Search

Background As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing’s holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care. Purpose To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation. Methods We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health. Findings Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed. Discussion Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas. Conclusions To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

Objectives Heart failure (HF) heavily burdens the global health system. Transitional care interventions attempt to streamline the hospital-to-home transition to ease the burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of transitional care interventions on health care utilization after hospitalization for HF. Design Systematic review and meta-analysis including dose-response relationship. Setting and Participants Randomized controlled trials (RCTs) of transitional care interventions vs usual care in older patients discharged from the hospital with HF. Methods Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL, were systematically searched from January 2009 to October 2019 to locate relevant systematic reviews or meta-analyses. The original RCTs included in the review articles were identified, and an additional search for recently published RCTs was performed from January 2014 to June 2020. This systematic review focused on health care utilization outcomes, including hospital readmissions for HF or any cause, emergency department (ED) visits, and length of hospital stay (LOS). Results Data were summarized from 38 RCTs covering 10,871 patients. Pooled evidence suggested a mean 11% [risk ratio (RR) 0.89, 95% confidence interval (CI) 0.82, 0.97] and 22% (RR 0.78, 95% CI 0.68, 0.89) risk reduction on all-cause and HF-specific readmissions, but no significant reduction (RR 0.94, 95% CI 0.83, 1.07) on ED visits. Findings were mixed for LOS. Subgroup analysis by different types of transitional care interventions indicated that multidisciplinary interventions currently have the best evidence for reducing readmissions up to 6 months post the index HF hospitalization. In addition, we observed an inverse linear dose-response relationship between intervention intensity (ie, frequency and duration of interventions) and complexity (ie, number of intervention components) and the risk of HF readmissions. Conclusions and Implications Transitional care interventions for hospitalized patients with HF reduced all-cause and HF-specific readmissions, but did not decrease ED visits. Multidisciplinary interventions are highly recommended if adequate resources are available.

Context The prevalence of chronic pain in cancer survivors is double that of the general U.S. population. Opioids have been the foundation of cancer pain management for decades; however, there is a paucity of literature on long-term opioid therapy (LTOT) in cancer survivors. An understanding of factors related to LTOT use in cancer survivors is needed to address chronic pain and balance opioid harms in the expanding population of cancer survivors. Objectives To analyze the research of LTOT utilization and factors associated with persistent opioid use in cancer survivors. Methods A five-stage integrative review process was adapted from Whittemore and Knafl. Data sources searched included Web of Science, PubMed, Embase, Cochrane, and Google Scholar. Quantitative research studies from 2010 to present related to cancer survivors managed on LTOT were included. Editorials, reviews, or abstracts were excluded. Results After reviewing 315 articles, 21 articles were included. We found that there were several definitions of LTOT in the reviewed studies, but the duration of opioid use (i.e., more than three months after completion of curative treatment) was the most common. The reviewed literature describes a relationship between LTOT and important biopsychosocial factors (cancer type, socioeconomic factors, and comorbidities). Conclusion The studies in this review shed light on the factors associated with LTOT in cancer survivors. LTOT was common in certain populations of cancer survivors and those with a collection of patient-specific characteristics. This review suggests that there is a critical need for specialized research on chronic cancer pain and opioid safety in cancer survivors.

Purpose Early detection and intervention of lymphedema is essential for improving the quality of life of breast cancer survivors. Previous studies have shown that patients have symptoms such as arm tightness and arm heaviness before experiencing obvious limb swelling. Thus, this study aimed to develop a symptom-warning model for the early detection of breast cancer-related lymphedema. Methods A cross-sectional study was conducted at a tertiary hospital in Beijing between April 2017 and December 2018. A total of 24 lymphedema-associated symptoms were identified as candidate predictors. Circumferential measurements were used to diagnose lymphedema. The data were randomly split into training and validation sets with a 7:3 ratio to derive and evaluate six machine learning models. Both the discrimination and calibration of each model were assessed on the validation set. Results A total of 533 patients were included in the study. The logistic regression model showed the best performance for early detection of lymphedema, with AUC = 0.889 (0.840–0.938), sensitivity = 0.771, specificity = 0.883, accuracy = 0.825, and Brier scores = 0.141. Calibration was also acceptable. It has been deployed as an open-access web application, allowing users to estimate the probability of lymphedema individually in real time. The application can be found at https://apredictiontoolforlymphedema.shinyapps.io/dynnomapp/ . Conclusion The symptom-warning model developed by logistic regression performed well in the early detection of lymphedema. Integrating this model into an open-access web application is beneficial to patients and healthcare providers to monitor lymphedema status in real-time.

Background Transitional care interventions that bridge the care gap from hospital to home have proven to be effective in lessening the burden of healthcare systems by reducing hospital readmissions. Yet, the effects of transitional care interventions on patient-centered health outcomes of mortality, quality of life, and emotional distress remains unclear. Objectives To evaluate the effectiveness and dose-response of transitional care interventions on patient-centered health outcomes of mortality, quality of life, and emotional distress among individuals with heart failure and to identify the trial-level characteristics potentially affecting the overall effectiveness. Design Systematic review with random-effects meta-analysis, meta-regression, and dose-response analysis of randomized controlled trials comparing transitional care interventions with usual care in adult people hospitalized with heart failure. Data sources Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL were systematically searched from January 1, 2000 to June 31, 2020. Review methods Authors independently reviewed the retrieved articles based on inclusion and exclusion criteria, extracted data, and assessed risk of bias using the Cochrane risk-of-bias tool version 2.0. We pooled data from each study using random-effects meta-analysis and performed meta-regression to explore the impact of pre-specified trial-level factors. Dose-response meta-analysis was conducted to examine the relationship between the intensity (i.e., frequency and duration of interventions) and complexity (i.e., number of intervention components) of transitional care interventions and the treatment effects. Results Data were synthesized from 42 trials covering a total of 10,784 people with heart failure. Comparing to usual care, transitional care interventions achieved pooled evidence of a mean 18% risk reduction on mortality (0.82, 95% CI 0.71 to 0.95, P = 0.009) and better improvement in quality of life (-4.37, 95% CI -7.20 to -1.54, P = 0.002). There were insufficient data to determine with certainty the effects on anxiety and depression. Meta-regression showed greater efficacy in trials that delivered the intervention by a multidisciplinary team. Dose-response analyses demonstrated that mortality and quality of life were improved with increased intensity and complexity of the transitional care interventions. Conclusions Transitional care interventions were effective in reducing mortality and improving quality of life for adult people with heart failure. The effects on emotional distress were inconclusive due to insufficient data, highlighting the need for further research. Registration number CRD42019132732

Accuracy of body weight perception is an individual's perception of their body weight in comparison with actual body weight and is associated with weight-related behaviors. Chinese Americans have increased risk for obesity but no studies have examined accuracy of body weight perception.This study was a descriptive and cross-sectional study, which was conducted in a community health center in New York. Study subjects were all Chinese-American adults. Demographic information, accuracy of perception of body weight, anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], hip circumference [HC], weight to height ratio, weight to hip ratio), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1C) and obesity-related diseases (hypertension, diabetes, heart disease, and stroke) were assessed.A total of 162 Chinese Americans were recruited. 52 subjects (32%) did not perceive body weight correctly: 32 subjects had underestimation and 20 subjects had overestimation of body weight. Significant differences were found among subjects in the three groups of different accuracy of body weight perception in terms of gender (p=0.003), age (p=0.003), education years (p=0.047), WC (p0.001), HC (p≤0.001), weight/height ratio (p=0.001), and BMI (p0.001). Accuracy of perception of body weight significantly predicted WC (p0.001), HC (p0.001), weight to height ratio (p=0.001), BMI (p0.001) and weight (0.001) even after controlling for all demographic factors.The study identified that around one-third of Chinese Americans did not perceive their body weight correctly. Intervention studies for obesity management in Chinese Americans should address gender difference, target on older subjects, and focus on educating the normal values and significances of WC, HC and HbA1C among Chinese Americans.

To translate the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI) into Chinese language and evaluate its psychometric properties among breast cancer survivors with and without lymphedema in China.The BCLE-SEI was translated from English to Chinese language using an integrative translation method. The Chinese version was then evaluated for its psychometric properties using a comparison-group and test-retest method. Purposive sampling was used to recruit 219 breast cancer survivors with and without lymphedema in Beijing, China. Cronbach's alpha and test-retest reliability were conducted to assess the reliability; discriminant validity, criterion-related validity and exploratory factor analysis were examined to assess the validity of the instrument.No semantic modifications to items were needed in terms of comparability of language and similarity of interpretability. Feedback on the pretest of the Chinese version by 15 Chinese breast cancer patients resulted in one item modification. The Chinese version of the instrument demonstrated excellent reliability (Cronbach's alpha = 0.930-0.967) and test-retest reliability (r = 0.572-0.705, p 0.001, n = 34). A significant difference was observed between the lymphedema group and non-lymphedema group (z = -7.127, p 0.001). The criterion-related validity was supported by negative correlation with the Short-Form Health Survey (physical component summary, r = -0.612; mental component summary, r = -0.540). Factor analysis for symptom occurrence revealed 5 factors, which explained 66.1% of the total sample variance; 5 factors were also identified in symptom distress, which explained 70.6% of the total sample variance.The Chinese BCLE-SEI is a reliable and valid instrument to evaluate breast cancer-related lymphedema symptom experience for Chinese breast cancer survivors.

Patients with head and neck cancer can experience pain that impacts quality of life. Therefore, we developed a patient-reported Electronic Patient Visit Assessment (ePVA) for early detection and intervention for pain. Patients use interactive touch screen technology to indicate presence and location of pain and functional limitations (eg. limited mobility of mouth, neck, shoulders). To test clinical usefulness of the ePVA, after informed consent, 72 participants with head and neck cancer completed the ePVA one time before, during, or after treatment at an academic cancer center in northeastern United States between August 2017 and August 2018. After completing the ePVA, participants answered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Quality of Life (QoL) scores were calculated using EORTC QLQ-C30 QoL subscale, ranging between 0 - 100, higher scores indicating better quality of life. Data were analyzed using means, frequencies, and t-test statistics. The mean age of the study population was 62. Majority of participants were male (64%), had stage III or IV cancer (69%), and were of the white race (68%). Majority of participants reported presence of pain (54%, 39 of 72), which significantly affected their QoL (Pain: mean QoL = 68.1; No pain: mean QoL= 83.3, p

Objectives To summarize the evidence of and identify factors influencing the psychosocial impact of lymphedema, as well as to discuss nursing strategies. Data Sources Peer-reviewed publications from 2004 to 2011 in 11 major medical indices. Conclusion Poorer overall health-related quality of life was reported among cancer survivors with lymphedema. The consistent, detailed, and vivid descriptions from the qualitative studies suggest that cancer-related lymphedema exerts tremendous negative psychosocial impact, which quantitative studies failed to capture. Implications for Nursing Practice Nursing strategies include helping patients to build a routine for daily care, setting goals, exercise, positive self-talk, providing helpful resources, and organizing support groups. Professional organizations should devote resources to public education through television advertisement, public meetings, and online education.