This paper draws on the results of a longitudinal, qualitative study of men with prostate cancer (treated with prostatectomy) and their spouses. Interviews were conducted separately and simultaneously with men and their spouses, at three points in time (pre-surgery, 8-10 weeks post-surgery and 11-13 months post-surgery). The primary focus in the paper is on men's responses to questions about their decisions to share information (or not) with others about their diagnosis and ongoing medical situation. Most men with prostate cancer avoided disclosure about their illness where possible, and placed great importance on sustaining a normal life. Factors related to limiting disclosure included men's low perceived need for support, fear of stigmatization, the need to minimize the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others. This study contributes to an understanding of disclosure issues related to prostate cancer, and raises issues about how best to be helpful to men, given their tendency to minimize the impact of illness, and the need for support.

Adaptation, Psychological↗

PubMedDate not supplied

A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer.

This study is a prospective, longitudinal investigation of the psychological factors associated with the duration of survival in patients with metastatic cancers of various kinds who were receiving group psychotherapy. A correlative approach rather than an experimental (trials) design was used in the study because our aim was to relate the psychological attributes of each individual to survival rather than to test the efficacy of the intervention. Twenty-two patients with medically incurable metastatic cancer of various kinds received weekly group psychotherapy for up to 1 year, the great majority remaining well enough to attend the group for at least 8 months. During this time, they provided extensive verbal data, through written homework, and from notes taken by the therapists at interviews and during group sessions. These data were subjected to detailed qualitative analysis, as a result of which a number of psychological themes were defined. A quantitative rating was assigned to the data for each theme in each individual patient through team discussions. The scores for the individual themes were summed to produce a 'total psychological score', representing the degree of each patient's involvement with psychological self-help work. The values for each patient were then related to his or her survival duration. Cox regression analyses showed that this composite score, and five of six major themes, were significantly related to survival duration. These themes were: ability to act and change; willingness to initiate change; application to self-help work; relationships with others; and quality of experience. In contrast, there was no relationship between survival and four standard psychometric measures taken at the onset of therapy. However, results on a 5-point scale measuring the subject's expectancy that psychological efforts would affect the disease showed a strong relationship to survival. To control for differences in severity of disease as a factor possibly influencing psychological work, the analyses were repeated, using the survival duration predicted for each patient by a panel of oncologists as a covariate. Closely similar results were obtained. Limitations on the interpretation of the results are discussed. Within these limits, it appears that there is a strong association between longer survival and psychological factors related to the involvement of cancer patients in psychological self-help activities. While causality cannot be inferred, reasons are given for believing that this is not a result of the disease influencing the patients' psychology, but rather the converse.

Adaptation, Psychological↗

PubMedDate not supplied

Identification of homer as a homologue of the Wiskott-Aldrich syndrome protein suggests a receptor-binding function for WH1 domains.

Explore the source record for details and available documents.

Amino Acid Sequence↗

PubMedDate not supplied

Iron, but not folic acid, combined with effective antimalarial therapy promotes haematological recovery in African children after acute falciparum malaria.

Whether children with malarial anaemia should receive supplementation with iron or folic acid is uncertain. Therefore, the effects of supplementary treatment with iron or folic acid, given together with chloroquine or pyrimethamine-sulfadoxine (Fansidar), has been assessed in 600 Gambian children with uncomplicated falciparum malaria. After one month, haematological recovery was significantly better in the group treated with Fansidar than in the chloroquine-treated group (difference in mean haemoglobin level = 0.54 g/dL, P = 0.01). Children who received iron had a significantly better response than those given placebo (differences in mean haemoglobin level after one month and at dry season follow-up = 0.70 g/dL, P = 0.006, and 0.81 g/dL, P = 0.001, respectively). Iron supplementation was not associated with increased prevalence of malaria. Supplementation with folic acid did not improve the haematological response but, among children who received Fansidar, the treatment failure rate was significantly higher among those given folic acid than among those given placebo. Thus, supplementation with iron, but not folic acid, improves haematological recovery without increasing susceptibility to malaria.

Acute Disease↗

PubMedDate not supplied

Presurgery experiences of prostate cancer patients and their spouses.

PURPOSE: In this article, the authors describe the experiences of men with prostate cancer and their spouses between diagnosis and surgery. DESCRIPTION: As part of a longitudinal qualitative study, semistructured interviews were held with 34 prostate cancer patients who were waiting for surgery. Separate interviews were held with their spouses. RESULTS: Six main components of experience were evident from the analysis of transcripts related to the presurgery period: 1) the news of a diagnosis of prostate cancer came initially as a shock for both partners, the impact of which lessened over time; 2) the new reality of illness necessitated readdressing the marital relationship, most often resulting in a sense of renewed connection and commitment; 3) the illness crisis precipitated a search for information to guide decisions about treatment; 4) there was a need for couples to decide who to inform about the cancer diagnosis and how much to say about it; 5) couples attempted to seek a semblance of normality in their lives, especially after treatment decisions had been made; and 6) despite attempts to minimize the potential impact of upcoming surgery, anxiety was typically experienced at least intermittently by one or both partners. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals need to facilitate attempts by the patient to gather and synthesize information. Cancer specialists can play a positive role in reducing distress in couples, and, thus, the attention of the specialists to communication issues is critical. The strain of waiting for surgery must be considered when treatment recommendations are made; watchful waiting protocols require further study from a psychological perspective. Clinicians need to be alert to the balance between being positive and carrying on as normal, and acknowledging and dealing with the distress that arises.

Activities of Daily Living↗

PubMedDate not supplied

Early postsurgery experience of prostate cancer patients and spouses.

PURPOSE: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery. DESCRIPTION OF STUDY: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery. RESULTS: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.

Activities of Daily Living↗

PubMedDate not supplied

Criteria for selecting textbooks.

Explore the source record for details and available documents.

Books↗

PubMedDate not supplied

Transient cutaneous vesicles in a teenager: the final piece to a puzzle.

Cicatricial pemphigoid is a chronic blistering disease that predominantly affects the mucous membranes. It has a peak occurrence in the seventh decade. Pediatric cicatricial pemphigoid is a rare entity, with fewer than 20 cases reported. We report an 18-year-old man who was recently diagnosed with cicatricial pemphigoid after six years of diagnostic uncertainty.

Adolescent↗

PubMedDate not supplied

Evaluation of the carbon dioxide laser on vital human primary pulp tissue.

PURPOSE: The purpose of this study was to evaluate the response of the human primary pulp to the carbon dioxide laser and formocresol for vital pulp therapy. METHODS: Fifteen healthy children with intact, caries-and-restoration-free, contralateral primary cuspids with at least two-thirds of the roots remaining who were scheduled for orthodontic extraction were randomly assigned to pulpotomy treatment with a carbon dioxide laser or formocresol. The treated teeth were clinically and radiographically evaluated at 28 and 90 days post-treatment prior to extraction. The extracted teeth were evaluated histologically for pulpal response. RESULTS: All teeth were asymptomatic and clinically normal at both observation periods. Internal root resorption was observed in one formocresol and two laser treated teeth. There was a significant inverse correlation between the laser energy applied to the pulp and the degree of inflammation at 28 days (P = .01) but not at 90 days (P = .27). CONCLUSION: Carbon dioxide laser treatment compared favorably to formocresol for pulpotomy in primary teeth.

Child↗

PubMedDate not supplied

Meta-analysis of dietary restriction during fecal occult blood testing.

CONTEXT: Dietary restriction is often recommended during fecal occult blood testing (FOBT) as a means of increasing test accuracy, but concern surrounds whether such restriction also reduces the chance that patients will complete the test. PURPOSE: We conducted a systematic review and meta-analysis to determine if advice about dietary restrictions affects the rate of completion of FOBT and the rate of positive results. METHODS: We searched the MEDLINE database and hand-searched the bibliographies of other systematic reviews and clinical practice guidelines to identify randomized trials of advice to perform dietary restriction during FOBT. We included only trials that reported the proportion of patients who completed the occult blood tests (completion rate). When such information was available, we also recorded the proportion of patients who had positive test results (positivity rate). RESULTS: Five randomized trials met our inclusion criteria. All used guaiac-based Hemoccult tests; none reported results from rehydrated test slides. In four trials, there was little or no difference in test completion between patients assigned to dietary restriction and those with no restriction. In one small trial that used an especially restrictive diet, completion was 21 percentage points lower in the restricted group. Positivity rates were reported in four trials, none of which found a statistically significant difference between groups. Meta-analysis showed no difference in the summary positivity rate between those assigned to dietary restriction versus those not restricted (difference in positivity rate, 0%; 95% CI, -1% to 1%). CONCLUSIONS: Available data suggest that advice to perform modest dietary restriction during unrehydrated FOBT does not affect the completion rate, but more severe restrictions may. Dietary restriction also does not appear to affect positivity rates. On the basis of these data, physicians do not need to advise patients to restrict their diet for nonrehydrated FOBTs.

Aged↗

PubMedDate not supplied

Assessment of constipation management in long-term care patients.

OBJECTIVES: To determine the prevalence of diagnosed constipation among nursing home patients; to assess the prevalence of routine (at least one time per week for 4 consecutive weeks) laxative use; and to investigate prescribing practices. DESIGN: A retrospective multi-center medical record evaluation. SETTING: Any one of 25 nursing facilities representative of a long-term care pharmaceutical provider's geographical coverage. PARTICIPANTS: All patients under the age of 65, and/or who had resided in the facility for less than 4 weeks, and/or who were placed in a specialty care bed (eg, Alzheimer's disease, hospice, HIV/AIDS) were excluded. RESULTS: A total of 712 resident charts meeting initial inclusion criteria were screened, 392 (55%) of which had a documented diagnosis of constipation and/or routine laxative use. Approximately 28% (CI +/- 3.3) of residents had a documented diagnosis of constipation. The rate of laxative use within the same sample population of 712 patients was 53.8% (CI +/- 3.7). Of the 392 patients with a diagnosis of constipation and/or routine laxative use, over 72% had at least one diagnosis or medication known to precipitate constipation. The most commonly prescribed laxatives were stool softeners (26.2%), saline laxatives (18.4%) and stimulant/irritant laxatives (15.6%). Almost half of the laxative users were prescribed more than one agent. CONCLUSION: This study supports the concern that there is often a gap between documentation of symptoms and constipation treatment decisions. No correlation was found between the specific laxative prescribed and the presence or absence of a documented diagnosis of constipation. Treatment decisions should be based on thorough examination and individualized patient needs. Furthermore, there is a need to increase monitoring for drug effectiveness.

Journal Article↗

PubMedDate not supplied

Hand hygiene.

Explore the source record for details and available documents.

Cross Infection↗

PubMedDate not supplied

A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics.

An 18-month intervention was implemented to increase breast and cervical cancer screening among poor African-American women in Chicago. Breast and cervical cancer screening programs were set up in two public clinics, one community-based and the other hospital-based. Nurse clinicians and public health workers were used in these programs to recruit women in the clinics and in targeted community institutions to receive free breast and cervical cancer screening. The following barriers were specifically addressed by the intervention: accessibility of screening, knowledge about breast and cervical cancers, access to followup screening examinations, and access to treatment. A computerized followup system was specifically designed to track patients. During the 18 months of the intervention, 10,829 visits were made by 7,654 low-income women. A total of 84 cases of breast cancer and 9 cases of cervical cancer were detected. Awareness of the program, as measured by a survey after the completion of the intervention, increased in both clinics compared with baseline results. Knowledge about breast and cervical cancers also increased, as measured by scores on tests given before and after a class on breast and cervical cancers. Followup rates were 86 percent for women attending the programs. More than 90 percent of the women referred for evaluation of breast abnormalities kept an appointment. In summary, the intervention was successful in reducing barriers to breast and cervical cancer detection and in attracting a high-risk group of women.

Adult↗

PubMedDate not supplied

Health beliefs and behaviors in rural high school juniors.

This descriptive study investigated the health beliefs and behaviors of 709 high school juniors in two rural counties of Pennsylvania. The Adolescent Wellness Appraisal (AWA) was utilized to survey this population in an attempt to understand rural adolescent health so that appropriate interventions could be implemented. Results demonstrated the presence of the usual adolescent problems, such as violence, substance usage, and poor nutritional and exercise habits. It also established the presence of a striking number of stressful events, such as parental loss and relocation, experienced in just a one year period of time. The results of this survey are discussed in relation to those from earlier surveys conducted by the AWA, tool creators at the University of Michigan. Overall implications suggest the need for greater availability of health promotion in rural areas, as well as suggestions for future research specific to needs of rural adolescents.

Adolescent↗