Do Patients Regret Having Received Systemic Treatment for Advanced Non-Small Cell Lung Cancer: A Prospective Evaluation.

BACKGROUND: Thousands of patients annually receive treatment for advanced non-small cell lung cancer (NSCLC), but little is known about their views on the decision to receive that treatment, or regret. This trial prospectively evaluated the incidence of regret and whether baseline characteristics, patient decision-making parameters, or clinical progress early in the treatment course predicts regret. MATERIALS AND METHODS: Patients receiving systemic treatment for advanced NSCLC completed every 3-week patient reported outcome (PRO) assessment using the electronic Lung Cancer Symptom Scale (eLCSS-QL), including the 3-Item Global Index (3-IGI; assessing overall distress, activities, and quality of life [QL]). A prespecified secondary aim was to determine the frequency of regret evaluated at 3 months after starting treatment. Patients were randomized to usual care or enhanced care (which included use of the DecisionKEYS decision aid). RESULTS: Of 164 patients entered, 160 received treatment and 142 were evaluable for regret. In total, 11.5% of patients and 9% of their supporters expressed regret. Baseline characteristics did not predict regret; regret was rarely expressed by those who had a less than 20% decline or improvement in the 3-IGI PRO score after two treatment cycles. In contrast, when asked if they would make the same decision again, only 1% not having a 20% 3-IGI decline expressed regret, versus 14% with a 3-IGI decline (p = .01). CONCLUSION: The majority of patients having regret were identified early using the PRO 3-IGI of the eLCSS-QL measure. Identifying patients at risk for regret allows for interventions, including frank discussions of progress and goals early in the treatment course, which could address regret in patients and their supporters. IMPLICATIONS FOR PRACTICE: This report documents prospectively, for the first time, the incidence of treatment-related regret in patients with advanced lung cancer and outlines that risk of regret is associated with patient-determined worsening health status early in the course of treatment. Identifying patients at risk for regret early in treatment (before the third cycle of treatment) appears to be crucial. Counseling at that time should include a discussion of consideration of treatment change and the reason for this change.

Methodologic Considerations for Transition Research Using the National Survey of Children with Special Health Care Needs: A Systematic Review of the Literature.

The purpose of this review was to describe methodologic considerations in using the National Survey of Children With Special Health Care Needs (NS-CSHCN) for transition research in terms of variable inclusion and definition of transition outcomes and to provide suggestions for using NS-CSHCN for transition research. A systematic review was conducted. Inclusion criteria included use of NS-CSHCN data and transition as an outcome variable. Fourteen studies were included. Ten (71%) studies evaluated a sample of all CSHCN. Ten (71%) articles used all four variables recommended by the Maternal and Child Health Bureau core outcome on transition. Other variables included patient-centered medical home. The NS-CSHCN provides a rich dataset that can be used in transition research addressing transition preparation from the parent perspective. Using the NS-CSHCN, we recommend analyzing all variables related to the Maternal and Child Health Bureau core outcome for transition, variables related to patient-centered medical home, and further analysis of specific health conditions.

A Comprehensive Approach to Undergraduate Nursing Students' Research Experiences.

BACKGROUND: As the demands for high-quality nursing care increase and organizations are held accountable for patient outcomes, health care must be driven by research and evidence-based practice (EBP). Historically, prelicensure nursing students have expressed little interest in these topics as they focus on establishing the clinical skills necessary to provide care and have found that courses on nursing research are not clinically relevant. METHOD: This article presents one institution's approach to undergraduate nursing research education by three initiatives: (a) a summer research program, (b) a distinguished major program, and (c) an EBP approach in the undergraduate nursing research course. RESULTS: The results of these initiatives have demonstrated positive outcomes in three areas: practice improvements, knowledge dissemination, and student interest in research and further professional development. CONCLUSION: These programs have proven to be clinically beneficial, while increasing student interest in research and further nursing education. [J Nurs Educ. 2018;57(1):58-62.].

Post-Transfer Predictors of Poor Outcomes in Pediatric Renal Transplant Recipients.

The aims of this study were twofold: 1) to describe the post-transfer (defined as from pediatric to adult providers) incidence of predictors (medication nonadherence, acute rejection, and change in kidney function), as well as outcomes (graft loss) for adolescent and young adult kidney transplant recipients during a three-year post-transfer follow-up period; and 2) to identify variables to monitor these predictors, in the form of a clinical profile, so providers can promote early intervention for these medically at-risk adolescents. National data were used to describe predictors and outcomes for 250 youth (16 to 25 years old) three years after transfer of care. These predictors were combined with previous literature to develop a preliminary clinical profile. Using an evidence-based clinical profile with predictors for graft loss by a dedicated healthcare professional as a transition coordinator will assist in identifying those at risk for poor outcomes after transfer.

The Optimal Time and Method for Surgical Prewarming: A Comprehensive Review of the Literature.

PURPOSE: Inadvertent hypothermia is a common problem in the operating room. This can contribute to many unfavorable outcomes --rising costs, increased complications, and higher morbidity rates. DESIGN: This review determined the optimal method and time to prewarm a surgical patient to prevent perioperative hypothermia. METHODS: CINAHL and PubMed were searched. Fourteen articles were ultimately included in this review. FINDINGS: Based on the literature reviewed, it was suggested that forced-air warming was most effective in preventing perioperative hypothermia. Eighty-one percent of the experimental studies reviewed found that there was a significantly higher temperature throughout surgery and in the postanesthesia care unit for patients who received forced-air prewarming. CONCLUSIONS: Thirty minutes was found to be the average suggested amount of time for prewarming among the literature; however, a minimum of 10 minutes of prewarming was suggested to significantly reduce rates of hypothermia in perioperative patients and decrease the adverse effects of hypothermia.

Measurable Outcomes After Transfer From Pediatric to Adult Providers in Youth With Chronic Illness.

Children with chronic medical conditions are requiring transition services to prepare for transfer of care. There has been little data on what qualifies as a successful transition or how to measure this goal. The purpose of this review was to identify measurable patient-level outcomes for transitioning youth with chronic illness from pediatric to adult health care. An integrative literature search was conducted using CINAHL and OVID Medline. Key words included transition to adult care and health transition. Research articles published between 2002 and 2015 and reported on measurable patient-level outcomes in youth with chronic illnesses were included. The initial search yielded 556 articles and 19 articles were selected. Most of the research reporting on outcomes after transfer is nonexperimental using secondary data. Additionally, there is inconsistency in the use of term transition. In the specific outcomes identified, there is little uniformity in measurement both in terms of timing and standardization of measurement. Further research is needed on outcomes after transfer that includes standardized measures and time intervals in order to evaluate successful transition services. This research is essential for health care providers who are instrumental in supporting young people during this high risk period.

Risk Factors for Graft Loss in Pediatric Renal Transplant Recipients After Transfer of Care.

BACKGROUND: Improvements in transplantation have increased the survival of children after kidney transplantation. These patients have complex needs, and the current medical system is not prepared to effectively transfer the care of these individuals from pediatric to adult health-care systems. Too often, transfer occurs during moments of crisis and is associated with poor outcomes. OBJECTIVE: The aim of this study was to use a national database, the Scientific Registry of Transplant Recipients, to test the hypothesis that the increased risk of graft loss after transfer of care (from pediatric to adult services) for young adult kidney transplant recipients over a 2- to 3-year posttransfer follow-up period was related to these posttransfer risk factors (medication noncompliance, acute rejection, insurance status). DESIGN: A retrospective, longitudinal, correlational design using secondary data was used to evaluate the transfer of care of 250 kidney transplant recipients (ages 16-25). RESULTS: Seventy-seven (30.8%) individuals lost their graft within 3 years after transfer of care. Medication noncompliance, acute rejection, and serum creatinine >2.0 mg/dL at transfer were significant predictors of graft loss after accounting for multiple other factors. CONCLUSION: These individuals are at risk for graft loss after transfer of care and may benefit from increased personalized care during this risky period.

Few U.S. schools of nursing on campuses with smoke-free policies: A Call for Action.

INTRODUCTION: Tobacco remains the leading cause of preventable death in the United States. Recognizing that smoke-free policies can significantly reduce tobacco-related morbidity and mortality by preventing exposure to second-hand smoke and increasing quit rates, members of the Tobacco Control Subgroup of the American Academy of Nursing's (AAN) Health Behavior Expert Panel launched a health policy initiative entitled the Smoke-Free Campus Policy for Schools of Nursing Campaign. Designed as a two-phased initiative, the Campaign is a Call to Action to increase smoke-free policies on campuses with Schools of Nursing across the United States by 2020. METHODS: Phase I of the AAN Campaign included a cross-sectional study using secondary data analysis to describe the presence of smoke-free policies on campuses of Schools of Nursing across the United States. A list of colleges and universities with smoke-free policies maintained by the Americans for Nonsmokers Rights Foundation in January 2015 was accessed to conduct the analysis. Schools of Nursing granting baccalaureate and graduate nursing degrees were included. Descriptive statistics were obtained for Schools of Nursing by region of the country and by highest level of nursing degree program of study at each institution. RESULTS: Smoke-free policies of 689 Schools of Nursing were examined. Of these, 442 (64%) did not have 100% smoke-free policies on their campuses. A greater percentage of nursing schools without a smoke-free policy were located in the Northeast (114, 79%) and West (70, 73%). Nearly half (57, 46%) of the Schools of Nursing with a PhD/DNS program had a smoke-free policy in place compared with all other degree program levels (BS/BSN: 69, 35%; MS/MSN: 83, 35%; DNP: 38, 30%). CONCLUSIONS: With only 247 (36%) of Schools of Nursing on campuses with comprehensive smoke-free policies, more must be performed to promote healthy learning and working environments for nursing students, staff, and faculty. As public health advocates, nursing leaders in Schools of Nursing have a moral and ethical imperative to advance tobacco control on college campuses to meet the American College Health Association goals for smoke-free/tobacco-free environments.