Artificial Intelligence in Dentistry: A Narrative Review of Diagnostic and Therapeutic Applications

Advancements in digital and precision medicine have fostered the rapid development of artificial intelligence (AI) applications, including machine learning, artificial neural networks (ANN), and deep learning, within the field of dentistry, particularly in imaging diagnosis and treatment. This review examines the progress of AI across various domains of dentistry, focusing on its role in enhancing diagnostics and optimizing treatment for oral diseases such as endodontic disease, periodontal disease, oral implantology, orthodontics, prosthodontic treatment, and oral and maxillofacial surgery. Additionally, it discusses the emerging opportunities and challenges associated with these technologies. The findings indicate that AI can be effectively utilized in numerous aspects of oral healthcare, including prevention, early screening, accurate diagnosis, treatment plan design assistance, treatment execution, follow-up monitoring, and prognosis assessment. However, notable challenges persist, including issues related to inaccurate data annotation, limited capability for fine-grained feature expression, a lack of universally applicable models, potential biases in learning algorithms, and legal risks pertaining to medical malpractice and data privacy breaches. Looking forward, future research is expected to concentrate on overcoming these challenges to enhance the accuracy and applicability of AI in diagnosing and treating oral diseases. This review aims to provide a comprehensive overview of the current state of AI in dentistry and to identify pathways for its effective integration into clinical practice.

Oral Cancer and Sleep Disturbances: A Narrative Review on Exploring the Bidirectional Relationship

Oral cancer is a common malignant tumor, and its incidence has steadily increased in recent years. Sleep disturbances, including insomnia and obstructive sleep apnea, are prevalent among patients with oral cancer and significantly impact their quality of life. Emerging research suggests a bidirectional relationship between oral cancer and sleep disorders. This article reviews how oral cancer induces or exacerbates sleep disorders, particularly obstructive sleep apnea (OSA), through factors such as pain, psychological stress, and treatment-related side effects (e.g., upper airway damage caused by chemotherapy, radiotherapy, or surgical interventions). Furthermore, it analyzes how sleep disorders may promote oral cancer progression via chronic inflammation, intermittent hypoxia, oxidative stress, and disruption of circadian rhythms. By elucidating these interactions, this review provides a theoretical foundation for optimizing clinical treatment plans through a holistic understanding of their shared pathophysiological mechanisms.

Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action

The increasing global burden of cancer necessitates innovative approaches to prevention and treatment. Lifestyle factors such as diet, physical activity, and smoking significantly contribute to cancer. At the same time, current guidelines are based on a one-size-fits-all approach, which limits their effectiveness across diverse populations. Obesity is a well-documented risk factor for cancer, directly affecting 13 types of cancer. The complex interplay of genetic, metabolic, hormonal, and environmental factors in obesity's etiology highlights the need for more tailored approaches to obesity-related cancers. This perspective article advocates for a shift toward an integrative, personalized approach that considers a variety of intrinsic and extrinsic factors associated with the etiology of obesity-related cancers. Lifestyle-based cancer prevention strategies should be tailored to an individual's biological profile, demographic background, behaviors, and environmental exposures. Following a diagnosis, a comprehensive treatment approach should consider how these genetic, physiological, lifestyle, and environmental factors interact in the onset and progression of the disease while also taking cancer type and stage into account. This approach paves the way for more precise and effective strategies in tackling cancer. Fulfilling collaboration across research, healthcare, and policy sectors is essential to achieve these goals.

Potential Biomarkers for IDH-Mutant and IDH-Wild-Type Glioblastomas: A Single-Center Retrospective Study

Background/Objectives: Glioblastoma ranks among the most aggressive brain tumors, with poor prognosis. Currently, there are insufficient data regarding the prognostic value of isocitrate dehydrogenase (IDH) mutation status and inflammatory markers. This study demonstrates the prognostic value of IDH mutation status and preoperative inflammatory markers in glioblastoma. Methods: This single-center retrospective study encompassed 66 glioblastoma patients who had surgical treatment in our institution from January 2020 to March 2022. The patients were categorized into two groups: IDH-mutant (n = 30) and IDH-wild-type (n = 36). We made a comparative assessment of demographic characteristics, clinical parameters, preoperative blood parameters, and survival outcome across the two groups. Statistical analyses included Kaplan-Meier survival curves, ROC analysis, and multivariate Cox regression. Results: The IDH-mutant group demonstrated a significantly lower mean age (53.93 ± 12.00) compared to the wild-type group (62.39 ± 10.12) (p = 0.003). Median overall survival was notably longer in the IDH-mutant group, at 16.0 months, versus 6.5 months in the wild-type group (p = 0.030). An elevated neutrophil/lymphocyte ratio above 3.39 (sensitivity 95.12%, specificity 52.0%) and a platelet/lymphocyte ratio exceeding 136.25 (sensitivity 80.49%, specificity 64.0%) were associated with poor prognosis. Cox regression analysis identified IDH-wild-type status (HR = 2.84, 95% CI: 1.56-5.18) and elevated NLR (HR = 1.84, 95% CI: 1.16-2.92) as independent poor prognostic factors. Conclusions: We show that IDH-wild-type glioblastomal patients have a significantly poorer overall prognosis. In this case, the metrics of preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio seem to be supplied with some value as biomarkers for the expansion of the disease and predicting likely outcomes.

Experiences and coping strategies related to financial toxicity among frail older colorectal cancer survivors in China: a qualitative study

PURPOSE

Cancer-related financial toxicity (FT) plays a key role in patients' disease prognosis, well-being, and quality of life. This study aimed to explore the experiences and coping strategies related to FT among frail older colorectal cancer (CRC) survivors in China.

METHODS

This study adopted a descriptive qualitative approach. Individual interviews were performed with 10 frail older CRC patients at a local hospital from March 2024 to August 2024. Relevant data were analyzed using the Colaizzi's phenomenological analysis.

RESULTS

The experiences of FT among frail older CRC patients included (1) insufficient economic income and inadequate medical security; (2) long course of cancer treatment and unaffordability of financial burden; (3) the vulnerability of household economies; and (4) under high psychological pressure and a sense of financial uncertainty. Meanwhile, the coping strategies to mitigate the impacts of FT in this population were as follows: (1) utilizing medical security and insurance policies to reduce FT; (2) financial planning, support, and sharing of responsibilities among family members; and (3) self-psychological adjustment and family members' emotional support.

CONCLUSION

Mitigating FT in frail older CRC survivors is crucial for improving their disease outcomes and quality of life. Understanding the experiences related to FT and identifying relevant coping strategies in this population may contribute to formulating medical and health policies for protecting these patients and their families from the adverse effects of FT. Future studies should be placed on developing effective interventions and providing personalized support for this population to alleviate FT.

Clinical practice guide for nurses that optimizes nurse's comprehensive care of patients undergoing immunotherapy

INTRODUCTION

Immunotherapy is revolutionizing oncological treatment, but its unique toxicity profile emphasizes the need for multidisciplinary teams involving nurses. In the absence of guidelines tailored for nurses, a comprehensive guide focusing on patient history and care is presented.

OBJECTIVE

To outline the methodology for creating a practical guide for nurses, aimed at improving care for patients undergoing oncologic immunotherapy by focusing on comprehensive support and complementing pharmacological treatment.

METHOD

A guide was developed following Evidence-Based Nursing principles, with the involvement of experts from Spanish oncology scientific societies. Through evidence searches, external review, and editing, robust and applicable recommendations were ensured.

RESULTS

The guide focuses on toxicity management, incorporating an algorithm for its handling, along with detailed descriptions and recommendations for early symptom identification from the nursing perspective.

CONCLUSION

The guide emphasizes the essential role of oncology nurses in immunotherapy, highlighting their contribution from advanced roles. Endorsed by scientific societies, it serves as an evidence-based resource.

Evaluation of Large Language Models in Tailoring Educational Content for Cancer Survivors and Their Caregivers: Quality Analysis

Background

Cancer survivors and their caregivers, particularly those from disadvantaged backgrounds with limited health literacy or racial and ethnic minorities facing language barriers, are at a disproportionately higher risk of experiencing symptom burdens from cancer and its treatments. Large language models (LLMs) offer a promising avenue for generating concise, linguistically appropriate, and accessible educational materials tailored to these populations. However, there is limited research evaluating how effectively LLMs perform in creating targeted content for individuals with diverse literacy and language needs.

Objective

This study aimed to evaluate the overall performance of LLMs in generating tailored educational content for cancer survivors and their caregivers with limited health literacy or language barriers, compare the performances of 3 Generative Pretrained Transformer (GPT) models (ie, GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo; OpenAI), and examine how different prompting approaches influence the quality of the generated content.

Methods

We selected 30 topics from national guidelines on cancer care and education. GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo were used to generate tailored content of up to 250 words at a 6th-grade reading level, with translations into Spanish and Chinese for each topic. Two distinct prompting approaches (textual and bulleted) were applied and evaluated. Nine oncology experts evaluated 360 generated responses based on predetermined criteria: word limit, reading level, and quality assessment (ie, clarity, accuracy, relevance, completeness, and comprehensibility). ANOVA (analysis of variance) or chi-square analyses were used to compare differences among the various GPT models and prompts.

Results

Overall, LLMs showed excellent performance in tailoring educational content, with 74.2% (267/360) adhering to the specified word limit and achieving an average quality assessment score of 8.933 out of 10. However, LLMs showed moderate performance in reading level, with 41.1% (148/360) of content failing to meet the sixth-grade reading level. LLMs demonstrated strong translation capabilities, achieving an accuracy of 96.7% (87/90) for Spanish and 81.1% (73/90) for Chinese translations. Common errors included imprecise scopes, inaccuracies in definitions, and content that lacked actionable recommendations. The more advanced GPT-4 family models showed better overall performance compared to GPT-3.5 Turbo. Prompting GPTs to produce bulleted-format content was likely to result in better educational content compared with textual-format content.

Conclusions

All 3 LLMs demonstrated high potential for delivering multilingual, concise, and low health literacy educational content for cancer survivors and caregivers who face limited literacy or language barriers. GPT-4 family models were notably more robust. While further refinement is required to ensure simpler reading levels and fully comprehensive information, these findings highlight LLMs as an emerging tool for bridging gaps in cancer education and advancing health equity. Future research should integrate expert feedback, additional prompt engineering strategies, and specialized training data to optimize content accuracy and accessibility.

Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial

Background

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC.

Objective

We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures.

Methods

STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions.

Results

Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59% vs benchmark: 50%), study assessment completion (9/10, 90% vs benchmark: 60%), dietitian appointment attendance (7/10, 70% vs benchmark: 60%), daily food intake logging adherence (6/10, 60% vs benchmark: 60%), and participant retention (10/10, 100% vs benchmark: 60%). Most participants rated the intervention as acceptable (8/10, 80% vs benchmark: 70%) and reported a high level of usability for dietitian services (10/10, 100%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study.

Conclusions

The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes.

Cancer patient-family caregiver mutuality: A concept analysis

PURPOSE

Mutuality between cancer patients and family caregivers affects treatment outcomes. Despite increasing recognition of the interdependent relationship between patients and family caregivers, a clear definition of mutuality in dyads is still lacking. This lack of definition challenges developing measurement tools, advancing research, and effectively applying the concept in practice. This concept analysis aims to examine the concept of mutuality between patients and family caregivers' dyads in cancer care.

METHODS

Walker and Avant's approach was used to define attributes, antecedents, consequences, and empirical referents of mutuality in cancer patient-family caregivers. Literature was searched from PubMed, Web of Science, CINAHL, and Embase.

RESULTS

While the definition of mutuality varies, it is characterized by interconnection, reciprocity, shared understanding, and adaptability. It originates from antecedents such as cancer diagnosis, existing bonds, effective communication, and supportive environments, leading to improved psychological health, enhanced relationship quality, and better coping strategies.

CONCLUSION

This study revealed the unique characteristics of mutuality related to cancer trajectory. This underscores the development of standardized tools and the need for cancer-type-specific research to enhance patient and caregiver well-being. Incorporating mutuality's core aspects into clinical practice can offer healthcare providers in-depth insights into cancer care, fostering improved interventions, communication, and collaborative approaches. Additionally, it advocates the need for integration of mutuality into healthcare strategies. It is needed to advance research and education, promoting improved quality of care for patient-family caregiver dyads globally.

Predictive Role of Perceived Social Support and Psychological Distress on Caregiver Burden in Parents of Children With Cancer

OBJECTIVES

This study aimed to explore the predictors of caregiver burden among parents of children with cancer.

METHODS

A descriptive correlational study was conducted on 254 parents of children with cancer in the oncology department of Baghaei 2 Hospital in Ahvaz, Iran from September 2022 to July 2023. The study's data was collected through the demographic information questionnaire, the caregiver burden scale (CBS), the perceived social support (PSS), and the General Health Questionnaire (GHQ). Data were analyzed using an independent t-test, 1-way ANOVA, Pearson's correlation coefficient, and multiple linear regression in SPSS-22.

RESULTS

Parents experienced a moderate level of CBS (54.74 ± 10.17), PSS (41.52 ± 12.94), and GHQ (18.95 ± 4.47). Regression models showed that PSS (β = -0.381, P < .001), GH (β = 0.199, P < .001), caregiving responsibilities for others (β = 0.195, P < .001), satisfaction with income (β = -0.151, P = .005), and hospitalization number (β = 0.142, P = .007) were significantly associated with the CB of parents of children with cancer. These variables accounted for 32% of the variance in CB.

CONCLUSION

This study demonstrated various degrees of CB among parents of children with cancer. A better understanding of the predictive factors of CB is needed to provide suitable interventions such as caregiving skills, and coping strategies to alleviate CB among parents and subsequently improve the quality of caregiving.

IMPLICATION FOR NURSING PRACTICE

Pediatric oncology nurses should adopt a holistic approach that addresses both the emotional and social needs of parents, in addition to the medical needs of the child. Developing support programs tailored to parents' experiences, educating them on managing caregiving challenges, and facilitating effective communication regarding treatment processes can help alleviate parental CB.

Breast asymmetry in idiopathic scoliosis (IS) patients with structural thoracic curve: a computed tomography (CT) morphometric analysis and assessment of patients' perceptions using the Breast-Q™ questionnaire

PURPOSE

To quantify the breast computed tomography (CT) parameters in IS patients. Patients' perceptions of their breast appearance before/after scoliosis surgery were also assessed with Breast-Q™ questionnaire.

OUTCOME MEASURE

Concave/convex side breast volume difference (BVD), computed tomographic external breast appearance parameters (extraversion angle (EA), coverage angle (CA), axial breast height (ABH), nipple-to-sternum distance (NSD), thoracic rib cage parameter (inclination angle (IA)), and Breast Satisfaction and Psychosocial Well Being domains of Breast-Q Q™ questionnaires.

METHODS

This was a prospective study of 50 IS patients recruited between June 2017 and December 2018 who had pre-operative CT scans available for review. Pre-operative radiological parameters as stated above were evaluated. Breast volume difference (BVD) was calculated using the formula: 100 * {(CC BV - CV BV)/[(CC BV + CV BV)/2]}. Breast-Q™ questionnaires were administered pre-operative and post-operatively. The percentage of patients who achieved the minimal clinically important difference (MCID) was reported.

RESULTS

Thirty-three patients (66%) had significant BVD with the concave side larger in 52.0% of patients. BVD had significant correlation with ABH, NSD, CA, and EA. There was no significant correlation between pre-operative Cobb angle with BVD and IA. There was also no significant correlation between Tanner stage and the radiological parameters. Breast satisfaction and psychosocial well-being domains improved after surgery and the satisfaction with breast domain minimal clinically important difference (MCID) was achieved in 83.7% of patients, while the psychosocial well-being domain reached the MCID in 75.5% of patients (p < 0.001).

CONCLUSION

Scoliosis led to significant breast asymmetry among patients with smaller volume on the convex side. Changes in breast volume (BV) contributed significantly towards the external breast appearance. Patient's breast satisfaction and psychosocial well-being improved post-operatively and, in the majority, MCID was achieved.

Factors associated with unmet supportive care needs among adult cancer survivors in South Korea: a cross-sectional survey

PURPOSE

This cross-sectional study assessed the prevalence of unmet supportive care needs and financial burdens among South Korean adult cancer survivors.

METHODS

A total of 1038 adult cancer survivors were recruited through convenience sampling from the 2022 Korean Population Census. Data were collected online from November 17 to December 15, 2022. Unmet supportive care needs were assessed across three domains: access and continuity of care, coping and emotional needs, and information needs. Ordinal logistic regression analyses were conducted, adjusting for relevant demographic and clinical characteristics.

RESULTS

Among study participants, 65.7% of those with severe financial toxicity reported high unmet supportive care needs. The most frequently reported unmet need was related to coping and emotional support (44.7%). Cancer survivors diagnosed 6-10 years ago had significantly lower unmet supportive care needs compared with those diagnosed within the past three years (AOR = 0.69, 95% CI: 0.49-0.98). Survivors with stage III/IV cancer (AOR = 1.62, 95% CI: 1.13-2.32) were more likely to report high unmet needs. Additionally, those with severe financial toxicity were at significantly higher risk of reporting unmet needs (AOR = 3.26, 95% CI: 2.13-5.02).

CONCLUSIONS

Unmet supportive care needs were significantly associated with severe financial toxicity, time since diagnosis, and cancer stage. Survivors with severe financial toxicity or advanced-stage cancer are at an increased risk of experiencing unmet needs.

IMPLICATIONS FOR CANCER SURVIVORS

These findings highlight the need for targeted interventions to address the unmet supportive care needs of cancer survivors, particularly those experiencing severe financial burdens or diagnosed with advanced-stage cancer. Interventions should be tailored to different survivorship stages to improve long-term health outcomes and quality of life for cancer survivors in South Korea.

Direct Economic Burden of Post-Cancer Treatment Pain Among Cancer Survivors in the United States: A Population-Based Retrospective Longitudinal Study

PURPOSE

Post-cancer treatment pain (PCTP) is prevalent among cancer survivors but remains understudied. It is critical to quantify PCTP prevalence over time and to estimate the resulting short and long-term incremental healthcare expenditures (total, third-party, and out-of-pocket) and out-of-pocket burden among cancer survivors.

METHODS

A longitudinal retrospective cohort design was used. To identify cancer survivors (≥ 18 years) with PCTP, the Medical Expenditure Panel Survey (MEPS) and its supplementary Cancer Self-Administered Questionnaire (CSAQ)were used. Recycled predictions from generalised linear models (GLM) with log-link and gamma distribution were used to estimate annual incremental healthcare expenditures at different PCTP gradations over time. To account for covariate imbalance, sensitivity analysis using inverse probability weighting was conducted.

RESULTS

2125 cancer survivors had PCTP. Post-cancer treatment, 10.5%-24.2% of survivors experienced some form of chronic PCTP, whereas between 21.9%-5.1% experienced acute PCTP. Across the survivorship journey, the adjusted total annual incremental healthcare expenditures were the highest among cancer survivors with moderate chronic PCTP (< 1-year post-cancer treatment), and severe chronic PCTP, (≥ 5 years post-cancer treatment) compared to survivors with no pain, reaching respectively, $27.3 and $40.2 billion nationally. There was a significant high out-of-pocket burden among cancer survivors with severe chronic PCTP compared to those with no pain.

CONCLUSION

These findings highlight the persistent financial burden of PCTP but also the critical need for effective pain management alongside the use of patient-reported outcomes for pain among cancer survivors.

Defining long-term survivors in metastatic lung cancer: insights from a Delphi study in Spain

The improvement in survival rates in metastatic lung cancer (mLC) has increased the number of survivors' special care needs. This study aimed to define and characterise these long-term survivors. A Delphi method with two successive rounds was conducted to reach a consensus (defined as an agreement ≥ 70%) on 56 items among 41 medical oncologists. The items included the definition of long-term survivors, their common characteristics, and oncological and non-oncological implications. The experts had an average age of 46 years, 53.7% were men, 90.2% attended for thoracic tumours, 40% had more than 15 years' experience in mLC, and 56.1% of managing > 50 patients/month. Consensus reached 53.6% in the first round and 73.2% in the second. The definition of long-term survivors reached 58.3% consensus, defined as overall survival ≥ 3 years and/or progression-free survival ≥ 2 years. Identification of common features obtained 76.2% consensus on adenocarcinoma subtype of non-small-cell lung cancer, high PD-L1 expression, absence of brain metastasis, and fewer than two metastatic locations. Consensus was reached on specialized medical follow-up to detect immune-mediated toxicities and second neoplasms (87.8%), on pharmacological/non-pharmacological treatment for fatigue (82.9%) and sexual dysfunction (85.4%); and also on the importance of support for work and social adaptation (92.7%), integration of primary and hospital care (90.2%), implementation of quality-of-life programmes (92.7%) and electronic media (73.2%). This consensus identifies common characteristics and highlights relevant implications that should guide the follow-up and clinical management of these patients, ensuring better care and quality of life.

The Relationship Between Nurses' Emotional Competence and Evidence-Based Nursing: A Scoping Review

Background: Emerging evidence suggests that emotions significantly influence clinical decision-making among healthcare professionals. Given that evidence-based nursing (EBN) relies heavily on clinical reasoning, and emotions play a critical role in shaping its quality, exploring the relationship between emotional competence and EBN is essential. Objective: This scoping review aims to map and synthesize existing knowledge on the relationship between nurses' emotional competence and EBN, while identifying research methodologies and integration challenges. Methods: Following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, a scoping review was conducted. The search strategy included studies from databases such as Scopus and CINAHL, as well as grey literature. Eligibility criteria included primary and secondary research articles in Portuguese, English, Spanish, and French, published since 1990, focusing on the relationship between emotional competence and EBN in nurses. Data were synthesized thematically. Results: Of 751 publications identified, 11 met the inclusion criteria. Three themes emerged: (1) the relationship between emotional competence and EBN in different healthcare contexts; (2) research methodologies used; and (3) integration challenges and suggestions. Findings suggest that nurses with higher emotional competence are more likely to adopt safer, evidence-based practices, facilitating EBN implementation and improving care quality and safety. Conclusions: The evidence highlights the importance of integrating emotional intelligence and EBN in nursing education and practice. Combined educational programs are recommended to enhance professional safety, performance, and well-being. Future research should further explore this relationship to develop practice models that reconcile emotional competencies with evidence-based nursing.

Predictors of Spiritual Well-being Among Oncology Nurses in Oman

BACKGROUND

Spiritual care is a crucial component of oncology nursing, addressing patients' holistic needs. However, limited research has explored spiritual well-being, competence, practices, and barriers among oncology nurses, particularly within specific cultural and religious contexts.

OBJECTIVE

To assess spiritual well-being and its predictors, including perceived competence, practices, and barriers to providing spiritual care among oncology nurses in Oman.

METHODS

A descriptive correlational study was conducted with 422 oncology nurses from 3 cancer care centers in Muscat, Oman. Convenience sampling was used, and data were collected through validated instruments, including the Spiritual Well-being Scale, Spiritual Care Competence Scale, Nurse Spiritual Care Therapeutics Scale, and Spiritual Care Practice Questionnaire. SPSS version 27 was used for data analysis, using descriptive statistics, Pearson correlation, independent t tests, analysis of variance, and multiple linear regression.

RESULTS

Nurses exhibited high spiritual well-being (mean, 102.1 [SD, 14.7]) and moderate spiritual care competence (mean, 96.1 [SD, 19.1]), yet spiritual care practices were infrequent (mean, 37.6 [SD, 13.1]). Major barriers included beliefs about the privacy of patients' spirituality (59.5%) and lack of time (54.7%). Higher competence and prior oncology training were significantly associated with greater spiritual well-being.

CONCLUSIONS

Although oncology nurses in Oman report high spiritual well-being, barriers such as time constraints and role perceptions hinder spiritual care practices.

IMPLICATIONS FOR PRACTICE

Targeted education and training programs are essential to enhance spiritual care delivery. Addressing systemic challenges, including time management and role clarity, can foster a supportive environment for integrating spiritual care into oncology nursing.

Spatial multilevel analysis of individual, household, and community factors associated with COVID-19 vaccine hesitancy in the Dominican Republic

Vaccine hesitancy or refusal poses a significant public health challenge resulting in the resurgence of preventable diseases and undermining the effectiveness of national and global health initiatives. This study investigates multilevel determinants of COVID-19 vaccine hesitancy in the Dominican Republic (DR) shortly after the launch of the national COVID-19 vaccination campaign in February 2021. Participants aged 18 years and older were enrolled through a national multistage cluster survey conducted from June-October 2021. The Health Belief Model guided the selection of potential factors contributing to vaccine hesitancy. Hierarchical mixed-effect logistic regression models were used to examine individual, household, and community factors associated with vaccine hesitancy. COVID-19 vaccine hesitancy was observed in 12.6% (95% CI: 11.7-13.5%) of participants (n = 5,566), with spatial variations at the cluster level. Individual factors associated with lower odds of vaccine hesitancy included older age, higher education levels, mulatto ethnicity, and perceiving vaccination as crucial for health. In contrast, factors significantly associated with hesitancy included being born in the DR and concerns about COVID-19 vaccine side effects. For factors at the household level, differential trust in health information sources significantly influenced vaccine hesitancy, with certain sources correlating with increased hesitancy and others with reduced vaccine hesitancy. Better access to healthcare, as indicated by a higher number of hospitals per population, was paradoxically associated with increased vaccine hesitancy. Future strategies to reduce vaccine hesitancy in the DR might consider these multifaceted factors.

The mediating effects of coping strategies between symptom clusters and quality of life in lung cancer patients undergoing immunotherapy

OBJECTIVE

Immunotherapy has significantly improved the survival rates of lung cancer patients. However, prevalent adverse immune reactions associated with this treatment can detrimentally affect their quality of life. Coping strategies play a crucial role throughout the cancer treatment process. Consequently, this study hypothesised that coping strategies act as a mediating factor between symptom clusters and quality of life. This study intended to provide a theoretical foundation and empirical data to support the optimisation of coping strategies for lung cancer patients, thereby enhancing their overall quality of life.

METHOD

This study consisted of a cross-sectional survey. Data were collected using the Memorial Symptom Assessment Scale, the Medical Coping Modes Questionnaire, the Quality of Life Questionnaire-Lung Cancer 43, and a self-designed General Information Evaluation Form. The data were fitted, and the model was refined using the maximum likelihood estimation method. Additionally, the Bootstrap method was employed to assess mediating effects.

RESULTS

In total, 240 participants completed the survey. During immunotherapy, lung cancer patients predominantly adopted the acceptance-resignation coping strategy, which served as a mediating factor between symptom clusters and quality of life. In contrast, the mediating effects of confrontation and avoidance coping strategies between symptom clusters and quality of life were not significant.

CONCLUSION

Both symptom clusters and the acceptance-resignation coping strategy negatively impacted quality of life, with acceptance-resignation serving as a mediating factor between symptom clusters and quality of life. Future research should focus on developing interventions for cognitive behaviour to improve coping strategies and quality of life throughout the disease trajectory.

An exploration of perceived impact of receiving complementary therapies on service users during the palliative and end-of-life care phase

BACKGROUND

To explore and understand the narratives of service users in the hospice setting regarding the value they place on complementary therapies and their perceived impact on overall wellbeing.

METHODS

This qualitative pilot study, informed by narrative inquiry principles, used purposive sampling to recruit and interview 11 service users receiving complementary therapies in a hospice setting. Data were analysed using a two-cycle coding approach, through manual inductive recognition of patterns.

FINDINGS

Three themes were identified: developing trust in complementary therapy; informal psychological support and applications to everyday life. The benefits derived from complementary therapy sessions include managing anxiety and stress, developing better sleep strategies and devising coping techniques for personal situations and contexts through guided discussions and personal reflection.

IMPLICATIONS

The study suggests a need for further inquiry and professional complementary therapist development to fully harness the therapeutic potential of complementary therapy in a palliative care context. There is potential for palliative settings that incorporate and provide complementary therapies to enhance the role that complementary therapy services play in facilitating coping abilities, reducing anxiety and potentially improving sleep and pain management.

The Effect of Virtual Reality on Chemotherapy-Associated Stress (Cortisol Value), Anxiety, and Pain Symptoms of Mastectomy Patients: A Randomized Controlled Pilot Study

BACKGROUND

Pain, anxiety, and stress are the most common symptoms experienced by patients receiving chemotherapy after breast surgery. Virtual reality (VR) can be used as a method to manage these symptoms.

OBJECTIVE

To determine the effect of VR on chemotherapy-associated stress (salivary cortisol value), anxiety, pain, and vital signs of mastectomy patients.

METHODS

A total of 62 participants were enrolled in this randomized, 2-group design. Participants in the experimental group watched videos with VR glasses during their chemotherapy treatments. Saliva samples were collected from participants in both the control and experimental groups before and immediately after their chemotherapy treatments. The Personal Information Form, state anxiety component of the State-Trait Anxiety Inventory, visual analog scale, and the patients' vital signs were also collected.

RESULTS

The State-Trait Anxiety Inventory state anxiety component and visual analog scale scores and the stress value mean scores differed significantly between the 2 groups at the second data point. There was also a statistically significant decrease in systolic blood pressure and diastolic blood pressure after chemotherapy in the experimental group.

CONCLUSION

The use of VR in women receiving chemotherapy significantly reduced their pain, anxiety, stress and blood pressure from before to immediately following the chemotherapy infusion.

IMPLICATIONS FOR PRACTICE

VR can be an appropriate intervention to reduce pain, anxiety, and stress in patients receiving chemotherapy after mastectomy.

7C model: An easy way to understand the role of palliative nurses

BACKGROUND

The holistic approach of palliative care emphasises the importance of specialised nursing to improve the quality of life for patients and families.

AIM

To propose a theoretical model encapsulating essential aspects of palliative nursing.

METHOD

A review of previous literature and existing models were used to identify the key competencies essential for palliative care nurses.

CONCLUSIONS

The proposed 7C model highlights the critical skills of caring and comforting, collaboration and coordination, communication and cohesion, compassion, conflict management, competence and cultural sensitivity as foundational to effective palliative nursing practice. Formal training is essential for nurses to master palliative care skills. The proposed 7C model for palliative nursing aims to integrate holistic care principles into training, practice and thereby improving nursing efficacy and patient care standards.

Interventions, programmes and resources that address culturally and linguistically diverse consumer and carers' cancer information needs: a mixed methods systematic review

BACKGROUND

Culturally and linguistically diverse (CaLD) consumers and carers have been identified as experiencing high levels of unmet needs relating to information and support across the cancer journey. This review identified and evaluated the effectiveness of strategies to meet the cancer information needs of consumers and carers from CaLD backgrounds.

METHODS

This review followed Joanna Briggs Institute (JBI) methodology for systematic reviews. Databases searched included MEDLINE, CINAHL Ultimate, PsycINFO and AMED, ProQuest Dissertations and Theses, and GreyNet. Published and unpublished studies between 2013 - May 2024 on interventions, programmes or resources developed for adults (aged 18 years and over) from CaLD communities in relation to cancer prevention, cancer treatment or life after cancer were reviewed for inclusion. The review protocol was registered in PROSPERO (CRD42023451557).

RESULTS

One hundred and twenty papers were included in the review. The majority were quasi-experimental studies (n = 52), followed by randomised controlled trials (n = 38) and qualitative studies (n = 25). The populations represented in the review included Latino (n = 47), Chinese (n = 28), Asian (n = 19), Korean (n = 16), and Vietnamese communities (n = 7). Most studies focused on prevention activities (n = 89) with a smaller number focused on active treatment (n = 6) and life after cancer (n = 20). Most studies focused on breast cancer (n = 37), followed by cervical cancer (n = 21). Engagement with community members was identified as an important requirement to develop and adapt interventions that were culturally acceptable, feasible and relevant to meet the communities' needs. The majority of interventions demonstrated a positive impact on the primary outcome measured. No studies reported on the experiences of consumers and carers from CaLD backgrounds in the development of interventions, programmes and resources to address their cancer information needs.

CONCLUSIONS

This review supports a tailored approach to develop information, resources and interventions that leverage community resources and expertise to ensure that they are accessible and relevant to CaLD communities. The onus for researchers and clinicians is the creation of information, resources and interventions that are both accessible in terms of language and comprehension and are culturally relevant.

Physical activity and exercise behaviour of breast cancer survivors: nationwide cross-sectional survey

OBJECTIVES

High physical activity levels have been associated with longer, healthier lifespans and improved quality of life among breast cancer survivors. The Japanese clinical guidelines for breast cancer survivors, similar to those in the USA, strongly recommend maintaining high physical activity levels. However, the extent of adherence to these guidelines among breast cancer survivors in Japan is unclear. This study aimed to assess adherence to guideline-recommended physical activities and identify associated factors.

METHODS

Self-administered questionnaires were distributed to breast cancer survivors without recurrence or metastasis from 34 facilities across Japan, with approximately 30 survivors per facility, between March 2019 and August 2020. The questionnaire collected information on participants' backgrounds, physical activity levels (assessed using the Global Physical Activity Questionnaire) and potential factors influencing their physical activity. Logistic regression analysis was performed to identify the factors associated with meeting the guideline recommendations.

RESULTS

In total, 791 patients (77.5%) were investigated, with 50.5% meeting the physical activity recommendations outlined in the guidelines. Factors associated with meeting the guideline recommendations included higher self-efficacy (OR 1.58, 95% CI 1.29 to 1.94), greater perceived social support (OR 1.54, 95% CI 1.26 to 1.89), lower annual household income (OR 1.58, 95% CI 1.07 to 2.33), relief from cancer-related symptoms through physical activity (OR 1.81, 95% CI 1.13 to 2.94) and urban location (OR 1.50, 95% CI 1.03 to 2.20).

CONCLUSIONS

Half of the breast cancer survivors in Japan did not meet the recommended physical activity levels, and several factors influencing adherence were identified.

Psychometric properties of the modified Chinese version of the family resilience assessment for families of patients with cancer

Family resilience is critical for families recovering and growing from a cancer crisis; however, there remains a lack of universal family resilience assessment tools for families of patients with cancer. This study aimed to modify the Family Resilience Assessment Scale (FRA) and examine its psychometric properties. First, the FRA scale was modified into the Family Resilience Assessment Scale for Family Cancer (FRAS-FC) based on cultural adaptations and cancer population applicability. During the modification phase, items were deleted, added, and reclassified through expert consultation and group discussion. The language of the scale items was further optimized after the pilot study, resulting in a test version of the FRAS-FC. Subsequently, a total of 455 patients with cancer or their family caregivers from China participated in scale validation. The factor analysis showed a 6-factor structure with reasonable fit (χ2/df = 2.064, RMR = 0.043, SRMR = 0.056, IFI = 0.903, CFI = 0.902, RMSEA = 0.066). Satisfactory indicators of convergent and concurrent criterion validity further supported the validity of the scale. The internal consistency was good (Cronbach's alpha = 0.939). The Pearson correlation coefficient for the test-retest sample was 0.719 (p < 0.01), reflecting the stability of the scale measures across time. The findings support the 29-item FRAS-FC as a valid and reliable tool for measuring family resilience in patients with cancer or their family caregivers. The FRAS-FC enables healthcare professionals to identify family resilience and act accordingly to fulfill the role of the family better. The modified scale can be used in a wider range of families living with cancer or be validated separately for different types of cancers. Further validation in a wider cancer population is still needed.

Effectiveness of Technology-Based Intervention in Symptom Management in Pediatric Oncology Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Technology-based interventions are increasingly integrated to improve symptom management of pediatric oncology patients. However, evidence for their effectiveness remains low across various studies characterized by different methodologies and patient populations. This study aimed to synthesize and analyze the effectiveness of technology-based intervention in symptom management in pediatric oncology patients.

METHODS

Six databases (PubMed, Web of Science, Cochrane Library, Ovid MEDLINE, CINAHL, and Scopus) were searched from January 1, 2014, to January 1, 2024. The methodological quality of the included studies was assessed using the Cochrane and JBI checklists. The PRISMA guidelines for systematic reporting were followed in this study. The search protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42024516320).

RESULTS

Thirteen studies with 624 pediatric oncology patients were analyzed. Significant differences were found between intervention and control groups in pain (Hedge's g = -0.695, 95% CI: -0.994 to -0.396, p < 0.001), fear (Hedge's g = -0.737, 95% CI: -1.01 to -0.464, p < 0.001), anxiety, and nausea and vomiting (Hedge's g = -0.573, 95% CI: -0.912 to -0.235, p < 0.001).

CONCLUSION

The findings indicate that VR, iPad, humanoid robots, and Pain Squad reduce pain in pediatric oncology. VR, biofeedback-based VR, and iPads also alleviate fear, while all three plus humanoid robots mitigate anxiety. VR, interactive mobile apps, tablet games, text reminders, and iPads effectively decrease nausea and vomiting. More research is needed to evaluate the long-term effects of these interventions.

Cognitive Authority Theory: Reframing health inequity, disadvantage and privilege in palliative and end-of-life care

BACKGROUND

There persist disparities in access to quality palliative and end-of-life care, often based on avoidable injustice. Research and theory to explain this health inequity focuses on structural or individual-based factors, overlooking important relational factors between health professionals, patients and families.

AIM

To apply Cognitive Authority Theory in palliative and end-of-life care to explain neglected relational drivers of inequity in access and experience.

METHODS

Cognitive Authority Theory, a middle-range theory of power relations between individuals and authority over knowledge, was developed from empirical and review data. This paper demonstrates its utility in explaining an overlooked component of inequity in palliative care: interactions between health professionals and patients/caregivers.

RESULTS

Using examples from the palliative care literature, we characterise how people who are socially disadvantaged have fewer resources to exploit during consultations with health professionals which makes it difficult for them to have their voices heard, their choices prioritised by others, and to express their expertise. We examine the implications of health professionals' judgements of expertise for care access, experience, involvement and appropriateness. We offer a fresh perspective on the mechanisms by which stereotypes, bias and power imbalances between health professionals and patients reinforce existing health inequities, drawing on the role of social privilege in shaping inequity in palliative care.

CONCLUSION

This paper provides a new language to articulate relational drivers of inequity in palliative care. It explains how to use Cognitive Authority Theory to design and interpret research to determine how healthcare interactions reinforce both social privilege and social disadvantage at end-of-life.

HPV vaccine hesitancy in the United States

PURPOSE OF REVIEW

Human papillomavirus (HPV) is the most common STI and accounts for roughly 37 000 HPV-associated cancers annually in the United States. Despite documented safety and effectiveness of the HPV vaccine, vaccination rates should be higher. We summarize literature surrounding vaccine hesitancy, a main reason for suboptimal vaccine coverage. We aim to describe the complex factors that lead to hesitancy in order to support improvement of vaccination rates in our communities.

RECENT FINDINGS

Studies document sustained immunogenicity and effectiveness 10 years post HPV vaccination. Vaccine coverage was rising until 2022, when initiation declined. Primary reasons for hesitancy are: perceived lack of provider recommendation, a lack of parental knowledge and necessity especially if an adolescent is not sexually active, and safety concerns. The COVID-19 pandemic challenged access to care and exacerbated vaccine-related discourse. Studies of hesitant adopters reveal that social processes, including conversations with community members, have a substantial impact on decisions to vaccinate.

SUMMARY

We highlight recent literature behind parental hesitancy toward the HPV vaccine, focusing on concerns about its necessity and safety, exacerbated by medical mistrust and misinformation. We summarize findings of successful educational outreach and community-based interventions to improve vaccination rates in the postpandemic social media era.

Effectiveness of a mobile-based return to work program for decent return to work, fatigue, stress, and quality of working life among cancer survivors

PURPOSE

This study aimed to develop a smartphone mobile application-based supportive return to work (RTW) program for cancer survivors and evaluate its effects on their RTW, fatigue, stress, and quality of working life. This program was developed through a comprehensive process involving literature review, interviews with cancer survivors, and consultations with experts.

METHODS

A non-equivalent control group pre- and post-test design was used, with 41 participants assigned to the experimental (n = 18) and control (n = 23) groups based on recruitment timing. The experimental group received a 6-week smartphone mobile application-based supportive RTW program comprising "Counseling and Education" and "Self-Management." Participants completed assessments of decent RTW, fatigue, stress, and quality of working life at baseline and 6 months later. The experimental group completed an additional post-program completion survey.

RESULTS

During the 6-week program, no experimental group participants dropped out. The program's impact on decent RTW remains unclear. Fatigue (F = 2.52, p = 0.095) and quality of working life (F = 0.86, p = 0.434) did not show statistically significant differences. However, there was a significant reduction in stress (F = 4.59, p = 0.017).

CONCLUSION

The smartphone application-based RTW program, focusing on self-management and counseling, effectively reduced participants' stress levels. To further evaluate the effectiveness of the program, a more diverse range of interventions and ongoing programs should be implemented.

IMPLICATIONS FOR CANCER SURVIVORS

This study underscores the importance of tailored digital interventions to support the RTW of cancer survivors. The use of mobile smartphone applications allows temporal and spatial flexibility in program participation. Interventions involving various activities should be implemented to ensure ongoing participation.

A synthesis of meta-analyses of immersive virtual reality interventions in pain

The severity and impact of pain can vary greatly, even in individuals with the same physical injury. This variation underscores the need for a variety of treatment strategies in effective pain management. Virtual reality (VR) is an emerging technology that has been used as a treatment in diverse pain populations and for diverse indications. In recent decades, many trials, systematic reviews, and meta-analyses have examined the impact of VR for pain management. While there is some evidence for efficacy in terms of distraction, pre-exposure, and physical therapy; populations, comparators and interventions differ significantly between existing meta-analyses. Thus, the present umbrella review was conducted to determine the overall strength of evidence for all identified populations, comparators, and interventions by synthesising available meta-analyses. Fifty-four meta-analyses reporting on the effect of immersive VR interventions in pain management were identified. Overall, VR interventions appeared efficacious for procedural pain conditions, where used for distraction, and when compared to standard care. While there was some evidence for efficacy in chronic pain populations, this only indicated short-term improvement in pain intensity. We also identified numerous areas for future research wherein the available results were inconclusive, such as examining long term interventions and outcomes for chronic pain populations, reporting of adverse events, and examining the efficacy of VR interventions designed for physical therapy, augmented cognitive therapies, or pre-exposure.

Patient-reported upper extremity impairment following mastectomy with breast reconstruction: A systematic review

BACKGROUND

Mastectomy is known to cause upper extremity impairment due to biomechanical disturbance and shoulder girdle instability. Forty percent of the patients undergoing mastectomy have immediate breast reconstruction, which may further alter the biomechanics of the chest, shoulder, and arm. However, the clinical significance of these alterations remain unknown. The authors present a systematic review of patient-reported upper extremity dysfunction following autologous or alloplastic breast reconstruction.

METHODS

A systematic review was conducted using PubMed, Cochrane Library, and Scopus databases according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies were screened according to title and abstract, and those that met the criteria for inclusion were read in full. Patient-reported outcomes focusing on upper extremity function were extracted. Overall, 7946 unique articles were identified; after title and abstract screening and full-text review, 29 studies met the inclusion criteria.

RESULTS

There was no consensus on upper extremity dysfunction associated with reconstruction compared to mastectomy alone. Patients with subpectoral implants had worse symptoms and functionality compared to preoperative state or prepectoral implant-based reconstruction. Patients with latissimus dorsi autologous reconstruction had worse symptoms and functionality compared to preoperative state and other autologous flap types.

CONCLUSIONS

When considering upper extremity function, the current evidence suggests no difference in the setting of mastectomy with or without reconstruction. Moreover, current evidence favors prepectoral implant-based reconstruction or abdominal-based flaps as the preferred options, while latissimus flaps have the highest reported impairments. Choice of reconstruction is multi-factorial and this review aids in comprehensive counseling and shared-decision making.

Trajectories of Fear of Cancer Recurrence: A Longitudinal Study on Spouses of Young and Middle-Aged Patients With Breast Cancer Postoperative Chemotherapy

OBJECTIVE

Spouses of young and middle-aged patients diagnosed with breast cancer encounter various challenges, among which fear of cancer recurrence (FCR) is particularly prominent. This study aimed to identify distinct FCR trajectories and investigate related factors.

METHODS

A longitudinal study was conducted with 230 spouses of patients with breast cancer at a medical college affiliated hospital in China. FCR was assessed at five time points: 1-3 days before the surgery to 7 months after the surgery. A growth mixture model was used to identify latent categories of the FCR developmental trajectory. The Wilcoxon rank-sum test and multiple logistics regression were used to analyze the influencing factors for the FCR trajectories.

RESULTS

Three FCR trajectories were identified: recovery class (RC, 32.2%), gradually improved class (GIC, 53.1%), and high class (HC, 14.7%). The place of residence, chronic disease, primary caregiver, and education influenced the developmental trajectory of FCR in spouses of patients with breast cancer postoperative chemotherapy.

CONCLUSIONS

Group heterogeneity in FCR was observed among spouses, mostly at moderate levels. Appropriate psychosocial care should be provided particularly to spouses with lower education levels and chronic conditions and those acting as primary caregivers.

Effects of behavioural activation on psychological distress among people with cancer: A systematic review and meta-analysis

BACKGROUND

Cancer is a life-threatening disease that can have a significant impact on patients' psychological well-being. Behavioural activation is an emerging psychological therapy that has been suggested effective in improving depression and anxiety. However, no review has yet summarised its effects on psychological distress among people with cancer.

OBJECTIVE

To identify studies of behavioural activation designed for people with cancer and examine the effects on psychological distress, including depression and anxiety.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search of PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library was performed from the inception to 6 April 2024. Randomised controlled trials reporting on the effects of behavioural activation on psychological distress among cancer patients were included. Two authors independently screened the eligible studies, assessed the quality of studies, and extracted data. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). The meta-analysis was performed by Review Manager 5.4, and narrative synthesis was employed when the meta-analysis was inappropriate. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the certainty of the evidence.

RESULTS

A total of nine studies were included in this systematic review, with 1811 participants. The pooled analysis showed that behavioural activation could improve depression (SMD = -0.24, 95 % CI -0.44 - -0.03, p = 0.020; moderate quality of evidence), and anxiety (SMD = -0.56, 95 % CI -1.01 - -0.10, p = 0.020; low quality of evidence) among people with cancer. The effects were robust in sensitivity analysis and yielded consistent results in studies that were not pooled due to insufficient data. Subgroup analyses suggested that face-to-face and group administration were more effective, whereas the effects of different dosages were uncertain. Besides, the effects of behavioural activation at different follow-up periods were not identified There was no consensus on the optimal components of intervention.

CONCLUSIONS

The evidence for behavioural activation as an effective treatment of psychological distress among people with cancer is promising. However, it should be noted that the quality of evidence was moderate and low, thus emphasising the need for caution when applying these findings. In order to explore which components may be most effective in improving psychological outcomes, more rigorous study designs and more detailed descriptions of interventions are necessary.

REGISTRATION

The protocol was registered on PROSPERO (Registration number: CRD42024533171).

Multimorbidity and Its Impact in Older U.S. Veterans Newly Treated for Advanced Non-Small Cell Lung Cancer

Rationale: Older adults make up the majority of patients with advanced non-small cell lung cancer (NSCLC) and often carry multiple other comorbidities (multimorbidity) when initiating treatment. The nature and impact of multimorbidity remain largely unknown, given the limitations of standard count-based comorbidity indices in aging patients and their exclusion from clinical trials. Objectives: Our objective is to identify and define multimorbidity patterns in older U.S. veterans newly treated for advanced NSCLC in the national Veterans Affairs healthcare system between 2002 to 2020, and whether they are associated with mortality and healthcare use. Methods: We measured 63 chronic conditions in 10,160 veterans aged ⩾65 years newly treated for NSCLC in the national Veterans Affairs healthcare system from 2002 to 2020. Latent class analysis was used to identify patterns of multimorbidity among these conditions, with final patterns determined on the basis of model fit and clinical meaningfulness. Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate the association of multimorbidity patterns with overall survival (primary outcome) and with emergency department visits and unplanned hospitalizations (secondary outcomes). Results: Five multimorbidity patterns arose from the latent class analysis, with overall survival varying across patterns (log-rank two-sided P < 0.001). Veterans with metabolic diseases (24.7% of all patients; hazard ratio [HR] [95% confidence interval (CI)], 1.10 [1.04-1.16]), psychiatric and substance use disorders (16.0%; HR [95% CI], 1.17 [1.10-1.24]), cardiovascular disease (14.4%; HR [95% CI], 1.22 [1.15-1.30]), and multisystem impairment (10.7%; HR [95% CI], 1.36 [1.26-1.46]) had a higher hazard of death than veterans with common conditions of aging beyond their NSCLC (34.2%, reference), controlling for age, sex, race, days between diagnosis and treatment, date of diagnosis, and NSCLC stage and histology. Associations held after adjusting for the count-based Charlson comorbidity index. Multimorbidity patterns were also independently associated with emergency department visits and unplanned hospitalizations. Conclusions: Our findings reveal that the numerous chronic conditions present in older veterans with late-stage NSCLC cluster together into distinct multimorbidity patterns; the nature of conditions in these patterns carries value beyond their number.

Combating chemoresistance: Current approaches & nanocarrier mediated targeted delivery

Chemoresistance, a significant challenge in effective cancer treatment needs clear elucidation of the underlying molecular mechanism for the development of novel therapeutic strategies. Alterations in transporter pumps, oncogenes, tumour suppressor genes, mitochondrial function, DNA repair processes, autophagy, epithelial-mesenchymal transition (EMT), cancer stemness, epigenetic modifications, and exosome secretion lead to chemoresistance. Despite notable advancements in targeted cancer therapies employing both small molecules and macromolecules success rates remain suboptimal due to adverse effects like drug efflux, target mutation, increased mortality of normal cells, defective apoptosis, etc. This review proposes an advanced nanotechnological technique precisely targeting molecular determinants of chemoresistance which holds promise for enhancing cancer treatment efficacy. Further, the review explores various cancer hallmarks and pathways implicated in chemoresistance, current therapeutic modalities, and their limitations. It advocates the combination of nanoparticle-conjugated conventional drugs and natural compounds to specifically target molecular pathways that can potentially reverse or minimize chemoresistance incidences in cancer patients.

Transition and Aftercare Following a Child's Discharge From ICU to a General Ward: A Qualitative Meta-Synthesis of Parental Experiences

BACKGROUND

Transitions from the intensive care unit (ICU) to the general ward cause great impairment of physical and psychosocial functioning in children and their parents. Better understanding of parental experiences during children's ICU-to-ward transitions is required to inform the development of ICU transitional care.

AIM

To examine the parental experiences during their children's ICU-to-ward transitions through the synthesis of original qualitative studies.

DESIGN

This study follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statements, uses Thomas and Harden's thematic synthesis framework rooted in a critical realist philosophy to present qualitative meta-synthesis.

DATA SOURCES

We conducted a systematic review in June 2024 and searched nine electronic databases including Pubmed, Embase, CINAHL, PsycINFO, Cochrane Library, Sinomed, CNKI, Wanfang and VIP. Eligible studies contained parents quotes about their children's ICU-to-ward transitions and published in either English or Chinese since 2005.

METHODS

Systematic searches yielded 2825 identified studies. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion with a third reviewer. Eighteen studies were finally agreed for inclusion. Data were extracted into a Microsoft Excel spreadsheet and synthesised through line-by-line coding of relevant quotes with the help of NVivo.

RESULTS

The qualitative synthesis resulted in four descriptive themes followed later by two analytical themes. Specifically, these were (1) the nature of the parental experience during ICU-to-ward transition (challenging but responded proactively) and (2) factors involved in the ICU-to-ward transition (both facilitators and barriers).

CONCLUSIONS

This study indicates the nature of parental experiences and factors involved during the critically ill child's ICU-to-ward transition. Healthcare providers serve as the primary support network for parents and should collaborate closely with them to facilitate a smooth transition by providing tailored support.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a meta-synthesis of previously published qualitative studies.

TRIAL REGISTRATION

We have registered in the PROSPERO and the number is CRD42023422055.

Immune checkpoint expression and therapeutic implications in IDH1-mutant and wild-type glioblastomas

Programmed cell death protein 1 (PDCD1) and cluster of differentiation 274 (CD274) expression is implicated in escaping tumors from immune surveillance. Immune checkpoint inhibitors show promise in cancer therapy, yet their efficacy in glioblastomas, particularly with IDH1 mutations, remains unclear. This study analyzed two independent NGS datasets (n = 577 and n = 153) from TCGA to investigate the expression of PDCD1 and CD274 in glioblastomas and their relationship with IDH1 mutations. We used cBioPortal for mutation analysis, RNA seq for expression analysis, miRDB and miRabel for differential expression of miRNAs, and Kaplan-Meier for survival prediction. We found that 5.4% of glioblastomas harbored IDH1 mutations, correlating with improved overall survival (OS) (p = 2.196e-3). Different glioblastoma cohorts showed a diverse IDH1 mutational prevalence (4-31%). Despite this, IDH1Mu was consistently associated with better OS (p = 8.235e-5). Notably, PDCD1 and CD274 were statistically significantly highly expressed in both IDH1Wt (p < 0.0001) and IDH1Mu tumors (p < 0.0001), with higher expression linked to poorer survival outcomes (PDCD1: p = 0.009; CD274: p = 0.02). Differential co-expression analyses revealed distinct gene and miRNA profiles for IDH1Wt and IDH1Mu glioblastomas, with specific upregulation of PTEN and downregulation of MUC16 in IDH1Wt, and upregulation of PIK3R1 in IDH1Mu. Additionally, PIK3R1 and ITGB2 emerged as critical druggable targets. Our findings indicate that PDCD1 and CD274 are highly expressed irrespective of IDH1 mutation statuses, suggesting that glioblastomas could benefit from immunotherapy. Moreover, IDH1Mu glioblastomas may require a combination of PI3K/AKT/mTOR inhibitors and immunotherapy due to PIK3R1 overexpression.

Pre-Treatment Perceived Social Support Is Associated With Chemotherapy-Induced Peripheral Neuropathy in Patients With Breast Cancer: A Longitudinal Study

OBJECTIVE

Previous studies have reported an association between cancer-related symptoms and perceived social support (PSS). The objective of this study was to analyze whether Chemotherapy-Induced Peripheral Neuropathy (CIPN), a prevalent side effect of chemotherapy, varies according to PSS level using a validated tool for CIPN at prospective follow-up.

METHODS

A total of 39 breast cancer patients were evaluated for PSS using the Multidimensional Scale of Perceived Social Support (MSPSS) prior to chemotherapy and were subsequently grouped into one of two categories for each subscale: low-to-moderate PSS and high PSS. CIPN was prospectively evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 (CIPN20) at five time points. A linear mixed-effects model with square root transformation was employed to investigate whether the CIPN20 scales varied by PSS level and time point.

RESULTS

Statistical analysis of the MSPSS total scale and subscales revealed a significant effect of the friends subscale group and time point on the CIPN20 sensory scale. The sensory scale score of CIPN20 was found to be lower in participants with high PSS from friends in comparison to those with low-to-moderate PSS at 1 month post-chemotherapy (p=0.010).

CONCLUSION

This is the first study to prospectively follow the long-term effect of pre-treatment PSS from friends on CIPN. Further studies based on larger samples are required to analyze the effects of PSS on the pathophysiology of CIPN.

Effects and Safety of Press-Needle Therapy for Improving Visual Function and Eye Blood Circulation in Patients With Glaucoma With Controlled Intraocular Pressure: Study Protocol for a Multicenter Randomized Controlled Trial

BACKGROUND

Glaucoma is the leading cause of irreversible blindness worldwide, causing continuous and progressively worsening damage to visual function, which leads to vision loss. Optic nerve protection is an important treatment for glaucoma with controlled intraocular pressure (GPCI), but to date, there is no universally accepted effective optic nerve protection agent. Acupuncture can protect the optic nerve by increasing blood flow to the eye. However, fear of pain or the limitations of treatment place and time lead to poor patient compliance. Press-needle therapy is a characteristic of traditional Chinese medicine (TCM) external treatment methods; its safety is high, the effect is fast and lasting, it is easy to conduct, and it has high patient compliance.

OBJECTIVE

The objective of the trial is to evaluate the safety and clinical efficacy of press-needle therapy and investigate whether it can improve visual function by regulating eye blood circulation in patients with GPCI.

METHODS

In total, 192 participants aged 18-75 years with GPCI from the Mianyang Central Hospital, the Mianyang Hospital of Traditional Chinese Medicine, and the Mianyang Wanjiang Eye Hospital will participate in this study. Participants will be allocated to 2 treatment groups (experimental and control groups) in a ratio of 1:1 and will undergo press-needle therapy and sham press-needle therapy, respectively, for the same 4-week period. Primary outcomes will include the best-corrected visual acuity (BCVA), optical coherence tomography angiography (OCTA), color Doppler flow imaging (CDFI), and visual field assessment results. Secondary outcomes will include the intraocular pressure (IOP) and traditional Chinese medicine (TCM) clinical symptom scales. The primary outcomes and safety assessments will be measured at baseline and 4 weeks thereafter, while the secondary outcomes will be measured at baseline and 1, 2, 3, and 4 weeks thereafter.

RESULTS

Recruitment and data collection began in February 2023. The final outcomes are expected in September 2025. As of October 2024, the project had recruited 220 eligible participants, of whom 192 (87.3%) will complete the study, exceeding initial projections for the study time frame. The remainder of the participants will provide the ability to explore cross-level interactions that could not be statistically powered at the outset. The strengths of the project include rigorous data collection, good retention rates, and high compliance rates.

CONCLUSIONS

This study will provide data on the effects of press-needle therapy on visual function and ocular circulation in patients with GPCI, and these results will help demonstrate whether acupuncture can improve patients' visual function by regulating ocular circulation, thus providing a clinical and theoretical basis for the wider application of acupuncture therapy in GPCI.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300067862；https://tinyurl.com/mrxd58x9.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/67737.

Effects of Virtual Reality on Preoperative Anxiety in Adult Patients: An Updated Meta-analysis

PURPOSE

To determine the effectiveness of virtual reality (VR) on preoperative anxiety in adult patients.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

METHODS

A systematic search was carried out using PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chinese Science and Technology Periodical Database (VIP), and Sino-Med from inception to December 18, 2022. All eligible randomized controlled trials published were included (published in English and Chinese). The Cochrane Collaboration "Risk of Bias" tool was used to assess the methodological quality of the included studies. Review Manager software 5.4 was used for data analysis.

FINDINGS

Nine studies with sample sizes ranging from 72 to 255 and 1,046 participants were identified. The results of the meta-analysis showed that VR significantly reduced preoperative anxiety in adults (standardized mean difference = -0.48, 95% CI: -0.93 to -0.03, P = .04). Our results suggested that VR improved postoperative satisfaction scores more effectively compared with control care (mean difference = 15.29, 95% CI: 6.25 to 24.33, P = .0009).

CONCLUSIONS

Study results support that VR has a positive effect in reducing preoperative anxiety in adults. VR can also significantly improve patients' satisfaction after surgery. However, the results need to be further assessed due to the small sample sizes and high heterogeneity.

Using network analysis to elucidate the relationships among support systems, trauma and depressive symptoms, self-silencing, and risk of HIV viral non-suppression among black women living with HIV

Human immunodeficiency virus (HIV) remains a major public health issue in the United States (US) and Black women living with HIV (BWLWH) are disproportionately impacted among women. This study investigates the complexities in influences of family, friend, and special person support systems and their association with post-traumatic stress disorder symptoms (PTSD), depressive symptoms, gendered coping (self-silencing), and a composite HIV risk score related to risk of viral non-suppression through missed medical visits, low medication adherence, and high viral load. Cross-sectional data among BWLWH were analyzed using network analyses via RStudio. Data from 119 BWLWH was reduced to 104, because of missing data on indicators as well as pairwise deletion for the correlation function. Findings revealed variances based on the type of network. For composite risk scores, friend support source had a weak to moderate significant correlation, while symptoms of PTSD and depression only showed a weak positive correlation with the composite risk variable through self-silencing as a form of coping. The post-hoc analysis showed a strong correlation with care as self-sacrifice, based on the composite risk score. Based on the findings from this study, insight was given into symptoms for depression and PTSD, as well as self-silencing and viral non-suppression risk in relation to sources of support for BWLWH. Future interventions to improve the overall health of BWLWH may benefit from incorporating support from friends and lowering care as self-sacrifice.

The Effect of Palliative Spiritual Care Education on Nursing Students' Perception of Spiritual Care and Attitudes towards Death in Turkey: A Quasi-Experimental Study

The aim of this study was to assess nursing students' perceptions of spiritual care, their attitudes toward death, and the impact of a palliative spiritual care course on these perceptions and attitudes. This study employed a quasi-experimental design with a pre-test/post-test structure and two groups. Data were collected through the Spirituality and Spiritual Care Rating Scale and Death Attitude Profile-Revised. The study group consisted of 106 students experimental (n = 53) and control group (n = 53), who took the public health nursing course in the 2021-2022 academic year. There was a significant difference between the mean scores on the Spirituality and Spiritual Care Rating Scale, as well as the Death Attitude Profile-Revised, between the control group students and the experimental group students. The importance of spirituality and spiritual care should be emphasized in course content and internships by integrating relevant topics into the nursing curriculum and creating more training opportunities to help nurses develop skills for caring for dying patients and their families in palliative care units.

Psychometric Properties of the Self Care Oral Anticancer Agents Index (SCOAAI)

OBJECTIVE

To test the Self-Care Oral Anticancer Agents Index (SCOAAI)'s psychometric properties (structural validity, convergent validity, predictive validity, and internal consistency) in a sample of patients with solid tumour on Oral anticancer agents (OAA).

METHODS

A methodological research in five in- or out-patient Italian facilities. Structural validity was tested by confirmatory factor analysis, and internal consistency was assessed through Cronbach's alpha and composite reliability. The Mann-Whitney U-test was used to test associations between SCOAAI scores and patient's emergency room admission, re-hospitalization, mortality, and quality of life measured three months after baseline.

RESULTS

We enrolled 356 patients; mostly were male (52.24%), and mean age was 59.10 years. Analyses demonstrated the SCOAAI's factorial validity and internal consistency. Moreover, patients that experienced emergency room admissions (U = 3484.5; P = .002) and re-hospitalization (U = 2446.0; P = .001) showed lower self-care maintenance scores; those who experienced emergency room admission (U = 3263.5; P = .019) and died at follow-up (U = 700.5; P = .025) had lower self-care monitoring scores; while patients that experienced re-hospitalisation (U = 2931.5; P = .040) and emergency room admission (U = 3285.0; P = .012) had lower self-care management scores. Patients with adequate self-care (≥ 70) reported significantly higher quality of life (self-care maintenance U = 1228.500, P < .001; self-care monitoring U = 3512.500, P < .001; self-care management U = 3287.500, P < .001).

CONCLUSION

According to our findings the SCOAAI is a valid and reliable tool. Patients with inadequate self-care can experience more emergency room accesses, re-hospitalization, death, and lower quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Adequate self-care behaviors can improve patient's outcomes and should be assessed by healthcare providers during the disease pathway.

Exploratory analysis of the professional quality of life in an Italian radiotherapy department: The role of empathy and alexithymia

PURPOSE

Professional quality of life (QoL) is crucial for healthcare workers as it affects performance at work and interaction with patients, but little is known about stressors influencing radiation oncology professionals. The present study aims to explore the professional QoL of radiation oncologists (ROs) and radiation therapists (RTTs) in an Italian radiotherapy department and to report data about the possible impact of personality factors, such as alexithymia and empathy.

MATERIAL AND METHODS

Participants filled out three validated questionnaires measuring the professional QoL, alexithymia, and empathy: (i) Professional Quality of Life Scale (ProQOL); (ii) Toronto Alexithymia Scale (TAS-20); (iii) Interpersonal Reactivity Index (IRI). Correlation, regression analyses and non-parametric tests were run.

RESULTS

A total of 48 professionals completed the survey (66.7% ROs, 33.3% RTTs). Considering the ProQOL dimensions, moderate levels of risk for burnout (BO) and secondary traumatic stress (STS) were found. BO was found to be predictive by TAS-20 total score (β=.37, p=.010), while STS resulted to be predictive by TAS-20 total score (β=.54, p <.001) and IRI Empathic Concern subscale (β=.45, p <.001). No significant differences were found between ROs and RTTs for all the considered variables, except for TAS-20 total score (p=.032), higher for RTTs.

CONCLUSIONS

Results showed no evidence of high risk of burnout and no intrinsic differences regarding the professional QoL between ROs and RTTs. Findings suggest a significant role of alexithymia and empathy predicting professional QoL. These results underscore the importance of promoting a positive work environment and emotional competencies to prevent high stress levels.

Trauma, PTSD, and Self-Efficacy: Predictors of Cervical Cancer Screening in Sexual Violence Survivors

Sexual violence is highly prevalent in the United States and is associated with a host of negative physical and mental health outcomes. Specifically, sexual violence is associated with increased rates of cervical cancer, one of the most common cancers found in women. Furthermore, sexual violence survivors report reduced participation in preventive healthcare behaviors (e.g., Pap tests) which may reduce individuals' risk of developing reproductive health conditions such as cancer. Sexual violence exposure is also associated with increased symptoms of posttraumatic stress disorder (PTSD) and reduced trauma-coping self-efficacy (TCSE), two factors that may impact trauma-exposed individuals' level of avoidance of cervical cancer screens. Current research on the connection between sexual violence and reproductive healthcare often fails to examine potential underlying mechanisms behind this association, nor does it account for confounding factors such as healthcare accessibility and need. Accordingly, the present study tested a proposed moderated mediation model to explore the association between sexual violence and cervical cancer screening participation, including analysis of the indirect effect of TCSE and potential moderation of this effect by PTSD symptoms. Participants were 554 participants who reported experiences of sexual violence on Amazon's Mechanical Turk. Severity of sexual violence was significantly associated with reduced likelihood of participation in recommended cervical cancer screening. TCSE did not mediate nor did PTSD moderate this association. Findings of this study suggest that individuals' reproductive healthcare behaviors are influenced by their experiences of sexual trauma, as well as by structural factors such as insurance and income. Limitations, directions for future research, and clinical implications of study findings are discussed.

Obstacles to Compliance and Implementation of ERAS Protocol From Nursing Perspective: A Qualitative Study

PURPOSE

Enhanced Recovery After Surgery (ERAS) is a concept that covers evidence-based practices and requires multidisciplinary teamwork, and nurses play a key role in this team. This qualitative research is conducted to describe the experiences of nurses implementing ERAS and the obstacles they encounter in practice.

DESIGN

This research was conducted using the phenomenology pattern, one of the qualitative research designs.

METHODS

The research study group was determined by criterion sampling, one of the purposeful sampling methods.The criterion for participation in this study is to follow at least one of the steps of the ERAS protocol and volunteer to participate in the study. In this context, 12 nurses who met the inclusion criteria participated in the study. Data were obtained from May 1 to May 31, 2023 using an introductory information form and a semistructured interview form. The introductory information form asked questions such as age, gender, marital status, working year, ERAS application time, and total working year. The semistructured interview form, developed by the authors based on the related literature, consisted of four open-ended questions 1The obtained data were analyzed using the seven-step Colaizzi method.

FINDINGS

The study identified three themes: the importance of the ERAS protocol, the obstacles to the ERAS protocol, compliance with the ERAS protocol and applicability. Nine subthemes were found: reducing complications and accelerating the healing process, increasing the level of satisfaction, lack of knowledge, leader confusion, resistance to change, lack of team cooperation, policy, leadership, and education.

CONCLUSIONS

This study revealed the experiences of nurses who implement at least one component of ERAS protocols regarding the obstacles to the implementation of the protocol. As a result, nurses stated that lack of information and team cooperation, leader complexity, and resistance to change were obstacles to the protocol. Identifying the obstacles encountered in the implementation of the protocols is important for producing solution suggestions.

Journey of touching death, nursing undergraduates' experiences in the simulated death graded exposure Programme: A qualitative descriptive study in China

BACKGROUND

Nursing undergraduates receive inadequate training in death and end-of-life care within the education system, resulting in feelings of unpreparedness and inadequacy when confronted with their first death event in clinical practice, as well as a low willingness to engage in end-of-life care.

OBJECTIVE

To explore the cognitive and emotional experiences of nursing undergraduate students participating in the simulated death graded exposure programme, and to evaluate the educational significance of the programme.

DESIGN

A qualitative descriptive study design.

SETTING

A comprehensive university in Jiangsu Province, China.

PARTICIPANTS

In October 2023, twenty-eight (age range, 19-21 years; 21 [75 %] female;) first-year nursing undergraduates were recruited to participate in the simulated death graded exposure programme.

METHODS

The research team developed and implemented a systematic simulated death graded exposure programme, consisting of four parts: end-of-life farewell role-playing, simulated funeral experience, post-simulation recovery and death reflection. Semi-structured interviews were conducted after the experience, and the interview data were analysed using content analysis.

RESULTS

The nursing students' experiences in the simulated death graded exposure programme could be divided into three phases through a longitudinal process: approaching death (dying), immersing in the world of death (death), and initiating the transformation of life's meaning (rebirth). In the first phase, participants felt integrated into the simulated roles, experienced the complex emotions of approaching death, and ultimately accepted the declaration of death. In the second phase, participants experienced a highly realistic simulation of death, guiding physical symptoms and emotional reactions. Additionally, their awareness of death began to awaken and disperse, leading to profound reflections on death. In the third phase, participants engaged in a process of self-examination which culminated in a self-proclaimed healing process from the experience of the simulated death. Through deep reflection, they were reacquainted with their values and professional mission.

CONCLUSIONS

The simulated death graded exposure programme enhances nursing students' psychological preparedness and emotional adjustment helping to prepare them for experiencing death in a clinical context, and deepens their understanding of life and death. This programme provides a practical example of nursing professionals' training and education in end-of-life care.

Therapeutic Efficacy and Factors Associated With Acceptance of a Newly Developed Compression Garment in Patients With Lower-Extremity Edema

Background The principle of edema treatment is compression therapy. We recently reported the development of a new compression garment designed to maintain a high pressure that is affected only to a small extent by changes in posture. In this study, we measured the pressure on this new product in patients with edema and conducted a questionnaire survey to assess its acceptability. Methods This is a retrospective observational study that uses existing data from healthy participants as a comparison. We investigated the effect of posture and movement on pressure when wearing the new product in six patients, compared the results with previous data from healthy participants, and statistically analyzed them. In addition, we administered a questionnaire survey on pressure, slipperiness, ease of wearing, and texture. Results Similar to the results in healthy participants, the effects of posture and movement were not observed in patients with edema. In contrast, the pressure was significantly lower than that in healthy individuals in the standing, dorsiflexion of the ankle joint, flexion of the toes, and tiptoe positions. The questionnaire suggested that there were issues with the ease of putting on and taking off and that there was a possibility of a discrepancy between the pressure actually measured and the pressure experienced by the participant. Conclusion In patients with edema, there are differences in the effects of posture and movement on the measured pressure compared to healthy individuals, which is thought to be due to excess extracellular fluid. However, the required pressure value was achieved, and this new garment could be a possible therapeutic approach with a higher therapeutic effect. The questionnaire results showed some cases in which there was a discrepancy between the patient's evaluation and the actual measurement values, suggesting the need for a quantitative and objective evaluation.

The Effect of Nonpharmacological Methods on Preoperative Anxiety in Breast Surgery Patients: A Meta-analysis

PURPOSE

To investigate the effect of nonpharmacological methods on anxiety before breast surgery, using the meta-analysis method.

DESIGN

A meta-analysis.

METHODS

Nine electronic databases were searched to identify studies published up to October 2023. The study was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses 2020 and Cochrane 2021 recommendations. The Risk of Bias 2 tool was used to assess the risk of bias. Heterogeneity and publication bias were also assessed.

FINDINGS

A search of 9 electronic databases identified 280 records. Six studies that met the inclusion criteria were eligible for meta-analysis. All the trials explained how the randomization was done. The studies selected were published between 2016 and 2022. A total of 519 female patients were included in the selected trials, 303 in the intervention group and 216 in the control group. The studies included aromatherapy, music, electro-acupuncture, and Yokukansan Kampo medicine practices. A meta-analysis was performed with anxiety levels measured immediately before surgery. In addition, a subgroup analysis was performed with trials that used anxiety-specific scales before surgery and trials that used aromatherapy.

CONCLUSIONS

The results of this meta-analysis indicated a moderate efficacy of nonpharmacological approaches, whereas aromatherapy showed a relatively lower efficacy in reducing preoperative anxiety in breast surgery patients.

Global prevalence of falls among older adults with cancer: A systematic review and meta-analysis

INTRODUCTION

Falls are a significant health concern among older adults, particularly those with cancer, due to aging-related frailty, treatment-related adverse effects, and comorbidities. Existing reviews have highlighted the burden of falls in this population; however, the absence of a comprehensive meta-analysis to synthesize pooled results from relevant studies has limited the generalizability of their findings. This systematic review and meta-analysis aimed to estimate the global prevalence of falls among older adults with cancer and provide evidence to guide prevention efforts.

MATERIALS AND METHODS

A systematic search of PubMed, Embase, and Web of Science databases was conducted through October 2024, following PRISMA 2020 guidelines. Studies reporting fall prevalence in patients with cancer aged 65 years or older were included. Pooled prevalence estimates were calculated using a random-effects meta-analysis.

RESULTS

Seventy-six studies, including 177,212 participants, met the inclusion criteria. The pooled prevalence of falls was 24 % (95 % confidence interval [CI], 20; 28), with significant heterogeneity (I2 = 100 %). Fall prevalence increased with follow-up duration: short-term 12 % (95 % CI, 5.2; 28.4), medium-term 23 % (95 % CI, 18.9; 29.5), and long-term 54 % (95 % CI, 14.9; 89.1) studies (p = 0.13). Older adults with breast cancer had the highest prevalence of falls at 31 % (95 % CI, 17; 48), while patients with colorectal cancer had the lowest at 15 % (95 % CI, 1; 78) (P ≤0.001). Fall prevalence ranged from 19 % in Australia to 24 % in North America (p = 0.89).

DISCUSSION

Falls are frequent among older adults with cancer, with prevalence varying by cancer type, geographic region, and follow-up duration.

Prognostic impact of preoperative cachexia in patients undergoing major hepatopancreatobiliary surgery for malignancy

BACKGROUND & AIMS

Data regarding the association between cachexia and clinical outcomes in hepatopancreatobiliary (HPB) malignancies are limited. This retrospective study sought to investigate the prognostic significance of preoperative cachexia in patients undergoing major HPB surgery for malignancies.

METHODS

Data from patients, who underwent major open surgery for HPB malignancies between March 2014 and December 2018, were retrospectively reviewed. Cachexia was evaluated a few days before surgery, and defined according to modified Asian Working Group for Cachexia criteria: low body mass index (<21 kg/m2) and decreased handgrip strength (<28 kg [males] and <18 kg [females]) or elevated C-reactive protein level (>0.5 mg/dL). The primary endpoint was postoperative overall survival (OS); secondary endpoints included disease-free survival (DFS) and postoperative complications.

RESULTS

Of 332 patients (228 male; mean age, 68.8 ± 10.3 years), 93 (28 %) had preoperative cachexia. There were 154 (46 %) deaths and 181 (55 %) combined events (death or recurrence) during a five-year follow-up (mean, 3.3 ± 1.7 years), with no significant differences in major postoperative complications between the 2 groups (P = 0.329). After adjusting for covariates, cachexia (n = 93) exhibited significant associations with shorter OS (adjusted hazard ratio [HR] 1.65 [95 % confidence interval (CI) 1.18-2.30]; P = 0.004) and DFS (adjusted HR 1.39 [95 % CI 1.01-1.91; P = 0.043) compared with non-cachexia (n = 239). Cachexia significantly shortened OS only in a subset with pathological stage ≤ II disease (adjusted HR 2.45 [95 % CI 1.27-4.74]; P = 0.008) but not otherwise (P for interaction, 0.040).

CONCLUSIONS

Preoperative cachexia did not affect short-term surgical complications but significantly deteriorated postoperative prognosis in patients who underwent surgery for HPB malignancies.