Lyme’s Disease: Recognition and Management for Emergency Nurses

This article may not exactly replicate the final version published in Emergency Nurse. It is not the copy of recordOver the last 10 years there has been a significant rise in the numbers of patients who present to the Emergency Department (ED) with a diagnosis of Lyme disease. Although some patients may remain asymptomatic a significant number of patients present with a rash focused around a previous tick bite. Others may present with a wide range of debilitating symptoms that can be very problematic, if left untreated. Due to the growing prevalence of Lyme disease within the United Kingdom (UK) and the US, this article offers an overview of the vector borne nature of this illness and provides the Emergency Nurse with information on the pathophysiology, prevention, presenting symptoms, and management of Lyme disease

Translating the power of Coverdell fellows to address global nursing challenges

Academic opportunities to enter undergraduate nursing should include access for mature, experienced professionals who are prepared to care for an ever more diverse patient population and who can provide nursing expertise in the global arena. The Coverdell Fellowships in nursing are designed to actively support Returned Peace Corps Volunteers (RPCV) in developing nursing skills in such a way that supports the local community. Coverdell Fellows already have the skills and abilities enabling them to communicate with sensitivity and to develop therapeutic relationships with diverse global populations. Many Colleges of Nursing are currently faced with the challenge of providing students with opportunities which will allow them to become more globally aware and culturally competent. Thus, working with the Peace Corps, a highly respected organization with longstanding international experience, is an obvious step not only to bolster the nursing workforce, but also to develop a more globally sensitive and competent nursing workforce in the U.S. and abroad

Supervised exercise reduces cancer-related fatigue: a systematic review

Question: Does supervised physical activity reduce cancer-related fatigue? Design: Systematic review with meta-analysis of randomised trials. Participants: People diagnosed with any type of cancer, without restriction to a particular stage of diagnosis or treatment. Intervention: Supervised physical activity interventions (eg, aerobic, resistance and stretching exercise), defined as any planned or structured body movement causing an increase in energy expenditure, designed to maintain or enhance health-related outcomes, and performed with systematic frequency, intensity and duration. Outcome measures: The primary outcome measure was fatigue. Secondary outcomes were physical and functional wellbeing assessed using the Functional Assessment of Cancer Therapy Fatigue Scale, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, Piper Fatigue Scale, Schwartz Cancer Fatigue Scale and the Multidimensional Fatigue Inventory. Methodological quality, including risk of bias of the studies, was evaluated using the PEDro Scale. Results: Eleven studies involving 1530 participants were included in the review. The assessment of quality showed a mean score of 6.5 (SD 1.1), indicating a low overall risk of bias. The pooled effect on fatigue, calculated as a standardised mean difference (SMD) using a random-effects model, was –1.69 (95% CI –2.99 to –0.39). Beneficial reductions in fatigue were also found with combined aerobic and resistance training with supervision (SMD = –0.41, 95% CI –0.70 to –0.13) and with combined aerobic, resistance and stretching training with supervision (SMD = –0.67, 95% CI –1.17 to –0.17). Conclusion: Supervised physical activity interventions reduce cancer-related fatigue. These findings suggest that combined aerobic and resistance exercise regimens with or without stretching should be included as part of rehabilitation programs for people who have been diagnosed with cancer.Open Access funded by Australian Physiotherapy Associatio

Assessing the impact of chemotherapy-induced peripheral neurotoxicity on the quality of life of cancer patients: The introduction of a new measure

Item does not contain fulltextPURPOSE: To investigate the impact of chemotherapy-induced neurotoxicity on daily activities and quality of life (QoL) of cancer patients. METHODS: QoL of all patients visiting the oncological outpatient ward of the Maxima Medical Centre in the Netherlands from October 2006 until March 2007 treated with taxanes, vinca-alkaloids and/or platinum compounds (n = 88) was compared with the QoL of patients that did not receive these treatments yet (n = 43). Patient-reported neuropathy symptoms were evaluated with the newly developed Chemotherapy Induced Neurotoxicity Questionnaire (CINQ) and the Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group/Neurotoxicity (FACT/GOG-Ntx) questionnaire. RESULTS: Patients treated with chemotherapy reported significantly more complaints of neuropathy (p < 0.001) and more paresthesias and dysesthesias in the upper (p < 0.001; p < 0.01) and lower extremities (p < 0.001) compared to those not treated with chemotherapy. They additionally experienced problems with fine motor function (e.g., getting (un)dressed, writing, and picking up small objects). Moreover, cold-induced paresthesias were frequently reported. Overall, patients indicated that their neuropathy had a negative effect on QoL. CONCLUSIONS: The newly developed CINQ and the FACT/GOG-Ntx results suggest a considerable negative impact of patient-reported neuropathy symptoms on daily activities and QoL in cancer patients treated with chemotherapy. However, further validation of the CINQ is needed

Eficácia do exercício físico na fadiga dos pacientes com câncer durante o tratamento ativo: revisão sistemática e meta-análise

El objetivo del estudio fue determinar la efectividad del ejercicio físico en la fatiga de pacientes con cáncer durante el tratamiento activo. Las bases de datos de PubMed Central, EMBASE y OVID fueron consultadas hasta abril de 2014 para identificar ensayos clínicos aleatorizados, que evaluaran el efecto del ejercicio en la fatiga de pacientes con cáncer sometidos a tratamiento activo. Once estudios (n = 1.407) fueron incluidos. La quimioterapia fue el tratamiento más común (n = 1.028). Los estudios tuvieron bajo riesgo de sesgo y alta calidad metodológica. Las estimaciones de efecto mostraron que el ejercicio físico mejoró significativamente la fatiga (SMD = -3,0; IC95%: -5,21; -0,80), p < 0,0001. Se encontraron efectos similares para el entrenamiento de resistencia (SMD = -4,5; IC95%: -7,24; -1,82), p = 0,001. Se encontraron mejoras significativas en pacientes con cáncer de mama y de próstata (p < 0,05). El ejercicio es una intervención segura y eficaz en el control de la fatiga en pacientes sometidos a tratamiento activoThis study aimed to determine the effectiveness of physical exercise in decreasing fatigue in cancer patients during active treatment. The PubMed Central, EMBASE, and OVID databases were consulted up to April 2014 to identify randomized clinical trials that evaluated the effect of exercise on fatigue in cancer patients undergoing active treatment. Eleven studies (n = 1,407) were included. Chemotherapy was the most common form of treatment (n = 1,028). The studies showed a low risk of bias and high methodological quality. Effect estimates showed that physical exercise significantly improved fatigue (SMD = -3.0; 95%CI: -5.21; -0.80), p < 0.0001. Similar effects were found for resistance training (SMD = -4.5; 95%CI: -7.24; -1.82), p = 0.001. Significant improvements were found in breast and prostate cancer patients (p < 0.05). Exercise is a safe and effective intervention in the management fatigue in cancer patients undergoing active treatmentO objetivo foi determinar a efetividade do exercício físico sobre a fadiga em pacientes com câncer durante o tratamento ativo. As bases de dados PubMed Central, EMBASE e OVID foram consultadas até abril de 2014 para identificar ensaios clínicos randomizados que avaliaram o efeito do exercício sobre a fadiga em pacientes com câncer em tratamento ativo. Onze estudos (n = 1.407) foram incluídos. A quimioterapia foi o tratamento mais comum (n = 1.028). Os estudos tiveram baixo risco de viés e alta qualidade metodológica. As estimativas de efeito mostraram que o exercício melhorou significativamente a fadiga (DMP = -3,0; IC95%: -5,21; -0,80), p < 0,0001. Efeitos semelhantes sobre o treinamento de resistência (DMP = -4,5; IC95%: -7,24; -1,82), p = 0,001 foram encontrados. O exercício físico é uma intervenção segura e eficaz contra a fadiga em pacientes submetidos ao tratamento ativoEl presente trabajo forma parte del Proyecto Práctica del autoexamen de seno y los conocimientos, factores de riesgo y estilos de vida relacionados con el cáncer de mama en mujeres jóvenes de la Universidad Santo Tomás de Bogotá: un análisis transversal (9ª Convocatoria FODEIN- Código del proyecto 4110060001 - 008)

Peripheral nerve function and symptom distress during biotherapy for malignant melanoma

Studies of biotherapy-induced physiological changes are few, and systematic monitoring for neurotoxic effects are lacking. The purpose of this exploratory pilot study was to determine the change in peripheral nerve function and symptom distress during treatment with biotherapy for malignant melanoma. A convenience sample of 11 participants with malignant melanoma receiving interferon-alpha had measures of peripheral nerve function measured at baseline, four and 12 weeks of treatment. Data were analyzed using plots and regression slopes to determine change over time in sensation, gait/balance, vision, hearing, vibratory sense, muscle strength, deep tendon reflexes, blood pressure, and symptom distress. Declines in hearing, sensation, vibration, and muscle strength were found. Changes in visual acuity, and orthostatic blood pressure were noted, while gait/balance remained stable. Additionally, neuropathy symptoms were associated with symptom distress. The characterization of such changes can increase our understanding of the nature of the physiological effects associated with high-dose biotherapy treatment and aid clinicians to better prepare patients for anticipated changes in function and subsequent lifestyle adjustments. These findings can be used to provide information in a larger study of this phenomenon regarding important outcomes and measurement time-points of therapy-induced neuropathy and decreasing symptom distress in patients receiving cancer treatment with biologic agents

La fonction nerveuse périphérique et la souffrance liée aux symptômes pendant la biothérapie du mélanome malin

Les études sur les changements physiologiques induits par la biothérapie sont peu nombreuses, et le suivi systématique des effets neurotoxiques indésirables, insuffisant. Le but de cette étude pilote était de déterminer l’altération de la fonction nerveuse périphérique et l’évolution de la souffrance liée aux symptômes pendant le traitement par biothérapie du mélanome malin. On a mesuré la fonction nerveuse périphérique au niveau de référence et à 4 et 12 semaines de traitement à l’interféron alpha, auprès d’un échantillon de convenance de 11 participants atteints d’un mélanome malin. Les données ont été analysées à l’aide des tracés et des courbes de régression, afin de déterminer les changements survenus au niveau du toucher, de la marche/de l’équilibre, de la vision, de l’audition, de la sensibilité vibratoire, de la force musculaire, des réflexes tendineux, de la tension artérielle et de la souffrance liée aux symptômes. Des dégradations de l’audition, du toucher, de la sensibilité vibratoire et de la force musculaire ont été observées, ainsi que des modifications de l’acuité visuelle et de la tension artérielle orthostatique, tandis que la marche/l’équilibre restaient stables. En outre, des symptômes neuropathiques étaient associés à la souffrance liée aux symptômes. La caractérisation de tels changements peut rehausser notre compréhension de la nature des effets physiologiques de la biothérapie à haute dose et aider les cliniciens à mieux préparer les patients aux changements fonctionnels auxquels ils doivent s’attendre ainsi qu’aux adaptations ultérieures de leur mode de vie. Dans le cadre d’une étude plus large de ce phénomène, ces conclusions pourraient constituer une source d’information sur des résultats importants et sur les intervalles des mesures de la neuropathie induite par la thérapie et sur l’allègement de la souffrance liée aux symptômes chez les patients recevant un traitement du cancer à base d’agents biologiques