Contracting quality health care.
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Health Planning↗
Biomedical subjects
P Strang
Publications and source records attributed to P Strang.
Caring for severely ill cancer patients. A comparison of working conditions in hospital-based home care and in hospital.
The goal of the study was to compare working conditions in a hospital with the conditions in a specialized hospital-based home care (HBHC) unit, which aims to replace hospital care for patients in need of institutional car. Staff (doctors included) in a HBHC unit (n = 35) and on three hospital wards (n = 113) participated in the study. All staff members worked regularly with severely ill cancer patients. Question about stress, job satisfaction and working conditions were asked in a self-administered questionnaire. Both groups showed a limited degree of continuous stress and a high degree of job satisfaction. Thus, the overall perception was than the working conditions were good. When significant differences were found, the responses of the HBHC staff were more positive. This included items such as more freedom to make their own decisions (P < 0.001), better co-operation between day and night shifts (P < 0.001), a more reasonable work load (P = 0.0001), fewer problems in communication with patients (P < 0.001), and fewer problems with tension (P < 0.05) and with sleeping (P < 0.05). The findings may be due to several factors: the HBHC staff were older, more often married, had more children, had worked longer in health care and were thus more experienced. Complementary explanations may be continuous education within the HBHC and an organization stimulating the staff's own initiative, but also capable of supporting when necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
Burnout, Professional↗
The organization of hospital-based home care for terminally ill cancer patients: the Motala model.
In 1977, the first palliative home care programme in Sweden, the Motala hospital-based home care, was established to provide a high level of medical care on a 24-hour basis, as an alternative and a replacement to hospital care. The current study summarizes the care and organizational needs of 179 consecutive terminally ill cancer patients treated during a 10-year period. Of the patients, 70% came from acute clinics. The median time of care was 36 days. The need for help with activities of daily living was a significant predictor of the length of survival, with the greatest difference between four or less compared to five or six items (p = 0.0006). Analgesics were needed by 96% of the patients, and 78% were provided with various facilities such as hospital beds. The input of family members as primary caregivers was essential for successful care, as were security factors such as easy availability of a nurse or doctor, at any time day or night, and an immediate, guaranteed hospital bed, if needed. As many as 89% of the patients who wished to live at home until death actually did so. We conclude that hospital-based home care according to the Motala model can replace hospital care for selected patients, but only if both the patient and the family approve.
Activities of Daily Living↗
The family in hospital-based home care with special reference to terminally ill cancer patients.
Eighty-seven next of kin, 80 spouses and seven adult children, were the primary caregivers of terminally ill patients (87% cancer patients) cared for at the hospital-based home care (HBHC) unit of Motala Hospital during 1989-1990. All of the patients died in their homes. Next of kin were asked to complete self-questionnaires and to give written comments on their experiences and their perception of how the patient had felt about 13 aspects of home care provided by the HBHC staff. The response rate was 94%. In nine out of 13 areas, such as adequate information at the time of referral about the HBHC, security, support, immediate extra help when needed, high quality of nursing, and care and pain control, 86%-97% of next of kin were very satisfied (7-9 on a 9-point scale); whereas information provided about the disease, economic support, and support given after death were very satisfactory according to 72%, 58%, and 80% of relatives, respectively. Gender and time from diagnosis to death did not seem to affect responses. Next of kin of cancer patients were generally more satisfied than next of kin of other terminally ill patients. A total time of care of more than 60 days (median time) was associated with significantly more positive responses. Older spouses were significantly more satisfied with the HBHC than younger ones; despite this, 99% of all next of kin would choose HBHC again in a similar situation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Emotional and social aspects of cancer pain.
The emotional and social consequences of pain were studied in 93 consecutive in-patients, 44 males and 49 females, suffering from cancer-related pain. The methods used were Visual Analogue Scales (VAS), standardized interviews and comprehensive self-questionnaires. Forty-seven patients (51%) experienced certain or pronounced anxiety (4-6 or 7-9 on a 9-grade scale) because of their pain and 66 patients (71%) expressed depressive pain-associated symptoms, which had a high correlation with the intensity of their pain. Physical activities such as movements, dressing/undressing, washing, cooking were hampered in about 2/3 of the patients and mental activities such as reading were significantly disturbed in 48% of the cases. For every social activity listed in the questionnaires (hobbies, seeing friends, etc) most patients reported a decreased activity because of pain and in most cases the decrease correlated significantly with the intensity of the pain. The family roles had changed since the patient could not participate in a usual manner. The study underlines the profound consequences of pain: physical suffering, emotional distress, social handicap and altered family roles. Thus, pain control should be a high-priority matter in palliative care.
Activities of Daily Living↗
Prognostic flow cytometric information in cervical squamous cell carcinoma: a multivariate analysis of 307 patients.
In a prospective study of 307 patients with invasive squamous cell carcinoma of the uterine cervix, the prognostic impact of flow cytometric parameters (ploidy level and the fraction of S-phase cells) and clinical variables was evaluated using univariate and multivariate analyses (Cox model). Mean follow-up time as 39 (4-84) months. A total of 93 patients died from their disease during the follow-up. The S-phase fraction was evaluable in 242 cases. By means of univariate models, lethality rate was found to increase significantly with increasing age, postmenopausal status, advancing stage, and increasing S-phase fraction. In a multivariate analysis of the clinical variables of age, stage, and grade, only clinical stage was prognostic. The inclusion of ploidy level in the analysis gave no additive prognostic information. In a multivariate analysis including all variables mentioned above, stage was the strongest predictor of survival. S-phase fraction was significantly related to survival both when studied as a continuous variable (P = 0.006) and when studied as a categorized variable (10, 15, 20% as cutoff points), and in this special analysis ploidy level was of prognostic interest with a poorer survival for near-diploid cases. The outcome was poorer with increasing age. The prognostic impact of the S-phase fraction remained highly significant in separate analyses of the clinically interesting stages Ib-IIb (P less than 0.001). We conclude that measurement of the S-phase fraction is of prognostic interest and may be used for the identification of high-risk patients within a given stage, whereas ploidy level yields little information.
Adult↗
Prognostic significance of proliferation in endometrial adenocarcinomas: a multivariate analysis of clinical and flow cytometric variables.
In a prospective study, the prognostic significance of clinical and flow cytometric variables was evaluated in univariate and multivariate analyses of 489 cases of endometrial adenocarcinoma. Age, uterine cavity depth, stage, histopathologic grade, myometrial invasion, ploidy level, and S-phase fraction were of prognostic value in the univariate analysis. In a multivariate analysis of clinical variables, age and uterine cavity depth were insignificant. When adding flow cytometric variables (DNA content and S-phase fraction) separately to the clinical variables, the significance of myometrial invasion was reduced, and histopathologic grade became nonsignificant when S-phase fraction was included. When adding both DNA content and S-phase fraction, the DNA content became prognostically insignificant. S-phase fraction was, next to clinical stages III and IV, found to be the strongest predictor of outcome. It is concluded that S-phase fraction is a new, objective parameter that can be used for the identification of prognostically different subgroups of patients within a given stage and grade.
Adenocarcinoma↗
Cost analysis and ethical aspects of hospital-based home-care for terminal cancer patients.
A study was undertaken to measure the costs of caring for 20 terminally ill/dying cancer patients at home, within a hospital-based home-care system. A new method was used, by which all staff expenses were registered and the work costs per minute were calculated for each personnel category (e.g. nurses, physicians). The total number of care days amounted to 857. The average daily cost was 509 Skr. (range 87-2999), but it was higher for patients with the shortest periods of home-care ( = the dying patients). Comparisons were made between the costs of hospital-based home-care and those of hospital care in 1) a geriatric unit, 2) other somatic departments, and 3) those departments from which the patients had been referred. The costs of hospital-based home-care were 40%, 55%, and 67% lower than the three different forms of hospital care, respectively. All the patients had relatives at home and were intensely dependent on their families. The important part played by the relatives contributed to the relatively low costs. The ethical aspects of caring for dying cancer patients at home are discussed.
Aged↗
Work stress and job satisfaction in hospital-based home care.
The entire staff of the hospital-based home care (HBHC) at Motala (n = 35) participated in a study concerning work stress and job satisfaction. A significant number of the patients in the HBHC have advanced malignancies and most of them are terminally ill. A total of 219 questions about stress and job satisfaction were asked in a self-administered questionnaire. Only 3%-17% of the staff often or very often experienced stress factors such as high expectations, confusing orders, or lack of information. Instead, a majority stated that they often/very often experienced different aspects of job satisfaction, such as meaningfulness, security, and stimulation. Staff members stating that they often were proud/very proud of their jobs, members feeling that their skill and experience were needed, as well as staff members who often received praise from their superiors, were less prone to look for other jobs (p less than 0.01, p less than 0.05, and p less than 0.05, respectively). Those who often/very often were allowed to take initiatives of their own more often regarded their jobs as non-monotonous (p less than 0.05) and stimulating to their personal development (p less than 0.001). Despite demanding jobs with severely ill patients, most of the staff gave high ratings for different aspects of job satisfaction. This positive spirit was also reflected in the exceptionally low job turnover among them. Possible explanations may be a careful selection of personnel and an organization which both stimulates the staff's own initiatives and provides support when necessary.
Clinical Competence↗
Cytogenetic and cytometric analyses in squamous cell carcinoma of the uterine cervix.
Cytometric methods allow a division of tumors into a near-diploid and an aneuploid group. In most carcinomas, aneuploidy has been associated with poor prognosis, but as regards squamous cell carcinomas of the uterine cervix, the results are conflicting. The introduction of flow cytometry, a reliable and rapid method for determination of ploidy level and S-phase rate, has resulted in a renewed interest in cytometric studies of cervical carcinomas. In this article, DNA content, S-phase rate, and tumor heterogeneity are reviewed, as well as correlations found between DNA patterns and stage, age, menopause, differentiation, malignancy grading systems, ABH blood group antigens, and prognosis. In summary, aneuploidy is more common in stages III and IV and correlates to aggressive histopathology, but because of a higher degree of radioresponsiveness, the biological differences between aneuploid and near-diploid tumors are not consistently reflected in prognosis. High S-phase rates are correlated both to aggressive histopathology and impaired short-term prognosis.
Carcinoma, Squamous Cell↗
DNA determination in endometrial carcinoma by flow and image cytometry.
Endometrial carcinomas from 29 patients were analyzed by flow and image cytometric techniques with respect to DNA-content. Good agreement of ploidy value was obtained in 22 of the cases. A correlation was demonstrated between percentage cells above 2.5 C in image cytometry and S-phase as determined by flow cytometry. The interpretation was that cells with major chromosomal abnormalities may also have a high proliferative rate. These two features cannot be separated by image cytometry, whereas this is claimed to be the case according to the terminology used in interpretation of flow cytometric data. Our findings underline the need for a clarification of the terminology used in cell measurements on clinical material as well as proper choice of cytometric method to be used in conjunction with diagnostic cytology. The possible clinical value of the descriptors chosen from the two methods awaits follow-up of the patients.
DNA, Neoplasm↗
Cadmium-substituted skeletal troponin C metal binding investigations and sequence assignment of the cadmium-113 resonances.
The binding of cadmium to the calcium binding subunit of skeletal troponin (STnC) has been reinvestigated using direct binding methods and fluorescent derivatives. These data provide straightforward explanations of the observed titration behavior in the 113Cd NMR (Ellis, P.D., Strang, P., and Potter, J.D. (1984) J. Biol. Chem. 259, 10348-10356). Further, fluorescent derivatives of skeletal troponin C provide an excellent means of establishing a sequence assignment for the resonances observed in the 113Cd NMR. The results of these experiments demonstrate that sites I and II, the Ca2+ regulatory sites, can be assigned to resonances at -108.5 and -101.5 ppm, respectively. Sites III and IV, the structural sites, are assigned to resonances -112.8 and -106.8 ppm, respectively. These data are discussed in terms of recent structural findings and speculations.
Animals↗
Primary aneuploid lymphoma of the uterine cervix: a case report.
A primary, diffuse, centroblastic lymphoma of the uterine cervix is described. The patient is a 77-year-old V-parous woman, who presented with postmenopausal bleeding, but no systemic symptoms. Gynecologic examination revealed a 4 x 8-cm tumor extending from the uterine cervix to the anterior vaginal wall and elevating the bladder neck, but with no sign of mucosal infiltration. According to the FIGO classification, the tumor was classified as stage IIIA. Flowcytometric analysis showed a grossly aneuploid tumor, with a DNA content of 3.5c. The S-phase rate was 30.6%. The patient was treated with external pelvic irradiation to 46 Gy. Six weeks later the therapy was completed with seven courses of a cyclophosphamide-vincristine-prednisolone (COP) regimen. Complete tumor response was achieved and 3 years later there is no sign of relapse. Despite unfavorable prognostic parameters: large tumor volume, diffuse growth pattern, aneuploidy, and a high S-phase rate, a combination of radiotherapy and chemotherapy was found to be a successful treatment of this rare form of advanced primary lymphoma of the uterine cervix.
Aged↗
DNA patterns and aggressive histopathologic features in 159 patients with cervical carcinoma.
In 159 patients with invasive squamous cell carcinoma of the uterine cervix, flow cytometric DNA patterns were related to eight histopathologic parameters according to a malignancy grading system, in which four of the parameters concern the tumor cell population and four concern the tumor-host relation. Each parameter was graded from 1 to 3 points. Flow cytometrically aneuploid values, contrasted to peridiploid ones, were more often found in specimens with immature, irregular nuclei, as well as in specimens with diffuse growth (p less than 0.05), obvious vascular invasion (p less than 0.05) or slight or no plasmolymphocytic response (p less than 0.05). For each histopathologic parameter, higher mean S-phase rates were found for the aggressive 3-point tumors than for the 1-point tumors. Tumors with total scores of 11-17 points were more often peridiploid than tumors with 18-22 points.
Adult↗
Kinetic investigations in single muscle fibres using luminescent and fluorescent Ca2+ probes.
The Ca2+-sensitive photoprotein aequorin and the Ca2+-dependent fluorescent indicators quin 2 and TnCDANZ have been used to investigate contractile processes in single crustacean muscle fibres. The investigations with quin 2 indicate that the free Ca2+ rises to a maximum value before peak force as with aequorin light (approximately 200 msec delay at 12 degrees C) and subsequently decays more slowly, unlike the majority of the aequorin signal, although an aequorin 'tail' signal remains. The resting quin 2 fluorescence from the cell suggests an upper limit of 348 nM for the resting calcium concentration. Experiments with TnCDANZ indicate that this fluorescence response rises rapidly but then the rate of rise slows to reach a maximum value at a time when peak force is achieved and then the fluorescence signal decays more slowly than force. The latter result implies that Ca2+ is attached to the Ca2+-specific sites of TnC when externally recorded force is small.
Aequorin↗
Training for health education with older people: a survey of district nurse and health visitor courses.
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Aged↗
General practitioner training and older people--health education perspectives on day release programmes.
The topic of health education and older people is being given greater emphasis in primary care settings. A survey was mounted to investigate the contribution of vocational training in preparing GPs for this area of work. The balance of education was found to be towards the sick and frail elderly; developing 'healthy lifestyles' for old age was given very limited attention. The article concludes with some suggestions for change in the context of training programmes.
Aged↗
Perceptions of community carers about elderly people: a sentence completion approach.
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Aged↗