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AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY
Title
AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY.
Creator
Crosby, William, Sole, Mary Lou, University of Central Florida
Abstract / Description
Background: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver...
Show moreBackground: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver anxiety and tracheostomy suctioning competency. Method: A quasi-experimental non-randomized control group design was used. The independent variable was method of instruction (T-CARES versus standard). Dependent variables were caregiver anxiety and tracheostomy suction competence. Caregivers (n=12) self selected into groups based on availability to attend T-CARES course. The control group was to receive the unit-based standard of education. The experimental group participated in the T-CARES course. Only one person chose to be in the control group; therefore, data were analyzed for the experimental group only (N=11). The T-CARES course, created by the researcher, was standardized and instructor-led; it incorporated media and simulated practice. Caregiver anxiety for both groups was obtained before (State/Trait Anxiety) and after (State Anxiety) tracheostomy care instruction was provided. Tracheostomy suctioning competence was assessed using a standardized checklist for participants in the T-CARES study group only. Demographic data were summarized with frequencies and descriptive statistics. Given the small sample size, non-parametric statistics were used for data analysis. Results: Data were analyzed from the experimental group only (n=11). The majority of caregivers were women (n=7), white/caucasian (n=10), married (n=8), employed full time (n=7), and were high school graduates or higher (n=10). The mean age of participants was 50.8 years. Seven of the participants reported previous caregiver experience. Mean score of caregiver trait anxiety was 36.8. Mean caregiver state anxiety score was 50.5 before, and 34.3 after the T-CARES intervention. A Related-Samples Wilcoxon Signed Rank Test was performed on the pre and post T-CARES intervention state anxiety scores. The T-CARES intervention significantly reduced anxiety (p=.008). Tracheostomy suctioning competency for 9 of the participants was evaluated upon completion of T-CARES. Mean score was10.8 skills performed correctly out of a possible 14. Caregivers' responses regarding their biggest fear/concern about tracheostomy care included "not doing it right," "trach coming out or being blocked," "hurting the patient," and "not being able to help in an emergency." Participants' suggestions for future improvements were creation of a Spanish language course and the addition of supplementary training to include CPR, First Aid, and the management of feeding tubes. Discussion: Research supported the hypothesis that the T-CARES course would be successful in reducing state anxiety. The T-CARES course also had a positive impact on tracheostomy suctioning competency, though without a control group it is difficult to quantify the effect. The continued development and dissemination of T-CARES to all tracheostomy patients and their caregivers may ease their transition home. The views expressed are those of the author and do not reflect the official policy or position of the US Air Force, Department of Defense or the US Government.
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Date Issued
2012
Identifier
CFH0004138, ucf:44824
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004138
A major double strand repair pathway and cancer-associated circulating proteins are effecters of epigenetic revision.
Title
A major double strand repair pathway and cancer-associated circulating proteins are effecters of epigenetic revision.
Creator
Allen, Brittany, Masternak, Michal, Khaled, Annette, Zhao, Jihe, Muller, Mark, Siddiqi, Shadab, University of Central Florida
Abstract / Description
DNA methylation is a vital epigenetic process that acts as a major control mechanism for gene expression. In addition to its essential role in many normal cellular processes, it is also implicated in a wide variety of disease states and processes including cancer. Along with genetic mutations, aberrant DNA methylation patterns, specifically the inappropriate DNA methylation or demethylation of CpG residues, may activate oncogenes or suppress tumor suppressor genes, respectively. These changes...
Show moreDNA methylation is a vital epigenetic process that acts as a major control mechanism for gene expression. In addition to its essential role in many normal cellular processes, it is also implicated in a wide variety of disease states and processes including cancer. Along with genetic mutations, aberrant DNA methylation patterns, specifically the inappropriate DNA methylation or demethylation of CpG residues, may activate oncogenes or suppress tumor suppressor genes, respectively. These changes can generate or facilitate the progression of tumorigenesis and tend to accumulate throughout the development of cancer. Although they play such a major role in cancer and in other diseases, it remains unclear what causes these epigenetic revisions to occur. This dissertation will focus on uncovering mechanisms that are sources of epigenetic revision, specifically as they relate to cancer. Due to rapid cell division and increased DNA damage, cells are increasingly dependent on DNA repair as they continue on a path of tumorigenic progression. We hypothesize that DNA repair, specifically the repair of DNA double strand breaks (DSB) by Non-Homologous End Joining (NHEJ) may play a role in inappropriate epigenetic revision. Using a GFP reporter system inserted into the genome of HeLa cells, we are able to induce targeted DNA damage that enables the cells, after successfully undergoing NHEJ repair, to express WT GFP. These GFP+ cells were segregated into two expression classes, one with robust expression (Bright) and the other with reduced expression (Dim). Using a DNA hypomethylating drug (AzadC) we were able to demonstrate that the different GFP expression levels was due to differential methylation statuses of CpGs in regions on either side of the break site. Deep sequencing analysis of this area in sorted Bright and Dim populations revealed a collection of different epi-alleles that display patterns of DNA methylation following repair by NHEJ. These patterns differ between Bright and Dim cells which are hypo- and hypermethylated, respectively, and between the post-repair populations and the original, uncut cells. These data suggest that NHEJ repair facilitates a rewrite of the methylation landscape in repaired genes, elucidating one potential source for the altered methylation patterns seen in cancer cells.The Dim cells generated during this study are known to have a hypermethylated GFP gene that is correlated with reduced expression, allowing it to be used as a screening tool for hypomethylating agents. We used this tool to screen the blood serum of patients with head and neck squamous cell carcinoma (HNSCC). We found that the serum from HNSCC patients, but not from healthy individuals, contains some factor that causes hypomethylation in exposed cells. Further, we were able to identify this factor as a protein capable of effecting changes in DNA methylation, gene expression, and miRNA levels in the treated Dim cells. The novel concept presented in this study has immense implications on the study of cancer progression as it evidences circulating proteins, presumably released by cancer cells, which are able to effect gene expression in cells that are distal to the location of the cancer. Further, the fact that these proteins are in circulation makes them a potential target for use in diagnostics. Changes in DNA methylation play a major role in the development of cancer and understanding the mechanisms by which this occurs could provide new therapeutic targets for preventing this process from contributing to tumorigenesis. This dissertation presents potential sources of epigenetic revision in cancer and thus provides answers to a major question that has yet to be answered in the area of cancer research.
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Date Issued
2017
Identifier
CFE0006555, ucf:51333
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006555