Teresa T. Goodell

In vivo determination of optical properties of normal and tumor tissue with white light reflectance and an empirical light transport model during endoscopy.

Determination of tissue optical properties is fundamental for application of light in either therapeutical or diagnostics procedures. In the present work we implemented a spatially resolved steady-state diffuse reflectance method where only two fibers (one source and one detector) spaced 2.5 mm apart are used for the determination of the optical properties. The method relies on the spectral characteristics of the tissue chromophores (water, dry tissue, and blood) and the assumption of a simple wavelength dependent expression for the determination of the reduced scattering coefficient. Because of the probe dimensions the method is suited for endoscopic measurements. The method was validated against more traditional models, such as the diffusion theory combined with adding doubling for in vitro measurements of bovine muscle. Mean and standard deviation of the absorption coefficient and the reduced scattering coefficient at 630 nm for normal mucosa were 0.87+/-0.22 cm(-1) and 7.8+/-2.3 cm(-1), respectively. Cancerous mucosa had values 1.87+/-1.10 cm(-1) and 8.4+/-2.3 cm(-1), respectively. These values are similar to data presented by other authors. Blood perfusion was the main variable accounting for differences in the absorption coefficient between the studied tissues.

Operationalizing symptom distress in adults with cancer: a literature synthesis.

PURPOSE/OBJECTIVES To address inconsistencies in the definition and operationalization of symptom distress by synthesizing the literature on cancer-related symptom distress in adults. DATA SOURCES Electronic nursing, psychology, and medicine databases; online meeting abstracts; and various print sources. DATA SYNTHESIS Eight distinct methods of operationalizing the concept were identified. Gender, ethnic, developmental, cultural, and individual differences in symptom distress have not been identified. Relationships among symptom frequency, intensity, and distress are unclear. CONCLUSIONS Lack of clarity and consensus in defining and operationalizing symptom distress hinder meta-analysis, research synthesis, and research utilization. Symptom distress may be emerging as a component of the multidimensional symptom experience. IMPLICATIONS FOR NURSING Defining and operationalizing symptom distress consistently will enhance research synthesis and assist clinicians with more effectively meeting the needs of people with cancer. Research is needed to identify the meanings of symptom distress to patients with cancer and to differentiate symptom distress from symptom frequency and intensity.

Nurse-Family Interactions in Adult Critical Care: A Bowen Family Systems Perspective

Nursing research has described the self-reported needs of families of critical care patients; however, very little has been written about specific intervention and assessment strategies for families experiencing critical illness. The purpose of this article is to illustrate a process for analyzing nurse-family interactions in critical care settings and to suggest methods of improving family nursing in critical care based on Bowen’s family systems theory. Bowen’s family systems theory is described and a case study is presented and discussed to illustrate the application of the major concepts of Bowen’s family systems theory in analyzing family dynamics in critical care. In this article, Bowen’s family systems theory is expanded to encompass an analysis of the family-like nurse-to-nurse relationships that occur on nursing units. Specific recommendations are made for critical care nurses who wish to implement family-focused nursing care with a basis in Bowen’s family systems theory.

Precision and Accuracy Comparison of Point-of-Care and Laboratory Glucose Concentrations in Cardiothoracic Surgery Patients

Background:There have been variable results on the practice of tight glycemic control, and studies have demonstrated that point-of-care (POC) glucometers have variable accuracy. Objective:The purpose of this study was to determine the difference between blood glucose concentrations obtained from POC glucometers as compared with laboratory results in cardiothoracic surgery (CTS) patients. Methods:This was a descriptive study on a convenience sample of 46 CTS patients. A single sample of arterial blood was collected and analyzed at the bedside with the POC glucometer and in the laboratory to obtain a serum glucose concentration and hematocrit (Hct). A paired t test was used to compare the mean differences along with Spearman ρ correlation to examine the relationship between difference scores and Hct. Results:The POC glucose was significantly higher than the laboratory result (t = 8.5, P < .001) with a mean of 12.3 (SD, 9.8) mg/dL. Spearman ρ correlation between the difference scores and Hct was −0.43, P = .003. Using a tercile split, groups with Hct of less than 26% (n = 16) and greater than 29% (n = 15) were identified. The unpaired t test on the mean difference scores of these 2 groups was t = −2.7, P < .01, with an overall mean difference 8.6 mg/dL (95% confidence interval, −15 to −2.2). The mean difference was 16.3 in the low-Hct group and 7.8 in the high-Hct group. Conclusions:Point-of-care glucometer results differ significantly from laboratory glucose concentrations, with the difference widening as the Hct decreases. This raises the concern about using POC devices to provide tight glycemic control in CTS patients.

Characteristics of hospitalised US veterans with nosocomial pressure ulcers

The objective of this study was to describe demographic and clinical characteristics of hospitalised US veterans with nosocomial pressure ulcer (NPU) referred to a certified Wound, Ostomy & Continence Nurse (WOCN). We conducted a retrospective review of electronic records at a Veterans Affairs Medical Center in the northwestern USA. Records of veterans with NPU referred to a WOCN (n = 29) from May 2005 to June 2006 were reviewed. Location and stage of pressure ulcer(s), Braden score on admission and when the ulcer was first noted, day of hospital stay when the ulcer was first noted, medical diagnoses and clinical conditions and events such as surgery, hypoxemia, hypoalbuminemia and hypotension were recorded. Mean age of the patients was 69·8. The most common location was the sacrum/coccyx. Most ulcers were stage 1 when identified. Braden score during admission classified half of the sample at risk, but 81% of Braden scores at ulcer occurrence were <18. Ninety percent of the sample had three or more comorbidities. Over half had died in the 1–14 months after the reviewed hospitalisation. Hospitalised veterans referred for WOCN consultation had multiple risk factors and comorbid conditions, including hypoxemia, serum albumin depletion, anaemia and hypotension. Veterans cared for in Veterans Affairs Medical Centers are known to have multiple health problems, and those in this sample not only had nosocomial pressure ulcer, but also other physiological derangements that may shorten survival.

Measuring subjective side effects and symptoms in palliative photodynamic therapy

PURPOSE/OBJECTIVES To evaluate the reliability and validity of the Photodynamic Therapy Side Effects and Symptoms Scale (PSES) and to begin to describe patient-reported outcomes of photodynamic therapy (PDT). DESIGN Repeated-measures instrument validation. The PSES uses a 10-point numeric scale to evaluate side effects or symptom trouble or burden on 13 items. SETTING A Pacific Northwest community hospital. SAMPLE 14 patients with end-stage lung or esophageal cancer undergoing palliative PDT. METHODS Participants completed five PSES surveys (i.e., at baseline and once a week for four weeks after PDT). Weekly phone calls were made to assess functional status, operationalized as Karnofsky Performance Status. MAIN RESEARCH VARIABLES Symptoms and functional status. FINDINGS The PSES possessed acceptable internal consistency reliability and concurrent validity. Functional status declined in the first week after PDT, concurrent with an increase in side-effect and symptom burden. Photosensitivity became more burdensome over time but was never extremely burdensome. CONCLUSIONS The feasibility of measuring a diverse set of side effects and symptoms in end-stage cancer with a single-page, large-type instrument essentially was supported. The study provided preliminary information about side effects and symptoms in patients undergoing palliative PDT. IMPLICATIONS FOR NURSING Nurses often are called on to provide information to patients considering various treatment options. This study offers the first data on patient-reported outcomes of palliative PDT that clinicians can use to help in answering inquiries. The design of the PSES may be replicated by researchers working with other populations with end-stage disease to reduce respondent burden and decrease attrition.