Strategies to Mitigate Moral Distress in Oncology Nursing.

Because of prolonged exposure to ethical dilemmas, including the inability to control pain, uncertainties in goals of care, and transition to end-of-life care, moral distress remains a problem for oncology nurses. Caring for.

Adult Survivorship: Considerations Following CAR T-Cell Therapy.

BACKGROUND: Significant improvement in overall survival observed in patients on clinical trials and U.S. Food and Drug Administration approval of two chimeric antigen receptor (CAR) T-cell therapies have resulted in an increasing population of survivors who have undergone this therapy. Although adult survivors may experience similar physiologic and psychosocial sequelae to traditional cancer therapies, unique late effects and considerations are related to CAR T-cell therapy. OBJECTIVES: This article reviews survivorship considerations, with particular attention paid to the physical, psychosocial, and financial effects for adults who have undergone CAR T-cell therapy. METHODS: A review of the physiologic and psychosocial sequelae resulting from CAR T-cell therapy is presented, with a focus on late effects and financial toxicities of treatment. Physiologic concerns include B-cell aplasia and resulting hypogammaglobulinemia, as well as prolonged cytopenias and associated risk for infection. FINDINGS: To date, adult CAR T-cell therapy survivorship data are limited. However, data from clinical trials suggest expected late effects from treatment. As this survivor population grows, research can identify physiologic and psychosocial needs unique to adult survivors and evaluate evidence-based interventions.

Validation of the Spanish version of the MD Anderson symptom inventory - heart failure (MDASI-HF-Spanish) module.

BACKGROUND: The lack of a validated symptom assessment instrument in Spanish for patients with cancer and heart failure (HF) can affect the care and impede the recruitment and participation of Spanish-speaking patients in clinical trials. Spanish is the second most common language spoken by the largest and most rapidly growing racial/ethnic minority group in the United States. To bridge the language barrier and improve symptom management in Spanish-speaking patients with cancer and HF, the MD Anderson Symptom Inventory-Heart Failure (MDASI-HF) was translated to Spanish (MDASI-HF- Spanish). AIM: To validate the MDASI-HF-Spanish symptom assessment instrument. METHODS: Following standard forward and backward translation of the original and previously validated English version of the MDASI-HF, a cognitive debriefing with nine native Spanish speaking participants was conducted to evaluate the participants' understanding and comprehension of the MDASI-HF-Spanish. To examine the comprehensibility, acceptability and psychometric properties of the translated instrument, the MDASI-HF-Spanish was tested in a convenience sample of 50 Spanish speaking patients with a diagnosis of cancer and HF. Evidence for the psychometric validity of the MDASI-HF-Spanish was demonstrated via its internal consistency reliability and known-group validity. RESULTS: Overall, the participants had no problems with the understandability, readability, or number of questions asked. The MDASI-HF-Spanish subscales showed good internal consistency reliability, with a Cronbach's coefficient alpha of 0.94 (13 core cancer symptoms), 0.92 (8 heart failure symptoms), and 0.90 (6 interference items) respectively. The MDASI-HF-Spanish was able to differentiate the functional status between patients based on the New York Heart Association (NYHA) functional classification. CONCLUSIONS: The MDASI-HF-Spanish is linguistically and psychometrically valid with ease of completion, relevance, and comprehensibility among the participants, and it can be a useful tool for clinical management and research purposes.

Immunotherapy Toxicities: 
A New Electronic Documentation Template to Improve Patient Care.

BACKGROUND: Emerging immunotherapies are associated with numerous toxicities. Although traditional health records allow nurses to document system-based assessments, few offer immunotherapy-based documentation templates to assess and grade toxicities.
. OBJECTIVES: The aim of this article is to present the development of a standardized template for documenting genetically modified cellular product-related toxicities in an electronic health record (EHR).
. METHODS: Through interprofessional collaboration, a documentation template for genetically modified cellular product-related toxicities was developed in an EHR, allowing for standardized documentation, data reporting, and tracking of immune-related toxicities. 
. FINDINGS: The documentation template has enhanced the quality and safety of practice at the authors' institution and provides a framework for other nursing units when initiating immunotherapy care.
.

Actividad reproductiva de Chelonia mydas (Testudines: Cheloniidae) en Isla de Aves, Venezuela (2001-2008) / Reproductive activity of Chelonia mydas (Testudines: Cheloniidae) in Isla de Aves, Venezuela (2001-2008)

Reproductive activity of Chelonia mydas (Testudines: Cheloniidae) in Isla de Aves, Venezuela (2001-2008). The second major nesting-site for green turtles in the Caribbean is Isla de Aves, an island protected as a wildlife refuge since 1972, located at 650km Northeast from La Guaira, Venezuela. In this island, the nesting population monitoring started in 1972 and in a more continuous way after 1978, when a Scientific-Naval Station was established and scientific observations started. Since historical data show that female captures had severely affected population levels in this island before 1978, this study aim to describe recent reproductive activities. For this, during the nesting seasons of 2001-2002 and 2005-2008, nesting females were measured and tagged using metal flipper tags. A total of 458 nights were sampled observing 5 154 female emergences, with a maximum of 53 in a single night. Non-observed emergences were calculated fitting the temporal distribution of observed emergences to a normal curve. Total emergences estimated varied from =637.1±106.6 in 2001 to =2 853±42.5 in 2008 (ANOVA F(6.5df)=60.37, p<0.0001). Internesting interval in the same season was estimated in =10.71±1.32 days. Clutch frequency in a nesting season was calculated as =1.71±1.6 times per female and season. Estimated number of nesting females per year varied from =373±12.5 females in 2001 to =1 669±56.1 females in 2008 (ANOVA F (5.6df)=89.42, p<0.0001); with a positive and significant trend (r=0.842, p=0.036). Results show that nesting females numbers are increasing. We suggest that the protection of the nesting area for more than 30 years, has contributed with this population increase. Rev. Biol. Trp. 60 (2): 745-758. Epub 2012 June 01.

Isla de Aves, una isla a 650km de La Guaira, Venezuela, protegida como Refugio de Fauna Silvestre, constituye el segundo sitio de mayor anidación de la tortuga verde (Chelonia mydas) (Linnaeus 1758) en el Caribe. El seguimiento de la población comenzó en 1972 y de manera más continua desde 1978. Los datos históricos indican que la captura de hembras en la isla, afectó severamente la población hasta 1978, cuando fue construida una base científico-naval. Durante las temporadas de anidación entre 2001-2008 con excepción de 2003 y 2004, las hembras fueron marcadas con placas metálicas y medidas. Asimismo, se muestreó durante 458 noches, en donde se observaron 5 154 eventos, con un máximo de 53 por noche. Los posibles eventos no observados fueron calculados ajustando la distribución temporal de eventos observados a una curva normal. El total de eventos estimados varió de =637.1±106.6 en 2001 a =2 853±42.5 en 2008 (ANOVA F(6.5gl)=60.37, p<0.0001). El intervalo entre reanidaciones fue de =10.7±1.32 días. La frecuencia de anidación se calculó en =1.71±1.6 veces por hembra. El número de hembras estimadas varió entre =373±12.5 para 2001 y =1 669±56.1 para 2008 (ANOVA F(5.6gl)=89.42, p<0.0001). La tendencia es significativa (r=0.842, p=0.036). Los resultados indican que el número de hembras que anidan en Isla de Aves ha aumentado, y se sugiere que más de 30 años de protección del área de reproducción está resultando en un creciente número de hembras.

[Reproductive activity of Chelonia mydas (Testudines: Cheloniidae) in Isla de Aves, Venezuela (2001-2008)]. / Actividad reproductiva de Chelonia mydas (Testudines: Cheloniidae) en Isla de Aves, Venezuela (2001-2008).

The second major nesting-site for green turtles in the Caribbean is Isla de Aves, an island protected as a wildlife refuge since 1972, located at 650km Northeast from La Guaira, Venezuela. In this island, the nesting population monitoring started in 1972 and in a more continuous way after 1978, when a Scientific-Naval Station was established and scientific observations started. Since historical data show that female captures had severely affected population levels in this island before 1978, this study aim to describe recent reproductive activities. For this, during the nesting seasons of 2001-2002 and 2005-2008, nesting females were measured and tagged using metal flipper tags. A total of 458 nights were sampled observing 5 154 female emergences, with a maximum of 53 in a single night. Non-observed emergences were calculated fitting the temporal distribution of observed emergences to a normal curve. Total emergences estimated varied from X=637.1+/-106.6 in 2001 to X =2 853+/-42.5 in 2008 (ANOVA F(6.5df)=60.37, p<0.0001). Internesting interval in the same season was estimated in X=10.71+/-1.32 days. Clutch frequency in a nesting season was calculated as X=1.71+/-1.6 times per female and season. Estimated number of nesting females per year varied from X=373+/-12.5 females in 2001 to X=l 669+/-56.1 females in 2008 (ANOVA F 55.6df)=89.42, p<0.0001); with a positive and significant trend (r=0.842, p=0.036). Results show that nesting females numbers are increasing. We suggest that the protection of the nesting area for more than 30 years, has contributed with this population increase.

[Impact of artificial light on nesting in the leatherback turtle Dermochelys coriacea (Testudines: Dermochelyidae) at Cipara beach, Venezuela]. / Impacto de la luz artificial sobre la anidación de la tortuga marina Dermochelys coriacea (Testudines: Dermochelyidae), en playa Cipara, Venezuela.

The number of Leatherback turtle nests and their spatial distribution was compared between years with and without artificial light, and between dark and lighted beach segments, in Cipara Beach, Paria Peninsula, Venezuela. Residents were interviewed to identify their perceptions about the impact of artificial light on sea turtles. Mean volume of sand per meter of beach was larger at La Peña, Cipara and La Remate and smaller at Varadero (p<0.001), increasing from April to June and later decreasing until August (p<0.05). Mean percentage of gravel was higher at Varadero and La Peña, and lower at La Remate and Cipara. Most interviewed people said that artificial light does not affect sea turtles. Between 2000 and 2005, 1,217 leatherback landings and 1,056 nests were observed. Successful nests increased with the years (p=0.035) as well as total nest number (p=0.015). From 2000 through 2003 there were 743 landings, 661 nests and 374 clutches. During the two years with electric light (2004-2005), there were 474 landings, 395 nests and 232 clutches. Proportion of landings with nest building decreased significantly during the years with electric light (p=0.005), but nesting success did not vary (p=0.402). No significant difference was found between landings per beach meter in dark and lighted sectors (p=0.244), between nests built (p=0.379) and in the rate of successful nesting (p=0.516). Dark and lighted sectors did not differ in the proportion of landings with nest building (p=0.067) and success rate (p=0.833).

Impacto de la luz artificial sobre la anidación de la tortuga marina Dermochelys coriacea (Testudines: Dermochelyidae), en playa Cipara, Venezuela

Impact of artificial light on nesting in the leatherback turtle Dermochelys coriacea (Testudines: Dermochelyidae) at Cipara beach, Venezuela. The number of Leatherback turtle nests and their spatial distribution was compared between years with and without artificial light, and between dark and lighted beach segments, in Cipara Beach, Paria Peninsula, Venezuela. Residents were interviewed to identify their perceptions about the impact of artificial light on sea turtles. Mean volume of sand per meter of beach was larger at La Peña, Cipara and La Remate and smaller at Varadero (p<0.001), increasing from April to June and later decreasing until August (p<0.05). Mean percentage of gravel was higher at Varadero and La Peña, and lower at La Remate and Cipara. Most interviewed people said that artificial light does not affect sea turtles. Between 2000 and 2005, 1 217 leatherback landings and 1 056 nests were observed. Successful nests increased with the years (p=0.035) as well as total nest number (p=0.015). From 2000 through 2003 there were 743 landings, 661 nests and 374 clutches. During the two years with electric light (2004-2005), there were 474 landings, 395 nests and 232 clutches. Proportion of landings with nest building decreased significantly during the years with electric light (p= 0.005), but nesting success did not vary (p= 0.402). No significant difference was found between landings per beach meter in dark and lighted sectors (p=0.244), between nests built (p=0.379) and in the rate of successful nesting (p=0.516). Dark and lighted sectors did not differ in the proportion of landings with nest building (p=0.067) and success rate (p=0.833). Rev. Biol. Trop. 57 (3): 515-528. Epub 2009 September 30.

En Playa Cipara, Península de Paria, Venezuela, se evaluó el impacto de la luz artificial sobre la anidación de la tortuga cardón. Se estimó el número de anidaciones y su distribución espacial a lo largo de la playa entre los años sin y con iluminación artificial y entre segmentos de playa iluminada y oscura. Se hicieron entrevistas a los residentes para conocer su percepción sobre el impacto de la luz artificial hacia las tortugas marinas. Entre el 2000 y 2005 se registraron 1 217 salidas de tortuga cardón; con 1 056 nidos. El número de nidos con huevos dependió significativamente del año (p=0.035) al igual que el número de nidos totales (p=0.015). En los años previos a la electricidad (2000-2003) se observaron 743 salidas, de las cuales 661 con nido y 374 nidadas confirmadas. En los dos años (2004-2005) con iluminación artificial, se contaron 474 salidas con 395 nidos y 232 nidadas. La proporción de salidas con construcción de nido disminuyó significativamente (p=0.005) en los años con luz eléctrica, pero no varió el éxito de desove (p=0.402). No se encontró diferencia significativa entre el número de salidas por metro de playa en los sectores oscuros y los iluminados (p=0.244), ni entre el número de nidos construidos (p=0.379), ni entre las anidaciones con desove (p=0.516). Tampoco en la proporción de las salidas totales que constituyeron anidaciones (p=0.067) entre los sectores iluminados y oscuros, ni en la proporción de nidos exitosos (p=0.833). El volumen medio de arena por metro de playa fue mayor en La Peña, Cipara y La Remate y menor en Varadero (p<0.001), aumentando de abril a junio y posteriormente disminuyó un poco hasta agosto (p<0.05). El porcentaje medio de gravas fue mayor en Varadero y La Peña y menor en La Remate y Cipara. La mayoría de los entrevistados consideraron que la luz artificial no afecta a las tortugas marinas.

A single-use site selection technique, using GIS, for aquaculture planning: choosing locations for mangrove oyster raft culture in Margarita Island, Venezuela.

Oyster culture has a potential to generate income for coastal communities and to lessen pressure on natural overexploited populations. A project to transfer mangrove oyster Crassostrea rhizophorae raft culture technology to selected coastal communities in Margarita Island, Venezuela is being developed, and an optimum location selection technique was devised. To pick the variables or factors that determine site suitability, a bibliographic database was made, aspects of interest chosen, and the most comprehensive ones singled out, eliminating redundant ones. Twenty variables were grouped in criteria based on the way they influence the project. Variables were classified as intrinsic environmental, environmental extrinsic, logistic, and socioeconomic criteria. Thirty-five experts were asked to evaluate the factors and to score each according to their suitability weight. Logistic criterion received the highest values, followed by environmental extrinsic issues. A Geographic Information System using a base map compiled from 1:25,000 scale maps was developed. A thematic map for each factor was completed, dividing graphically the 3896-km2 study area into polygons of equal weight for each factor. The Multi-Criteria Evaluation (MCE) was used to combine the variables. Resultant vectors in thematic maps were added to obtain smaller polygons with the same value sum. Finally, MCE was used to generate a final output: the optimum sites for oyster aquaculture resulting from the added values of over 3000 polygons in the maps, for the 20 criteria. Higher scores were reached in 13 areas covering 4.1 km2, those places having the optimum conditions for oyster raft aquaculture in the region. Additional locations meeting 75% to 70% of the demanded criteria for a final suitable selection cover 137 sites encompassing 37.5 km2.

La tortuga Carey (eretmochelys imbricata) en Venezuela / The hawksbill turtle (eretmochelys imbricata) in Venezuela

La tortuga carey, Eretmochelys imbricata, está considerada como en "peligro crítico" de extinción. Ciertas características biológicas, como el complejo ciclo de vida, la longevidad y maduración tardía, el hábitat y dieta especializados y sus extensas migraciones, dificultan las medidas tendientes a su recuperación. La carey anida en Venezuela en varias playas aisladas, pero principalmente en las Dependencias Federales y la Peninsula de Paria. Los neonatos ocupan un ambiente pelágico, derivando pasivamente en giros y frentes por el Caribe, en sitios y duración poco conocidos hasta que al alcanzar unos 20m de longitud, cuando pasan a ocupar ambientes someros generalmente asociados a arrecifes coralinos. Los juveniles permanecen en estos ambientes al menos dos décadas, en grupos de continentes originarios de diversas playas de anidación de la región. Los adultos permanecen en los arrecifes con una dieta basada en esponjas, hasta que, en ciclos bi i tri anuales, realizan la migración reproductiva hacia las playas de anidación. La carey enfrenta múltiples amenazas. La cacería, principalmente por su concha, utilizada para elaborar diversos objetos, provocó el tráfico internacional de centenares de miles de caparazones durante los años que fue legal, disminuyendo sus poblaciones drásticamente. Las capturas intencionales continúan de manera ilegal, así como su captura incidental en las pesquerías. La contaminación afecta de diversas maneras todos los ambientes que ocupa la carey y su principal hábitat, los arrecifes coralinos, es uno de los ecosistemas más amenazados de la región. El "Plan de Acción para la Recuperación de las Tortugas Marinas de Venezuela" contempla varias medidas que colaborarán en ña recuperación de la especie en un escenario de mediano a largo plazo