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Influence of Self-Practice Oriented Teaching plus Psychological Intervention on Blood Glucose Level and Psychological State in Patients with Type 2 Diabetes Mellitus on Insulin Therapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5606697. [PMID: 35978998 PMCID: PMC9377873 DOI: 10.1155/2022/5606697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Background. The study aimed to examine the effect of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological status of type 2 diabetic patients on first insulin therapy. Methods. A total of 80 patients with type 2 diabetes admitted from April 2020 to November 2020 were assessed for eligibility and included. They were then assigned to a control group and an observation group via the random number table method, with 40 cases in each group. In addition to insulin injection treatment in both groups prior to intervention, the control group received health education and psychological intervention, whereas the observation group adopted a self-practice oriented teaching strategy plus psychological intervention. Insulin injections, nursing satisfaction, blood glucose level, and disease awareness were compared between the two groups. The Exercise of Self-Care Agency (ESCA) scale was used to assess the patients’ self-care ability, the Generic Quality of Life Inventory-74 (GQOLI-74) scale was used to assess their quality of life, and the emotional state of patients was evaluated by the Hospital Anxiety and Depression (HAD) scale. Results. Patients in the observation group outperformed the control group in terms of insulin injection after intervention (
). Significantly higher nursing satisfaction and ESCA scores were observed after intervention (
). Self-practice oriented teaching plus psychological intervention resulted in remarkably lower postintervention glycemic indexes (
). Markedly higher disease knowledge scores and GQOLI-74 scores were witnessed in the observation group in contrast to those of the control group (
). The observation group patients showed lower HAD scores than those of the control group (
). Conclusion. Self-practice oriented teaching plus psychological intervention could effectively alleviate the negative emotions of type 2 diabetic patients on first insulin therapy, stabilize glycemic indexes, and improve quality of life, demonstrating good potential for clinical promotion.
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Predictors of emotional distress in uveal melanoma survivors: a systematic review. Eye (Lond) 2022; 37:907-924. [PMID: 35941183 PMCID: PMC10049992 DOI: 10.1038/s41433-022-02193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Uveal melanoma (UM) survivors can experience significant emotional distress, although the factors underpinning this are poorly understood. Systematic reviews of distress in UM only include cross-sectional studies, thereby limiting our understanding of causal factors. This review identified prospective clinical, demographic, social and psychological predictors of distress in UM survivors. A systematic search of the literature for English language prospective studies was conducted. Thirteen papers, reporting data from seven unique datasets were included in a narrative synthesis of the results. Younger age (3 studies from 3 datasets), physical health (including visual impairment, ocular symptoms, and other UM-related factors; 3 studies from 3 datasets), and psychological factors (mainly baseline distress; 3 studies from 3 datasets and worry about recurrence; 2 studies from 2 datasets), significantly predicted distress. There was no consistent evidence for other demographic, clinical or social variables (significant in <50% of datasets). Generally, the quality of the papers was adequate. However, attrition rates were high or not reported in over half of the included studies. The findings of this review emphasise the importance of attempts to prevent and recognise distress immediately post-diagnosis of UM. Particular focus should be given to younger patients, those with physical and psychological health difficulties at the time of diagnosis, and those who develop adverse treatment symptoms during survivorship. More research into potential social and psychological variables and their role in predicting distress in survivors is recommended.
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Beasley AB, Chen FK, Isaacs TW, Gray ES. Future perspectives of uveal melanoma blood based biomarkers. Br J Cancer 2022; 126:1511-1528. [PMID: 35190695 PMCID: PMC9130512 DOI: 10.1038/s41416-022-01723-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 01/06/2023] Open
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy affecting adults. Despite successful local treatment of the primary tumour, metastatic disease develops in up to 50% of patients. Metastatic UM carries a particularly poor prognosis, with no effective therapeutic option available to date. Genetic studies of UM have demonstrated that cytogenetic features, including gene expression, somatic copy number alterations and specific gene mutations can allow more accurate assessment of metastatic risk. Pre-emptive therapies to avert metastasis are being tested in clinical trials in patients with high-risk UM. However, current prognostic methods require an intraocular tumour biopsy, which is a highly invasive procedure carrying a risk of vision-threatening complications and is limited by sampling variability. Recently, a new diagnostic concept known as "liquid biopsy" has emerged, heralding a substantial potential for minimally invasive genetic characterisation of tumours. Here, we examine the current evidence supporting the potential of blood circulating tumour cells (CTCs), circulating tumour DNA (ctDNA), microRNA (miRNA) and exosomes as biomarkers for UM. In particular, we discuss the potential of these biomarkers to aid clinical decision making throughout the management of UM patients.
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Affiliation(s)
- Aaron B Beasley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia
- Department of Ophthalmology, Perth Children's Hospital, Perth, WA, Australia
| | - Timothy W Isaacs
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia
- Perth Retina, West Leederville, WA, Australia
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia.
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Brown SL, Fisher PL, Morgan A, Davies C, Olabi Y, Hope-Stone L, Heimann H, Hussain R, Cherry MG. 'I Don't Like Uncertainty, I Like to Know': How and why uveal melanoma patients consent to life expectancy prognostication. Health Expect 2022; 25:1498-1507. [PMID: 35474381 PMCID: PMC9327814 DOI: 10.1111/hex.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Technological advances have led to cancer prognostication that is increasingly accurate but often unalterable. However, a reliable prognosis of limited life expectancy can cause psychological distress. People should carefully consider offers of prognostication, but little is known about how and why they decide on prognostication. Using uveal melanoma (UM) patients, we aimed to identify (i) how and why do people with UM decide to accept prognostication and (ii) alignment and divergence of their decision-making from conceptualizations of a 'well-considered' decision. METHODS UM provides a paradigm to elucidate clinical and ethical perspectives on prognostication, because prognostication is reliable but prognoses are largely nonameliorable. We used qualitative methods to examine how and why 20 UM people with UM chose prognostication. We compared findings to a template of 'well-considered' decision-making, where 'well-considered' decisions involve consideration of all likely outcomes. RESULTS Participants wanted prognostication to reduce future worry about uncertain life expectancy. They spontaneously spoke of hoping for a good prognosis when making their decisions, but largely did not consider the 50% possibility of a poor prognosis. When pressed, they argued that a poor outcome at least brings certainty. CONCLUSIONS While respecting decisions as valid expressions of participants' wishes, we are concerned that they did not explicitly consider the realistic possibility of a poor outcome and how this would affect them. Thus, it is difficult to see their decisions as 'well-considered'. We propose that nondirective preference exploration techniques could help people to consider the possibility of a poor outcome. PATIENT OR PUBLIC CONTRIBUTION This paper is a direct response to a patient-identified and defined problem that arose in therapeutic and conversational discourse. The research was informed by the responses of patient participants, as we used the material from interviews to dynamically shape the interview guide. Thus, participants' ideas drove the analysis and shaped the interviews to come.
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Affiliation(s)
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Morgan
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Cari Davies
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Yasmin Olabi
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Laura Hope-Stone
- School of Psychology, University of Plymouth, Plymouth, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heinrich Heimann
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Brown SL, Fisher PL, Hope-Stone L, Heimann H, Hussain R, Cherry MG. Prediction of all-cause mortality from 24 month trajectories in patient-reported psychological, clinical and quality of life outcomes in uveal melanoma patients. J Behav Med 2021; 45:115-123. [PMID: 34453274 PMCID: PMC8818627 DOI: 10.1007/s10865-021-00252-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022]
Abstract
A number of patient-reported outcomes (PROs) predict increased mortality after primary cancer treatment. Studies, though, are sometimes affected by methodological limitations. They often use control variables that poorly predict life expectancy, examine only one or two PROs thus not controlling potential confounding by unmeasured PROs, and observe PROs at only a single point in time. To predict all-cause mortality, this study used control variables affording good estimates of life expectancy, conducted multivariate analyses of multiple PROs to identify independent predictors, and monitored PROs two years after diagnosis. We recruited a consecutive sample of 824 patients with uveal melanoma between April 2008 and December 2014. PROs were variables shown to predict mortality in previous studies; anxiety, depression, visual and ocular symptoms, visual function impairment, worry about cancer recurrence, and physical, emotional, social and functional quality of life (QoL), measured 6, 12 and 24 months after diagnosis. We conducted Cox regression analyses with a census date of December 2018. Covariates were age, gender, marital and employment status, self-reported co-morbidities, tumor diameter and thickness, treatment modality and chromosome 3 mutation status, the latter a genetic mutation strongly associated with mortality. Single predictor analyses (with covariates), showed 6-month depression and poorer functional QoL predicting mortality, as did 6–12 month increases in anxiety and 6–12 month decreases in physical and functional QoL. Multivariate analyses using all PROs showed independent prediction by 6-month depression and decreasing QoL over 6–12 months and 12–24 months. Elevated depression scores six months post-diagnosis constituted an increased mortality risk. Early intervention for depressive symptoms may reduce mortality.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK.
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK
| | - Laura Hope-Stone
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - Rumana Hussain
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, L7 8XP, UK
| | - M Gemma Cherry
- Department of Psychological Sciences, University of Liverpool, Liverpool, L69 3GB, UK
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Furdova A, Horkovicova K, Furda R, Sramka M, Rybar J, Kusenda P, Pridavkova Z. Two 11-Years Periods Statistics and Trends of Enucleation and Evisceration. J Craniofac Surg 2021; 32:2701-2705. [PMID: 34015800 PMCID: PMC8549453 DOI: 10.1097/scs.0000000000007727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The indications for evisceration and enucleation are still evolving and controversial. The study aims to describe trends of enucleation versus evisceration in one center. Methods: In period 1998–2019 were 353 patients were included in the study. Statistical results and Chi-square test for pair-wise comparisons for the statistical significance in comparing two subgroups (years periods 1998–2008 and 2009–2019) per category have been evaluated. Results: The enucleation was performed in 306 patients, and the evisceration was performed in 47 patients. In 221 patients with the tumor exclusively enucleation was indicated. For the operation technique, the authors got a chi-square value of 0.027, and the associated P value is at 0.8695, then the number of evisceration and enucleation in subgroups have not confirmed independency. For the tumor presence, the authors got a chi-square value of 5.4, and the associated P value is at 0.02, then the number of validated/nonvalidated tumor presence in subgroups confirmed independency. Conclusions: The performed enucleations had 98% cases uveal melanoma, 1% of cases of another type of malignancy (lymphoma non-Hodgkin type), and 1% cases with benign tumor. Enucleation is also today most frequently due to malignant intraocular tumors, whereas evisceration if most frequently for the phthisis eye after a trauma or a previous intraocular surgery. In our study in 22 years interval also in the second period, there was an increased trend of enucleation due to intraocular malignancy. It can have many reasons, especially, that patients are sent to oncology centers late in the advanced stage of tumor.
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Affiliation(s)
- Alena Furdova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic Department of Information Systems, Faculty of Management, Comenius University Department of Stereotactic Radiosurgery, St. Elisabeth Cancer Institute and St. Elisabeth University College of Health and Social Work Institute of Automation, Measurement and Applied Informatics, Faculty of Mechanical Engineering, Slovak University of Technology, Bratislava, Slovak Republic
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