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Biomedical subjects

D Howell

Publications and source records attributed to D Howell.

At least 19 recordsLinked to original sources
PubMed2000

Influencing nurses' knowledge, attitudes, and practice in cancer pain management.

The purpose of this study was to explore the effects of an education intervention on nurses' knowledge, attitudes, and practice in pain assessment and management over 3 months. The education intervention program was designed to change knowledge and influence the attitudes of registered nurses through a values clarification process using a conceptual framework based on a theory of reeducation. Participants in this descriptive, exploratory study were 53 nurses from six oncology units. Data were collected on their knowledge, attitudes, documentation practices, and analgesic choices in defined patient situations. The intervention was effective in changing the knowledge, attitudes, and behaviors of nurses in the study, but the effect was not maintained over time. Study findings suggest that further educational and organizational support is needed for effective practice in pain assessment and management. Further research should explore education programs that will maintain new knowledge over time. In addition, assessment of the effect that new knowledge has on the achievement of improved pain relief for patients should be explored in the future.

Attitude of Health Personnel↗
PubMed1999

Response

Explore the source record for details and available documents.

Journal Article↗
PubMed1999

Canadian women's perspectives on ovarian cancer.

OBJECTIVE: To describe the perspectives of Canadian women living with ovarian cancer regarding their experiences with the disease. DESIGN: A cross-sectional survey of a convenience sample of Canadian women with ovarian cancer. SETTING: Survey questionnaires were sent to physicians in 26 cancer programs that treat women with ovarian cancer and to ovarian cancer self-help groups for subsequent distribution to women. PARTICIPANTS: Women diagnosed with ovarian cancer and able to read English or French. MAIN OUTCOME MEASURES: A variety of individual items in the survey related to information received, communication, physical and psychosocial symptoms, impact of illness and quality of life. RESULTS: A total of 315 women returned the survey. The average age of the respondents is 59 years. Each province and territory is represented in the sample. Over one-half of the women received a diagnosis of ovarian cancer within a month of seeking help for a concern and 85% had multiple treatment modalities. The majority of the women felt adequately informed (80%) and were satisfied with communication with their physicians (mean of 4.1 to 4.5 on a 5-point scale). A majority (62%) said that their lifestyle had changed as a result of their disease. Problems were experienced most frequently regarding side effects (58%), fear of recurrence (54%), sleeping difficulties (46%), bowel difficulties (44%), fear of dying (36%) and difficulty concentrating (32%). Many who experienced problems reported receiving inadequate help for them (16% to 49%). Quality of life was reported as significantly lower following the diagnosis and treatment of ovarian cancer (p = 0.0001). CONCLUSION: This study provides an important foundation for further investigation. There is a pressing need for research regarding the early identification of ovarian cancer and issues of support and coping. Care for women with ovarian cancer requires the expertise of a range of disciplines and community-based agencies working collaboratively as a team.

Adaptation, Psychological↗
PubMed1998

Experiences of mothers in five countries whose child died of cancer.

Although increasing attention is being focused on the emotional aspects of caring for dying children and their families, few research reports concentrate on the experiences of mothers, particularly in different countries. This article describes the findings of an exploratory, descriptive study that investigated the experiences of mothers from five different countries who each had a child die from cancer in the past 6 months. Principal investigators, members of the International Work Group on Death, Dying, and Bereavement, conducted semistructured interviews with 21 mothers in their own countries. No culturally related differences were noted among mothers, and the mothers' recall of their experiences are more similar than different. All mothers, irrespective of country, described similar reactions to the diagnosis, management of the end-stage illness, and challenge of coping with bereavement. Lessons learned from this project provide suggestions for future research across countries.

Adolescent↗
PubMed1998

Management of occluded biliary Wallstents.

BACKGROUND: Wallstents (Schneider Stent, Inc., USA) used for the palliation of malignant biliary strictures, although associated with prolonged patency, can occlude. There is no consensus regarding the optimal management of Wallstent occlusion. AIMS: To evaluate the efficacy of different endoscopic methods for managing biliary Wallstent occlusion. METHODS: A multicentre retrospective study of patients managed for a biliary Wallstent occlusion. RESULTS: Data were available for 38 patients with 44 Wallstent occlusions, all of which had initial endoscopic management. Twenty four patients had died and 14 were alive after a median follow up of 231 (30-1095) days following Wallstent occlusion. Occlusions were managed by insertion of another Wallstent in 19, insertion of a plastic stent in 20, and mechanical cleaning in five. Endoscopic management was successful in 43 (98%). Following management of the occlusion, bilirubin decreased from 6.0 (0.5-34.3) to 2.1 (0.2-27.7) mg/100 ml (p < 0.05). No complications occurred. The median duration of second stent patency was 75 days (95% confidence interval 43 to 107) after insertion of another Wallstent, 90 days (71 to 109) after insertion of a plastic stent, and 34 days (30 to 38) after mechanical cleaning (NS). The respective median survivals were 70 days (22-118), 98 days (54-142), and 34 days (30-380) (NS). Incremental cost effective analysis showed that plastic stent insertion is the most cost effective option. CONCLUSION: Although all three methods are equally effective in managing an occluded Wallstent, the most cost effective method appears to be plastic stent insertion.

Cholestasis↗
PubMed1998

The 1997 Helene Hudson Memorial Lecture. Reaching to the depths of the soul: understanding and exploring meaning in illness.

The nurse who hopes to respond to the experience of individuals and their families with a diagnosis of cancer must understand and explore meaning in illness. Meaning has been described as a fundamental dimension of personhood (Cassel, 1982). There can be little understanding of the person's behaviour and responses to cancer without understanding the meaning of illness in their lives. The meaning ascribed to a situation can have a profound impact on the individual and family's coping and adjustment and may influence their relationships with the health care team. Meaning in illness may be influenced by cultural beliefs, religion, values, life philosophy and past experience. Meaning goes beyond the surface reactions of the individual to the very depths of the person's soul and can be a source of despair and suffering. Meaning evolve throughout the illness trajectory and can have a profound influence on the person's lived experience. The skills required to understand meaning and the lived experience of illness for the individual are extensive. It is only through true presence, mutual understanding and a sharing of the life of the other that nurses are able to understand and co-construct meaning. It is a respect and understanding of the individual within the whole context of their personhood and the meanings assigned to their experience of cancer which allows the nurse to practice beyond the surface, to touch the person's soul.

Adaptation, Psychological↗
PubMed1998

Making cancer bearable: the Interlink Community Cancer Nurses model of supportive care.

Most cancer patients and their families experience the full impact of their diagnosis and the disruptions cancer brings to their lives in their own homes and communities. Access to supportive care programs within the community is critical if we are to assist these individuals in coping and adjusting to the realities of cancer. Interlink Community Cancer Nurses, a nonprofit nursing agency, provides supportive care across the continuum of cancer care from early diagnosis and treatment through to remission and/or palliative care through its independent model of supportive care delivered by expert oncology nurses. The program utilizes a unique, client-centred model of care delivery to ensure that needs are met, and to link patients to community services which promote their ability to meet the demands of cancer. Interlink's program of supportive care demonstrates that oncology nurses can make a significant impact on the outcomes of cancer for individuals and their families which may impact on cost, influence survival and enhance quality of life.

Community Health Nursing↗
PubMed1997

Successful treatment of post-cholecystectomy bile leaks using nasobiliary tube drainage and sphincterotomy.

OBJECTIVE: Bile leaks are known complications of cholecystectomy. The combination of sphincterotomy and nasobiliary tube (NBT) drainage is effective for the immediate decompression of bile ducts and provides access for follow-up cholangiography. Our objective was to study, retrospectively, 19 patients who had undergone treatment for bile leaks with this combination between October 1991 and December 1995. METHODS: Nineteen patients (15 F, 4 M) ages 23-83 yr (mean 50 yr) presented with bile leaks secondary to open cholecystectomy (n = 1) and laparoscopic cholecystectomy (n = 18). All patients had sphincterotomy and NBT placement. Symptoms, findings at ERCP, and outcome were reviewed. RESULTS: Patients presented from 0 to 150 days after cholecystectomy (median = 2) with pain (n = 17), fever (n = 8), bile leakage in a surgical drain (n = 4), elevated liver tests (n = 8), and nausea and vomiting (n = 4). Fourteen patients had diagnostic imaging before endoscopic management. ERCP findings included cystic stump leak (n = 12), including one with a colocutaneous biliary fistula, gallbladder fossa leak (n = 3), right hepatic branch leak (n = 1), or no leak (n = 3). Three patients had choledocholithiasis. NBT drainage was used for a mean of 3.9 days (range 1-12 days). Fourteen patients had radiographic evidence of leak closure. One patient ultimately required surgical correction for a chronic colocutaneous biliary fistula. There were no early or late endoscopic complications. CONCLUSIONS: Endoscopic management with nasobiliary drainage and sphincterotomy is effective for acute uncomplicated bile leaks but may not be adequate for chronic fistulas. The advantages over endoprostheses include access for subsequent cholangiography, improved biliary decompression, and catheter removal without further endoscopy.

Adult↗
PubMed1994

Evaluation of new monoclonal antibody-based latex agglutination test for detection of cryptococcal polysaccharide antigen in serum and cerebrospinal fluid.

We evaluated the performance of CRYPTO-LEX (Trinity Laboratories, Inc., Raleigh, N. C.), a new mouse immunoglobulin M monoclonal antibody latex agglutination reagent which reacts with the capsular polysaccharide of the four serogroups of Cryptococcus neoformans. This test was compared with CALAS (Meridian Diagnostics, Cincinnati, Ohio) for the ability to detect cryptococcal antigen in serum and cerebrospinal fluid (CSF). A total of 580 clinical specimens (327 serum and 253 CSF samples), primarily from human immunodeficiency virus-infected patients, were tested in this study. Sixty-seven specimens (44 serum and 23 CSF samples) were positive for cryptococcal antigen with both tests, and 511 (282 serum and 229 CSF samples) were negative. The two latex reagents agreed for 326 of 327 serum specimens (44 positives and 282 negatives). One serum specimen with a titer of 1:2 was CALAS positive but CRYPTO-LEX negative. The titer correlation coefficient for the two tests was 0.884 when two highly discordant serum specimens were eliminated from analysis of the data. The two latex tests agreed for 252 of 253 CSF specimens (23 positives and 229 negatives). One specimen with a titer of 1:2 was positive with CALAS and negative by CRYPTO-LEX. The correlation coefficient of the two tests for CSF titers was 0.886. The sensitivity and specificity of CRYPTO-LEX were 97 and 100%, respectively, with a 99.6% correlation with CALAS. These data show that the performance of CRYPTO-LEX is comparable to that of CALAS for detection of cryptococcal antigen in serum and CSF.

Animals↗
PubMed1993

Induction of immune-mediated glomerulonephritis in normal mice immunized with bacterial DNA.

Normal mice immunized with bacterial DNA produce high titers of anti-DNA antibodies and represent a new model for autoantibody production in systemic lupus erythematosus. To determine whether DNA immunization can also provoke clinical manifestations of lupus, the occurrence of nephritis in immunized mice was assessed and correlated with levels of anti-DNA as well as antibodies to glomerular antigens. BALB/c mice immunized with Escherichia coli single-stranded DNA in complexes with methylated bovine serum albumin in adjuvant showed increased proteinuria compared to control mice immunized with mBSA alone. Furthermore, DNA immunized mice had significantly greater glomerular proliferative changes and immunoglobulin deposition than control mice. In an in vitro assay, sera from DNA immunized mice exhibited greater binding to glomerular antigens than sera from control mice. Compared to sera, renal eluates from DNA-immunized mice were enriched for anti-DNA and glomerular binding activity. These data indicate that immunization of normal mice with E. coli DNA induces an immune-mediated proliferative glomerulonephritis that is likely secondary to the renal deposition of anti-DNA antibodies.

Animals↗
PubMed1992

Interferon-alpha-dependent and -independent participation of accessory cells in natural killer cell-mediated lysis of HSV-1-infected fibroblasts.

Human natural killer (NK) cells require an HLA-DR+ accessory cell (AC) population to lyse herpes simplex virus-type 1 (HSV-1)-infected fibroblasts (HSV-Fs) but not K562 target cells. It has been postulated that ACs may function by producing interferon-alpha (IFN-alpha), which stimulates NK cells. Using a sequential enrichment protocol, ACs were found to coenrich with the interferon-producing cells (IPCs). Treatment of the ACs with a protein synthesis inhibitor, emetine, inhibited both their IFN production and AC function, results that support a central role for IFN in AC activity. In contrast, when the arginine analogue canavanine was added to NK assays, no IFN-alpha was produced and NK(HSV-Fs) activity was only partially inhibited. Consistent with IFN-independent AC function, treatment with either polyclonal sheep or bovine anti-IFN-alpha neutralized all the IFN-alpha produced during the NK assays but caused either no or partial reduction of NK(HSV-Fs) activity, respectively. However, when limiting numbers of ACs were used, the bovine antiserum neutralized both IFN-alpha and NK(HSV-Fs) activity. We further found that HLA-DR+ cells are required for cell clustering, suggesting a role for cell contact. Finally, fixation of activated ACs prevented the accessory function. Together, these results demonstrate that ACs can provide help to NK cells in both IFN-alpha-dependent and -independent manners.

Animals↗