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L Oakes

Publications and source records attributed to L Oakes.

16 recordsLinked to original sources
PubMed2001

End-of-life decision making by adolescents, parents, and healthcare providers in pediatric oncology: research to evidence-based practice guidelines.

Participating in end-of-life decisions is life altering for adolescents with incurable cancer, their families, and their healthcare providers. However, no empirically developed and validated guidelines to assist patients, parents, and healthcare providers in making these decisions exist. The purpose of the work reported here was to use three sources (the findings of three studies on decision making in pediatric oncology, published literature, and recommendations from professional associations) to develop guidelines for end-of-life decision making in pediatric oncology. The study designs include a retrospective, descriptive design (Study 1); a prospective, descriptive design (Study 2); and a cross-sectional, descriptive design (Study 3). Settings for the pediatric oncology studies included a pediatric catastrophic illness research hospital located in the Midsouth (Studies 1 and 2); and that setting plus a children's hospital in Australia and one in Hong Kong (Study 3). Study samples included 39 guardians and 21 healthcare providers (Study 1); 52 parents, 10 adolescents, and 22 physicians (Study 2); and 43 parents (Study 3). All participants in the studies responded to six open-ended questions. A semantic content analysis technique was used to analyze all interview data. Four nurses independently coded each interview; interrater reliability per code ranged from 68% to 100% across studies. The most frequently reported influencing factors were "information on the health and disease status of the patient," "all curative options having been attempted," "trusting the healthcare team," and "feeling support from the healthcare provider." The agreement across studies regarding influencing factors provides the basis for the research-based guidelines for end-of-life decision making in pediatric oncology. The guidelines offer assistance with end-of-life decision making in a structured manner that can be formally evaluated and individualized to meet patient and family needs.

Adolescent↗
PubMed2000

An international feasibility study of parental decision making in pediatric oncology.

PURPOSE/OBJECTIVES: To describe parental decision making about treatment options for children with cancer and determine the feasibility of a similar but larger international study. DESIGN: Exploratory. SETTINGS: A pediatric catastrophic illness research hospital in the United States and children's hospitals in Australia and Hong Kong. SAMPLE: A convenience sample of 43 parents (5 fathers and 38 mothers ages 23-59 years). METHODS: Six open-ended interview questions posed to parents during private individual interviews. Content analysis techniques were used. MAIN RESEARCH VARIABLES: Parental perceptions of (a) factors considered in the decision-making process, (b) behaviors of healthcare professionals that affected the process, and (c) satisfaction with the process. Feasibility of a larger study was estimated by considering ease of access to parents, number of refusals to participate, understanding of the interview questions, and level of interest at each setting. FINDINGS: Access to parents was possible at all sites. Refusal to participate was reported only at the U.S. site. Certain factors (e.g., getting information from the healthcare team, trusting staff) were important to all parents considering end-of-life decisions. Site-specific factors included considering alternative therapies (at the Australian site) and strengthening faith (at the U.S. site). CONCLUSIONS: A larger international study of parental decision making is feasible. Sufficient similarities in parental decision making exist across these sites to justify future efforts to identify universal decision-making factors that, in conjunction with site-specific differences, could be helpful in developing guidelines for healthcare professionals who assist parents in making treatment-related decisions for a sick child.

Adolescent↗
PubMed2000

NCCN Practice Guidelines for Cancer Pain.

The overall approach to pain management encompassed in these guidelines is comprehensive. It is based on objective pain assessments, utilizes both pharmacologic and nonpharmacologic interventions, and requires continual reevaluation of the patient. The NCCN Cancer Pain Practice Guidelines Panel believes that cancer pain can be well controlled in the vast majority of patients if the algorithms presented are systematically applied, carefully monitored, and tailored to the needs of the individual patient.

Acetaminophen↗
PubMed1998

The effects of norethisterone on endometrial abnormalities identified by transvaginal ultrasound screening of healthy post-menopausal women on tamoxifen or placebo.

Tamoxifen (tam) is used extensively for treatment of patients with breast cancer and is being evaluated for chemoprevention in healthy women. It has, however, been reported to increase the risk of endometrial cancer in post-menopausal women, probably by an oestrogenic effect on the endometrium. It also causes endometrial cysts and polyps. The aims of this study were to identify the incidence of endometrial thickening, polyps and cysts by transvaginal ultrasound (TVUS) screening of a population of post-menopausal healthy women in the Royal Marsden tamoxifen chemoprevention trial and to evaluate the possible benefit from the use of intermittent norethisterone (NE) in women with persistent changes. Since 1990, we have undertaken regular TVUS, using an endovaginal B mode probe, of the 463 post-menopausal women in the trial randomized to tam (20 mg day(-1)) or placebo (plac), without breaking the randomization code. Endometrial thickening (ET) was defined as > or = 8 mm at the widest point across the myometrial cavity in the longitudinal plane, including any stromal changes. Cystic changes were defined as more than one hypoechogenic area > 1 mm. Polyps were identified using saline hydrosonography. Oral NE (2.5 mg day(-1)) was used for 21 days out of 28 for three consecutive cycles by women with persistent endometrium > or = 8 mm, including cystic and polypoid changes. TVUS was repeated after the three courses to evaluate any change caused by NE and endometrial biopsies, including hysteroscopy, was performed on those women with persistent abnormalities. A persistent ET > or = 8 mm was identified in 56 (24%) of the 235 women on tamoxifen compared with only 5 (2%) of 228 women on placebo (P <0.0005). Stromal changes, including cysts, were detected in 36 (15%) and polyps in 26 (11%) of the women on tamoxifen compared with only two (< 1%) of the women on placebo (P << 0.0005). After 3 months of cyclical norethisterone, 39 of 47 women (83%) on tamoxifen had persistent ultrasound changes. However, 45 (96%) had a progesterone withdrawal bleed. Hysteroscopy was performed in 39 women on tamoxifen (28 endometrial biopsy, 15 polypectomy), five of whom had histological evidence of a proliferative endometrium and a further three had an atypical hyperplastic endometrium (one of whom had a focus of invasive carcinoma). The cysts and polyps which were detected in women on tam could not be reversed by NE and were presumably stromal and not of malignant risk. However, 96% of the women had withdrawal NE bleeding, indicating an oestrogenically primed endometrium which could be a mechanism for an increased risk of endometrial cancer. Further studies are required to ascertain whether a progestin would protect against this risk. As in other studies, these results indicate that any increased risk of endometrial cancer caused by tamoxifen is low, and that TVUS screening is probably not justified for asymptomatic women on tamoxifen.

Aged↗
PubMed1997

MICs of rifampicin and chloramphenicol for mucoid Pseudomonas aeruginosa strains are lower when human lactoferrin is present.

MlCs of rifampicin and chloramphenicol for mucoid strains of Pseudomonas aeruginosa were lower in the presence of human lactoferrin (0.9 mg/mL, the concentration found in cystic fibrosis sputum) than in its absence. MICs for some strains were lowered to clinically achievable levels of the antibiotics, which is compatible with impressions of greater clinical efficacy in pseudomonas infections than would be predicted by standard sensitivity tests. The routine addition of lactoferrin to sensitivity media for testing of cystic fibrosis isolates may give more useful results than conventional tests as in-vivo conditions are more closely simulated.

Anti-Bacterial Agents↗
PubMed1997

Decision making by parents and healthcare professionals when considering continued care for pediatric patients with cancer.

PURPOSE/OBJECTIVES: To better define the treatment-related decisions considered most difficult by parents of pediatric patients with cancer and the factors that influenced their final decisions. DESIGN: Retrospective-descriptive design. SETTING: Pediatric oncology institution in the mid-southern region on the United States. SAMPLE: 39 parents representing 37 of 83 eligible families, 16 attending physicians, three nurses, and two chaplains. METHODS: Parent participants responded by telephone to six open-ended interview questions and a 15-item questionnaire about factors that were important when making the decision to continue care. Healthcare professionals were interviewed face-to-face. MAIN RESEARCH VARIABLES: Most difficult treatment-related decisions; factors influencing decision making. FINDINGS: Parents reported 15 types of difficult decisions, the majority of which were made late in the course of treatment. Deciding between a phase I drug study or no further treatment (n = 14), maintaining or withdrawing life support (n = 11), and giving more chemotherapy or giving no further treatment (n = 8) were the most frequently reported difficult decisions. Parents rated "recommendations received from healthcare professionals" as the questionnaire factor most important in their decision making, and healthcare professionals rated "discussion with the family of the patient" as the most important factor. CONCLUSION: Parents of children or adolescents with cancer and their healthcare providers face difficult treatment-related decisions, many of which occur late in the course of treatment. Parents and healthcare professionals cite similar factors in their decision making but differ in their ratings of the factors' importance. For parents, the information and recommendations they receive from healthcare professionals figure most frequently and most importantly in their decision making. For healthcare professionals, the certainty that the patient will not get better and discussions with the patient's family figure most importantly in their decision making. Once parents conclude that their child can not get better, they are more likely to choose noncurative options such as choosing no further treatment or withdrawing life support. IMPLICATIONS FOR NURSING PRACTICE: Nurses can help determine what information parents need in their decision making. Particular attention must be given to ways to communicate the likelihood of the their child's survival.

Adolescent↗
PubMed1994

Measuring pain in pediatric oncology ICU patients.

Thirty patients (ages 5 to 13) hospitalized in a pediatric oncology intensive care unit (ICU) rated the presence and severity of their pain on the Faces Pain Scale (FPS) and the Poker Chip Tool (PCT). Parents independently rated the child's pain on these scales and each patient's nurse completed the Objective Pain Scale (OPS). Patients' ratings on the FPS correlated significantly with parents' ratings on this scale (tau = .48, P = .002) but not on the PCT (tau = .23, P = .16). Nurses' ratings on the OPS were moderately correlated with patients' FPS ratings (tau = .37, P = .02) but were only weakly associated with PCT ratings (tau = .27, P = .09). The majority of patients, parents, and nurses expressed a preference for the FPS over the PCT. The FPS appears to be a clinically useful and accurate approach for measuring the pain of pediatric oncology patients in an ICU but is limited to those who can participate in a self-report measurement.

Adolescent↗
PubMed1993

Postoperative analgesia following thoracotomy in children: interpleural catheters.

The authors retrospectively review their experience in children with the latest addition to the postoperative analgesic armamentarium: interpleural analgesia (IPA). IPA was used in 14 children following thoracotomy. There were 9 boys and 5 girls. Patients varied in age from 2 months to 17 years 4 months (mean +/- SEM = 7.6 +/- 1.6 yr). Catheters were left in place from 10 to 72 hours (mean +/- SEM = 45.1 +/- 4.6 h). Four patients received intermittent bolus doses and 10 patients received a continuous infusion through the interpleural catheters. Adequate analgesia, as judged by both subjective responses (decreased irritability or complaints of pain) and by objective physiologic responses (decreased heart rate, respiratory rate, and systolic blood pressure), was achieved in 13 of 14 patients. Eight of the 14 children required no additional analgesic agents. One child received 2 doses of oral codeine and 4 patients received 2 to 3 doses of intravenous narcotic during IPA. IPA was not effective in one patient who required 6 doses of intravenous meperidine. Patients more than 10 years of age required significantly more (P < 0.05) intravenous narcotic supplementation than patients less than 10 years of age (1.60 +/- 0.50 v 0.14 +/- 0.11 mg meperidine/kg/d). No complications related to placement or subsequent use of IPA were identified in any of the patients. IPA provides effective postoperative analgesia following thoracotomy in children.

Adolescent↗
PubMed1992

Pediatric analgesia with epidural fentanyl citrate administered by nursing staff.

Even though epidural analgesia is effective and has advantages over conventional postoperative analgesia, it is also labor intensive, requiring 24-hour supervision by an anesthesiologist. In an effort to decrease the manpower requirements, some hospitals allow the nursing staff to administer epidural narcotics to adult patients. In children, however, this practice has been limited. We retrospectively reviewed our experience over 12 months with this procedure. Epidural catheters (caudal, lumbar, or thoracic) were placed in 43 pediatric patients for acute and chronic pain management. All patients received a continuous epidural infusion of bupivacaine hydrochloride with fentanyl citrate. Eleven (26%) of the 43 patients required supplemental analgesia and were given 45 doses of epidural fentanyl. Adequate analgesia was achieved in all patients. No intravascular or intrathecal injections were noted, nor did any inadvertent epidural injections of medications occur. No patient had respiratory depression (respiratory rate less than 10% for age). We believe epidural administration of fentanyl by a carefully educated nursing staff is safe and effective in children.

Adolescent↗
PubMed1992

Continuous epidural anesthesia for postoperative analgesia in the pediatric oncology patient.

When compared with conventional techniques, epidural anesthesia not only provides improved analgesia, but also has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although the efficacy of this technique in children has been demonstrated, extensive experience in the pediatric oncology patient has not been previously reported. We retrospectively reviewed our 2-year experience with epidural analgesia and discuss the techniques involved in implementing this service for the pediatric oncology patient. An epidural catheter was successfully placed in 58 of 60 patients (97%) who ranged in age from 4 months to 19 years and in weight from 4.1 to 68 kg. Postoperative analgesia was provided by a continuous infusion of a bupivacaine/fentanyl mixture, supplemented with intermittent epidural fentanyl by bolus dose as needed. No complications related to epidural catheters were noted. Our review supports the efficacy of this technique for providing postoperative analgesia after various major surgical procedures in the pediatric oncology patient.

Adolescent↗
PubMed1992

Bedside nursing research. A new category of research?

A new category of clinical nursing research, labeled "bedside nursing research," is proposed and described in this article. Justification for this research category is based on its particular characteristics, such as its narrow focus on direct care procedures that have well-defined parameters and the patient outcomes of those procedures. Findings from this type of research have high clinical relevance and can directly influence nursing practice at the study site.

Clinical Nursing Research↗
PubMed1991

Percutaneous lumbar intrathecal catheter for the administration of chemotherapy.

We present a patient with Burkitt's lymphoma in whom the initial diagnostic lumbar puncture was difficult due to a recent lumbar laminectomy and residual spinal cord tumor. According to our current protocol, he was to receive intrathecal chemotherapy for three consecutive days. To avoid the need for repeated attempts at lumbar puncture and to ensure the proper instillation of therapy, a percutaneous IT catheter was placed for 48 hours and the three doses of IT chemotherapy were administered through this catheter. Due to the importance of IT chemotherapy, options must be available to deliver these medications when technical or anatomic abnormalities exist. One such option is the short term placement of a percutaneous IT catheter.

Adolescent↗
PubMed1991

Reduction of complications associated with total parenteral nutrition by introduction of a clinical monitoring team. The Total Parenteral Nutrition Committee.

The introduction of Total Parenteral Nutrition (TPN) in the treatment of malnourished patients with unusable gastrointestinal tracts has become commonplace throughout the world. However there are significant metabolic (4.2 to 7.7%) and septic (7 to 27%) complications associated with this therapy. In 1984 a TPN committee was formed at Royal Newcastle Hospital and a TPN nurse was appointed. This series documents the use of TPN at Royal Newcastle Hospital from August 1984 to July 1989. There were 251 patients who received TPN, representing 3422 days of TPN. The primary catheter sepsis rate was 10.4% at the commencement of the series and decreased appreciably to 3.2%. The formation of the TPN committee and the appointment of a TPN nurse have represented a considerable cost in time and money but this action has been justified by the drop in the sepsis rate resulting in a decrease in morbidity and mortality associated with TPN.

Adolescent↗