The Kidney Transplant Self-Management Scale: Instrument Development and Psychometric Testing.

This study reports the development and psychometric testing of the Kidney Transplant Self-Management Scale (KT-SMS). The instrument development phase included the following: (a) conceptual definition, item generation, and framework; (b) face validity assessment; and (c) content validity assessment. The psychometric testing phase included the following: (a) construct validity testing; (b) internal consistency reliability testing; (c) convergent validity testing; and (d) predictive power of the KT-SMS using a cross-sectional sample of kidney transplant recipients (N = 153). Factor analysis results supported the 16-item KT-SMS as multidimensional with five domains (medication adherence, cardiovascular risk reduction, protecting kidney, ownership, and skin cancer prevention). Internal consistency reliability for the total scale and five subscales was adequate. Convergent validity was supported as the intercorrelations of the KT-SMS total score with the five subscales were significant. The KT-SMS total score and five subscales were significantly correlated with self-efficacy for managing chronic disease, patient activation, and health-related quality of life.

Using Facebook in Recruiting Kidney Transplant Recipients for a REDCap Study.

This web-based study recruited kidney transplant recipients from Facebook using three recruiting methods over a 5-week period. Participants completed 125 survey items via REDCap (Research Electronic Data Capture) survey. Facebook recruitment generated 153 eligible participants who completed surveys. The average survey response time was 15.07 min (SD = 6.12; range: 4-43), with a low missing item rate (<5%). Facebook's standard ads were most effective for recruiting subjects (n = 78, 51%), followed by three targeted Facebook kidney transplant support groups (n = 52, 34%) and a pay-to-promote study page (n = 12, 7.8%). The average cost paid for each valid survey was US$2.19 through standard Facebook ads and US$2.92 from the study page. The cost for online survey completion is economically feasible even for those with limited funds. Issues related to online surveys including extreme survey response times and participant misrepresentation were reported in this study.

Exercise Interventions to Manage Fatigue in Women With Gynecologic Cancer: A Systematic Review.

PROBLEM IDENTIFICATION: Fatigue has a negative impact on the quality of life of patients with cancer. The aim of this review is to evaluate studies on the effectiveness of exercise interventions in reducing fatigue in women with gynecologic cancer. LITERATURE SEARCH: The review was conducted according to the PRISMA guidelines using the CINAHL®, MEDLINE®, EMBASE, PsycINFO®, and Cochrane Library databases. The Critical Appraisal Skills Programme was used for quality assessment. DATA EVALUATION: Five studies met the inclusion criteria. SYNTHESIS: Evidence suggests that exercise interventions result in significant reductions in fatigue in women with gynecologic cancer. However, the current evidence is limited. Additional studies are required to address the dose-dependent outcomes of exercise interventions on fatigue in women with gynecologic cancer. IMPLICATIONS FOR NURSING: Findings support the positive effects of exercise interventions in reducing fatigue in women with gynecologic cancer, suggesting that healthcare professionals may consider including exercise programs into management plans for this population.

A pilot study evaluating daily physical activity before and after cardiac resynchronization therapy.

Benefits of daily physical activity are well known, but there are limited data to describe physical activity in heart failure patients who receive cardiac resynchronization therapy devices. The purpose of this pilot study was to evaluate changes in physical activity (PA) levels before and 3 months after Cardiac Resynchronization Therapy (CRT) and determine relationships of PA to physical function and comorbidities, as well as describe changes in heart failure symptoms. This was a prospective pre-/post- design that included a convenience sample of 21 subjects using self- report questionnaires and 6-minute walk test (6MWT). In this sample, there was a 2.6 hour increase in high level PA (p = 0.024). 6MW distance improved 27% (p < .0001). Subjects experienced a 25% reduction in dyspnea (p = 0.015). Knowledge gained from this study adds to the understanding of the patient response to CRT. Further study is recommended to generalize findings and explore whether an intervention (cardiac rehabilitation) is indicated.

Fatigue in women with type 2 diabetes.

PURPOSE: The purpose of this study was to explore the relationship between fatigue and physiological, psychological, and lifestyle phenomena in women with type 2 diabetes (T2DM) in order to establish the magnitude and correlates of fatigue in women with T2DM and explore the interrelationships between fatigue and specific diabetes-related factors that may be associated with increased levels of fatigue. These factors included physiological factors (glucose control, diabetes symptoms), psychological factors (diabetes emotional distress, depressive symptoms in general), and lifestyle factors (body mass index, physical activity). METHODS: A cross-sectional, descriptive design was used. Women who reported conditions known to cause fatigue were excluded. Physiological measures included fasting blood glucose (FBG), hemoglobin A1C (A1C), glucose variability, and body mass index (BMI). Women completed questionnaires about health, fatigue levels, diabetes symptoms, diabetes emotional distress, depressive symptoms, physical activity, and current diabetes self-care practices. A subset of the women wore a Medtronic Gold CGM sensor for 3 days for assessment of glucose variability. RESULTS: Eighty-three women aged 40 to 65 years with T2DM completed the study. Fatigue was significantly related to diabetes symptoms, diabetes emotional distress, depressive symptoms, higher BMI, and reduced physical activity. There was no relationship between fatigue and FBG or A1C. The strongest explanatory factors for fatigue were diabetes symptoms, depressive symptoms, and BMI, which accounted for 48% of the variance in fatigue scores. Glucose variability was not significantly associated with fatigue in these women. CONCLUSIONS: Fatigue is a persistent clinical complaint among women with T2DM and may signal the presence of physiological, psychological, and lifestyle-related phenomena that could undermine diabetes health outcomes.

Helping patients with cancer prepare for hospice.

People with life-limiting cancer will make decisions about their end-of-life (EOL) care at some point during their illness. Hospice is an option of care aimed at providing optimal quality of life at EOL. Nursing plays a major role in helping people transition from curative treatments or treatments that control the disease to EOL care. Choosing hospice is difficult for many patients with cancer. In addition, healthcare providers also face challenges in discussing EOL care. This article explores issues pertaining to EOL care conversations between nurses and patients and offers strategies that can be implemented by nurses to aid patients' transition to hospice care.

Regional body composition: cross-calibration of DXA scanners--QDR4500W and Discovery Wi.

Differences exist in body composition assessed by dual-energy X-ray absorptiometers (DXAs) between devices produced by different manufacturers and different models from the same manufacturer. Cross-calibration is needed to allow body composition results to be compared in multicenter trials or when scanners are replaced. The aim was to determine reproducibility and extent of agreement between two fan-beam DXA scanners (QDR4500W, Discovery Wi) for body composition of regional sites. The sample was: 39 women 50.6 +/- 9.6 years old with BMI 26.8 +/- 5.5 kg/m(2), body fat 33 +/- 7%. Four whole body scans (two on each device) were performed over 3 weeks. Major variables were fat mass, nonosseous lean mass, and bone mineral content (BMC) for the truncal and appendicular regions. Extent of agreement was assessed using Bland and Altman plots. Both devices demonstrated good precision with mean test-retest differences close to zero for fat mass, nonosseous lean mass, and BMC of the truncal and appendicular regions. Evaluation of interdevice agreement revealed significant differences for truncal and appendicular BMC, nonosseous lean mass, and fat mass. The greatest interdevice difference was for truncal fat mass (0.69 +/- 0.60 kg). Differences in truncal and appendicular fat mass increased in magnitude at higher mean values. Furthermore, differences in truncal and appendicular fat mass were strongly related to BMI (R = -0.61, R = -0.55, respectively). In conclusion, in vivo cross-calibration is important to ensure comparability of regional body composition data between scanners, especially for truncal fat mass and for subjects with higher BMI.

Fatigue in women receiving intraperitoneal chemotherapy for ovarian cancer: a review of contributing factors.

Women diagnosed with stage III or IV ovarian cancer typically are treated with surgery followed by chemotherapy. Intraperitoneal (IP) chemotherapy, the direct administration of chemotherapy into the IP cavity, has been explored as a viable treatment option for some women with advanced ovarian cancer. Fatigue may occur as a result of the disease process, treatment, or a wide variety of physical, psychological, or situational factors. Fatigue is one of the most common and distressing side effects associated with chemotherapy and it may be intensified in women receiving IP chemotherapy. The purpose of this article is to examine fatigue in women receiving IP chemotherapy for advanced ovarian cancer and to examine what aspects of IP chemotherapy may contribute to fatigue development. Factors reviewed include surgery for debulking the tumor and placement of the IP catheter, administration of IV chemotherapy in addition to IP chemotherapy, pain, anemia, sleep disturbances, gastrointestinal disturbances, and emotional distress. Oncology nurses who are knowledgeable about the factors that contribute to fatigue in women receiving IP chemotherapy will be better prepared to conduct a comprehensive assessment and develop effective treatment strategies.

Importance of cross-calibration when replacing DXA scanners: QDR4500W and Discovery Wi.

The aim of the study was to determine reproducibility and extent of agreement between 2 dual-energy X-ray absorptiometers (Hologic QDR4500W, Discovery Wi). The average age of the sample (n = 42) was 50.4 (SD = 9.9) years old and 27.1 (SD = 6.1) kg/m2 body mass index. Four scans were performed with each subject (2 on each device) over approximately 3 weeks. Whole body, proximal femur, and spine scans were performed at each visit. Major variables were whole body bone mineral content (BMC), fat mass, and nonosseous lean mass, and bone mineral density (BMD) of total proximal femur, femoral neck, total spine. Bland and Altman plots assessed the extent of the agreement. Regression analysis was used to develop correction equations if indicated. Both devices demonstrated good precision for whole body composition and BMD of central sites (< 1% different). Interdevice agreement was acceptable for BMD of central sites (< 1% different), but there were systematic differences for whole body composition between the 2 devices. It was concluded that when replacing an existing scanner with a new model, in vivo cross-calibration is important to ensure comparability of scan data, especially for whole body composition.