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Purpose Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC. Design and Methods A prospective study of 36 CMC admitted to a children's hospital from 4/15/2015 to 4/14/2016 identified with a possible high risk of hospital readmission and offered a post-discharge home visit within 72 h of discharge. The visit was staffed by a hospital nurse familiar with the child's admission. The home visit goals were to reinforce education of the discharge plan, assess the child's home environment, and identify and address any problems or issues that emerged post-discharge. Results The children's median age was 6 years [interquartile range (IQR) 2–18]. The median distance from hospital to their home was 38 miles (IQR 8–78). All (n = 36) children had multiple chronic conditions; 89% (n = 32) were assisted with medical technology. The nurse identified and helped with a post-discharge problem during every (n = 36) visit. Of the 147 problems identified, 26.5% (n = 39) pertained to social/family issues (e.g., financial instability), 23.8% (n = 35) medications (e.g., wrong dose), 20.4% (n = 30) durable medical equipment (e.g., insufficient supply or faulty function), 20.4% (n = 30) child's home environment (e.g., unsafe sleeping arrangement), and 8.8% (n = 13) child's health (e.g., unresolved health problem). Conclusions Home visits helped identify and address post-discharge issues that occurred for discharged CMC. Practical Implications Hospitals should consider home visits when optimizing discharge care for CMC.

Objectives There are no evidenced-based rehabilitative guidelines for postsurgical non–small cell lung cancer (NSCLC) patients. This qualitative study provides evidence on the acceptability of an effective postsurgical exercise intervention targeting the self-management of cancer-related fatigue to fill this gap. Data Sources Qualitative perspective of 37 individuals randomized to a 6-week exercise program following hospital discharge post-thoracotomy for NSCLC. Conclusion Postsurgical NSCLC participants found this rehabilitative exercise intervention highly acceptable because it removed traditional barriers to exercise. Implication for Nursing Practice A highly acceptable and effective solution for meeting the unmet rehabilitative support needs of NSCLC patients has broader implications for extension to other vulnerable, aging, deconditioned populations.

Background Fatigue remains a prevalent and debilitating symptom in persons with non-small cell lung cancer (NSCLC). Exercise has been shown to be effective in reducing fatigue, yet interventions are limited for postsurgical NSCLC patients. To date, while surgery is offered as a standard curative treatment for NSCLC, no formal guidelines exist for postsurgical rehabilitation. Objective This study focuses on the design and testing of a postsurgical intervention for NSCLC patients to promote perceived self-efficacy for fatigue self-management targeting cancer-related fatigue (CRF) severity and its associated fatigability through exercise. Methods A 2-arm randomized controlled trial was used to examine the impact of a 6-week rehabilitative CRF self-management exercise intervention on 37 NSCLC participants compared with 35 control group participants receiving usual care from diagnosis to 6 weeks' postsurgical hospital discharge. Results We exceeded goals for recruitment (66%), retention (97%), adherence (93%), and acceptability. Our 6-week exercise intervention demonstrated preliminary efficacy in significantly reducing CRF severity and fatigability as compared with usual care, with mean CRF levels restored to levels lower than presurgery. Likewise, the exercise group's functional performance (physical and mental health scores) exceeded usual care. Furthermore, no adverse events were reported; participants had a mean age of 67 years and a mean of 8 comorbid conditions. Conclusions An exercise intervention for postsurgical NSCLC patients is feasible, safe, and highly acceptable showing positive changes in CRF self-management. Implications for practice To advance practice, testing of the effectiveness of this health-promoting self-management exercise intervention in a larger-scale randomized controlled trial is needed.

Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.

Background Two prevalent unmet supportive care needs reported by the non-small cell lung cancer (NSCLC) population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Yet, there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy. Objective The objective of this study was to evaluate the feasibility, acceptability, safety, and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue (CRF) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home. Interventions/methods Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management, a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus. Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks. Results The intervention positively impacted end points such as CRF severity; perceived self-efficacy for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercises); and functional performance (number of steps taken per day). Conclusions A home-based, light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. Implications for practice Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention. Next steps include testing of this health-promoting self-management intervention in a larger-scale randomized controlled trial.

Objectives To discuss the significant issues surrounding the prescribing of physical activity as a first line of defense against the development of age-associated life-limiting illnesses such as cancer while providing strategic knowledge for clinicians regarding its prescription and management. Data Sources Literature review on physical activity in cancer prevention. Conclusion There is growing evidence that reduced physical activity increases the risk of co-morbid conditions such as cancer, yet there is limited clinician education and subsequent prescription of physical activity. Implications for Nursing Practice Nurses in partnership with other primary care clinicians have a unique opportunity to effect change of our nation's greatest modifiable public health threat, physical inactivity.

Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pre-treatment values, were observed at post-treatment and at 3 and 9 months follow- up but not at 6 or 12 months follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at 3, 6, 9, and 12 months follow-up points, respectively. Moreover, at 12 months post-treatment, 81% of the sample reported that still used the self-hypnosis skills learned in treatment. Overall the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.

Background Critical gaps exist in the understanding of cancer symptoms, particularly for cancer-related fatigue (CRF). Existing theories and models do not examine the key role perceived self-efficacy (PSE) plays in a person's ability to manage symptoms. Objectives The objective of this study was to test the hypothesis that physical functional status (PFS) is predicted through patient characteristics, CRF, other symptoms, and PSE for fatigue self-management in persons with cancer. Methods This study is a secondary data analysis from the baseline observation of two randomized control trials. The combined data set includes 298 participants who were undergoing a course of chemotherapy. Key variables included physiological and contextual patient characteristics, the severity from CRF and other symptoms, PSE, and PFS. Path analysis examined the relationships among the variables in the proposed theoretical model. Results Persons with cancer reported CRF as the most prevalent symptom among a mean of 7.4 other concurrent symptoms. The severity from CRF had a direct and indirect effect on PFS, with CRF having a direct adverse impact on PFS (t = -7.02) and an indirect adverse effect as part of the severity from the other symptoms (t = 9.69), which also adversely impacted PFS (t = -2.71). Consistent with the proposed theoretical model, PSE had a positive effect on the PFS (t = 2.87) of persons with cancer while serving as a mediator between CRF severity and PFS. Discussion Cancer-related fatigue is prevalent and related to the presence of other symptoms, and PSE for fatigue self-management is an important factor influencing CRF and PFS. A foundation is provided for future intervention studies to increase PSE to achieve optimal PFS in persons with cancer.

Case study research suggests that hypnosis treatment may provide benefits that are not necessarily the target of specific suggestions. To better understand satisfaction with and the beneficial "side effects" of hypnosis treatment, questions inquiring about treatment satisfaction and treatment benefits were administered to a group of 30 patients with chronic pain who had participated in a case series of hypnotic analgesia treatment. The results confirmed the authors' clinical experience and showed that most participants reported satisfaction with hypnosis treatment even when the targeted symptom (in this case, pain intensity) did not decrease substantially. Study participants also reported a variety of both symptom-related and nonsymptom-related benefits from hypnosis treatment, including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress, although no single benefit was noted by a majority of participants.

Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment.

(1) To describe one aspect of social support, social integration, longitudinally for 2 years following lower limb amputation and (2) to explore the impact of social support on depression, pain interference, life satisfaction, mobility, and occupational functioning.Eighty-nine adults recruited from consecutive admissions to an orthopaedic surgery service completed telephone interviews 1, 6, 12 and 24 months following amputation surgery. Dependent variables included the Social Integration (SI) sub-scale of the Craig Handicap Assessment and Reporting Technique (CHART) and the Multidimensional Scale of Perceived Social Support (MSPSS).There was a high level of SI among most persons following lower limb amputations that was relatively unchanged in the 2 years following surgery. However, mean levels of SI were lower in this group compared to a sample without disabilities. MSPSS scores were highly variable, ranging from almost no support to the maximum amount of support. MSPSS was an important concurrent predictor of pain interference, life satisfaction, and mobility, controlling for demographic and amputation-related factors. Baseline MSPSS predicted mobility and occupational functioning 6 months post-amputation, controlling for demographic and amputation-related factors.Findings suggest that interventions aimed at improving the quality of social relationships after amputation may facilitate participation in activities.

Objectives To determine if cerebral palsy-related pain and frequency of use of pain treatments change over time and to examine the association between use of pain treatments and changes in pain intensity. Design Longitudinal study of 50 adults with cerebral palsy-related chronic pain, interviewed five times during the course of 2 yrs (6 mos between each interview). Subjects ranged in age from 18 to 76 yrs old and included 25 women and 25 men. Results Pain intensity did not change significantly during the time period of the study (2 yrs), although there was a substantial increase in the frequency of use of several pain treatments from the initial to the second interview. Participants reported that many pain treatments were at least moderately helpful, but only three of the treatments (whirlpool, ultrasound, and transcutaneous electrical nerve stimulation) seemed to be associated with a decrease in pain among those who started using these treatments during the study. Conclusion Pain does not seem to become systematically better or worse during the course of a 2-yr time period in adults with cerebral palsy-related pain. Although several pain treatments are reported to provide pain relief, many of these were rarely used by (or provided to) the study participants. There is a need for more research to determine which pain treatments are most helpful for cerebral palsy-related pain and to increase patient accessibility to effective pain treatments.

Engel JM, Jensen MP, Hoffman AJ, Kartin D. Pain in persons with cerebral palsy: extension and cross validation. Arch Phys Med Rehabil 2003;84:1125–8. Objective: To cross-validate and extend the assessment of pain in persons with cerebral palsy (CP). Design: Standardized in-person interviews. Setting: University medical clinics and local residential and community housing for persons with developmental disabilities. Participants: One hundred adults with CP. Interventions: Not applicable. Main Outcome Measures: Measures of pain intensity, pain interference in daily activities, psychologic function, significance of pain problem, and satisfaction with pain treatment. Results: Sixty-seven (67%) subjects reported 1 or more chronic pain problem(s). Low back, hip, and leg pain were most common. Twenty-four percent reported constant pain; 19% reported that pain occurred daily. Mean pain intensity ± standard deviation over the previous week on an 11-point scale (0, no pain; 10, pain as bad as could be) was 4.08±2.25. Minor interference (2.55±3.03; scale range, 0–10) from pain with routine daily activities was reported. Responses to the Satisfaction with Life Scale (n=63) indicated only moderate life satisfaction (18.44±8.34; scale range, 5–35) among those with 1 or more pain problem(s). Responses to the Rand Mental Health Inventory (n=65; mean score, 60.65±20.36) revealed relatively high levels of psychologic distress in those with chronic pain. Consumer satisfaction with pain management care varied, with 32.8% of the subjects reporting dissatisfaction. Conclusions: The study findings are consistent with earlier findings concerning pain problems in adults with CP and provide further evidence that pain problems may be overlooked and undertreated in this population.

Objective:This study examined the variation in role stress and career satisfaction among hospital-based registered nurses (RNs) by shift length.Summary background data:Many hospitals have reorganized care delivery into 12-hour work shifts to improve RN recruitment, retention, and cost effectiveness.

Amy J Hoffman,1 Ruth Ann Brintnall,2 Alexander von Eye,3 Lee W Jones,4 Gordon Alderink,5 Lawrence H Patzelt,6 Jean K Brown7 1College of Nursing, Michigan State University, East Lansing, MI, USA; 2Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA; 3Psychology Department, Michigan State University, East Lansing, MI, USA; 4Duke Center for Cancer Survivorship Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA; 5Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, MI, USA; 6Spectrum Health, Grand Rapids, MI, USA and College of Human Medicine, Michigan State University, East Lansing, MI, USA; 7School of Nursing, University at Buffalo, the State University of New York, Buffalo, NY, USA Objective: The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue (CRF), other symptoms, functional status, and quality of life (QOL) for patients with non-small cell lung cancer (NSCLC) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy. Materials and methods: Five patients with NSCLC completed the Brief Fatigue Inventory (measuring CRF severity) and the MD Anderson Symptom Inventory (measuring symptom severity) before and after thoractomy, and at the end of each week of the 16-week exercise program. Additionally, the Medical Outcomes Study Short Form-36 (measuring physical and mental functional status) and the Quality of Life Index (measuring QOL) were completed before and after thoracotomy, after weeks 3, 6, 12, and 16 (the end of the exercise program). Further, the 6-minute walk test (measuring functional capacity) was administered before thoracotomy, prior to the initiation of chemotherapy and/or radiation therapy, and at the end of the 16-week exercise program, after completion of chemotherapy. Results: Participants had a mean age of 63 years and a mean of five comorbid conditions; the exercise program was initiated within 4 days after hospital discharge. Participants' CRF severity scores were reduced to mild levels, while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program, with mean levels of severity and interference decreasing to below prethoracotomy levels. Likewise, participants' functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels. Conclusion: The home-based, light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity, other symptom severity, functional status, and QOL. Further testing via a two-arm randomized controlled trial is being conducted. Keywords: lung cancer, exercise, cancer-related fatigue, symptoms, functional status, quality of life

Post-thoracotomy non-small cell lung cancer (NSCLC) patients report cancer-related fatigue (CRF) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life (QOL). The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF, other symptoms, functional status, and QOL for post-surgical NSCLC patients starting within days after hospital discharge.Seven post-thoracotomy NSCLC patients completed the Brief Fatigue Inventory (BFI) measuring CRF severity, and the M.D. Anderson Symptom Inventory measuring symptom severity at pre- and post-surgery, and at the end of each week of the six-week intervention. Additionally, the Medical Outcomes Short-Form-36 measuring physical and mental functional status; and the Quality of Life Index (QLI) measuring QOL were completed pre- and post-surgery, after week 3, and at the end of the intervention (week 6).Participants had a mean age of 65 years, a mean of 6 co-morbid conditions, and initiated the intervention within 4 days after hospital discharge. Participants' CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference. Likewise, participants' post-intervention functional status and QOL improved to near or above pre-surgical levels.The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF, other symptom severity, functional status, and QOL. Further testing via a two-arm randomized controlled trial is being conducted.

Background Little is known about rehabilitation for postthoracotomy non-small cell lung cancer (NSCLC) patients. This research uses a perceived self-efficacy-enhancing light-intensity exercise intervention targeting a priority symptom, cancer-related fatigue (CRF), for postthoracotomy NSCLC patients. This article reports on phase II of a 2-phase study. Phase I focused on initiation and tolerance of exercise during the 6 weeks immediately after thoracotomy, whereas phase II addressed maintenance of exercise for an additional 10 weeks including participants initiating and completing chemotherapy and/or radiation therapy. Objective The objective of this study was to investigate the feasibility, acceptability, and preliminary efficacy of an exercise intervention for postthoracotomy NSCLC patients to include those initiating and completing adjuvant therapy. Interventions/methods A single-arm design composed of 7 participants postthoracotomy for NSCLC performed light-intensity exercises using an efficacy-enhancing virtual-reality approach using the Nintendo Wii Fit Plus. Results Despite most participants undergoing chemotherapy and/or radiation therapy, participants adhered to the intervention at a rate of 88% with no adverse events while giving the intervention high acceptability scores on conclusion. Likewise, participants' CRF scores improved from initiation through the conclusion of the intervention with perceived self-efficacy for walking at a light intensity continuously for 60 minutes, improving significantly upon conclusion over presurgery values. Conclusions Postthoracotomy NSCLC patients maintained exercise for an additional 10 weeks while undergoing adjuvant therapy showing rehabilitation potential because the exercise intervention was feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. Implications for practice A randomized controlled trial is needed to further investigate these relationships.

Background In today's world, greater patient empowerment is imperative because 90 million Americans live with 1 or more chronic conditions such as cancer. Evidence reveals that healthy behaviors such as effective symptom self-management can prevent or reduce much of the suffering from cancer. Oncology nurses play a pivotal role in developing a symptom self-management plan that is critical to optimizing a patient's symptom self-management behaviors. Objective This article uses exemplars to describe how oncology nurses can apply a tested middle-range theory, the Theory of Symptom Self-management, to clinical practice by incorporating interventions to increase a patient's perceived self-efficacy to optimize patient outcomes. Methods The Theory of Symptom Self-management provides a means to understand the dynamic aspects of symptom self-management and provides a tested framework for the development of efficacy-enhancing interventions for use by oncology nurses in clinical practice. Results Exemplars based on the Theory of Symptom Self-management depict how oncology nursing can use perceived self-efficacy-enhancing symptom self-management interventions to improve the functional status and quality of life of their patients. Conclusion Guided by a theoretical approach, oncology nurses can have a significant positive impact on the lives of their patients by reducing the symptom burden associated with cancer and its treatment. Implications for practice Oncology nurses can partner with their patients to design tailored approaches to symptom self-management. These tailored approaches provide the ability to implement patient-specific behaviors that recognize, prevent, relieve, or decrease the timing, intensity, distress, concurrence, and unpleasant quality of symptoms.

Illuminated (320 ≤ X ≤ 370 nm), aqueous suspensions of transparent quantum-sized (Q-sized) ZnO semiconductor colloids in the presence of carboxylic acids and oxygen are shown to produce steady-state concentrations of H_2O_2 as high as 2 mM. Maximum H_2O_2 concentrations are observed only with added electron donors (i.e., hole scavengers). The order of efficiency of hole scavengers is as follows: formate > oxalate > acetate > citrate. Isotopic labeling experiments with ^(18)O_2 are consistent with the hypothesis that hydrogen peroxide is produced directly by the reduction of adsorbed oxygen by conduction band electrons. Quantum yields for H_2O_2 production are near 30% at low photon fluxes. However, the quantum yield is shown to vary with the inverse square root of absorbed light intensity [Φ ∝ ((I_(abs))^(-1)½)], with the wavelength of excitation, and with the diameter of the Q-sized colloids. The initial rate of H_2O_2 production is 100-1000 times faster with Q-sized ZnO particles (D_p = 4-5 nm) than with bulk-sized ZnO particles (D_p = 0.1 µm).

A detailed analysis of the reaction products and mechanisms of the photocatalytic oxidation of acetate in the presence of quantum-sized ZnO colloids (Dp ≈ 40 A) is presented. The principal oxidation products and reaction intermediates are determined to be CO_2, HCO_2^-, CHOCO_2^-, HCHO, CH_3OOH, CH_3COOOH, and H_2O_2. Formate and glyoxylate, which are found as intermediates in the photooxidation of acetate, also serve as effective electron donors on illuminated ZnO surfaces. The proposed relative reactivity of electron donors toward photooxidation is in the following order: CHOCO_2- > HCO_2^- > HCHO > CH_3CO_2^- ≥ H_2O_2 CH_3COOOH > CH_3OOH. Observed product distributions are discussed in terms of pathways involving direct oxidation of surface-bound acetate by valence band holes (or trapped holes) and the indirect oxidation of acetate by surface-bound hydroxyl radicals. The product distribution observed at low photon fluxes is not consistent with oxidation primarily by free hydroxyl radicals. A mechanism involving the reaction of an intermediate carbon-centered radical with > ZnOH surface sites is proposed. When electron donors are strongly adsorbed to semiconductor surfaces, surface-mediated reactions appear to play a dominant role in the determination of the time-dependent product distributions.

Background Persons with chronic illness commonly report fatigue. Measurement of perceived self-efficacy for fatigue self-management (PSEFSM) is essential if fatigue is to be monitored and enhanced to improve physical functional status. Objective The objective of the study was to describe the development and testing of the PSEFSM instrument. Methods The PSEFSM instrument was incorporated into 2 randomized controlled trials for secondary analysis (N=298): 63 persons with lung cancer and 235 persons with other cancer diagnoses undergoing a course of chemotherapy. Result : Evidence for construct validity and generalizability was supported through hypotheses testing of the mediation pathway from fatigue to physical functional status through PSEFSM, with results indicating support for partial mediation. Structural modeling indicated a good model fit that further supported the construct validity of the PSEFSM instrument. Conclusions The instrument provides a reliable and valid measure of PSEFSM that could be used in research to facilitate the development of interventions to increase perceived self-efficacy to achieve optimal symptom self-management. Implications for practice The PSEFSM instrument is brief and easy to complete, which results in a low response burden for persons who are already fatigued, providing for regular use in transdisciplinary research and practice settings. This is important because the use of this instrument can impact how we partner with our patients to better understand how to manage this troublesome symptom, fatigue.

The polymerization of methyl methacrylate has been shown to occur readily using Q-sized ZnO semiconductors as photoinitiators. We have examined the effects of solvent, monomer concentration, initiator concentration, light intensity, and semiconductor particle size upon the reaction rates. The reaction pathway appears to be via anionic initiation, followed by free-radical propagation steps. The holes formed upon illumination are scavenged by the solvent. Increasing the concentration of the photoinitiator increased polymer yield until a saturation value was achieved. The rate of polymerization rapidly increased with increasing monomer concentration, due to the Trommsdorf effect. The rate of polymerization was found to depend upon the square root of the incident light intensity, as predicted from simple kinetic theory. Quantum yields of polymerization decreased as particle size decreased, due to either increased surface defects or enhanced rates of competing electron-hole recombination. Under the same experimental conditions, no polymerization occurred with bulk-size ZnO particles as photoinitiators; thus Q-sized ZnO particles were more efficient photoinitiators of polymerization.

Q-sized CdS semiconductors have been synthesized in several nonaqueous solvents without the use of added stabilizers. The effects of solvent viscosity and dielectric strength, concentration of excess cadmium ions, temperature, and stirring upon the colloids' absorption spectra have been examined. In addition, efficiency of photoinitiation of polymerization of several vinylic monomers has been examined using both bulk and quantum-sized CdS, ZnO, and TiO_2. The Q-sized semiconductors demonstrated significantly higher quantum yields for photopolymerization than their bulk-sized counterparts. A correlation between the reactivity of a monomer toward polymerization and its Alfrey and Price Q and e values was observed. Hole scavenging by the solvent was necessary for efficient polymerization to occur. A correlation between the semiconductor photoinitation efficiency, and the reduction potential of its conduction band electrons was also found. On the basis of these observations, a mechanism of an anionic initiation step followed by free radical chain propagation steps has been proposed.

Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pretreatment values, were observed at posttreatment and at 3- and 9-month follow-up but not at 6- or 12-month follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at the 3-, 6-, 9-, and 12-month follow-up points, respectively. Moreover, at 12-months posttreatment, 81% of the sample reported that they still used the self-hypnosis skills learned in treatment. Overall, the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.

Purpose/objectives To examine the relationships among pain, fatigue, insomnia, and gender while controlling for age, comorbidities, and stage of cancer in patients newly diagnosed with lung cancer within 56 days of receiving chemotherapy. Design Secondary data analysis. Setting Accrual from four sites: two clinical community oncology programs and two comprehensive cancer centers. Sample 80 patients newly diagnosed with lung cancer. Methods Analysis from baseline observation of a randomized clinical intervention trial. Multinomial log-linear modeling was performed to explain the relationships among pain, fatigue, insomnia, and gender. Main research variables Pain, fatigue, insomnia, and gender. Findings For all people with lung cancer, fatigue (97%) and pain (69%) were the most frequently occurring symptoms; insomnia occurred 51% of the time. A model containing all main effects (two-way interactions of pain and fatigue, pain and insomnia, and insomnia and gender; and the three-way interaction of pain, fatigue, and insomnia, along with three covariates [age, comorbidities, and stage of cancer]) was a good fit to the data. Parameter estimates indicated that a statistically significant effect from the model was the three-way interaction of pain, fatigue, and insomnia. Gender did not make a difference. Age, comorbidities, and stage of cancer were not significant covariates. Conclusions For people newly diagnosed with lung cancer undergoing chemotherapy, multiple symptoms occur simultaneously rather than in isolation; a symptom cluster exists, consisting of pain, fatigue, and insomnia; and no relationship was found among gender, pain, fatigue, and insomnia. Implications for nursing By understanding this symptom cluster, healthcare providers can target specific troublesome symptoms to optimize symptom management and achieve the delivery of high-quality cancer care.

Jensen MP, Hoffman AJ, Stoelb BL, Abresch RT, Carter GT, McDonald CM. Chronic pain in persons with myotonic dystrophy and facioscapulohumeral dystrophy. Objective To determine the nature and scope of pain in working-aged adults with myotonic muscular dystrophy (MMD) and facioscapulohumeral muscular dystrophy (FSHD). Design Retrospective, cross-sectional survey. Setting Community-based survey. Participants Convenience sample of subjects with MMD and FSHD. Interventions Not applicable. Main Outcome Measures Overall intensity and duration of pain, pain inference, pain sites, pain treatments, and relief provided by pain treatments. Results More subjects with FSHD (82%) than with MMD (64%) reported pain. The most frequently reported pain sites for both diagnostic groups were lower back (66% MMD, 74% FSHD) and legs (60% MMD, 72% FSHD). Significant differences in pain intensity were found between the diagnostic groups in the hands, legs, knees, ankles, and feet, with patients with MMD reporting greater pain intensity at these sites than patients with FSHD. Age was related to the onset of pain (participants reporting pain were younger than those not reporting pain in the FSHD sample), but pain severity was not significantly associated with age in those reporting pain. Respondents with both diagnoses that reported mobility limitations and used assistive devices (eg, wheelchair, cane) reported more pain severity than those with mobility limitations who did not use assistive devices, who, in turn, reported more pain severity than respondents who reported no mobility limitations at all. The treatments that were reported to provide the greatest pain relief were not necessarily those that were the most frequently tried or still used. Conclusions The findings indicate that pain is a more common problem in persons with FSHD than in persons with MMD, although it is common in both populations. In addition, these pain problems are chronic, underscoring the need to identify and provide effective pain treatments for patients with these neuromuscular diseases.

This qualitative study is a secondary analysis of comments written on survey questionnaires about pain mailed to community-dwelling persons with spinal cord injury (SCI) or amputation. Narrative comments were added by 54.1% of 797 respondents. The purpose of this study was to determine the characteristics of those who wrote comments and to understand what was being communicated in their comments. A qualitative content analysis was used to identify the major themes, subthemes, and thematic categories in the unsolicited comments. The overarching theme was desiring dialogue with the researcher. Presenting themselves as experts on living with pain because of a chronic disabling condition, respondents described personal experiences of living with pain, coping with pain, and educating others about pain. Examining comments and narratives written in the margins of quantitative survey questionnaires can add value to and extend understanding of survey findings and implications.

Chronic Pain in Persons with Neuromuscular Disease Amy J. Hoffman, MPH, Mark P. Jensen, PhD, R. Ted Abresch, MS, Gregory T. Carter, MD* Department of Rehabilitation Medicine, Box 356490, University of Washington School of Medicine, Seattle, WA 98195-6490, USA Multidisciplinary Pain Center, University of Washington Medical Center–Roosevelt, 4245 Roosevelt Way Northeast, Seattle, WA 98105-6920, USA Department of Physical Medicine and Rehabilitation, PM&R TB 191, University of California, Davis, CA 95616, USA

Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment.

Dudgeon BJ, Ehde DM, Cardenas DD, Engel JM, Hoffman AJ, Jensen MP. Describing pain with physical disability: narrative interviews and the McGill Pain Questionnaire. Objectives To identify common pain descriptors used by people with physical disability-related pain and to suggest words that are likely to prompt responses in clinical interviews and assessments. Design Open-ended interviews were coded and then contrasted with responses to a pain questionnaire, obtained through mail or interview surveys. Setting Rehabilitation research program. Participants Twenty-eight people with physical disability-related pain in a series (n=54) of in-depth interviews and 1053 participants with disabilities who responded to mailed questionnaires or structured interviews about pain and its impact (459 with acquired lower-limb amputation, 471 with spinal cord injury, 123 with cerebral palsy). Interventions Not applicable. Main outcome measures Pain interview descriptions and McGill Pain Questionnaire (MPQ). Results Different pain experiences were reflected in narrative descriptions and self-report questionnaire responses. We report the common terms, but across diagnoses use of terms does not appear to clearly differentiate distinct pain phenomenon. Narrative interviews support the use of several MPQ pain descriptors. However, discrete descriptors are recommended when assessing adults with physical disability. Conclusions We identified pain descriptors that appear to be most useful in assessing daily life and participation experiences with physical disability-related pain. These may be clinically useful, but caution is advised when doing diagnostic workups based solely on sensory and affective pain descriptions.

To evaluate the utility of a biopsychosocial model to predict long-term adjustment to lower-limb amputation and phantom limb pain (PLP).One month after lower-limb amputation, 70 participants completed measures of PLP intensity, cognitions (catastrophizing, perceived control over pain), coping (pain-contingent rest), social environment (social support, solicitous responding), and functioning (pain interference, depressive symptoms). The measures of functioning were administered again at 1- and 2-years post-amputation. Multiple regression analyses were used to examine the ability of the psychosocial variables at 1-month post-amputation to predict changes in the functioning measures over time.The psychosocial variables at 1-month post-amputation, controlling for initial PLP intensity, accounted for 21% of the variance in change in depressive symptoms at 1-year (p0.05), and 27% and 22% (p's0.01 and 0.05, respectively) of the variance in change in pain interference and depressive symptoms, respectively, at 2-years post-amputation. Catastrophizing and social support were associated with decreases (improvement) in both criterion measures, while solicitous responding was associated with increases (worsening) in both measures.The findings support a biopsychosocial model of long-term adjustment to amputation and PLP. In addition, results suggest that some psychosocial variables are more important than others for predicting adjustment, providing important implications for early interventions after amputation.

Chronic pain is a common condition in persons with cerebral palsy (CP), although there is a paucity of research studying CP-related pain. One of the barriers to a better understanding of pain in persons with CP is the lack of information concerning the validity of pain measures that may be used with this population. The purpose of this study was to determine the relative validity of several pain measures in a sample of persons with CP-related pain. Six pain rating scales and measures of depression and pain interference were administered to a sample of 45 adults participating in a longitudinal study of pain in persons with CP. An additional 24 persons with CP were administered 5 of the 6 pain intensity scales. The results of factor analyses support the validity of each measure of pain in this sample of persons with CP. However, an examination of the pattern of associations between each of the pain ratings with measures of pain interference and depression suggest that the 7-point Faces Scale may be somewhat less valid than the other measures.

To cross-validate and extend the assessment of pain in persons with cerebral palsy (CP).Standardized in-person interviews.University medical clinics and local residential and community housing for persons with developmental disabilities.One hundred adults with CP.Not applicable.Measures of pain intensity, pain interference in daily activities, psychologic function, significance of pain problem, and satisfaction with pain treatment.Sixty-seven (67%) subjects reported 1 or more chronic pain problem(s). Low back, hip, and leg pain were most common. Twenty-four percent reported constant pain; 19% reported that pain occurred daily. Mean pain intensity +/- standard deviation over the previous week on an 11-point scale (0, no pain; 10, pain as bad as could be) was 4.08+/-2.25. Minor interference (2.55+/-3.03; scale range, 0-10) from pain with routine daily activities was reported. Responses to the Satisfaction with Life Scale (n=63) indicated only moderate life satisfaction (18.44+/-8.34; scale range, 5-35) among those with 1 or more pain problem(s). Responses to the Rand Mental Health Inventory (n=65; mean score, 60.65+/-20.36) revealed relatively high levels of psychologic distress in those with chronic pain. Consumer satisfaction with pain management care varied, with 32.8% of the subjects reporting dissatisfaction.The study findings are consistent with earlier findings concerning pain problems in adults with CP and provide further evidence that pain problems may be overlooked and undertreated in this population.

Background: Until recently, very little has been written regarding chronic pain as a secondary problem in persons who already have a physical disability, despite the potential for pain to increase the negative impact of what may already be a very disabling condition. The purpose of this review is to summarize what is currently known concerning the nature and scope of chronic pain as a secondary condition to disability, specifically spinal cord injury, acquired amputations, cerebral palsy, multiple sclerosis, neuromuscular disease, and postpolio syndrome. Method: What is known concerning the frequency, severity, impact, and treatment of pain in these specific conditions is reviewed, as are the factors that contribute to, or are associated with, adjustment to chronic pain in these disability groups. The authors conclude with several research questions that emerge from this knowledge, the answers to which will contribute to the long-term goal of the reduction of pain and suffering in persons with disabilities. Conclusions: The existing literature clearly documents that many persons with disabilities experience chronic pain. Many questions remain unanswered regarding the scope, severity, and treatment of chronic pain in these groups.

Biopsychosocial models of chronic pain hypothesize a role for psychological and environmental factors in adjustment to chronic pain. To test the utility of such models for understanding phantom limb pain, 61 persons with recent amputations were administered measures of average phantom limb pain intensity, pain interference, depression, pain coping use, pain cognitions and appraisals, and social environmental variables 1 month post-amputation, and the measures of pain intensity, pain interference, and depression again 5 months later. Multiple regression analyses showed that the psychosocial predictors made a statistically significant contribution to the concurrent prediction of average phantom limb pain, pain interference, and depression at the initial assessment, and a significant contribution to the prediction of subsequent change in pain interference and depression over the course of 5 months. The results support the utility of studying phantom limb pain from a biopsychosocial perspective, and identify specific biopsychosocial factors (e.g., catastrophizing cognitions, social support, solicitous responses from family members, and resting as a coping response) that may play an important role in adjustment to phantom limb pain.

Amy J Hoffman,1 Ruth Ann Brintnall,2 Alexander von Eye,3 Julie Cooper,2 Jean K Brown41College of Nursing, Michigan State University, East Lansing, MI, USA; 2Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA; 3Psychology Department, Michigan State University, East Lansing, MI, USA; 4School of Nursing, State University of New York at Buffalo, Buffalo, NY, USAObjective: Individuals with lung cancer present with multiple comorbid conditions and complex treatment plans. They are frequently vulnerable during critical transitions in the cancer survivorship trajectory. Limited research exists on the postsurgical non-small-cell lung cancer (NSCLC) population, relative to unmet supportive care needs. However, what is known is that the lung cancer population reports significantly more unmet supportive care needs than other cancer populations. The purpose of this study was to identify the postsurgical NSCLC patients’ unmet supportive care needs during transition from hospital to home and through recovery after participating in a 16-week exercise intervention.Materials and methods: Participants were 53–73 years of age with NSCLC (stage Ib-IIIa) and participated in a 16-week light-intensity exercise program after hospital discharge. For this study, participants were interviewed 12-18 months post-thoracotomy. A qualitative design was used, incorporating a semistructured guide with open-ended questions to support discussion regarding recovery experiences through 16 weeks after transitioning from hospital to home. The interview was transcribed verbatim, and data were analyzed using content analysis. Content themes were independently coded by investigators and later combined into a single report verified through participant verification of the report.Results: Participants reviewed and agreed with the focus group report. Dominant themes included: 1) unpreparedness for post-thoracotomy recovery; 2) significant unmet needs upon hospital discharge and throughout the cancer survivorship trajectory; 3) unexpected symptom burden after initial month of recovery; 4) the quality of information given when pain and fatigue were troublesome during recovery; and 5) the effectiveness of exercise during the recovery process.Conclusion: Understanding the changing needs of this population during these transitions will assist in the development of targeted supportive care interventions, to preempt negative outcomes associated with breakdowns in care during critical transition periods of the cancer survivorship trajectory.Keywords: quality of life, symptom, exercise, qualitative research

Twenty-four adults with phantom limb pain (PLP) and/or residual limb pain (RLP) participated in a double-blind crossover trial. Participants were randomly assigned to receive gabapentin or placebo and later crossed over to the other treatment, with a 5-week washout interval in which they did not receive medication. Gabapentin was titrated from 300 mg to the maximum dose of 3,600 mg. Measures of pain intensity, pain interference, depression, life satisfaction, and functioning were collected throughout the study. Analyses revealed no significant group differences in pre- to posttreatment change scores on any of the outcome measures. More than half of the participants reported a meaningful decrease in pain during the gabapentin phase compared with about one-fifth who reported a meaningful decrease in pain during the placebo phase. In this trial, gabapentin did not substantially affect pain. More research on the efficacy of gabapentin to treat chronic PLP and RLP is needed.