Factors related to quality of life after video-assisted thoracoscopic surgery in patients with stage I adenocarcinoma lung cancer: A longitudinal study.

PURPOSE: This study aimed to assess the 5-year survival, quality of life for cancer- and lung-specific symptoms, and to identify predictive factors of quality of life during a 12-month period after video-assisted thoracic surgery (VATS) for early-stage lung adenocarcinoma. METHODS: A convenience sample of 53 patients who had undergone VATS for lung cancer was used for this longitudinal, prospective study. All participants provided responses to the cancer-specific quality-of-life European Organization for Research and Treatment of Cancer questionnaire as well as a questionnaire for lung cancer-specific symptoms using structured interviews at baseline (T0) and 3-, 6-, 9-, and 12-months post-surgery (T1, T2, T3, and T4, respectively). Generalized estimating equation models were used to investigate whether quality of life scores improved from baseline measures and to determine characteristics associated with changes in scores for quality-of-life post-surgery. RESULTS: The mean age of participants was 58.5 years (SD = 8.76), and most were female (64.2%). Participants received either a wedge or sublobular lobectomy (47.2%) or a lobectomy (52.8%). The size of the primary tumour for most participants was <2 cm (78.7%). The five-year survival rate was 90%. Lung-specific symptoms of insomnia were worse at T1 compared with baseline. Significant improvements in scores for function and cancer symptoms were seen at T4 compared with scores at T0. Age, marital status, smoking, alcohol consumption, and a history of previous cancer were significantly associated with quality of life. CONCLUSIONS: Surgical resection with VATS resulted in good 5-year survival rates and long-term improvements in quality of life. Our findings suggest VATS for patients with early-stage lung adenocarcinoma should be considered as a means of improving long-term survival and quality of life.

Effectiveness of simulation-based learning on student nurses' self-efficacy and performance while learning fundamental nursing skills.

It was noted worldwide while learning fundamental skills and facing skills assessments, nursing students seemed to experience low confidence and high anxiety levels. Could simulation-based learning help to enhance students' self-efficacy and performance? Its effectiveness is mostly unidentified. This study was conducted to provide a shared experience to give nurse educators confidence and an insight into how simulation-based teaching can fit into nursing skills learning. A pilot study was completed with 50 second-year undergraduate nursing students, and the main study included 98 students where a pretest-posttest design was adopted. Data were gathered through four questionnaires and a performance assessment under scrutinized controls such as previous experiences, lecturers' teaching skills, duration of teaching, procedure of skills performance assessment and the inter-rater reliability. The results showed that simulation-based learning significantly improved students' self-efficacy regarding skills learning and the skills performance that nurse educators wish students to acquire. However, technology anxiety, examiners' critical attitudes towards students' performance and their unpredicted verbal and non-verbal expressions, have been found as possible confounding factors. The simulation-based learning proved to have a powerful positive effect on students' achievement outcomes. Nursing skills learning is one area that can benefit greatly from this kind of teaching and learning method.

Avellis syndrome as presenting manifestation of ulcerative colitis.

We described a 41-year-old woman presenting with subacute onset of left hemihypesthesia, left facial palsy, dysphagia and dysgeusia. A cranial T2-weighted magnetic resonance imaging revealed bilateral inhomogeneous medullary hyperintensities. The clinical manifestations conformed to Avellis syndrome, and were linked to the diagnosis of ulcerative colitis which was proved by serological findings and pathological evidence on rectosigmoid mucosa. She recovered favorably under conservative medical treatment with complete remission over one month of follow-up. Brainstem syndromes are rarely associated with neurological complications of ulcerative colitis and can be the presenting manifestation beyond gastrointestinal symptoms.

Effects of a therapeutic lifestyle-change programme on cardiac risk factors after coronary artery bypass graft.

AIMS: The aim of this study was to explore the behavioural and clinical impact of a therapeutic lifestyle-change intervention for cardiac risk factors in patients after coronary artery bypass graft surgery. BACKGROUND: Coronary atherosclerosis-induced cardiovascular disease involves a progressive process. Progression of coronary atherosclerosis remains a significant problem after coronary artery intervention, requiring patients to make ongoing modifications in their lifestyle to reduce cardiac risk factors. DESIGN: A prospective quasi-experimental design was used. METHODS: Patients who received coronary artery bypass graft surgery at a medical centre in Taiwan were sampled by convenience and assigned to two groups. The control group (n = 37) and experimental group (n = 36) both received routine postoperative rehabilitation, with the experimental group also receiving the therapeutic lifestyle-change programme. Measures of behavioural and clinical outcomes were compared before surgery, one and three months after discharge. RESULTS: The results revealed that the amount of cigarette smoking, blood pressure control, frequency of physical activity and dietary behaviour were modified in both groups. Both groups improved significantly in blood lipid profiles and fasting glucose levels from presurgery to the first month after discharge and the experimental group improved even more (p < 0.05). Similar findings were also noted for changes in cigarette smoking and dietary behaviour. Three months after discharge, blood pressure control and frequency of physical activity in the experimental group were significantly higher than in the control group. CONCLUSIONS: Incorporating a therapeutic lifestyle-change intervention into a postoperative cardiac rehabilitation programme effectively modified cardiac risk factors and may improve postoperative recovery and prognosis. RELEVANCE TO CLINICAL PRACTICE: Guidelines for Taiwanese patients with cardiovascular disease should stress and support implementation of and adherence to therapeutic lifestyle changes in addition to drug therapy.

Effective treatment of experimental autoimmune neuritis with Fc fragment of human immunoglobulin.

IV immunoglobulin (IVIg) and its Fc fragment proved effective in preventing further progression of experimental autoimmune neuritis (EAN) in the rat induced by whole bovine peripheral nerve myelin and shortening disease duration. This effectiveness was associated with significant differences in electrophysiological parameters including less prolongation of somatosensory evoked potential (S wave) latencies, better maintained S wave amplitudes, less reduction of distal motor nerve conduction velocity, and better maintained amplitudes of compound muscle action potentials of dorsal foot muscles after stimulation at ankle and hip. Moreover, treatment with IVIg and Fc fragments resulted in less extensive inflammation and demyelination in nerve roots evidenced by significantly lower histological grades. The current study provides direct evidence for the first time that Fc fraction of IVIg is the effective component in the treatment of rat EAN.

Effective treatment of experimental autoimmune neuritis with human immunoglobulin.

High-dose intravenous immunoglobulin (IVIg) is an effective treatment for inflammatory demyelinating neuropathies, although the mechanism(s) of action remain incompletely understood. Experimental autoimmune neuritis (EAN) is an animal model of inflammatory demyelinating neuropathies; however, there have been conflicting reports regarding the efficacy of human IVIg in EAN. To obtain a model suitable for the study of the mechanism(s) of action of IVIg in Guillain-Barré syndrome, we investigated the effect of IVIg in EAN in the rat using clinical, electrophysiological and morphological measures. Human IVIg administered at the onset of signs of disease proved effective in preventing further progression of disease and shortening disease duration. This effectiveness was associated with significant differences in electrophysiological parameters including less prolongation of somatosensory evoked potential (S wave) latencies, better maintained S wave amplitudes, less reduction of distal motor nerve conduction velocity, and better maintained amplitudes of compound muscle action potentials of the dorsal foot muscles after stimulation at ankle and hip. Moreover, treatment with IVIg resulted in significantly lower histological grades in rat EAN. The current study provides evidence that human IVIg is effective in the treatment of EAN in the rat, indicating that this model may facilitate further investigation of the mechanism(s) of action of IVIg in inflammatory demyelinating neuropathies.