Kim, S., & Kim, H. (2005). Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nursing, 28, 79–83.
An educated treatment group received the intervention consisting of a 30-minute tape and researcher on relaxation breathing exercise (RBE). The intervention was given every day at 4 pm for six weeks during hospitalization for allogeneic stem cell transplantation.
A randomized controlled trial design was used.
Patients in the RBE group had a mean decrease of 13.3 points in anxiety (p < 0.05).
RBE could be an effective nursing intervention to reduce anxiety in hospitalized patients undergoing allogeneic stem cell transplantation.
The study had a small sample size.
Kim, H.S., Shin, S.J., Kim, S.C., An, S., Rha, S.Y., Ahn, J.B., . . . Lee, S. (2013). Randomized controlled trial of standardized education and telemonitoring for pain in outpatients with advanced solid tumors. Supportive Care in Cancer, 21, 1751–1759.
To evaluate whether standardized educational tools, with or without telemonitoring, can improve the pain levels, pain interference, anxiety, depression, distress, performance, and quality of life of outpatients with cancer who have advanced tumors
Patients were randomized to receive either standard pain education plus telemonitoring or standard education alone. A nurse practitioner (NP) performed telemonitoring of pain every day for one week. The NP telephoned the patients and asked for average visual analog scale (VAS) pain score and worst VAS pain score in the last 24 hours. This provided patients with the opportunity to assess the severity of pain themselves. Using the National Comprehensive Cancer Care Network (NCCN) guidelines for pain management, the NP advised patients whether to increase or decrease medication. The NP was trained in pain management but had no specific training for other psychosocial interventions. Standard education included a video and booklet with individual coaching, to correct misconceptions, and an outline of decision making for pain control. Outcomes were measured at one week, and average pain was measured at two months.
A randomized controlled trial design was used.
Pain intensity, for all patients, had significantly improved at one week, including worst pain (7.3–5.7, p < 0.01) and average pain (4.6–3.8, p < 0.01). Additionally, anxiety (HADS score ≥ 11, 75%–56%, p < 0.01), depression (HADS score ≥ 11, 73%–51%, p < 0.01), quality of life (fatigue and insomnia), and Karnofsky score (32–66, p < 0.01) were significantly improved at one week. However, the level of distress did not improve. The study revealed no significant differences between groups in these areas.
Standardized pain education delivered by a nursing specialist is an efficient means of improving not only pain but also anxiety, depression, performance, and quality of life. This study did not show that the addition of telemonitoring substantially improved pain management in the outpatient setting.
Findings show that comprehensive pain education was associated with short-term reduction in pain, anxiety, and depression scores. The addition of telemonitoring follow-up for pain management did not result in a significant difference in these scores; however, the follow-up period was only one week. Longer-term studies of the effects of monitoring via telephone and other technologies, for the purpose of improved symptom management, may be helpful in identifying effective methods of improving symptom control in outpatient settings.
Kim, Y. J., Sung, K. W., Hwang, H. S., Jung, S. H., Kim, J. Y., Cho, E. J., . . . Koo, H. H. (2011). Efficacy of itraconazole prophylaxis for autologous stem cell transplantation in children with high-risk solid tumors: a prospective double-blind randomized study. Yonsei Medical Journal, 52, 293–300.
To evaluate the effectiveness of prophylactic itraconazole in preventing fungal infections in pediatric autologous hematopoietic stem cell transplant (HSCT) recipients.
Patients with high-risk solid tumors undergoing autologous HSCT were divided into prophylaxis and empirical treatment groups to evaluate the effectiveness of itraconazole prophylaxis in pediatric autologous HSCT. High-risk solid tumors included high-risk neuroblastoma, high-risk embryonal brain tumor, bilateral advanced retinoblastoma, and relapsed solid tumors. Patients were then randomized to prophylaxis or empirical treatment groups. In the prophylactic group, itraconazole was given intravenously at 2.5 mg/kg/dose twice daily for the first two days followed by 2.5 mg/kg/dose once daily for the duration of treatment after the absolute neutrophil count (ANC) fell below 0.5x109/L, even in the absence of fever. In the empirical treatment group, a placebo was given once the ANC fell below 0.5x109/L after the initiation of high-dose chemotherapy, and itraconazole was started only when a fever persisted for more than three days or if fever recurred despite the use of first-line antibiotics (in this case, cefepime) for more than three days. All antibiotics, including itraconazole, were discontinued after three consecutive days of no significant fever (<37.5°C), no evidence of documented or clinically suspected infection, and an ANC greater than 0.5x109/L. For microbiologically documented infections, the antibiotic regimen was altered as needed.
This was a prospective double-blind, randomized study.
No cases of proven, probable, or possible invasive fungal infection occurred in either group. The duration of fever higher than 38ºC was significantly shorter in the prophylaxis group than in the empirical group. The number of patients who had fever for more than seven days, which was the duration of antibiotic use, and the number of patients who needed additional second-line antibiotic treatment, were lower in the prophylactic group than in the empirical group. There was no difference in the development of serious adverse events between the prophylaxis group and the empirical treatment group. The expected benefit of prophylaxis in patients with severe mucositis did not seem to be relevant because there was a reduced duration of fever regardless of the severity of mucositis.
Although there were no infections in the prophylactic group, this was not different than the results in the empirical group. There was no statistically significant finding to come from this study. There were some promising findings, such as decreased need for second-line antibiotics and decreased duration of fever, but a larger study would be necessary to prove that these are relevant findings because the power was not high enough in this study. This was a limited population, and the findings may not be generalizable to adult patients undergoing HSCT.
This article educated about fungal infections and the need for antibiotics, as well as neutropenia and the expected adverse effects of transplant. There are no specific nursing implications for this study because there were no significant findings.
Kim, H.C., Lee, Y.H., Jeon, Y.T., Hwang, J.W., Lim, Y.J., Park, J.E., & Park, H.P. (2015). The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection: A double-blind randomised study. European Journal of Anaesthesiology, 32, 596–601.
To determine the effect of intraoperative dexmedetomidine on incidence of catheter-related bladder discomfort
Patients were randomized to control and dexmedetomidine. After induction, the dexmedetomidien group had a loading dose of 1 mcg/kg over 10 minutes and then a continuous infusion of 0.5 mcg/kg per hour until the end of surgery. Control patients received an identical volume of normal saline.
The incidence of catheter-related bladder pain was higher in the control group (p = 0.004) and, at one hour after surgery, pain severity was lower in the experimental group (p = 0.041). The incidence of moderate-to-severe pain was higher in the control group (p = 0.006).
Intraoperative dexmedetomidine may reduce postoperative catheter-related bladder pain.
Findings suggest that intraoperative dexmedetomidine may reduce bladder pain associated with an indwelling catheter; however, more well-designed research is needed. This study had multiple limitations.
Kim do, S., Sim, Y.J., Jeong, H.J., & Kim, G.C. (2010). Effect of active resistive exercise on breast cancer-related lymphedema: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91(12), 1844–1848.
To investigate the effects of complex decongestive physiotherapy with and without active resistive exercise on volume reduction of the upper limb and improvement of quality of life (QOL) in patients with breast cancer-related lymphedema
Patients were randomly assigned to the active resistive exercise (ARE) group or the the nonactive resistive exercise group. Both groups received complete decongestive physiotherapy (CDPT) led by a physical therapist once a day, five days a week, for two weeks. The nonactive resistive exercise group then continued self-administered CDPT for another six weeks. The ARE group performed shoulder stretching exercises followed by using dumbbells for 15 minutes while wearing a compression stocking or multilayer bandage.
The study took place in an outpatient setting at Kosin University Gospel Hospital in Korea.
The study has clinical applicability for late effects and survivorship.
The study used a randomized controlled trial design.
Both groups showed significantly reduced volumes after treatment, but the difference between the reduced volume in the distal arm and that of the total arm was not significant. The ARE group showed a significantly reduced volume in the proximal arm. Although CDPT is described as manual lymphatic drainage, compression therapy, and remedial exercise, description of the remedial exercises does not identify whether or not a compression garment or multilayer bandages were worn. Patients in the ARE group wore a compression stocking or a multilayer bandage to avoid aggravation of the lymphedema in the shoulder and arm while doing exercises.
Both groups had reduced QOL demonstrated by baseline values on the SF-36v2. After treatment, patients in the ARE group showed significant improvements in the SF-36v2 categories of physical functioning, role-physical, body pain-general and mental health. The nonactive resistive exercise group experienced improvements in physical functioning, role-physical, body pain, and mental health. By comparison, the ARE group showed significant improvements in role-physical and general health as compared with the nonactive resistive exercise group.
ARE demonstrated volume reduction in the proximal arm, with no statistically significant reduction in the distal or overall measurement. More robust research focusing on the relationship between resistive exercise and lymphedema is needed.
Exercise, including ARE, appear to be beneficial for patients with BCRL. It is important to note that all participants in this small study received CDPT, with self-administration techniques included. Nurses should encourage patients to speak with a therapist experienced in CDPT prior to initiating an exercise program.
Kilgour, R, Jones, D. Keyserlink, J. (2008). Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: A preliminary study, Breast Cancer Research and Treatment, 109(2), 285–295.
To study the effects of a self-administered home-based exercise video program designed to help women regain shoulder mobility immediately following surgery for modified radical mastectomy and axillary node dissection
Patients were randomly assigned to usual care control or home-based exercise groups. Usual care consisted of standard written information on diet and skin care and a nine-page brochure entitled “Exercise Guide After Breast Surgery”. Participants were not encouraged to follow exercises, nor were they instructed not to do the exercises. The study was conducted during the immediate two-week recovery period following surgery. Over the next 11 days, women assigned to the home-based exercise intervention received the usual care education and followed the home-based exercise video program. Exercises involved upper-extremity movement designed to increase general range of motion, various neck movements, and stretches.
The study took place at an outpatient setting in Montreal, Canada.
The study used a randomized controlled trial design.
The experimental group demonstrated a significantly greater increase in flexion (p = 0.003) and abduction (p = 0.036) of shoulder. There was no significant difference in forearm circumference measurements, external rotation, grip strength, or pain. None of the patients in the home-based exercise group demonstrated any significant change in forearm circumference that would indicate lymphedema. Fifty percent of the patients in the home-based exercise group did not complete exercises because of pain at the shoulder joint and axillary swelling, 25% because of lack of support from family and others, 12.5% for no specific reason.
Self-directed home exercise was associated with greater improvement in some range of motion over time and did not appear to aggravate lymphedema development. There was generally low adherence to the self-directed program.
Poor adherence to the home based self-directed program point to the challenges associated with the approach described in the study.
Kieviet-Stijnen, A., Visser, A., Garssen, B., & Hudig, W. (2008). Mindfulness-based stress reduction training for oncology patients: Patients’ appraisal and changes in well-being. Patient Education and Counseling, 72, 436–442.
The MBSR intervention emphasized the following.
The intervention was offered in eight weekly sessions that were each 2.5 hours in length. Participants were encouraged to practice at home for 45 minutes using an exercise CD and other homework assignments. Each training group was guided by two therapists experienced in working with patients with cancer. Outcomes were assessed at baseline, at week 8, and a year after intervention.
The intervention was modeled after the MBSR program at the Stress Reduction and Relaxation Clinic, Massachusetts Medical Center as described by Kabat-Zinn (1990).
Not described
The MBSR intervention did not significantly improve fatigue outcomes for patients at the eight-week intervention end-point or at one-year follow-up.
Kietpeerakool, C., Supoken, A., Laopaiboon, M., & Lumbiganon, P. (2016). Effectiveness of tranexamic acid in reducing blood loss during cytoreductive surgery for advanced ovarian cancer. Cochrane Database of Systematic Reviews, 2016, CD011732.
STUDY PURPOSE: To assess the effects of tranexamic acid for reducing blood loss in women undergoing surgery for advanced ovarian cancer
PHASE OF CARE: Active antitumor treatment
Preoperative tranexamic acid was associated with reduced loss of blood compared to placebo; however, the difference from placebo was not statistically significant, and the difference seen did not demonstrate a clearly clinically important benefit (mean difference = -248.59, 95% CI [-550.9, 53.79]). Average number of RBC units were not different between groups, although the rate of RBC transfusion was lower in those given tranexamic acid.
Evidence regarding the effectiveness of tranexamic acid from this review is inconclusive because only one study was found and reviewed.
This review provided no new information to evaluate efficacy of tranexamic acid for prevention of bleeding.
Kienzle-Horn, S., Vix, J.M., Schuitjt, C., Peil, H., Jordan, C.C., & Kamm, M.A. (2007). Comparison of bisacodyl and sodium picosulfate in the treatment of chronic constipation. Current Medical Research and Opinion, 23, 691–699.
To compare the safety and efficacy of bisacodyl and sodium picosulphate.
Patients received 5 to 10 mg of bisacodyl sugar-coated tablets or sodium picosulphate drops daily over four weeks. The study schedule included four visits: an initial screening visit followed by a seven-day baseline period, a randomization visit (1:1 basis) and two follow-up visits on days 15 and 29.
15 centers (outpatient clinics and specialist gastroenterology units) in Germany
This was a phase IV, open-label, randomized, parallel group study.
Bisacodyl and sodium picosulphate are equally tolerated and effective in the treatment of chronic constipation.
Kienzle-Horn, S., Vix, J.M., Schuitjt, C., Peil, H., Jordan, C.C., & Kamm, M.A. (2006). Efficacy and safety of bisacodyl in acute treatment of constipation: A double-blind, randomized, placebo-controlled study. Aliment Pharmacology and Therapeutics, 23, 1479–1488.
To determine the effect and safety of oral bisacodyl on stool frequency and consistency.
Patients received bisacodyl 10 mg (two 5-mg tablets) or placebo (two tablets) orally once daily on three successive days following a three-day run-in period. The study had a three-day baseline period and three treatment days. Patients were asked not to drink milk or take antacids at the same time as study medications because they could dissolve the enteric coating. Randomization was 1:1. Unused medication was collected at the end of the treatment period. Primary endpoints during the three-day treatment period were mean number of stools per day and mean stool consistency.
Eight primary care practices in Germany
This was a phase IV, multicenter, double-blind, randomized, placebo-controlled, parallel group design study.
Bisacodyl is effective and safe in improving stool frequency and consistency.