Implementing Distress Screening and Hospital Management of Oncology Patients with Distress

Of the nearly 2 million new cancer cases projected to occur in the United States in 2022, up to 65% of patients may be hospitalized in the first year of their diagnosis. Hospitalized oncology patients have been documented to experience psychological distress during their hospitalization related to physical and emotional challenges related to their disease. In ***, a tertiary hospital located in ***, Oregon, hospitalized cancer patients with hematologic malignancies and aggressive or advanced solid cancers have verbalized distress, including depression, anxiety, feelings of isolation, and fatigue during prolonged hospital stays. According to the National Comprehensive Cancer Network (NCCN), distress in cancer patients is exceedingly common. It is associated with significant reductions in a patient\u27s emotional and physical well-being, decreased quality of life, longer hospital length of stays, higher likelihood of hospital readmissions, and increased healthcare costs. Evidence-based oncology literature suggests that multidisciplinary palliative interventions that emphasize patient education and mental, physical, and psychological strategies effectively combat patient distress in the hospital. Observational and translational studies suggest that nurses who are educated in identifying patient distress contribute to better referral rates to psychosocial oncology services and play critical roles in patient decision-making and intervention implementation. Furthermore, ***’s Distress Management Policy and national cancer associations specify that all new cancer patients have access to psychosocial distress screening at their first new patient visit, which may occur in the inpatient setting for the population specified above. This scholarly project aimed to assess *** inpatient oncology nurses\u27 knowledge regarding distress in the oncology population and to design an educational intervention that supports nurses\u27 ability to identify distress, improve distress screening, and intervene in the hospital setting. This project integrated the National Comprehensive Cancer Network’s (NCCN) distress thermometer into inpatient patient care areas and presented the opportunity to screen for distress during the patient’s initial hospital stay. Furthermore, this project utilized institution- approved strategies and educational resources to address multiple facets of what contributes to patients’ distress. Finally, this project assessed the impact of the offered distress education on oncology nursing knowledge, skills, and attitudes regarding distress. The topics and resources covered in the distress education included the definition of oncological distress, the rationale for distress screening, the national guidelines for distress screening and management, the distress screening policy of ***, the NCCN distress thermometer and problem list, a compendium of printed and electronic cancer, and distress related outpatient resources, and nursing interventions to address patients in distress. One hour of continuing nursing education was offered for completing this education. At the completion of this scholarly project, oncology nurses reported increased efficacy in identifying distress, increased intention in using the NCCN distress thermometer and discussing distress with their patients, and increased confidence in discussing distress and distress-related interventions. During the five-month implementation period of this project, there was a notable increase in distress screening during the patient\u27s hospitalization and increased referral rates to outpatient oncology social workers before hospital discharge

Exploring the connection between tightness-looseness, sexual health, and well-being: A mixed-methods approach

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThis thesis is an exploration of the multifaceted realm of sexual attitudes, sexual health, and sex education, with a central focus on their relationship with mindset (tightness-looseness). Across four studies, we delve into the attitudes and intentions toward infidelity (chapter 2), perceived psychological benefits of comprehensive sex education (chapter 3), exploration of tightness-looseness and sexual health-related policies within a ‘loose’ nation (chapter 4), and examination of outcomes associated with tightness-looseness within a gamified sexual health training program (chapter 5). Our results suggest that discernible patterns emerge within a framework of tightness-looseness concerning sexual health outcomes, both when considered as a regional factor and as an individual difference factor. Specifically, on the regional level, ‘looser’ states tended to implement policies that ensured inclusive approaches to sex education and were more likely to have legislation protecting access to contraceptive care (i.e., abortion), compared to tighter states. On the individual level, people with a looser mindset tended to express more positive attitudes and greater intentions toward infidelity, compared to tighter mindsets. Likewise, looser mindsets tended to score lower on sexual-related guilt and higher on sexual-related comfort in comparison to tighter mindsets. Notably, individuals with a tighter mindset showcased greater confidence in sexual self-efficacy. Our findings indicate that the tightness-looseness framework plays a significant role in shaping patterns related to sexual attitudes and experiences, as well as outcomes related to sexual health. In addition to mindset, our participants emphasized that comprehensive sex education brings a range of positive mental health and well-being benefits. This includes contributing to the normalization and destigmatization of sexual experiences and gender-expansive identities, fostering increased feelings of psychological safety, awareness, and informed decision-making. Taken together, this thesis contributes to the growing body of literature exploring the complex intersections of mindset, sexual attitudes, and health outcomes. Specifically, we investigate sexual attitudes and intentions toward infidelity, the psychological benefits of sex education, regional trends in sexual health-related policies, and individual-level outcomes when engaging in a sexual health training program. Furthermore, and to our knowledge, this thesis is the first of its kind to evaluate the use of the tightness-looseness framework as an explanatory model for sexual behaviors, experiences, attitudes, and policies. Implications, contributions, and advancements to the field of sexual health are discussed, as well as directions for future researchers

Modulations of the Chicken Cecal Microbiome and Metagenome in Response to Anticoccidial and Growth Promoter Treatment

With increasing pressures to reduce or eliminate the use of antimicrobials for growth promotion purposes in production animals, there is a growing need to better understand the effects elicited by these agents in order to identify alternative approaches that might be used to maintain animal health. Antibiotic usage at subtherapeutic levels is postulated to confer a number of modulations in the microbes within the gut that ultimately result in growth promotion and reduced occurrence of disease. This study examined the effects of the coccidiostat monensin and the growth promoters virginiamycin and tylosin on the broiler chicken cecal microbiome and metagenome. Using a longitudinal design, cecal contents of commercial chickens were extracted and examined using 16S rRNA and total DNA shotgun metagenomic pyrosequencing. A number of genus-level enrichments and depletions were observed in response to monensin alone, or monensin in combination with virginiamycin or tylosin. Of note, monensin effects included depletions of Roseburia, Lactobacillus and Enterococcus, and enrichments in Coprococcus and Anaerofilum. The most notable effect observed in the monensin/virginiamycin and monensin/tylosin treatments, but not in the monensin-alone treatments, was enrichments in Escherichia coli. Analysis of the metagenomic dataset identified enrichments in transport system genes, type I fimbrial genes, and type IV conjugative secretion system genes. No significant differences were observed with regard to antimicrobial resistance gene counts. Overall, this study provides a more comprehensive glimpse of the chicken cecum microbial community, the modulations of this community in response to growth promoters, and targets for future efforts to mimic these effects using alternative approaches

Epoxide-Opening Cascades in the Synthesis of Polycyclic Polyether Natural Products

The structural features of polycyclic polyether natural products can, in some cases, be traced to their biosynthetic origin. However in case that are less well understood, only biosynthetic pathways that feature dramatic, yet speculative, epoxide-opening cascades are proposed. We summarize how such epoxide-opening cascade reactions have been used in the synthesis of polycyclic polyethers (see scheme) and related natural products. The group of polycyclic polyether natural products is of special interest owing to the fascinating structure and biological effects displayed by its members. The latter includes potentially therapeutic antibiotic, antifungal, and anticancer properties, and extreme lethality. The polycyclic structural features of this class of compounds can, in some cases, be traced to their biosynthetic origin, but in others that are less well understood, only to proposed biosynthetic pathways that feature dramatic, yet speculative, epoxide-opening cascades. In this review we summarize how such epoxide-opening cascade reactions have been used in the synthesis of polycyclic polyethers and related natural products

Determinants of Effort and Associated Cardiovascular Response to a Behavioral Restraint Challenge

This study directly tested implications of motivation intensity theory on effort to restrain against a behavioral urge or impulse (i.e. restraint intensity). Two factors were manipulated—magnitude of an urge and the importance of successfully resisting it—with cardiovascular (CV) responses related to active coping measured. Male and female undergraduate students were presented with a mildly- or strongly evocative film clip with instructions to refrain from showing any facial response. Success was made more or less important through coordinated manipulations of outcome expectancy, ego-involvement, and performance assessment. As expected, systolic blood pressure responses assessed during the performance period were proportional to the evocativeness of the clip when importance was high, but low regardless of evocativeness when importance was low. These findings support a new conceptual analysis concerned with the determinants and CV correlates of restraint intensity. Implications of the study and associations with current self-regulatory literature are discussed

Trajectories of Burden and Depression in Caregivers Following Traumatic Injury: The Role of Resilience

As part of an effort to understand psychological consequences among family members of patients sustaining a traumatic injury, medical research has turned to the role of resilience – or the ability to bounce back from and maintain psychological well-being in the wake of an adverse event— in mitigating the potential distress (i.e., depression and burden) of caregiving (Bonanno, 2004; Roberson et al., under review). This study sought to examine the ability for trait-resilience to predict trajectories of distress over the course of a year among 124 family members and loved ones of patients admitted to a Level I Trauma Center. A cross-lagged path model examining resilience, burden, and depression at baseline, 3, 6, and 12 months after injury showed that, while depression strongly predicted later burden, resilience was not a significant predictor of either outcome in the model. When depression and burden were subjected to a person-centered analysis (i.e., latent growth curve analysis), two major classes were identified: caregivers with high, chronic distress (33% of the sample) and low-moderate distress that declined over time. A three-class solution for caregiver burden further identified a moderate, increasing trajectory class. Predictive discriminant analyses revealed that trait-resilience was a major differentiating trait between class membership (rs = .23 for depression; rs = .32 for burden); further, presence of PTSD symptoms at baseline, gender, and history of depression were shown to be strong factors in distinguishing class membership across both outcomes. This study helps shed insight into the well-being of caregivers in the wake of a loved one's traumatic injury, in addition to possible identifying risk factors while patients are still admitted in the ICU. Lastly, the study provides alternatives for analyses that focus on longitudinal outcomes, particularly person- vs. variable-centered solutions

Examining the oral communication strategies used by a group of Nepalese adult learners in an ESL context

This paper sought to examine the oral communication strategies (CSs) used by a group of Nepalese adult learners in an oral task in an ESL context. There has been a long history of CS studies in L2 acquisition research; however, there are no studies yet reporting the CSs employed by Nepalese learners in an ESL context. Hence, six Nepalese learners with intermediate language proficiency were engaged in a picture storytelling task. Their narrations were recorded and transcribed, and their responses during the interview were elicited. Four significant results were revealed. Firstly, the Nepalese learners experienced a considerable amount of communication difficulties as manifested by various gap markers. To overcome these problems, the learners simultaneously used a variety of non-verbal CSs alongside verbal CSs. Secondly, linguistic errors were abound in their narrations but were ignored due to their communication goal. Hence, there are areas of communication (e.g., vocabulary and sentence structure) where the learners were having trouble, and these concerns should require instructional attention. Thirdly, the majority of the verbal CSs were avoidance strategies while most of the non-verbal CSs were achievement strategies. Lastly, examining the CSs used by the learners paved the way to culture-based strategies that were employed during storytelling. These CSs provided new inputs to the existing CS frameworks used by English language learners. Implications for language teaching and learning as well as future research are discussed