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M H Tattersall

Publications and source records attributed to M H Tattersall.

At least 73 records · Page 4Linked to original sources
PubMed1994

Identification of apoptotic and necrotic human leukemic cells by flow cytometry.

Glucocorticoids kill human leukemic cells, CCRF-CEM.f2, by apoptosis. Cell death is preceded by DNA fragmentation into nucleosomal subunits which can be evaluated by DNA gel electrophoresis or by determining the proportion of cleaved DNA in whole cell lysates. Hyperthermic treatment of CCRF-CEM.f2 cells induces necrotic cell death which is characterized by a different DNA gel electrophoretic pattern. However, these techniques cannot distinguish the individual contributions of both forms of death in a heterogeneous population. Therefore, we have developed a flow cytometric method that readily distinguishes apoptotic and necrotic cells on the basis of propidium iodide staining and cellular light scatter characteristics. This method can be used to analyze factors influencing the mechanisms of cell death after cytotoxic drug treatment.

Apoptosis↗
PubMed1994

Detection of human papillomavirus type 16 E6/E7 transcripts in histologically cancer-free pelvic lymph nodes of patients with cervical carcinoma.

Human papillomavirus (HPV) 16 E6/E7 mRNAs have been detected in paraffin-embedded sections of histologically cancer-free pelvic lymph nodes from four of six patients with HPV 16-associated cervical cancer. The cDNA obtained from the viral mRNA by reverse transcription was amplified by the polymerase chain reaction (PCR). Transcripts were present in a small but significant proportion (6/42, 14%) of the histologically negative/HPV 16 DNA-positive lymph node blocks; but neither HPV 16 DNA nor transcripts were found in 12 lymph node blocks from two patients whose cervical cancers were not HPV-related. Both of the HPV 16 mRNAs detectable by the PCR primers used in the assay (the E6*I and the full-length E6 transcript) were found in the primary tumors, but the transcription patterns in the lymph nodes were variable. The presence of HPV E6/E7 mRNAs in lymph nodes of patients with HPV-related cancer may be a more sensitive indicator of metastasis than conventional histology. In addition, their detections is likely to be more significant than that of HPV DNA sequences alone. The practical significance of the findings, however, awaits correlation with the ultimate clinical outcome.

Adult↗
PubMed1994

Patient participation in the cancer consultation: evaluation of a question prompt sheet.

BACKGROUND: Active participation and asking questions are important ways in which patients can ensure they understand what the doctor has said. This study evaluated a question prompt sheet designed to encourage patients to ask questions in the cancer consultation. PATIENTS AND METHODS: Patients (n = 142) were randomised to receive (i) a question prompt sheet or (ii) a general sheet informing patients of services available through the regional Cancer Council. Recall of information was assessed in a structured interview 4-20 days after the consultation. Questionnaires to assess patient satisfaction and adjustment to cancer were sent by mail. RESULTS: The question prompt sheet had a significant effect in one content area: prognosis. Thirty-five percent of patients who received the question handout asked questions about prognosis compared to 16% of those receiving the information handout. The prompt sheet did not increase the mean number of questions asked overall. Age, in/out-patient status, gender and involvement preference were predictive of both number and duration of patient questions. CONCLUSIONS: A question prompt sheet has a limited but important effect on patient question asking behaviour in the cancer consultation.

Adaptation, Psychological↗
PubMed1994

The take-home message: patients prefer consultation audiotapes to summary letters.

PURPOSE: Despite reports of poor patient understanding and recall after cancer consultations, few doctors provide communication aids. We conducted a randomized trial comparing an audiotape of the consultation versus individualized summary letters to patients after their first consultation with a medical oncologist. METHODS: One hundred eighty-two cancer patients were randomized to receive either (1) the audiotape followed 7 to 10 days later by the letter or (2) the letter followed by the audiotape. Outcome measures included patient recall, anxiety and depression, satisfaction with and use of the communication aids, and patient preferences for six communication options. Demographic and disease variables and information and involvement preferences were documented. RESULTS: Eighty percent of patients wanted all information and 72% wanted to participate in treatment decisions. Patients listened to the tape on average 2.3 times and read the letter 2.8 times over 4 weeks, and 90% showed the tape or letter to a friend, relative, or doctor. Satisfaction with the tape and letter were uniformly high and they did not differentially affect recall, anxiety, or depression. When asked to rank six communication options, 46% of patients gave the highest rank to the tape and 21% to the letter. CONCLUSION: Patients use audiotapes of their cancer consultation and individualized letters to review the information given and communicate information to relatives and friends. They prefer audiotapes to letters. Clinicians should consider installing audiotape-recording facilities that could be used to tape new-patient consultations.

Adult↗
PubMed1993

Hypercalcaemia: historical perspectives and present management.

Hypercalcaemia is a well-recognised complication in patients with several types of cancer. Since determination of the serum calcium has become routine particularly in hospital patients, the identification of hypercalcaemia associated with cancer has increased. Cancer is the most common cause of hypercalcaemia arising in hospitalised patients, and overall approximately one-third of all patients presenting with hypercalcaemia have an underlying cancer. In Western countries, the common causes of hypercalcaemia are cancers of the lung and breast. The median survival of patients with hypercalcaemia and cancer is only 5 weeks, indicating that in many patients treating hypercalcaemia may not achieve prolonged survival, even if symptoms are palliated. The clinical presentations of hypercalcaemia are well known, encompassing gastrointestinal, neurological, cardiovascular and renal symptoms. Management approaches have evolved over the past few years from hydration and use of drugs that promote calcium excretion to new treatments that inhibit bone resorption.

Humans↗
PubMed1993

Undergraduate education about cancer. A survey of clinical oncologists and clinicians responsible for cancer teaching in Australian medical schools.

Undergraduate cancer education in Australian medical schools is not integrated and there is little evidence of change in content or structure in recent years in spite of major changes in knowledge about cancer epidemiology and cancer biology, and in cancer management. A recent survey of graduating students/interns from all Australian medical schools revealed a disturbing variability in experience and lack of important knowledge. There was evidence of substantial differences in knowledge of, and rating of teaching between the different disciplines involved in cancer control and cancer management. To examine possible reasons for this, we surveyed cancer clinicians and teachers of oncology in the undergraduate curriculum at Australian medical schools. We asked them the same questions of knowledge as the students, and also to comment on the type and emphasis of teaching desirable in the medical students' cancer curriculum. The results indicate not only that the survey instrument was seen to be relevant, but also that some of the bias and misinformation detected in the student experiences may be attributed to attitude, knowledge and differences of opinion of the teachers. The results highlight the need for an integrated cancer curriculum to inform graduates about an illness which will be diagnosed in more than a quarter of the Australian population.

Australia↗
PubMed1993

Prevalence of anticipatory nausea and other side-effects in cancer patients receiving chemotherapy.

98 patients receiving chemotherapy for cancer were interviewed to determine the prevalence of anticipatory nausea and vomiting, anxiety and dietary changes. Among those who had received at least four treatments 41% reported at least mild anticipatory nausea (AN). For 24% this was a moderate to severe problem, which was significantly associated with a high level of anxiety about treatment. Prevalence at this level was independent of whether the subject was receiving treatment as an in- or an outpatient. Anticipatory vomiting (AV) was reported by only 12 patients, of whom 11 were women; this was the only effect of gender found in the sample. Independence between moderate AN and AV was also suggested by a difference in type of event triggering the effect: predominantly odours for AN and thoughts of the treatment for AV. Changes in diet after commencing chemotherapy were reported by 50% of patients who had received at least four treatments. These most commonly took the form of aversions to meat and then to coffee, and were attributed most frequently to changes in taste and then to loss of appetite.

Adolescent↗
PubMed1993

The take-home message: doctors' views on letters and tapes after a cancer consultation.

BACKGROUND: Patients' understanding of their disease and treatment varies in detail and accuracy. In order to participate in decisions about their care patients must understand, evaluate and retain complex information. METHODS: We canvassed doctors' views about the use of individualised letters and the use of audiotapes of the initial cancer consultation to improve doctor-patient communication. The study sample consists of doctors whose patients participated in a trial of the latter technique. RESULTS: One hundred sixty of 194 doctors (82%) responded to a mailed questionnaire. Sixty-one percent of respondents felt that providing patients with a tape of their initial cancer consultation would be beneficial, and 71% felt that an individualised letter would be better. General practitioners were more supportive of providing tape recordings to patients than were specialists (p = 0.057), but both groups favoured letters over tapes. Specialists were more concerned about the risks of providing tapes to patients than were general practitioners (p = 0.001), but only 13% of respondents felt that the risks were prohibitive. DISCUSSION: Wide support for providing individualised letters or tapes to patients, and copies to their doctors, indicate that the doctors surveyed believe that both doctor-patient and doctor-doctor communication could be improved by the use of these techniques.

Communication↗
PubMed1993

General information tapes inhibit recall of the cancer consultation.

PURPOSE: Studies of tape recordings of cancer consultations have produced conflicting results. At the same time, audiotapes containing general information about cancer are poorly evaluated and are distributed to patients in an ad hoc manner. We compared the effects of both interventions on patient satisfaction, psychologic adjustment, and recall of information following their first consultation with a medical oncologist. PATIENTS AND METHODS: Patients (n = 142) were randomized to receive (1) an audiotape of their consultation, (2) an audiotape describing cancer in general terms, or (3) no tape. Recall of information was assessed in a structured interview 4 to 20 days after the consultation. RESULTS: Satisfaction with the consultation increased linearly from no tape to general tape to consultation tape. Satisfaction with the tape itself was higher in patients who received the consultation tape (satisfaction score, 61%) compared with those who received the general tape (43%). Average recall for all groups was 6.4 of the 25 items of information presented, and 2.4 of the six points identified as particularly important by the oncologist. The consultation tape did not improve recall over the no tape control, but the general tape caused a decrease of almost two items in total recall. Spontaneous (ie, unprompted) recall was significantly poorer with the general information tape. Psychologic adjustment to cancer was unaffected. CONCLUSION: We conclude that individual audiotapes have a limited potential to increase recall of information from the oncology consultation. General information tapes about cancer appear to inhibit recall actively.

Adolescent↗
PubMed1993

Cancer by another name: a randomized trial of the effects of euphemism and uncertainty in communicating with cancer patients.

PURPOSE: In this study we tested some assumptions about the use of euphemism in communicating with cancer patients. Does an explicit statement about the diagnosis of cancer cause patients to respond with greater anxiety than when uncertainty or ambiguity is allowed to persist? Do patients believe they cope better with cancer when the diagnosis is explicit? METHODS: A heterogeneous sample of 165 cancer patients completed a new measure of emotional adjustment to cancer using random assignment among four testing variables: agent (self-report v interview), terminology (the words cancer v illness), identification (patient identified v anonymous), and supervision (clinic v home). Internal consistency (Cronbach's alpha) for the 39-item set was 0.74 and face and content validity were determined using the focus-group technique and preliminary factor analysis. After answering the adjustment measures, subjects completed the Spielberger State-Trait Anxiety Inventory (STAI). RESULTS: Overall anxiety levels were significantly lower in the sample than published norms for general medical and surgical patients. Exposure to the word cancer as distinct from illness increased anxiety, but did not alter adjustment scores. Supervision and agent conditions did not affect anxiety, but reported adjustment was poorer in the interview condition compared with the self-report condition. Ambiguous instructions, such as asking patients to complete the questionnaire anonymously but return it in person to staff in the clinic, resulted in poorer adjustment, which was reversed by the consistent instruction to complete the questionnaire anonymously at home and return it by mail. CONCLUSION: Use of the word cancer generated anxiety to levels similar to those reported in general medical and surgical patients, but did not produce any distortion in reported adjustment. However, any ambiguity associated with the conditions under which adjustment is assessed may lead to distortion and an increase in the patient's reported psychologic distress.

Adult↗
PubMed1993

Magnetic resonance spectroscopy detects cancer in draining lymph nodes.

The spread of cancer cells to draining lymph nodes is an important prognostic factor for many cancers and influences postoperative therapy in patients. Histopathology is used routinely to assess if lymph nodes contain metastases. There are, however, time and resource constraints on the volume of lymph node tissue that can be examined by the pathologist in a routine laboratory (less than 2% of each node), thus major sampling errors are possible. Conventional histopathology also relies on identifying aggregates of malignant cells for a positive diagnosis. Proton (1H) magnetic resonance (MR) spectroscopy can detect chemical changes, specifically increased levels of lactate, choline, fucose and amino acids, in lymph nodes infiltrated by cancer. Increase in lactate indicates the presence of anaerobically respiring cells, whereas choline reports that the cells are replicating. Since MR spectroscopy can identify early infiltration by malignant cells, before cell clusters are visible under the light microscope, it detects micrometastases in lymph nodes missed histopathologically. Furthermore, MR spectroscopy eliminates sampling errors since the entire lymph node is examined.

Adenocarcinoma↗