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PubMed2005

A communication intervention for training southern European oncologists to recognize psychosocial morbidity in cancer. I--development of the model and preliminary results on physicians' satisfaction.

BACKGROUND: The detection of psychosocial distress is a significant communication problem in Southern Europe and other countries. Work in this area is hampered by a lack of data. Because not much is known about training aimed at improving the recognition of psychosocial disorders in cancer patients, we developed a basic course model for medical oncology professionals. METHODS: A specific educational and experiential model (12 hours divided into 2 modules) involving formal teaching (ie, journal articles, large-group presentations), practice in small groups (ie, small-group exercises and role playing), and discussion in large groups was developed with the aim of improving the ability of oncologists to detect emotional disturbances in cancer patients (ie, depression, anxiety, and adjustment disorders). RESULTS: A total of 30 oncologists from 3 Southern European countries (Italy, Portugal, and Spain) participated in the workshop. The training course was well accepted by most participants who expressed general satisfaction and a positive subjective perception of the utility of the course for clinical practice. Of the total participants, 28 physicians (93.3%) thought that had they been exposed to this material sooner, they would have incorporated the techniques received in the workshop into their practices; 2 participants stated they would likely have done so. Half of the doctors (n = 15) believed that their clinical communication techniques were improved by participating in the workshop, and the remaining half thought that their abilities to communicate with cancer patients had improved. CONCLUSIONS: This model is a feasible approach for oncologists and is easily applicable to various oncology settings. Further studies will demonstrate the effectiveness of this method for improving oncologists skills in recognizing emotional disorders in their patients with cancer.

Affective Symptoms↗
PubMed2005

From the emergency department to home.

AIM: The purpose of this study was to explore dimensions of the management of the older person following care in an emergency department in preparation for discharge home by identifying perceptions and attitudes of staff in both emergency department and primary care sectors. BACKGROUND: It is recognized that older people discharged home directly from the emergency department are a vulnerable group. Effective communication and liaison are seen to be keys to the provision of high quality care for older people in the emergency department and in ensuring a seamless care between sectors. DESIGN: A purposeful sample was collected that comprised the total population (n = 222) of all grades of medical and nursing staff in both the emergency department and all nursing (Public Health Nurses & Practice nurses) and medical staff (General Practitioners) in the primary care area. METHODS: Methodology used was that of a survey approach of nursing and medical staff in both the emergency department and primary care services. Standardized questionnaires were employed which comprised both open and closed questioning style. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were content analysed for themes. RESULTS: Many staff in the primary care area reported the level of communication between the emergency department and the primary care area as unsatisfactory with confusion regarding follow-up care and a lack of support for older people on discharge. Hospital staff reported the level of communication to be much greater than that perceived by their colleagues in primary care. There was agreement of staff in both sectors in relation to the perceived usefulness of a discharge liaison nurse in the emergency department. CONCLUSIONS: Previous research highlights communication difficulties when patients are discharged from hospital. Findings from this study indicate that this problem can also be applied to the emergency department. RELEVANCE TO CLINICAL PRACTICE: Implications for practice include a need for a multidisciplinary approach to developing referral guidelines, staff training and a comprehensive dissemination of information between sectors ultimately to improve quality and continuity of care for the older person.

Aftercare↗
PubMed2001

Effectiveness of a learner-centred training programme for primary care physicians in using a patient-centred consultation style.

OBJECTIVE: The aim of the present study was to find out if a training programme adapted to family physicians with several years of clinical experience changes their behaviour when they deal with fibromyalgic patients in the sense of introducing the communication skills that define the 'patient-centred' approach. METHODS: A randomized, and simple blind, educative study was carried out. Twenty full-time family physicians were invited to participate. They were allocated randomly to two groups: an intervention and a control group. A total of 110 patients were recruited from people attending physicians' surgeries for the first time and who complained of generalized pain that finally fulfilled criteria for generalized musculoskeletal chronic pain/fibromyalgia. This was done for an entire year. The intervention group received an 18 hour intensive course. One week after the course, all doctors carried out a video-recorded encounter with a patient who played the part of a typical fibromyalgia clinical case. The interviews were coded by an observer blind to the training status of the participants, using the GATHARES-CP questionnaire. All patients were contacted by telephone during a 1-2-month period by a different interviewer who was 'blinded' to the patient's experimental status. They were asked to respond to three questions that represent the key components of patient-centred style. RESULTS: The average score on the GATHARES-CP questionnaire was 11.3 +/- 0.9 and 9 +/- 2.3, for doctors from the intervention and control groups, respectively (P < 0.01). For 11 items, scores were higher in the intervention group. The patients' answers to all three questions showed statistically significant differences in a positive direction for the trained doctors. CONCLUSIONS: The doctors improved the use of strategies and skills for carrying out patient-centred consultations after they had received an interactive course. The doctors' behaviour appeared to have changed as much in a more experimental situation as in the actual consultations. Moreover, the gain was observed immediately after the intervention was completed, and after having run for a variable period of time up to 1 year.

Adult↗
PubMed1992

Typing of Hantaviruses from five continents by polymerase chain reaction.

Hantavirus, a genus in the family Bunyaviridae, is comprised of at least four serologically distinct types: Hantaan, Seoul, Puumala and Prospect Hill. The present communication reports the use of polymerase chain reaction (PCR) for typing 27 independently isolated Hantaviruses from 5 different continents. Total cellular RNA was extracted from virus-infected Vero E6 cell monolayers by the acid guanidium thiocyanate-phenol-chloroform method. We have utilized 5 different sets of oligonucleotide primers ranging from 18 to 22 nucleotides in length; one set was specific for a conserved region of the S genomic segment and used as genus-specific primers, the other 4 sets of primers were designed from unique sequences of the M genomic segment such that each primer set was specific to only one serological type of Hantavirus. The PCR products were analyzed by restriction endonuclease digestion for further confirmation. We typed 10, 12, 3 and 1 isolates into Hantaan, Seoul, Puumala and Prospect Hill respectively. The results of PCR were 100% agreeable with that of serological typing, and thus, PCR can be used as an adjunct test with serological method(s) or an independent test for diagnosis and for typing of new isolates of Hantaviruses.

Animals↗
PubMed1996

Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms.

OBJECTIVES: This study sought to determine the degree of interinstitutional agreement in the interpretation of dobutamine stress echocardiograms. BACKGROUND: Dobutamine stress echocardiography involves subjective interpretation. Consistent methods for acquisition and interpretation are of critical importance for obtaining high interobserver agreement and for facilitating communication of test results. METHODS: Five experienced centers were each asked to submit 30 dobutamine stress echocardiograms (dobutamine up to 40 micrograms/kg body weight per min and atropine up to 1 mg) obtained in patients undergoing coronary angiography. Thus, a total of 150 dobutamine stress echocardiograms were interpreted by each center without knowledge of any other patient data. Left ventricular wall motion was assessed using a 16-segment model but was otherwise not standardized. No patient was excluded because of poor image quality or inadequate stress level. Echocardiographic image quality was assessed using a five-point scale. RESULTS: Angiographically significant coronary artery disease (> or = 50% diameter stenosis) was present in 95 patients (63%). By a majority decision (three or more centers), the sensitivity, specificity and accuracy of dobutamine echocardiography were 76%, 87% and 80%, respectively. Abnormal or normal results of stress echocardiography were agreed on by four or all five of the centers in 73% of patients (mean kappa value 0.37, fair agreement only). Agreement on the left anterior descending artery territory (78%) was similar to that for the combined right coronary artery/left circumflex artery territory (74%), and for specific segments the agreement ranged from 84% to 97% and was highest for the basal anterior segment and lowest for the basal inferior segment. Agreement was higher in patients with no (82%) or three-vessel coronary artery disease (100%) and lower in patients with one- or two-vessel disease (61% and 68%, respectively). Agreement on positivity or negativity of stress test results was 100% for patients with the highest image quality but only 43% for those with the lowest image quality (p = 0.003). CONCLUSIONS: The current heterogeneity in data acquisition and assessment criteria among different centers results in low interinstitutional agreement in interpretation of stress echocardiograms. Agreement is higher in patients with no or advanced coronary artery disease and substantially lower in those with limited echocardiographic image quality. To increase interinstitutional agreement, better standardization of image acquisition and reading criteria of stress echocardiography is recommended.

Cardiotonic Agents↗
PubMed2007

Effects of subchronic exposure to radio frequency from a conventional cellular telephone on testicular function in adult rats.

PURPOSE: We investigated the effects of subchronic exposure to radio frequency emitted from a conventional cellular telephone on the testicular function in adult rats. MATERIALS AND METHODS: A total of 16 male Wistar rats at age 30 days were randomly divided into 2 groups, including experimental and control groups. The experimental group was exposed to radio frequency emitted from a conventional GSM (global system for mobile communications) cellular telephone (1,835 to 1,850 MHz) for 1 hour daily during 11 weeks. Rectal temperature was measured before and after the exposure period. Testicular and epididymal weight, lipid peroxidation levels in these organs, serum total testosterone and the epididymal sperm count were evaluated. Maturation phase spermatid retention at stage IX-X, interstitial infiltration, cellular vacuolation and multinucleate giant cells were among the qualitative testicular histopathological end points analyzed. Each rat had 10 consecutive round seminiferous tubules at stage VII-VIII evaluated for the mean seminiferous tubular diameter measurement, the crude histological count of round spermatids, pachytene spermatocytes and Sertoli's cells with evident nucleoli, and the true histological count (Abercrombie's correction factor) of round spermatids and pachytene spermatocytes. RESULTS: Mean rectal temperature did not alter following exposure. There was no statistical difference between the control and experimental groups in any end points evaluated. CONCLUSIONS: The current study shows that the low intensity pulsed radio frequency emitted by a conventional cellular telephone does not impair testicular function in adult rats.

Age Factors↗
PubMed2000

Effects of electronic communication in general practice.

OBJECTIVE: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. METHODS: We retrieved all publications in the English language indexed in MEDLINE under the MESH term 'Computer Communication Networks' AND having either 'family practice' or 'primary health care' as MESH term OR 'GP', or 'GPs' as text word. RESULTS: A total of 176 publications were retrieved of which 30 publications met the criteria. In 28 of these 30 publications potential effects were described; one described claimed effects, three described demonstrated effects with subjective data and five described demonstrated effects with objective data. The studies documented, furthermore, effects on the speed of communication, the content of information and records, a change of processes involved in the communication, quality of care, costs, workload of physicians, appreciation of physicians, confidentiality, and adherence. CONCLUSIONS: We conclude that only a few studies evaluated electronic communication versus paper communication. Of these studies, only a few report improvement. Our final conclusion is that, so far, literature has not shown that the positive effects can be explained by electronic communication as such.

Computer Communication Networks↗
PubMed2004

The North Dublin randomized controlled trial of structured diabetes shared care.

BACKGROUND: A new diabetes shared care service was introduced in North Dublin. It was designed as a randomized controlled trial with a complex intervention comprising education of participating practitioners, the introduction of a community-based diabetes nurse specialist, local agreement on clinical protocols and structured communication across the primary-secondary care interface. OBJECTIVES: Our aim was to assess the feasibility and effectiveness of a structured diabetes shared care service in a mixed health care system and to analyse the impact on total patient care. METHODS: A Cluster randomized controlled trial lasting 18 months was carried out in 183 patients with type 2 diabetes from 30 general practices in North Dublin. Biophysical outcomes (HbA1c, blood pressure, body mass index), psychosocial measures (smoking status and Diabetes Clinic Treatment Satisfaction and Diabetes Well-being scores) and process outcomes were collected. RESULTS: There were significant improvements in diabetes care delivery and in psychosocial outcomes, but no significant improvements in biomedical outcomes. Process data collection revealed a significant increase in diabetes care-related activity for participating patients with an increase in structured annual reviews and fewer patients defaulting from care. There were also significant improvements in information exchange between primary and secondary care. CONCLUSION: Structured diabetes shared care, in a mixed health care system, can produce significant improvements in diabetes care delivery and in psychosocial outcomes for patients, with improved information exchange across the primary-secondary care interface.

Adult↗
PubMed1992

Unbound plasma phenytoin concentrations measured using enzyme immunoassay technique on the cobas MIRA analyser--in vivo effect of valproic acid.

This communication describes a modification of the total plasma phenytoin enzyme immunoassay technique (EMIT) run on the Cobas MIRA analyser that allows quantitation of unbound phenytoin concentrations in human plasma for routine therapeutic drug monitoring (TDM) purposes. An application of this method is also presented to consider the previously described protein binding drug interaction with concomitantly administered valproic acid in patients with epilepsy. The coefficients of variation for the unbound phenytoin assay ranged from 7.5 to 9.6% and the assay had a reproducibility and accuracy similar to the total phenytoin assay, acceptable for routine TDM. Phenytoin protein binding was linear over a range of total plasma concentrations of 3-65 mg/L. Patients also receiving valproic acid (nine patients, 105 specimens) had a significantly (p less than 0.0001) greater mean +/- SD unbound phenytoin fraction (13.3 +/- 3.1%) compared to nine patients (110 specimens) not receiving valproic acid (8.3 +/- 1.6%). There was also a significant correlation (p less than 0.001) between plasma valproic acid concentration and unbound phenytoin fraction, which resulted in greater intrasubject variability in phenytoin protein binding.

Blood Proteins↗
PubMed2006

Innovative training for new surgical roles--the place of evaluation.

BACKGROUND: This paper describes the central role of 'external' evaluation, provided by an independent researcher, in developing an innovative curriculum for new professional roles with surgery. Workforce changes affecting the National Health Service provided an opportunity to develop 2 new roles and design training programmes to support them. The perioperative specialist practitioner (PSP) role was designed from scratch, while surgical care practitioner (SCP) training built on existing practice. Training programmes combined formal modules at Imperial College London (approximately 48 days over 10 months) with supervised clinical practice in each participant's base hospital. Programmes balanced factual knowledge, clinical and communication skills, professional issues and personal development and used a range of innovative techniques. EVALUATION METHODS: A qualitative approach based on a utilisation-focused model monitored the development and implementation of 4 pilot PSP and SCP training programmes. A total of 124 individual and 48 group interviews were conducted at intervals over 3 years, sampling course participants, the project team clinical supervisors and administrators. An independent researcher collected, analysed and presented data at key stages, feeding back findings to the project team as the programmes evolved. DISCUSSION: Effective training programmes for new roles can be developed, but the process is time-consuming and requires sensitivity. An independent evaluator offers great benefits, modulating the collaborative partnership between participants and project team. Positive responses (relating to content and teaching methods) from our study enabled us to refine a learner-centred programme. Negative responses often demanded immediate action to address important concerns, and evaluation provided early warning. External evaluation provides a vital perspective in the development of curricula supporting new roles.

Curriculum↗
PubMed1998

Cytokine expression by first-trimester human chorionic villi.

PROBLEM: Communication at the human maternal-fetal interface occurs by an intricate cytokine network. This study examines cytokine expression by normal first-trimester human chorionic villi. METHOD OF STUDY: Tissues were obtained at elective pregnancy terminations (7-9 weeks). Total RNA was isolated from chorionic villi by guanidinium isothiocynate-acid phenol extraction. A reverse transcriptase-polymerase chain reaction technique was used to examine cytokine expression. beta-Actin was used as the housekeeping gene, and mitogen-stimulated lymphocytes served as positive controls. RESULTS: beta-Actin was uniformly expressed by all chorionic villous samples. Interferon (IFN)-alpha and -beta also were highly expressed. Moderate expression was noted for interleukin (IL)-10, IL-6, tumor necrosis factor (TNF)-alpha, and IL-1 beta. In contrast, transforming growth factor-beta 1, IFN-gamma, IL-2, and IL-1 alpha were either weakly expressed or absent in first-trimester villi. CONCLUSIONS: Cytokines may contribute to pregnancy immunotolerance (IFN-alpha, IFN-beta, and IL-10), viral resistance (IFNs), hormone secretion (IL-1 and IL-6), and cellular remodeling (IFN-gamma and TNF-alpha) within the chorionic villous.

Adjuvants, Immunologic↗
PubMed2000

Mild forms of Guillain-Barré syndrome in an epidemiologic survey in The Netherlands.

OBJECTIVE: Assessment of incidence rates of Guillain-Barré syndrome (GBS) in the Netherlands over a 10-year period; investigation of a relationship between possible seasonality in GBS and the occurrence of preceding infections; and determination of distinctive characteristics in patients with GBS who are only mildly affected (able to walk unaided at nadir). METHOD: Records of patients with GBS admitted between 1987 and 1996 from all 45 hospitals in the southwest Netherlands were evaluated, covering a population of 4.2 million inhabitants. RESULTS: A total of 476 patients met National Institute for Neurological and Communicative Disorders and Stroke criteria for GBS. This resulted in a crude incidence rate (IR) of 1.18/100,000 inhabitants. This IR increased linearly with age (p < 0.001). Men were more frequently affected than women (p < 0.001). No seasonal preponderance for GBS, nor for any of the preceding infections, was found. Patients under 50 years of age (p < 0.001) and men (p = 0.01) were more frequently found in the mildly affected group. In both groups a preceding infection was reported in 70% of the cases. In the severely affected group, serologic evidence for infection with Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, or Mycoplasma pneumoniae was found more frequently than in the mildly affected group (41% versus 16%, p = 0.001). CONCLUSIONS: Overall IR in the Netherlands are similar to those found in other studies. The incidence increases linearly with age and men are more frequently affected than women. Distinctive characteristics for mildly and severely affected patients were found regarding age, sex, and preceding infections. This suggests that other infectious agents or host factors may be involved in mild forms of GBS.

Data Collection↗
PubMed2006

[A conversation analysis of communication between patients with dementia and their professional nurses].

PURPOSE: The purpose of this study was to understand conversations and to identify typical conversational problems between nurses and patients with dementia. METHOD: A conversation analysis method was used. The data was collected in a geriatric institutional setting, using a videotape recorder, and transcribed. The transcribed data was analyzed in terms of expressions, contents, and relationships to identify communicative problems and their resolutions. RESULTS: Among a total of 532 episodes, 440(82.7%) were identified as nurse-involved episodes. In addition, 66 of the 440 episodes were selected based on the significance of the conversation. The communicative problems between nurses and patients in terms of expressions were identified as "directive and authoritative expressions", "emotional and competitive expressions", "evasive and on-looking expressions", and "excessive use of title only", such as calling them granny or grandpa without proper names. In terms of content and relationships, "lack of themes in psychosocial areas" and "nurse-led relations" were identified respectively as communicative problems. CONCLUSION: The results of this study will provide substantial guidelines for nurses in caring for elderly patients with dementia by deeply understanding linguistic structures and problems of everyday conversations between nurses and patients with dementia.

Aged↗
PubMedDate not supplied

Arteriovenous shunts associated with peripheral obliterative arterial disease. Haemodynamic, arteriographic and isotope studies.

From among 210 patients with severe peripheral obliterative arterial disease, the presence of an arteriovenous shunt was demonstrated in 17 cases. Arteriovenous communications were visualized by serial angiographic records and 99mTc macroaggregate isotope testing. The regulation of the limb circulation was investigated using the venous isotope dilution method. Characteristic haemodynamic changes were revealed in arteriovenous shunts associated with peripheral arterial obliterative disease: total limb blood was comparatively high, arteriovenous difference was low and limb O2 consumption was decreased. The clinical significance of the haemodynamic changes in arteriovenous shunting associated with obliterative arterial disease is discussed.

Adult↗
PubMed1990

[Total cavo-pulmonary anastomosis in the surgery of complicated congenital heart defects].

The authors discuss experience in 8 operations for total cavo-pulmonary anastomoses in patients with various complicated congenital heart anomalies in which radical or anatomical correction could not be undertaken. The operation for total cavo-pulmonary anastomosis is an alternative of Fonten's method since many authors claim that the last-named has some shortcomings. Total cavo-pulmonary anastomosis was established in 4 stages under conditions of extracorporeal circulation. End to side cavo-pulmonary anastomosis was formed in the first stage; the proximal end of the divided superior vena cava was joined to the pulmonary artery in the second stage; the communication between the heart and pulmonary artery was closed in the third stage, and, finally, a tunnel was formed between the inferior and superior venae cavae by means of a xenopericardial flap in the fourth stage. Six patients tolerated the operation successfully. The immediate postoperative period was more favourable than after Fonten's operation. However, to come to a deeper general conclusion and compare the two methods clinical material must be accumulated and the long-term results of the operations studied.

Abnormalities, Multiple↗
PubMed1993

Ratings of the performances of practicing internists by hospital-based registered nurses.

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.

Adult↗
PubMed2003

Systematic review of the use and value of computer simulation modelling in population health and health care delivery.

BACKGROUND: The objective of the review was to evaluate the extent, quality and value of computer simulation modelling in population health and health care delivery. METHODS: A narrative systematic review was carried out of world literature from 1980 to 1999, searching Medline, INSPEC, Embase, HealthSTAR, Science Citation Index, CINAHL, MathSci, INFORMS Online and SIGLE databases, and researchers in the field were contacted. Papers were included if they contained a computer simulation model of individuals in a stochastic system and the topic or setting related to population health or health service delivery. RESULTS: A total of 182 papers met the inclusion criteria. Simulation modelling has been undertaken in a wide range of health care topic areas, including hospital scheduling and organization, communicable disease, screening, costs of illness and economic evaluation. However, the quality of published papers was variable and few reported on the outcomes of implementation of models, so that the value of modelling could not be assessed. CONCLUSION: Simulation modelling is a powerful method for modelling both small and large populations to inform policy makers in the provision of health care. It has been applied to a wide variety of health care problems. Although the number of modelling papers has grown substantially over recent years, further research is required to assess the value of modelling.

Communicable Disease Control↗
PubMed2004

Potential of chemotherapy-herb interactions in adult cancer patients.

GOALS OF WORK: The purpose of this study was to examine the specific herbs or vitamins (HV) used by patients receiving chemotherapy. Specifically, the following aspects were investigated: (1) HV use among adult cancer patients receiving chemotherapy, (2) the frequency of potential chemotherapy-HV interactions, (3) communication patterns between oncologists and their cancer patients taking HV, and (4) patients' reactions to two hypothetical scenarios of chemotherapy-HV interactions. PATIENTS AND METHODS: Adult cancer patients receiving chemotherapy at a university-based outpatient clinic over a 1-month period were sent a validated eight-page questionnaire regarding the use of complementary/alternative medicine, focusing on HV use. A total of 76 patients participated; relevant medical information was obtained from study participants' charts. The chemotherapy received was compared with HV use to assess for potentially detrimental chemotherapy-HV interactions. RESULTS: HV use in patients receiving chemotherapy was common (78%), with 27% of the study participants being at risk of a detrimental chemotherapy-HV interaction. Most patients (>85%) would discontinue their HV or ask their medical oncologist for advice if a detrimental chemotherapy-HV interaction was suspected. Although most patients discussed HV use with their oncologist, the majority also relied on their friends and naturopathic physician for information regarding HV. CONCLUSIONS: Considerable potential exists for detrimental chemotherapy-HV interactions. Methods to improve communication of HV use between cancer patients receiving chemotherapy and health-care practitioners are necessary to identify and minimize the risk of these interactions.

Adult↗