have provided evidence that over half of pituitary adenomas secrete IL-6 which is bioactive and that IL-6 is synthesized within the tumor by the adenoma cells.
Adenoma↗
A descriptive study of immune status in patients undergoing colorectal surgery: lymphocyte phenotypes.
PURPOSE/OBJECTIVES: To describe immune status in patients prior to colorectal surgery for cancer, to establish values to serve as a baseline for subsequent analyses, and to describe a procedure for studying phenotypes of the immune system, elucidating its advantages. DESIGN: One component of a larger longitudinal survey. SETTING: Two large, inner-city university hospitals and two of their affiliated hospitals in the northeastern United States. SAMPLE: Patients undergoing surgery for colorectal cancer (N = 94). Subjects were primarily male (n = 57) and Caucasian (n = 85) and ranged in age from 26-88 years (mean = 63). Seventy-seven percent (n = 73) had cancer, 23% (n = 21) had benign diseases or conditions. METHODS: Flow cytometry analysis of lymphocyte phenotypes was performed on blood samples drawn from patients before they underwent surgery for colorectal cancer. MAIN OUTCOME MEASURES: The average absolute lymphocyte subset levels and the average relative lymphocyte subset levels of blood samples taken from patients undergoing surgery for colorectal cancer were compared (using t-tests) with the subset levels of two normal reference samples. FINDINGS: The average absolute lymphocyte subset levels and average relative lymphocyte subset levels of patients undergoing surgery for colorectal cancer fell within normal ranges. CONCLUSIONS: These findings suggest that this sample of patients undergoing surgery has one essential element of an intact immune system--normal levels of lymphocyte subsets. IMPLICATIONS FOR NURSING PRACTICE: There is no indication preoperatively that this population is at a higher risk for infection or delayed wound healing. However, there may be other times in the illness trajectory when the immune system does become compromised, and these values prior to surgery will serve as a baseline to identify changes in patients' immune status over time. Further longitudinal studies are necessary.
Adult↗
Determinants of subsequent home health care nursing service use by hospitalized patients with cancer.
BACKGROUND: The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. METHODS: The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. RESULTS: A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. CONCLUSIONS: The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.
Activities of Daily Living↗
A shortened version of an instrument measuring bereavement.
The purpose of the study was to develop a tool to measure the grief experience. The Grief Experience Inventory (GEI) [Sanders et al., A Manual for the Grief Experience Inventory. C. M. Sanders, Charlotte, NC (1979)] was revised according to the Parkes [Bereavement: Studies of Grief in Adult Life. International Universities Press, New York (1972)] framework. Four hundred and eighteen subjects who had been primary care givers for significant others prior to the loss of the person through death completed Revised Grief Experience (RGEI) questionnaires. The internal consistency reliability (coefficient alpha) for the RGEI was 0.93. A principal components factor rotation was performed yielding a four factor solution consistent with the theoretical structure (Parkes, 1972). Results demonstrated that the RGEI is a concise, valid, and reliable measure sensitive to the grief experience.
Adaptation, Psychological↗
Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D).
Confirmatory factor-analytic models are used to examine gender biases of individual items of the Center for Epidemiologic Studies Depression (CES-D) Scale. In samples containing 708 cancer patients and 504 caregivers of the chronically ill elderly, two CES-D items are identified as producing biased responses in comparisons of male and female respondents. Three additional CES-D items are excluded on the basis of other psychometric problems, yielding a subset of 15 CES-D items that capture almost all the information of the original 20-item CES-D scale but are free of any gender bias. Gender differences in mean levels of depressive symptomatology are significantly reduced, but not eliminated, when the 15-item scale is used.
Activities of Daily Living↗
Choosing a master's program in cancer nursing in the United States.
Returning to school to obtain a master's degree in cancer nursing in the United States is an undertaking that requires much thought. Going to school is an investment in oneself and, like any investment, many questions must be addressed before taking the step. Questions such as "Why go to school?" and "When to go?" need to be answered. The question "How will I pay for my education?" also needs to be answered. "Where to go to school?" often is the most difficult question. This article offers you some things to think about and some questions to ask when trying to choose a graduate program. In the final analysis, you will need to determine what is important to you and what school can best meet your personal needs to fulfill your professional goals.
Education, Nursing, Graduate↗
Gaps and contract: evaluating the diffusion of new information. Part I. A description of the strategy.
Time and fiscal constraints on oncology nurses require that continuing education programs yield demonstrable benefit to the clinician, the institution, and patient outcomes. This article describes "gaps and contract," a strategy that provides nurses with a tool to transfer knowledge from theory to practice, in a measurable form. The framework for this strategy lies within the concept of innovation diffusion. This strategy was used by two universities collaborating to educate 912 oncology health professionals in 38 continuing education programs. Part II of this article will describe the measurement of this strategy.
Child↗
Gaps and contract: evaluating the diffusion of new information. Part II. The measurement of the strategy.
This article is the second of a two-part series describing "gaps and contract," a strategy that provides nurses with a mechanism to transfer knowledge from theory into practice in a measurable format. Two universities under contract from the Pennsylvania state cancer plan used this strategy to evaluate the effectiveness of a cancer continuing education program. Two hundred seventy-four (274) contracts from one setting and 205 from a second setting are described. Recommendations for using this strategy to measure the efficacy of cancer continuing education programs are included.
Adult↗
Quality of life issues in patients with disseminated breast cancer.
Over half the women treated for breast cancer will experience advanced disease, and issues related to quality of life are particularly important. This article has reviewed components of quality of life specific to women with advanced breast cancer following two clinical courses:those who develop a recurrence and those who present with advanced disease. It is clear that additional research is warranted on the quality of life in women with advanced breast cancer. Work to date has clearly indicated that the management of women with advanced disease requires the resources available from a multidisciplinary perspective. Efforts to manage advanced breast cancer must include both current medical therapies and attention to the critical factors associated with enhancing the quality of their lives. Of final concern is the relationship of social class to advanced disease. Following Freeman's recent outline of the agenda for the American Cancer Society, more attention must be given to people who are economically disadvantaged because cancer incidence and mortality are greater among poor people than among the affluent. It is possible that over 50% of women presenting with advanced cancer of the breast are economically disadvantaged. Validation of this problem through research should lead to prevention programs targeted to this population. Women with breast cancer who are economically disadvantaged may be particularly receptive to interventions that will enhance their quality of life.
Breast Neoplasms↗
Continuing care in the community.
Early discharge from the hospital or home health agency necessitates effective continuity of care planning in order to assure that patients and families will have their health care needs met after discontinuance of formal health care services. In this article, we have defined continuity of care from several perspectives, presented two theoretical viewpoints on this concept, and, with four models of care that have actually been implemented, analyzed the commonalities and differences among models. In addition, recommendations for future research and care delivery for the purpose of enhancement of continuity of care have been made.
Community Health Services↗
Measurement of stress in clinical nursing.
The Nurse Stress Checklist was developed to measure stress in clinical nursing as a multidimensional construct. The instrument was formulated within a transactional model of stress. The items were derived from five domains thought to contribute to nurse stress in clinical settings and were organized into a questionnaire. Holmes Schedule of Recent Events was included as a validity measure. The instrument was tested on 104 staff nurses working in three institutions in an urban community. Exploratory factor analysis was applied to the 74 items presented to subjects in Likert-type format. Five factors were derived and subjected to psychometric evaluation. Internal consistency reliability for the five factors was good, ranging from 0.80 to 0.91. Means and measures of dispersion supported the potential of the five subscales to discriminate among respondents on the attributes being measured. Intercorrelations of the factors provided evidence of the distinctiveness of the five components of stress, although factor loadings showed some overlap between Personal Reactions and Work Concerns and Work Concerns and Work Completion Concerns. Validity of the factors also was supported by correlations with Holmes' Schedule of Recent Events. Content validity was supported by comparison of these results with findings of other investigators. Limitations of the results are discussed, and recommendations for future work on the instrument are offered.
Adult↗
Evidence against extended DR3-related haplotypes in Graves' disease.
Three HLA-DR3-linked polymorphisms of the DPA, DPB and DRB genes, previously associated with myasthenia gravis or coeliac disease, have been examined in Caucasian patients with Graves' disease. The patients did not differ from healthy DR3 subjects, indicating an absence of any association of Graves' disease with specific DR3 subtypes.
Graves Disease↗
A randomized clinical trial of home nursing care for lung cancer patients.
A randomized clinical trial was conducted to assess the effects of home nursing care for patients with progressive lung cancer. One hundred sixty-six patients were assigned to either an oncology home care group (OHC) that received care from oncology home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were entered into the study 2 months after diagnosis and followed for 6 months. Patients were interviewed at 6-week intervals across five occasions. At the end of the study, there were no differences in pain, mood disturbance, and concerns among the three groups. There were significant differences in symptom distress, enforced social dependency, and health perceptions. The two home nursing care groups had less distress and greater independence 6 weeks longer than the office care group. In addition, the two home nursing care groups steadily reported worse health perceptions over time. Thus, it was remarkable that the office care group, which indicated more symptom distress and social dependency with time, also indicated perceptions of improved health with time. These results suggest that home nursing care assists patients with forestalling distress from symptoms and maintaining their independence longer in comparison to no home nursing care. Home care may also include assisting patients in acknowledging the reality of their situation.
Adult↗