ABSTRACT
PURPOSE: Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. METHODS: Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). RESULTS: Twenty participants were 26-71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. CONCLUSIONS: According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.
Subject(s)
Genital Neoplasms, Female/nursing , Genital Neoplasms, Female/rehabilitation , Nurse's Role , Radiation Injuries/nursing , Radiation Injuries/rehabilitation , Sexual Behavior/physiology , Aged , Brachytherapy/adverse effects , Constriction, Pathologic/etiology , Constriction, Pathologic/nursing , Constriction, Pathologic/rehabilitation , Female , Genital Neoplasms, Female/physiopathology , Genital Neoplasms, Female/radiotherapy , Humans , Middle Aged , Pilot Projects , Prospective Studies , Radiation Injuries/etiology , Radiation Injuries/physiopathology , Surveys and Questionnaires , Vagina/pathology , Vagina/physiopathology , Vagina/radiation effectsABSTRACT
PURPOSE OF THE RESEARCH: Implement and evaluate the Care Programme for Palliative Radiotherapy (CPPR) in the Outpatient Clinic of the Department of Radiotherapy, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands. METHODS: Participatory Action Research (PAR). Qualitative descriptive design: participatory observations, semi-structured interviews with patients and professionals and focus groups with professionals; content analysis of documents. SAMPLE: Patients with impending paraplegia due to metastatic spinal cord compression, nurse practitioners (NPs), nurse manager, staff and ward nurses, radiographers, radiotherapists and medical doctors. KEY RESULTS: After a shift from inpatient to outpatient radiotherapy treatment, patients and healthcare professionals perceived shortcomings in the oncological chain care. The CPPR was developed in a participative way giving a key role to the NP. Evaluation after implementation of the programme showed that patients and professionals were predominantly positive about its effects. However, implementation was not sustained due to lack of institutional and managerial support. CONCLUSIONS: The technological innovation far preceded the organisational changes needed to provide innovative, patient-centred care. Implementing this programme with a central role for the NP was seen as the solution to the problems identified. However, in spite of the systematic approach using PAR, the programme was not successful in bringing about sustained improvements. NPs fulfil a valuable role in the care and support of patients with palliative care needs but need institutional support. More attention should have paid to the organisational context. Involve all relevant actors; use a participatory approach to enhance commitment; ensure the support of management during the whole project.
Subject(s)
Health Plan Implementation/organization & administration , Nurse Practitioners/organization & administration , Nurse's Role , Oncology Nursing/organization & administration , Palliative Care/organization & administration , Patient-Centered Care/organization & administration , Ambulatory Care/organization & administration , Female , Health Services Research , Humans , Male , Needs Assessment , Netherlands , Program Development , Program Evaluation , Quality of Health Care , Radiotherapy, Adjuvant , Treatment OutcomeABSTRACT
Fucoidan, a sulfated fucopolysaccharide, mimics the fucosylated glycans of glycoproteins and has therefore been used as a probe for investigating the role of membrane polysaccharides in cell-cell adhesion. In the present report we have characterized the interaction of fucoidan with the Ca(2+)- and phospholipid-binding protein annexin II tetramer (AIIt). AIIt bound to fucoidan with an apparent K(d) of 1.24 +/- 0.69 nM (mean +/- SD, n = 3) with a stoichiometry of 0.010 +/- 0.001 mol of fucoidan/mol of AIIt (mean +/- SD, n = 3). The binding of fucoidan to AIIt was Ca(2+)-independent. Furthermore, in the presence but not the absence of Ca(2+), the binding of fucoidan to AIIt caused a decrease in the alpha-helical content from 32% to 7%. A peptide corresponding to a region of the p36 subunit of AIIt, F(306)-S(313), which contains a Cardin-Weintraub consensus sequence for heparin binding, was shown to undergo a conformational change upon fucoidan binding. This suggests that heparin and fucoidan bound to this region of AIIt. The binding of fucoidan but not heparin by AIIt also inhibited the ability of AIIt to bind to and aggregate phospholipid liposomes. These results suggest that the binding of AIIt to the carbohydrate conjugates of certain membrane glycoproteins may have profound effects on the structure and biological activity of AIIt.
Subject(s)
Annexin A2/chemistry , Polysaccharides/chemistry , Amino Acid Sequence , Annexin A2/antagonists & inhibitors , Annexin A2/metabolism , Binding Sites , Calcium/chemistry , Circular Dichroism , Dose-Response Relationship, Drug , Fucose/chemistry , Heparin/chemistry , Liposomes/antagonists & inhibitors , Liposomes/chemistry , Molecular Sequence Data , Polysaccharides/metabolism , Polysaccharides/pharmacology , Protein Binding , Protein Conformation/drug effects , Seaweed , Sulfuric Acid Esters/chemistryABSTRACT
In this report, we have characterized the interaction of heparin with the Ca2+- and phospholipid-binding protein annexin II tetramer (AIIt). Analysis of the circular dichroism spectra demonstrated that the Ca2+-dependent binding of AIIt to heparin caused a large decrease in the alpha-helical content of AIIt from approximately 44 to 31%, a small decrease in the beta-sheet content from approximately 27 to 24%, and an increase in the unordered structure from 20 to 29%. The binding of heparin also decreased the Ca2+ concentration required for a half-maximal conformational change in AIIt from 360 to 84 microM. AIIt bound to heparin with an apparent Kd of 32 +/- 6 nM (mean +/- S.D., n = 3) and a stoichiometry of 11 +/- 0.9 mol of AIIt/mol of heparin (mean +/- S.D., n = 3). The binding of heparin to AIIt was specific as other sulfated polysaccharides did not elicit a conformational change in AIIt. A region of the p36 subunit of AIIt (Phe306-Ser313) was found to contain a Cardin-Weintraub consensus sequence for glycosaminoglycan recognition. A peptide to this region underwent a conformational change upon heparin binding. Other annexins contained the Cardin-Weintraub consensus sequence, but did not undergo a substantial conformational change upon heparin binding.
