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PubMed2001

Histologic upgrading of prostate cancer occurs frequently over a short period of time: single hospital experiences of radical prostatectomy.

A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well-, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2-3 weeks postoperatively and had regular follow-up treatment. The mean age (+/- SD) was 68.75 (+/- 5.59) years and the mean follow-up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three-year, 5-year and 7-year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ-confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months).

Aged↗
PubMed1999

Use and overuse of sumatriptan. Pharmacoepidemiological studies based on prescription register and interview data.

The serotonin agonist sumatriptan was marketed in Denmark in 1992 for the treatment of acute attacks of migraine and cluster headache. The clinical development program of the drug was impressive. However, knowledge of the long-term use of sumatriptan in unselected patients was lacking. Misuse of sumatriptan was reported in single patients shortly after the introduction of the drug. The aim of the present thesis was, therefore, to provide an epidemiological description of sumatriptan use with particular emphasis on overuse. The author conducted three studies, two of which were exclusively based on population-based data from a regional (Odense Pharmacoepidemiological Database) and a national (Registry of Drug Statistics, Danish Medicines Agency) prescription registry. Both registries record patient-specific information, thus enabling the conduct of longitudinal studies of drug use. The regional registry covers the county of Funen (reimbursable prescription drugs only), while the national registry records information on all prescriptions presented in the entire country. Consumption was described by means of the Defined Daily Dose (DDD) unit. One DDD of sumatriptan amounts to 100 mg orally or 6 mg subcutaneously. Subjects were classified as recipients of single or multiple prescriptions. Individuals in the latter category were characterized by the 30-day period with the most intensive dispensing of sumatriptan (peak use): low (less than 30 DDD/30 days), intermediate (30-59 DDD/30 days) and high-peak users (60 or more DDD/30 days). In 1995, 33,206 users of sumatriptan were identified in Denmark, corresponding to a 1-year period prevalence of use of 7.8 per 1,000 inhabitants (only persons aged > or = 16 years were included). A female-to-male ratio of 3.8:1 was found. Use was most common among women aged 35-54 years and was highest among 45 to 49-year-olds for both sexes. The standardized period prevalence of sumatriptan use varied regionally between the Danish counties from 6.4 to 9.6 per 1,000 inhabitants. The period prevalence of sumatriptan use in the county of Funen was highly comparable with that of the entire nation. Among the 43,389 sumatriptan users presenting prescriptions for sumatriptan in Denmark in 1994 and 1995, 507 (1.1%) and 1726 (4.0%) belonged to the high and intermediate-peak-use group, respectively. Patients belonging to these two groups were responsible for 38% of the total consumption of sumatriptan. For patients in the high-peak-use group the median span between first and last prescription was 693 days while the median quantity of sumatriptan purchased was 648 DDD. Highly comparable patterns of long-term intense sumatriptan use were found in the data from the regional registry, which covered the 27-month period after the introduction of the drug (February 1992). The register data were highly suggestive of overuse, but lacked essential information, e.g., the indication for use. A third study was therefore conducted using a combination of register and interview data. During a 14-day period, current users of sumatriptan were recruited through community pharmacies in the county of Funen. Respondents returned a signed consent form, including their unique personal identification number (CPR), allowing us to retrieve patient-specific data from the regional registry. For each respondent, all available relevant prescription data for the period 1992-96 were retrieved. Subjects were classified into high, intermediate, and low-peak-use groups according to register data from the 4-year period. The register data were used to evaluate representativity after anonymizing nonrespondent data. The response rates were 33% (7/21) in the high-peak-use group, 47% (30/64) in the intermediate-peak-use group, and 56% (196/350) in the low-peak-use group. Respondents and nonrespondents in the three groups were comparable with regard to age and use of other drugs. (ABSTRACT TRUNCATED)

Cluster Headache↗
PubMed2003

Family carers of ICU survivors: a survey of the burden they experience.

Intensive care unit (ICU) survivors may experience deterioration in their quality of life for months following their return home, with families assuming a caregiving role. The aim of this study was to measure the burden associated with caring for a family member who had been critically ill. The study also sought to describe the relationship between three factors (filial obligation, social support, self-efficacy) and caregiver burden. Seventy-one family carers, 51 females (72%) and 20 (28%) males of long-term intensive care patients completed a mailed survey, after signing an informed consent form. Although the vast majority of the caregivers were providing substantial number of hours of care each week, they scored lower than the midpoint on all caregiver burden inventory subscales. Filial obligation was found to be positively associated with caregiver burden; however, there was no association between social support, self-efficacy and caregiver burden. Male caregivers experienced significantly more burden than female caregivers. The findings suggest that an understanding of the factors that impact on caregiver burden of families of ICU survivors is only beginning to emerge.

Adaptation, Psychological↗
PubMed2002

Pharmacokinetic behaviour of antithrombin III following intravenous infusion in healthy volunteers.

Antithrombin III (CAS 52014-67-2) is produced from plasma of healthy donors and is purified from any detectable agent of transmissible infection. This drug is used in therapy by i.v. route to manage acute thrombotic episodes and to treat patients suffering from its deficiency. The present trial was conducted with the aim to evaluate the pharmacokinetics and the safety of a new preparation of antithrombin III, which in the purification procedure has included a nanofiltration step to increase the safety against the transmission of any agent of infection. The trial was conducted in twelve healthy volunteers of either sex. All the ethics procedures were fully respected, namely the approval from Ethics Committee, the notification to the central regulatory authority, the approval of consent form in writing. Volunteers were hospitalized about 36 h before drug treatment. The baseline situation was investigated throughout the day before the treatment (day-1). On day 1, the drug was infused i.v. for 20 min. Twenty blood samples were drawn from each volunteer, in baseline situation, during and after the infusion. Functional antithrombin III, antithrombin III antigen, prothrombin time, partial thromboplastin time were evaluated in all plasma samples. Both functional antithrombin III and antithrombin III antigen produced well defined plasma concentration-time profiles after the infusion, which allowed net values of these two analytes to be obtained subtracting baseline from post-infusion concentrations. Net pharmacokinetic parameters of functional antithrombin III and antithrombin III antigen proved to be almost superimposable. A comparison of data obtained in this trial on healthy volunteers with those previously obtained by other authors on target population demonstrates similar and fully comparable results. The authors conclude that the nanofiltration step neither affects at all the pharmacokinetics/pharmacodynamics nor the safety of the formulation investigated.

Adult↗
PubMed2004

[Subcutaneously tunnelled cuffed venous hemodialysis catheters in chronic renal failure].

BACKGROUND: Silastic cuffed catheters play an increasing role in providing long-term vascular access for hemodialysis. The reasons for this were related to increased patient age and an increased number of patients who had exhausted sites for vascular access. We report our experience with subcutaneously tunnelled cuffed hemodialysis catheters. METHOD: From May 1, 2001 to February 28, 2003, 258 consecutive hemodialysis catheters were placed in 203 patients (122 men, mean age 70 +/- 12 years) as access for hemodialysis (1.3 catheters/patient). Catheter implantation was explained to all patients and a protocol consent form was signed. The catheter was implanted via the internal jugular, subclavian or femoral vein and the correct final catheter position was determined fluoroscopically. Short and long-term catheter-associated complications were collected from the time of catheter insertion until a follow up of at least 6 months after implantation. RESULTS: The mean duration of implantation procedure was 38 +/- 12 minutes with an initial clinical success rate of 100 % and a periprocedural complication rate of 6 %. The median catheter indwell time was 9 months with a primary patency rate of 72 % at the end of the follow-up. Inadequate flow rate < 200 ml/min was noted at one per 41 patient-months but sufficient blood flow was restored in 50 % of these patients with non- or semi-invasive interventions. Bacteremic episodes occurred at a rate of one episode per 16 patient-months. Catheter removal due to severe exit site infections or bacteremic episodes were necessary at one per 73 patient-months. There were no cases of bacterial endocarditis. CONCLUSION: Subcutaneously tunnelled cuffed venous hemodialysis catheters are a safe und highly feasible vascular access with a low complication rate and a long use-life especially for elder patients with limited life expectancy, exhausted sites for vascular access or in case of failing hemodialysis arteriovenous fistulas.

Aged↗
PubMed1997

Ethical issues in the management of chronic nonmalignant pain.

Chronic pain represents a challenge to patients, families, employers, and the physicians who care for these individuals. Opioids remain the mainstay of the analgesic medications for the treatment of both acute and chronic pain. Controlled release preparations of morphine, oxycodone, fentanyl and long acting opioid agents such as methadone and levorphanol have been medically and ethically accepted in managing chronic cancer pain. However, the continued use of these medications for patients with chronic noncancer pain has been fiercely debated. This article attempts to reconcile the medical and ethical dilemma of using opioid medications for chronic noncancer pain. Growing clinical experience in the field of pain medicine has helped to clarify: (1) the misunderstanding of addiction, physical dependence and analgesic tolerance, (2) the misconception that chronic opioid therapy inevitably causes personality changes, depression, and impairment of cognitive and physical function, (3) the lack of information on the correct use of opioid analgesics with regard to titration and management of related side effects. The behavioral management of pain patients undergoing chronic opioid therapy is also discussed. A protocol for optimal patient management is proposed. Particular emphasis is given to the consent form, behavioral contracting, and the consequences of noncompliance. The importance of psychologic evaluation before a long-term opioid trial, to minimize future complications, is stressed. Although most patients on the opioid regimen do well, special attention must be given to patients with current addiction, a past history of addiction, or current misuse of opioid medications. Pharmacologic and conservative interventions are often warranted in those patients with significant behavioral problems. If such strategies fail, and chronic opioid therapy is deemed necessary, some treatment guidelines are offered.

Analgesics, Opioid↗
PubMed2003

A pilot study to test the efficacy of oral administration of interferon-alpha lozenges to patients with Sjögren's syndrome.

BACKGROUND: Complications from Sjögren's syndrome-induced xerostomia may cause a significant disruption in daily routines such as speech and eating habits. In addition, the reduction in salivary output may lead to increased incidence of caries, oral ulcers, sialadenitis, periodontal problems, and Candida infections. Interferon-alpha has been suggested as an effective drug therapy to increase salivary output. OBJECTIVE: The objective was to test the efficacy of interferon-alpha lozenges in relieving the symptoms of dry mouth and dry eyes when administered orally to patients with Sjögren's syndrome in double-blind placebo-controlled and open-label trials. STUDY DESIGN: Twelve patients with a diagnosis of primary Sjögren's syndrome were provided an Institutional Review Board-approved, written informed-consent form. During the double-blind placebo-controlled study they were randomized to receive 150 IU of interferon-alpha (8 patients) or placebo (4 patients) for 24 weeks with 6-week reevaluations. Five patients who received interferon-alpha in the double-blind placebo-controlled trial were treated in an open-label study for another 24 weeks. Whole saliva was measured during each visit, and symptoms were assessed by questionnaires and visual analog scales. The Wilcoxon signed rank test was used to detect significant changes for each variable. RESULTS: The results indicated that, by the end of 24 weeks, patients who received interferon-alpha had a statistically significant improvement in unstimulated salivary flow rate (P < .05), and statistically significant changes were observed in the median ocular dryness visual analog scale (P < .05) and oral dryness visual analog scale (P < .05). No significant changes were observed among the placebo patients. By the end of 48 weeks, medicated patients had better results than they had at the end of the double-blind placebo-controlled study and showed improvements in whole stimulated salivary flow rate, conditions of throat, and swallowing dry food. CONCLUSION: Oral administration of 150 IU interferon-alpha 3 times a day for the patients with primary Sjögren's syndrome improved saliva production, relieved symptoms of xerostomia and xerophthalmia, and was well tolerated by the patients.

Administration, Oral↗
PubMed2003

Pregnancy during obstetrics and gynecology residency: effect on surgical experience.

OBJECTIVE: This study explored residents' views about pregnancy during residency and the effect leaves of absence had on the quantity of surgical procedures performed. STUDY DESIGN: Physicians who graduated from an obstetrics and gynecology residency between 1994 and 2002 were contacted by mail. Respondents completed a questionnaire and consented to use of the program's surgical database to obtain information regarding surgical procedures performed during their training. RESULTS: Thirty-one of the 41 eligible resident physicians returned the questionnaire and consent form (response rate, 75.6%). Among the 14 responding men, 2 had taken a total of three nonvacation, noneducational leaves. Among the 17 women respondents, there were 16 leaves associated with deliveries, and the nonvacation, noneducational leave for women who were pregnant was statistically longer than for other residents (median of 6 weeks compared with 0 weeks, P<.001). Most pregnancies were planned (27/29, 93.1%) and were delivered in the third or fourth year of training (11/16, 68.8%). Former residents listed several ways that the program accommodated pregnancy and were satisfied with the program. The mean number of procedures for women with deliveries compared with other residents were as follows: cesarean section, 315 versus 281 cases (P=.20); abdominal hysterectomy, 116 versus 102 cases (P=.08); laparoscopy, 87 versus 92 cases (P=.72); vaginal hysterectomy, 51 versus. 45 cases (P=.11). CONCLUSION: Pregnancy and delivery did not decrease surgical experience of four major procedures in this program, and pregnant physicians perceived appropriate support from their colleagues and the program administration.

Cesarean Section↗
PubMed2006

Breast-feeding and feeding practices of infants in a developing country: a national survey in Lebanon.

OBJECTIVE: Breast-feeding (BF) provides the ideal food for the healthy growth and development of infants. The prevalence of BF in Lebanon shows mixed results. The present study was the first large-scale, extensive survey on BF parameters in Lebanon that aimed to explore demographic, socio-economic and other fundamental issues associated with the initiation and duration of BF by Lebanese mothers. DESIGN: The survey was cross-sectional in design and administered over 10 months. SETTING: Information on all variables was collected from mothers at health centres. SUBJECTS: Two-stage sampling was conducted to select participants. A total of 1,000 participants were randomly selected. A consent form was provided to each participant. Data were collected from 830 of these. RESULTS: Almost all mothers were Lebanese, married and had given birth in a hospital. About a third stated that breast milk was the first food introduced after birth. Although 55.9% started breast-feeding their newborns within a few hours after birth, and 18.3% within half an hour, 21.2% replied that they initiated BF a few days after birth. Only 4.6% of the mothers replied that they never breast-fed their infant. Timing of initiation of BF was associated with the type of delivery (vaginal/Caesarean section) and hospital-related factors (rooming-in, night feedings and frequency of mother-infant interaction). Of the mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a few hours following delivery, while only 13.3% had initiated BF a few days later. Compared with the exceptionally high proportion of BF initiation, exclusivity of BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated with place of residence (urban/rural) and negatively associated with educational level of the mother. Duration of BF was inversely associated with the use of pain killers during delivery and maternal education. Rural mothers and those who practised exclusive BF maintained BF for a longer duration. CONCLUSION: Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low and duration of BF is short. Future research targeting the factors associated with BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers who initiated BF, an ecological perspective on intervention aimed at women and their social support system is required to improve duration and exclusivity.

Adult↗
PubMed2006

Applying theory to practice in undergraduate education using high fidelity simulation.

High-fidelity patient simulation allows students to apply their theoretical knowledge of pharmacology and physiology to practice. The purpose of this study was to determine if experiential education using high-fidelity simulation improves undergraduate performance scores on simulation-based and written examinations. After receiving research ethics board approval, students completed a consent form and then answered a ten question multiple-choice quiz to identify their knowledge regarding the management of cardiac arrhythmias. Four simulation scenarios were presented and students worked through each scenario as a team. Faculty facilitated the sessions and feedback was given using students' videotaped performances as a template for discussion. Performance evaluation scores using predetermined checklists and global rating scales were completed. Students then reviewed the American Heart Association guidelines for the management of unstable cardiac arrhythmias. The afternoon session involved repetition of the four case scenarios with the same teams involved but different team leaders. Students then repeated the quiz they received in the morning. Descriptive statistics, paired t-test and repeated measures analysis of variance (ANOVA) were used to analyse results. Two hundred and ninety-nine students completed the study. There was a statistically significant improvement in performance on the pharmacology written test. Simulation team performance also statistically improved and a good correlation between checklist and global rating scores were demonstrated in all but one scenario. Student evaluation of the experience was extremely positive. High-fidelity simulation can be used to allow students to apply theoretical knowledge to practice in a safe and realistic environment. Results of this study indicate that simulation is a valuable learning experience and bridges the gap between theory and practice. Simulation technology has the potential to provide an enriching venue to examine the role of communication and dynamics of novice learners in team environments.

Anesthesiology↗
PubMed2003

Problem-solving by traumatically brain injured and neurologically intact subjects on an adaptation of the twenty questions test.

PRIMARY OBJECTIVE: RAPS (Rapid Assessment of Problem-Solving) is a clinical measure for assessing verbal problem-solving in hard-to-test patients or those that may not be able to tolerate a longer, more detailed assessment. The design of the test is based on Mosher and Hornsby's Twenty Question test, but RAPS contains several modifications to facilitate its use with brain-injured individuals. This study used RAPS to compare the verbal problem-solving ability of subjects that were neurologically intact and subjects that had chronic traumatic brain injuries. METHODS AND PROCEDURES: Twenty-one adults that were neurologically intact (NI) and 21 adults that had incurred a traumatic brain injury (TBI) matched for age, gender and education took part in the study. Before being tested with RAPS, participants signed an IRB-approved consent form and completed a battery of neurocognitive measures. RAPS entailed the solving of three verbal problems. Each problem involved an array of 32 pictures of common objects (e.g. football) arranged in a 4x 8 grid. The subjects were instructed to ask yes/no questions to determine which picture the examiner was 'thinking of '. Three scores were computed for each problem solved: number of questions asked, percentage of constraint-seeking questions, and question-asking efficiency scores for the first four questions. OUTCOMES: No learning effects across the problems were found for any of the RAPS measures. Scores were averaged across the three problems to determine group effects. Groups of TBI and NI subjects did not differ significantly in the number of questions asked in solving RAPS problems. Members of the NI group asked significantly more constraint-seeking questions (e.g. Is it an animal?) than those in the TBI group, and the subjects that had incurred brain injuries did more guessing than the NI group. Over 70% of the time, guessing took place after the semantic category containing the target picture was known to the subject. Guesses took the form of pseudo-constraint questions (e.g. Is it the animal with a long neck?) rather than frank guesses (e.g. Is it the giraffe?). These trends were seen for both groups. Question-asking efficiency scores, computed for the first four questions of each problem, reflected the amount of information gained by the subjects' questions. It was anticipated that subjects' questioning strategies would target larger rather than smaller number of pictures and systematically reduce the number of total pictures under consideration. Question-asking efficiency scores were significantly higher for the group of NI subjects. Both groups increased question-asking efficiency scores across the first four questions, and there was no significant group x question interaction. Further analysis of the question-asking efficiency scores revealed that questions from the group of NI subjects tended to target multiple categories of pictures and larger single semantic categories of pictures on the 32-item problem-solving board, whereas those from the group of TBI subjects often targeted smaller categories or portions of categories. CONCLUSIONS: Two meta-cognitive functions, planning and strategy shifting, appeared to explain most of the differences in the verbal problem-solving performance between the groups. Both groups, however, demonstrated a range of abilities on RAPS. Until a larger normative database for RAPS is available, it behooves clinicians using the test to analyse results on an individual basis, to consider the subject's pre-morbid problem-solving ability and to weigh those factors associated with brain injury that could affect RAPS performance.

Adult↗
PubMed1993

Six years of clinical experience using postcoital contraception in college women.

Postcoital contraception (PCC), also known as the "morning-after pill," has been used at the University of Rochester Health Service for several years. In 1985, the healthcare providers developed a formal protocol for dispensing PCC to female students presenting with the complaint of unprotected intercourse within the previous 72 hours. Patients are screened for any absolute contraindications to using birth control pills, are asked to sign a consent form, and are told to schedule a follow-up visit to evaluate pregnancy status and contraceptive options. Data from 1985 to 1991 is presented and include total number of times PCC was dispensed, side effects of medication, patient profiles, and predicted and actual pregnancy rates. The authors compare the data from the University of Rochester with data described in the literature and discuss recommendations for practice.

Adult↗
PubMed2000

Adolescent girls' knowledge of and attitudes toward breast self-examination: evaluating an outreach education program.

BACKGROUND: The purpose of the study was to analyze the effectiveness of a one-hour educational intervention to increase knowledge about and improve attitudes towards breast self-examination (BSE) and early cancer detection among adolescent girls. METHODS: The sample used in this quasi-experimental study was selected from schools participating in an education program provided by a regional health education center. The instrument and scales used in the study were developed and pilot-tested for reliability and validity in the area schools prior to the start of the study. The sample consisted of 137 adolescent girls who provided consent forms and participated in the intervention. The comparison group, which consisted of students attending the same schools, was scheduled to receive the intervention at a later date. RESULTS AND CONCLUSIONS: Findings suggest that a one-hour lesson can improve knowledge and attitudes of adolescent girls with respect to BSE and early cancer detection. Suggestions for further research are discussed.

Adolescent↗
PubMed2004

Impact of injury level and self-monitoring on free time boredom of people with spinal cord injury.

PURPOSE: The purpose of this study was to determine whether or not level of injury and personality characteristics creates an interaction effect that impacts the free time boredom of individuals with spinal cord injury (SCI). METHOD: Using a survey method, a packet containing a cover letter, a consent form, research questionnaires, and a self-addressed, stamped envelope was sent to 500 individuals with SCI who were randomly selected by computer at one of the rehabilitation centres in USA. The research questionnaires included the measures of self-monitoring (SM) and free time boredom (FTB) along with some demographic factors such as gender, ethnicity, age, injury level, and etc. RESULTS: This study found that a significant interaction effect between injury level and SM on FTB. That is, low self-monitors with tetraplegia reported higher levels of boredom in free time than high self-monitors with paraplegia. CONCLUSION: Not all individuals with similar injury levels rate FTB in a similar degree. Individuals' personality characteristics play an important role in experiencing FTB. In particular, the significant interaction effect indicates a potential risk factor for clients with tetraplegia who are low in SM which should be an important consideration in the lives of people with tetraplegia following rehabilitation.

Adult↗
PubMed2004

Obtaining DNA from a geographically dispersed cohort of current and former smokers: use of mail-based mouthwash collection and monetary incentives.

The feasibility of collecting DNA through the mail from a cohort of current and former smokers was assessed. Also examined was whether monetary incentives would increase response rates. A random sample of 300 subjects, stratified by 20 U.S. communities, was selected to participate. The sampling frame included the 6,726 people who were in both the Community Intervention Trial for Smoking Cessation (COMMIT) between 1988 and 1993 and the follow-up study in 2001, and who consented to being contacted again. Subjects were further randomized within communities to incentive arms of 10 US dollars, 2 US dollars, or 0 US dollars. A total of 110 usable samples were returned (37%), and the 10 US dollars incentive arm had the highest response (43%). Logistic regression revealed no significant predictors of sending a DNA sample, although in a larger study, similar-sized odds ratios would be statistically significant for subjects who received the 10 US dollars incentive and for those who were White, female, or college graduates or whose household incomes were more than 60,000 US dollars per year. The spectrophotometer-determined median DNA yield was 44.93 microg (range=4.00-425.86 microg). Assuming that 50 ng of DNA would be needed for polymerase chain reaction amplification to determine any given genotype, 80-8,517 runs would be attainable. Qualitative findings suggest several methodological improvements to boost response rates. Institutional review board requirements, which are standardized on the inpatient, clinical protocol model, stipulated that noninstitutionally based subjects needed a witness to initial and date every page as well as sign the consent form. This pilot study showed that this requirement could pose some challenges in population-based research.

Adult↗
PubMed2004

Assessing internet survey data collection methods with ethnic nurse shift workers.

An increasing number of ethnic minorities are expected to enter the United States workforce based on projected demographic changes. This includes American Indian/Alaskan Native (AI/AN) nurses. Sociocultural influences on sleep disturbances, sleepiness, and other aspects related to shift-work tolerance are of unrecognized importance. More minority nurses are needed to provide culturally congruent care; however, AI/AN nurses represent less than 1% of nurses located throughout the American workforce. This article aims to verify the feasibility of Internet data collection (Web-based survey) methods and instrument stability as the first part of a two-phase study comparing individual differences and shift-work-related sleep disturbances between AI/AN and White non-Hispanic (WNH) nurses. In the first phase, an Internet survey was used to reach a cross-section of AI/AN and WNH nurses. The on-line survey was composed of accepted shift-work-related instruments. Items estimating sleep disturbances, sociocultural choices, time awareness, polychronicity, morningness/ eveningness, ethnic identity, and demographic questions were asked. The survey was linked to a series of Web pages describing the study purpose, inclusion and exclusion criteria, consent form, Web survey, and the second phase of the study in which subjects were invited to participate in actigraphy measurements. The survey was pilot-tested for error codes, item confusion, length, and completion time. Forced-answer questions were added asking ethnicity, age group, license type, state where licensed, and legal name on nursing license before accessing the survey. Data were saved periodically, cued by the word "continue." The database was located on a secure server and password protected. Nurses were recruited using published articles and printed advertisements, hospital e-mail systems, national nursing organization Web sites (minoritynurse.com; NANAINA.org), nursing Web site discussion groups, snow-balling, and word of mouth. The site was accessed 656 times with the Internet survey being completed by 138 WNH and 56 AI/AN nurses meeting the inclusion criteria. Except for the polychronicity measure (PAI3), instruments measuring time awareness, chronotype, and situational sleepiness achieved acceptable reliability coefficients with Internet data collection. Using pull-down menus would improve questions asking specific times. Internet data collection with different ethnic groups is possible; however, accessing the target population may be difficult. Despite extensive recruitment efforts, few AI/AN nurses participated. Computer literacy and failing to relate to the study's purpose may have limited the interest of the AI/AN nurses. It is possible to recruit nurse shift workers and collect individual difference and sleep disturbance data through the Internet; however, the researcher must remain vigilant throughout the process.

Adult↗
PubMed2002

A pilot study for the detection of acute ciguatera intoxication in human blood.

INTRODUCTION: Ciguatera fish poisoning arises from consumption of any of the 400 species of tropical marine reef fish containing polyether toxins. No laboratory method is available for clinical diagnosis of acute ciguatera poisoning. The objective of this pilot study was to ascertain the potential usefulness of a bioassay to detect ciguatoxins in humans suspected of acute intoxication. We analyzed plasma of healthy volunteers (asymptomatic negative controls), participants with gastrointestinal (GI) illness but without recent fish consumption (symptomatic negative controls), and participants with GI illness who had recently consumedfish. MATERIALS AND METHODS: Blood samples, questionnaires, and consent forms were collected from 11 symptomatic negative controls and 86 patients that visited emergency rooms in southern Puerto Rico over a 1-year period. Patients had consumed fish within 24 hour prior to the symptoms. Plasma samples were analyzed by a neuroblastoma cell bioassay that detects seafood toxins active at the sodium voltage-gated channel in a dose-dependent fashion. Concentrations were expressed in terms of brevetoxin-1 equivalents (ng PbTx-1 equiv/mL). RESULTS: The mean plasma concentration of 14 asymptomatic negative controls was 39.4 ng PbTx-1 equiv/mL (range 2-74). Of 86 potential ciguatoxic patients who reported fish consumption, 43 had values within the range of normal volunteers, and 9 had concentrations in the nondiagnostic range (73.9-100 ng). Thirty-four patients (40%) had concentrations 3 standard deviations above asymptomatic negative controls (>100 ng PbTx-1 equiv/mL). They had a mean concentration of 1,074 +/- 244.5 ng PbTx-1 equiv/mL (range 101-7,056ng). CONCLUSION: Preliminary findings of elevated PbTx-1 equivalents in 40% of the patients with both ciguatera symptomatology and fish consumption in a geographical area where ciguatera is common suggest that the neuroblastoma bioassay may be a potential diagnostic tool for acute ciguatera intoxication.

Acute Disease↗
PubMed2004

The use of dietary supplements by veterans with cancer.

OBJECTIVE: To study the patterns of dietary supplement use in veterans with cancer. DESIGN: Using a detailed questionnaire, a cross-sectional study was conducted to determine the patterns of dietary supplement use by patients with cancer. SETTING/LOCATION: The study was conducted at the Hematology/ Oncology Clinic at the VA Hospital in Cincinnati, OH. SUBJECTS: Patients with malignancy who were attending the above clinic and willing to participate and sign a consent form were enrolled in the study. OUTCOMES/MEASURES: The use of dietary supplements, the type, frequency, and reason for use was captured, along with the source of dietary supplements and perceived benefits. RESULTS: Two hundred (200) veterans were surveyed, with a median age of 68 years (36-82). The type of malignancy included cancer of the genitourinary system (39.5%), lung (19.5%), gastrointestinal tract (14.5%), hematologic system (16%), skin/head/neck (6.5%), and other (4%). One hundred and twenty-two patients (122) used dietary supplements (61%). Multivitamins were the most commonly used dietary supplement reported by 98 patients (80.3%), followed by mineral use by 52 patients (40.6%). Ten (10) patients used herbal supplements. Patients who were employed and patients with higher education were more likely to use dietary supplements. Different reasons were given for dietary supplement use and 74% of the users reported perceived benefits, such as improved overall health and energy. While 38% of the patients did not disclose dietary supplement use to their physicians, 37.8% of them learned about dietary supplements from their physicians and 25% obtained their dietary supplements from the VA hospital. CONCLUSION: The use of dietary supplements is common among veterans with cancer. Health care professionals should inquire about them in a systematic fashion and be prepared to provide counseling to their patients about them.

Adult↗