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Biomedical subjects

A Eardley

Publications and source records attributed to A Eardley.

At least 19 recordsLinked to original sources
PubMed1992

The "retinoic acid syndrome" in acute promyelocytic leukemia.

OBJECTIVE: To describe a novel complication of therapy with all-trans retinoic acid in patients with acute promyelocytic leukemia. DESIGN: Case series. SETTING: Comprehensive cancer center. PATIENTS: Consecutive patients with a morphologic diagnosis of acute promyelocytic leukemia who underwent remission induction treatment with all-trans retinoic acid, 45 mg/m2 body surface area per day. MEASUREMENTS AND RESULTS: Nine of 35 patients (26%; 95% CI, 9% to 52%) with acute promyelocytic leukemia who were treated with all-trans retinoic acid developed a syndrome consisting primarily of fever and respiratory distress. Additional prominent signs and symptoms included weight gain, lower-extremity edema, pleural or pericardial effusions, and episodic hypotension. The onset of this symptom complex occurred from 2 to 21 days after starting treatment. Three deaths occurred; post-mortem examinations in two patients showed pulmonary interstitial infiltration with maturing myeloid cells. Six other patients survived, each achieving complete remission (five patients with all-trans retinoic acid only; 1 patient with chemotherapy). In six of the nine cases, the onset of the syndrome was preceded by an increase in peripheral blood leukocytes to a level of at least 20 x 10(9) cells/L. Certain therapeutic interventions, including leukapheresis, temporary cessation of therapy with all-trans retinoic acid, and cytotoxic chemotherapy in moderate doses were not useful after respiratory distress was established. However, the administration of high-dose corticosteroid therapy (dexamethasone, 10 mg IV intravenously every 12 hours for 3 or more days) early in the course of the syndrome resulted in prompt symptomatic improvement and full recovery in three of four patients. CONCLUSIONS: The use of all-trans retinoic acid to induce hematologic remission in patients with acute promyelocytic leukemia is associated in some patients with the development of a potentially lethal syndrome that is not uniformly accompanied by peripheral blood leukocytosis. Early recognition of the symptom complex of fever and dyspnea, combined with prompt corticosteroid treatment, may decrease morbidity and mortality associated with this syndrome.

Adult↗
PubMed1991

Ethical issues in psychosocial research among patients with cancer.

The ethical implications of psychosocial research among patients with cancer are discussed. Two key issues were identified: obtaining informed consent and the impact of participating in research. Barriers to obtaining genuinely informed consent are described, as well as the costs and benefits of participation in research. Recommendations are made for the conduct of future research, relating to the removal of barriers to informed consent and monitoring the impact of the research process on its subjects.

Attitude to Health↗
PubMed1990

How district health authorities organise cervical screening.

OBJECTIVES: To examine how district health authorities organised cervical screening with respect to Department of Health guidelines and to determine their assessment of the problems encountered. DESIGN: Postal questionnaire sent to all 190 district health authorities in England in 1989. PARTICIPANTS: 190 District health authorities in England. MAIN OUTCOME MEASURES: Population coverage of screening, quality of smear testing, and follow up of abdominal test results in comparison with national guidelines for district cervical screening services, and problems encountered by districts. RESULTS: Replies were received from 178 (94%) of districts, in 143 of which the person named as responsible for cervical screening contributed. All districts implemented a computer managed scheme, 150 by the target date of 31 March 1988, but not all of these conformed with the guidelines. At the time of the survey only just over half called women in the target age group of 20-64 and only 70% expected to meet the target date of 13 March 1993 for completing the call. Considerable variation was evident among the schemes with regard to how they dealt with issues related to population coverage, quality of testing, and follow up of abnormal results. The problems most commonly identified by the districts (n = 174) were laboratory workload (107, 61%), computer software (104, 60%), availability of resources (78, 45%), non-attendance (77, 44%), rate of opportunistic screening (62, 36%), and investigation and treatment (60, 34%). CONCLUSIONS: Current practice in running cervical screening schemes needs to be examined to determine the extent to which it contributes to the goal of reducing mortality from cervical cancer.

Adult↗
PubMed1990

A pilot study of attendance for breast cancer screening.

Previous research has identified some characteristics related to attendance for breast cancer screening, but few research findings carry practical implications for the optimum organisation of the service. The present study describes the reactions of women attending one of the first breast screening units to be established in the U.K. following government directives. Responses to the invitation to be screened and reasons for attendance suggest ways in which the idea of screening can be conveyed in health education. Practical problems were few, but some negative features of the design of the screening unit and of the experience of being screened were identified. Recommendations for the organisation of breast cancer screening are presented using the typology of factors influencing health behaviour developed by Green et al.

Anxiety↗
PubMed1990

Patients' needs after radiotherapy, the role of the general practitioner.

This study assessed the physical and psychosocial sequelae of radical radiotherapy among patients with bladder or prostate cancer and investigated the support received from community health services. When interviewed two months after treatment, over half reported that they had experienced several physical side-effects as well as curtailment of social and everyday activities. Such side-effects were still being experienced by up to half the patients at the time of interview. Seventy-one per cent were unprepared for the duration and type of such effects. Most had seen their general practitioner in connection with their side-effects and 76% felt that this contact had been helpful. Patients appreciated the willingness to spend time listening to their concerns and explaining side-effects, as well as accessibility and flexibility which made it easy to obtain advice and support. Patients who expressed dissatisfaction with their general practitioner all felt that they should have been visited at home. The study suggests that general practitioners can play a valuable role in meeting patients' needs after radiotherapy.

Community Health Services↗
PubMed1990

Consumer satisfaction with breast screening: a pilot study.

One hundred and forty-six women registered with a general practice and 84 members of health authority staff, who had attended a breast screening unit by invitation, completed a postal questionnaire about their reactions to screening. The staff of the unit also recorded their observations. The letter of invitation and accompanying health education leaflet were favourably received, and most women were glad of the opportunity offered, although some experienced anxiety. Few practical problems were reported with regard to attending the clinic. In general, the facilities in the clinic were thought to be of a high standard but specific criticisms included problems with access and privacy and feelings of claustrophobia. Some women experienced anxiety or discomfort when the mammogram was being taken, but many favourable comments were made about the helpfulness of staff. Almost all women said that they would return for screening if invited again.

Anxiety↗
PubMed1990

Trends in the organization of cervical cancer screening.

Cervical cytological screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.

Appointments and Schedules↗
PubMed1989

Cervical screening: what are the communication problems?

Computer-managed call and recall schemes offer the opportunity for effective cervical screening. However, such schemes involve several different agencies, often independent of one another. As a result, problems of communication can arise. This paper discusses potential areas of difficulty and presents some suggestions for improvement.

Adult↗
PubMed1989

Computer-managed call and recall for cervical screening: a typology of reasons for non-attendance.

Three pilot studies looked at women who had not attended for cervical screening following a computer-generated invitation to a health authority clinic. From these a typology of reasons for non-attendance for computer-managed screening has been developed, specifying inaccessibility, ineligibility, unsuitability, failure of communications, misclassification and refusal because of practical problems, inappropriate beliefs or attitudinal barriers. Underlying the typology are issues connected with the inaccuracy of the database, service organization and provision, and the characteristics of the women themselves.

Appointments and Schedules↗
PubMed1989

Well you can come in but i'm not having it. The role of the health visitor in computer-managed cervical screening.

Health visitors called on women who had not attended for a cervical smear test, following an invitation via a computer-managed scheme. Reasons for non-attendance were identified and the study showed that health visitors can be successful in encouraging some non-attenders to be screened. However, there are problems involved in undertaking such a role, which must be acknowledged if the health visitors's time is to be used effectively.

Community Health Nursing↗
PubMed1988

Reasons for non-attendance for computer-managed cervical screening: pilot interviews.

A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.

Attitude to Health↗
PubMed1988

Loosening the bonds of cancer: how feasible?

This paper assesses the scope that exists for increasing the personal autonomy of people with cancer. Current organization of cancer services does little to promote autonomy. However, coping theory suggests that autonomy can be enhanced by complementary therapies, by changing perceptions of cancer, and by techniques which minimize the emotional response to the stress of this disease.

Adaptation, Psychological↗
PubMed1987

Synthesising research findings and practical experience to formulate principles in cervical screening.

Compared particularly with Scandinavian countries, the effects of cervical screening in the United Kingdom have been disappointing, both in terms of women screened and in relation to incidence and mortality. The underlying problem is the under-representation of women most at risk of cervical cancer in the screened population. In this paper we examine two possible hypotheses for such under-representation: one concerns the behavioural aspects of women's failure to attend and the second the effect of the organisation of current screening services on their attendance. We outline the features that an effective service would need to incorporate and propose principles for the development of a screening system designed to maximise the potential of the cervical smear test.

Behavior↗