Psychological morbidity is high for women with breast cancer and is often undetected and untreated. Encouragingly, there are well-evaluated strategies to help improve psychological outcomes, but the challenge remains as to how to transfer these to routine care settings. The National Health and Medical Research Council (NHMRC) National Breast Cancer Centre used evidence-based psychosocial clinical practice guidelines and breast cancer treatment guidelines to develop a comprehensive specialist breast nurse (SBN) model of care and conducted a feasibility study to observe its implementation in diverse clinical conditions. Seven SBNs at four Australian cancer treatment centres implemented the model of care to support 196 women with a new diagnosis of early or locally advanced breast cancer. The SBN role in detecting women's psychological difficulties is reported here. Two months after diagnosis, 36% of women had a likely psychological disorder on the General Health Questionnaire 12-item (GHQ12) version. The SBNs detected as many as 85% and as few as 20% of high GHQ12 scorers, depending upon a woman's psychosocial risk factors and consultation factors. Few women were referred to psychological services, suggesting other barriers to care. More specific communication skills training, psychological symptom screening questionnaires and better access to psychological services may help the implementation of the model of care.

Adult↗

PubMedDate not supplied

Transient global amnesia after sexual intercourse.

BACKGROUND: Transient global amnesia presents as paroxysmal, transient loss of memory function and has been shown to have a number of inciting factors. AIMS: To report a case and its inciting factor in order to heighten awareness of the condition. METHODS: A 56-year-old woman who presented with TGA after sexual intercourse is reported. RESULTS: The episode of TGA resolved after 14 hours. Results of laboratory tests including MRI brain and MR angiogram and venogram were normal. CONCLUSION: An inciting event can often be identified for TGA and a targeted history should be used to help elicit such events.

Amnesia, Transient Global↗

PubMedDate not supplied

Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department.

Adults presenting to an emergency department with acute respiratory illness were studied prospectively in an effort to identify sensitive clinical criteria for the diagnosis of pneumonia. Of 308 patients studied, 118 (38%) had definite or equivocal infiltrates and were considered to have pneumonia. No single symptom or sign was reliably predictive of pneumonia. Cough was the most common symptom in patients with pneumonia (86%), but was equally common in those with other respiratory illness. Fever was absent in 36 patients with pneumonia (31%). Abnormal findings on lung examination, that is, rales, rhonchi, decreased breath sounds, wheezes, altered fremitus, egophony, and percussion dullness, were each found in fewer than half of the patients with pneumonia. Twenty-six patients (22%) with a completely normal chest examination had pneumonia. Abnormal vital signs (temperature greater than 37.8 degrees C (100 degrees F), pulse greater than 100/min, or respirations greater than 20/min) were 97% sensitive for the detection of pneumonia. These criteria retained their sensitivity when films were subjected to a second, blinded interpretation by a senior radiologist. We conclude that restricting chest roentgenograms to patients with at least one abnormal vital sign will detect almost all radiographically demonstrable pneumonia in adult emergency department patients.

Adolescent↗

PubMedDate not supplied

Salmonella infection in badgers in the South West of England.

Explore the source record for details and available documents.

Animals↗

PubMedDate not supplied

Limited benefit of atropine as premedication for colonoscopy.

A prospective double-blind trial was performed comparing atropine (0.5 mg) by slow intravenous administration to placebo as premedication for colonoscopy, to assess the possible beneficial effects of this vagolytic agent on the performance and safety of the procedure. A total of 77 patients was randomly assigned to receive atropine (38 patients) or placebo (39 patients) before colonoscopy in conjunction with our standard initial medications for conscious sedation (meperidine, 0.4 mg/kg and midazolam, 0.03 mg/kg). Total procedure time was 31 min for the atropine group and 35 min for the placebo group (p greater than 0.05), and there was no overall difference in the total amount of intra-procedural medications required. No statistically significant differences were observed relative to the number or severity of vagal episodes, and neither the endoscopist nor the patients noted any differences in the ease or tolerance of the procedure (p greater than 0.05). Although these results fail to demonstrate a significant benefit of atropine when given routinely as premedication for colonoscopy, this study does not rule out the potential usefulness of atropine in counteracting vagal episodes when they occur.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Optimizing the targeted chemical nuclease activity of 1,10-phenanthroline-copper by ligand modification.

Our interest in improving the efficiency of targeted scission reagents has prompted us to study the influence of ring substituents on the nuclease activity of 1,10-phenanthroline-copper conjugated to oligonucleotides and DNA-binding proteins. Since methyl substitution at all but the 2 and 9 positions enhances the copper-dependent chemical nuclease activity of 1,10-phenanthroline, we have compared the activity of conjugates prepared from 5-(aminomethyl)-1,10-phenanthroline (MOP) to those of conjugates prepared from 5-amino-1,10-phenanthroline (amino-OP). Tethering MOP derivatives to the Escherichia coli Fis protein enhances DNA scission several-fold at the weaker cleavage sites initially observed with conjugates prepared from amino-OP. However, scission efficiency is not increased at the stronger cleavage sites, or when scission is targeted to single-stranded DNA by a complementary oligonucleotide. These results are consistent with a change in the rate-determining step for cleavage associated with the differential accessibility of the DNA-bound coordination complex to solvent and reductant. Although the free bis cuprous complex of 2,9-dimethyl-1,10-phenanthroline (neocuproine) is redox-inactive, an oligonucleotide tethered to neocuproine through C5 of the phenanthroline ring efficiently cleaves a complementary DNA sequence. These results establish that the nucleolytic species in targeted scission is the 1:1 cuprous complex and suggest that the oxidative reaction proceeds through a copper-oxo intermediate rather than a metal-coordinated peroxy species. However, substituents at the 2 and 9 positions of the ligand will often hinder close approach of the phenanthroline-copper moiety to the oxidatively sensitive ribose as shown by the preference of the oligonucleotide-targeted chimera for cleavage of single-stranded regions and the failure of neocuproine-DNA-binding protein chimeras and a C2-tethered chimera to cleave DNA.

Amino Acid Transport Systems, Neutral↗