Self-care Protocols Research Articles

Hypofractionated whole breast IMRT with HDR brachytherapy boost in early-stage breast cancer: Long-term results from a single-center

INTRODUCTION/OBJECTIVESThe addition of a boost to the lumpectomy bed after whole-breast (WB) radiotherapy plays a key role in the treatment of patients with breast cancer (BC). The clinical benefits of a boost with high-dose-rate brachytherapy (HDR-BT) after conventional fractionation is supported by a large body of evidence. However, few studies have described its outcomes after a hypofractionated scheme. MATERIALS AND METHODSWe included all patients treated with adjuvant WB-IMRT in 15 sessions followed by a single-session HDR-BT boost with local anesthesia on an outpatient basis. RESULTSBetween 2009 and 2017, 638 patients with early-stage BC were treated according to the aforementioned protocol after breast-conserving surgery. Median follow-up was 6 years (4–11). Despite the low incidence of side effects and their slightness, we did identify an impact of breast volume on the risk of acute radiodermatitis, fibrosis, pain and edema. However, we did not identify any relationship between the volume in cubic centimeters of the BT-implant with acute or long-term side effects. 2.2% patients had an actual local relapse, 2.4% a 2nd primary in the same breast and 2.39% were diagnosed with contralateral BC. Event-free survival at 11 years was 85.5% with an overall survival of 95.7%. CONCLUSIONAdjuvant hypofractionated whole-breast IMRT followed by a single dose HDR-BT boost has a low incidence of acute and chronic toxicity and excellent oncological outcomes. However, it may be worthwhile to intensify self-care protocols and surveillance in women with large breasts who may be at increased risk of side effects.

Elimination of lymphatic filariasis as a public health problem in Malawi.

Lymphatic filariasis (LF) is a parasitic disease transmitted by mosquitoes, causing severe pain, disfiguring, and disabling clinical conditions such as lymphoedema and hydrocoele. LF is a global public health problem affecting 72 countries, primarily in Africa and Asia. Since 2000, the World Health Organization (WHO) has led the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support all endemic regions. This paper focuses on the achievements of the Malawi LF Elimination Programme between 2000 and 2020 to eliminate LF as a public health problem, making it the second sub-Saharan country to receive validation from the WHO. The Malawi LF Programme addressed the widespread prevalence of LF infection and disease across the country, using the recommended WHO GPELF strategies and operational research initiatives in collaboration with key national and international partners. First, to stop the spread of infection (i.e., interrupt transmission) and reduce the circulating filarial antigen prevalence from as high as 74.4% to below the critical threshold of 1-2% prevalence, mass drug administration (MDA) using a two-drug regime was implemented at high coverage rates (>65%) of the total population, with supplementary interventions from other programmes (e.g., malaria vector control). The decline in prevalence was monitored and confirmed over time using several impact assessment and post-treatment surveillance tools including the standard sentinel site, spot check, and transmission assessment surveys and alternative integrated, hotspot, and easy-access group surveys. Second, to alleviate suffering of the affected populations (i.e., control morbidity) the morbidity management and disability prevention (MMDP) package of care was implemented. Specifically, clinical case estimates were obtained via house-to-house patient searching activities; health personnel and patients were trained in self-care protocols for lymphoedema and/or referrals to hospitals for hydrocoele surgery; and the readiness and quality of treatment and services were assessed with new survey tools. Malawi's elimination of LF will ensure that future generations are not infected and suffer from the disfiguring and disabling disease. However, it will be critical that the Malawi LF Elimination programme remains vigilant, focussing on post-elimination surveillance and MMDP implementation and integration into routine health systems to support long-term sustainability and ongoing success. Lymphatic filariasis, also known as elephantiasis, is a disabling, disfiguring, and painful disease caused by a parasite that infected mosquitoes transmit to millions of people worldwide. Since 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) has supported endemic countries such as Malawi in south-eastern Africa, to eliminate the disease as a public health problem. The Malawi National LF Elimination Programme has worked tirelessly over the past two decades to implement the GPELF recommended strategies to interrupt the transmission with a two-drug regime, and to alleviate suffering in patients with lymphoedema and/or hydrocoele through morbidity management and disability prevention. Additionally, the LF Programme has collaborated with national and international stakeholders to implement a range of supplementary operational research projects to address outstanding knowledge gaps and programmatic barriers. In 2020, the World Health Organisation validated that Malawi had successfully eliminated LF as a public health problem, making it the second country in sub-Saharan Africa to achieve this, which is remarkable given that Malawi previously had very high infection rates. The LF Programme now remains vigilant, putting its efforts towards post-elimination surveillance and the continued implementation of care for patients with chronic conditions. Malawi's elimination of LF will ensure that future generations are not affected by this devastating disease.

The effectiveness of the self-care protocol in managing pain in Tempro-mandibular joint disordered patients: Scope review

Background: Temporomandibular Joint disorder (TMD) consists of a variety of conditions which affect the jaw joints, surrounding muscles and ligaments. It can be caused by trauma, improper bites, or arthritis. These conditions are usually associated with pain and dysfunction of the temporomandibular joint, masticatory muscles, and other bone structures. Self-care protocol is a non-invasive approach. Self-care is commonly an initial management method for temporomandibular disordered patients. Objectives: This review aims to assess the effectiveness of self-care in managing pain in TMJ-disordered patients when applied alone and in combination with other management methods. Contents: This is a rapid review of the literature. The review was done in the databases Science Direct, Pubmed and Google Scholar. Articles in English published between 2010 and 2022 were included. Twelve articles were selected. These articles were included in accordance with predetermined inclusion and exclusion criteria. Conclusion: There are two main goals in the management of temporomandibular disordered patients: the reduction of pain and the improvement of function. Self-care protocols are effective in achieving these two goals. TMJ-disordered patients present faster improvement in TMJ pain symptoms when self-care is combined with any other TMJ management methods.

Ashes2Art: Mitigation Strategies for Short-and Long-term Distress in Emergency Services Personnel During COVID-19.

Ashes2Art, a nonprofit organization working with fire fighters and first responders since 2017, promotes creativity to counter balance the exposure to extreme loss and trauma. Operating under the Northern Virginia Emergency Medical Services Council, Ashes2Art provides art supplies, art classes, and a creative community of support to mitigate the deleterious effects the stress of the job can take on fire fighters and first responders’ health and mental health. During the COVID-19 pandemic, Ashes2Art has seen an increased demand for art supplies and the, now online, creative arts classes and self-care strategies. Currently, approximately 100 emergency services personnel and family members are actively participating in these initiatives during this crisis. Managing the cumulative emotional load these first responders and their families experience is paramount to COVID-19 recovery efforts and post-pandemic operations. Helping first responders and their families manage the short- and long-term emotional toll from the work they do in responding to the COVID-19 crisis is paramount to the United States’ successful recovery back to a well-functioning post-pandemic society. This paper suggests that enhancing well-being through mindfulness-focused creative arts engagement might be one effective tool to be included as part of routine self-care protocols for first responders and their families.

Experiences and challenges of adults living with type 2 diabetes mellitus presenting at the University Teaching Hospital in Lusaka, Zambia

ObjectiveThe study explored the experiences and challenges of adults living with type 2 diabetes mellitus (T2DM) presenting at the University Teaching Hospital (UTH) in Lusaka.Research designA qualitative descriptive study was...

Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial

BackgroundMobile Health technology for the management of patients with atrial fibrillation is unknown. MethodsThe simple mobile AF (mAF) App was designed to incorporate clinical decision-support tools (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, Prior Stroke or TIA, Vascular disease, Age 65–74 years, Sex category], HAS-BLED [Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly], SAMe-TT2R2 [Sex, Age <60 years, Medical history, Treatment, Tobacco use, Race] scores), educational materials, and patient involvement strategies with self-care protocols and structured follow-up. Patients with atrial fibrillation were randomized into 2 groups (mAF App vs usual care) in a cluster randomized design pilot study. Patients' knowledge, quality of life, drug adherence, and anticoagulation satisfaction were evaluated at baseline, 1 month, and 3 months. Usability, feasibility, and acceptability of the mAF App were assessed at 1 month. ResultsA total of 113 patients were randomized to mAF App intervention (mean age, 67.4 years; 57.5% were male; mean follow-up, 69 days), and 96 patients were randomized to usual care (mean age, 70.9 years; 55.2% were male; mean follow-up, 95 days). More than 90% of patients reported that the mAF App was easy, user-friendly, helpful, and associated with significant improvements in knowledge compared with the usual care arm (P values for trend <.05). Drug adherence and anticoagulant satisfaction were significantly better with the mAF App versus usual care (all P < .05). Quality of life scores were significantly increased in the mAF App arm versus usual care, with anxiety and depression reduced (all P < .05). ConclusionsThe pilot mAFA Trial is the first prospective randomized trial of Mobile Health technology in patients with atrial fibrillation, demonstrating that the mAF App, integrating clinical decision support, education, and patient-involvement strategies, significantly improved knowledge, drug adherence, quality of life, and anticoagulation satisfaction.

Personal and Organizational Predictors of Compassion Fatigue Symptoms in Local Television Journalists

Compassion fatigue is a form of traumatic stress that results from repeated encounters with victims of trauma and traumatic situations. Most often studied in counselors, nurses, and first responders, this study applies the concept to journalists who often encounter the same victims and traumatic scenes. Seventy reporters from different television markets were measured for the personal and professional factors that contribute to compassion fatigue symptoms and its components of secondary traumatic stress and burnout. Results showed personal traumatic events and perceived peer support were the strongest predictors of compassion fatigue symptoms in television reporters. Implications for reporter self-care and newsroom protocols are discussed.

Burnout, Stress, and Compassion Fatigue in Occupational Therapy Practice and Education: A Call for Mindful, Self-Care Protocols

Burnout, Stress, and Compassion Fatigue in Occupational Therapy Practice and Education: A Call for Mindful, Self-Care Protocols

Development and pilot test of a dyadic psychosocial intervention for couples coping with head and neck cancer.

187 Background: Patients receiving radiotherapy for head and neck cancers (HNCs) experience significant persistent side effects such as abnormally reduced salivation, difficulty swallowing, and taste changes. To control these side effects and minimize discomfort, intensive self-care protocols are prescribed, but adherence is poor. Spouses/partners play a critical role in supporting adherence, but often lack knowledge, experience high rates of distress, and display poor communication that can interfere with patient self-management and self-care. Methods: We developed and pilot-tested a skills-training intervention comprised of tailored manuals and 6 counseling sessions delivered over the telephone to HNC patients and their partners. The goal is to reduce healthcare utilization and improve patient and partner quality of life (QOL). To guide the development and content of the intervention, qualitative interviews with 6 HNC patients (83% male) and 6 spouses were analyzed using a grounded theory approach. For the pilot test, couples completed surveys prior to initiating radiotherapy and were randomized to the intervention or usual medical care. Eight weeks later, they completed follow-up surveys. Results: Based on the qualitative findings, we developed the intervention to teach: 1) self-management skills; 2) communication skills; and 3) strategies to improve communal coping and confidence in the ability to work as a team. To date, 20 couples (Mean Age = 57 years; SD = 8) have participated. Solid recruitment (83%) and low attrition rates demonstrate feasibility. Strong program evaluations (Mean = 8.7 out of 10) and homework completion rates (85%) support acceptability. Conclusions: This is the first program in HNC that actively involves both members of the couple to address barriers in the home environment in which self-management occurs. By empowering couples with the skills to coordinate care and support, the program holds great promise for improving self-management behaviors, reducing costly hospitalizations and treatment interruptions, and improving patient and partner QOL.

Several Aspects of Internet and Web-Based Technology in Diabetes Management.

As evidenced by a large number of well-conducted randomized trials, the complications and confounding conditions that can result from mismanagement of diabetes can be reduced or prevented with appropriate medical care (1–5). Observational studies to ascertain the level of glycemic control, blood pressure control, and cholesterol control in people with diabetes provide evidence of poor adherence to established self-management protocols (6–9). Although diabetes shares characteristics with other chronic lifelong diseases that require a model of continuous care, successful management of diabetes is primarily based on patients’ ability to maintain consistency in self-care–related behaviors (10–14). Diabetes care requires long-term self-management and a willingness to adapt to a new lifestyle, which includes changes in eating habits, regular exercise, and adherence to medication schedules (15–19). Thus, diabetes health care providers have limited control over the actual development and treatment of the disease (20–24). Lack of adherence to diabetes self-care protocols is multifaceted but includes factors such as perceived lack of time for check-ins and follow-ups with primary care providers (PCPs), treating providers, and specialist (25). In addition to patient complexities, some strategies used by treating providers and specialists for providing self-management classes or interventions have shown promise but are limited by costs to both education/intervention providers and patients. For providers, costs may include staffing, conducting classes, and securing locations for them; for patients, costs may include transportation, missed time from work, and childcare services. An additional barrier is providers’ inability to provide frequent, long-term contact with patients who have completed such interventions; there are limited available resources to devote to sustaining lifelong intervention to encourage adherence to effective self-management practices (26,27). PCPs normally serve as the central point of care and arrange for patient appointments with other specialists such …

An observational study of social control, mood, and self-efficacy in couples during treatment for head and neck cancer

Objective: Head and neck cancer (HNC) patients experience debilitating side effects, including abnormally reduced salivation and difficulty swallowing. Intensive self-care protocols are prescribed to control side effects and minimise discomfort, but non-adherence rates are high. Although spouses are in a prime position to encourage adherence, studies have yet to examine how spouse social control (i.e. attempts to influence patient behaviour to support adherence) affects HNC patient mood and self-efficacy for engaging in these self-care routines.Methods: One-hundred twenty-five HNC couples, where the patient (86% male) was undergoing radiotherapy, were recorded in the laboratory as they discussed a cancer-related issue that the patient identified as being a topic of concern.Results: Sixty-eight couples discussed side effects and spouses engaged in social control in 61 of these discussions. Although oral complications and pain were frequently identified by patients as being topics of concern, dental/oral care and pain management were some of the least likely self-care behaviours to be targeted by spouses, who focused primarily on encouraging patients to maintain their weight and hydration. Although spouses engaged in an almost equal number of positive and negative control attempts, only positive control was significantly (p < .05) associated with patient positive mood and self-efficacy.Conclusion: HNC couples may benefit from programmes that emphasise the regular practise of self-care routines to control oral side effects, pain and nutrition/hydration problems. Likewise, programmes that encourage spouses to maximise their use of positive social control may also boost patients’ mood during treatment and empower them to engage in recommended self-care behaviours.

Irish insights into the lived experience of breast cancer related lymphoedema: implications for occupation focused practice

There is limited qualitative occupational research into the lived experience of breast cancer, with the international literature reporting that occupational therapy practice in oncology needs to be more occupation-focused. Based on a longitudinal, qualitative research design and using an existential phenomenological methodology, this paper reports on a group of Irish women’s experiences of living with breast cancer related lymphoedema (BCRL) in terms of their prescribed self-management conservative treatments. Three rounds of in-depth semi-structured interviews were collected over three years and were analysed using Interpretative Phenomenological Analysis. Results reveal that the women found compliance with self-management protocols for BCRL a difficult dilemma. The majority of the women deliberately risked their vulnerable arms in order to preserve familiar occupational performance and to express their occupational identities. It is argued that there is an important role for occupational therapists with this growing international population to enable occupation in ways that accommodate compliance with self-care protocols.

Health Literacy and Self-care of Patients With Heart Failure

Today's complex healthcare system relies heavily on sophisticated self-care regimens. To navigate the system and follow self-care protocols, patients must be able to understand and use health information, which requires health literacy. However, nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Understanding how to effectively care for one's self is thought to improve heart failure symptoms and patient outcomes, but little is actually known about how health literacy influences self-care in patients with heart failure. The purpose of this pilot study was to examine the relationship between health literacy and self-care of patients with heart failure. Patients with a diagnosis of heart failure were recruited from a variety of community settings. Participants completed the Short-Form Test of Functional Health Literacy (measured health literacy), the Self-care Index of Heart Failure (measured self-care maintenance, management, and confidence), and a demographic questionnaire. Spearman ρ correlations were used to assess the strength of the relationship between health literacy level and self-care scores. Among the 49 participants recruited, health literacy was positively related to self-care maintenance (Rs = 0.357, P = .006). Health literacy had a negative relationship with self-care management (Rs = -0.573, P = .001). There was no association between health literacy and self-care confidence (Rs = 0.201, P = .083). This project provides preliminary data regarding the association between health literacy and self-care in heart failure, showing support for higher health-literate patients performing more self-care maintenance, which has been shown to improve patient outcomes in heart failure. Patients with higher health literacy trended toward having greater self-care confidence, which can increase the likelihood of performing self-care, but this finding was not statistically significant. It was unexpected to find that lower health-literate patients performed more self-care management.

Self-care coping strategies in people with diabetes: a qualitative exploratory study

BackgroundThe management of diabetes self-care is largely the responsibility of the patient. With more emphasis on the prevention of complications, adherence to diabetes self-care regimens can be difficult. Diabetes self-care requires the patient to make many dietary and lifestyle changes. This study will explore patient perceptions of diabetes self-care, with particular reference to the burden of self-care and coping strategies among patients.MethodsA maximum variation sample of 17 patients was selected from GP practices and diabetes clinics in Ireland to include patients with types 1 and 2 diabetes, various self-care regimens, and a range of diabetes complications. Data were collected by in-depth interviews; which were tape-recorded and transcribed. The transcripts were analysed using open and axial coding procedures to identify main categories, and were reviewed by an independent corroborator. Discussion of the results is made in the theoretical context of the health belief, health value, self-efficacy, and locus of control frameworks.ResultsPatients' perceptions of their self-care varied on a spectrum, displaying differences in self-care responsibilities such as competence with dietary planning, testing blood sugar and regular exercise. Three patient types could be distinguished, which were labeled: "proactive manager," a patient who independently monitors blood glucose and adjusts his/her self-care regime to maintain metabolic control; "passive follower," a patient who follows his/her prescribed self-care regime, but does not react autonomously to changes in metabolic control; and "nonconformist," a patient who does not follow most of his/her prescribed self-care regimen.ConclusionPatients have different diabetes self-care coping strategies which are influenced by their self-care health value and consequently may affect their diet and exercise choices, frequency of blood glucose monitoring, and compliance with prescribed medication regimens. Particular attention should be paid to the patient's self-care coping strategy, and self-care protocols should be tailored to complement the different patient types.

A New Understanding of Clergy Compassion Fatigue for Facilitators of Trainings for the Prevention of Sexual Misconduct

Abstract Compassion fatigue (CF) has been described by Charles R. Figley as “the cost of caring.” Clergy compassion fatigue (CCF) will be discussed in this article from both personal experience and current research, the latter of which has shown that religious leaders are viewed as attachment figures in times of great need. Clergy who facilitate trainings for the prevention of sexual misconduct need to be aware of the potential for a traumatic stress response when viewing films and hearing case studies in group discussions. Facilitators may avoid painful loneliness, loss of hope, and failure of confidence by sharing their reactions with others through appropriate supervisory sessions and by creating intentional self-care protocols as part of their ministry.

How to develop personalised self-care protocols for use during a crisis

Self-care is a tool that helps employees function effectively during normal work conditions and — especially — during crisis situations and business interruptions. This paper will further define self-care, its relevance to business continuity and emergency management, and the benefits of including it as a part of formal training and pre- or post-intervention strategies. Finally, it provides best practice guidance on how to implement self-care protocols, including examples of current practice.

Effective algorithm-based triage and self-care protocols: Quality medicine at lower costs

The triage phase of an algorithm-based medical care system was analyzed in three military patient environments. Combat medics triaged 4,799 patients using a physician-prepared triage manual which specified levels of initial health care based on the patient's presenting complaints and a brief history. Evaluation indicated that 36% of those reporting for sick call were eligible for treatment by medically appropriate self-care protocols. Of the remaining 64%, all but 4% could receive initial evaluation by non-physician health care extenders. The study demonstrates that personnel receiving basic medical training and orientation to an algorithm-directed triage system can direct military patients to appropriate levels of health care.