In this pilot study the authors set out to: (a) describe the incidence of taste changes associated with intravenous (i.v.) pentamidine treatment; and (b) determine the factors that are related to making the taste changes better and worse. A convenience sample (N = 18) of adult male outpatients with AIDS participated in this study. One hundred percent of the participants experienced an unpleasant taste after the administration of pentamidine. The largest percentage of patients had a metallic taste (89%, n = 16); while 67% (n = 12) experienced a bitter taste. These data suggest that healthcare providers need to assess for the unpleasant taste associated with i.v. pentamidine and develop appropriate management strategies.

AIDS-Related Opportunistic Infections↗

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Changes in taste associated with intravenous administration of pentamidine.

AIDS-Related Opportunistic Infections↗

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Factors influencing oral mucositis in patients receiving chemotherapy.

PURPOSE: Oral mucositis is a painful complication of chemotherapy and can greatly affect patients' morbidity and mortality. Findings from two previous studies suggested a decrease in the prevalence of chemotherapy-induced mucositis in patients with solid tumors. The purposes of this study were to follow a large cohort of outpatients to determine the prevalence of mucositis and to identify whether certain clinical factors were significant in the development of mucositis. DESCRIPTION OF STUDY: In this prospective study, a convenience sample of 199 outpatients was followed for three cycles or until mucositis developed. The clinical factors monitored included the following: pretreatment dental examination/repair; initial standard chemotherapy dosage; prophylactic use of colony-stimulating factors; and use of preventive mouthwashes or other prophylactic measures. RESULTS: Oral mucositis developed in 50 patients (25.1%). Prechemotherapy dental examination/repair and initial standard chemotherapy dosage were equivalent among both groups. Of the 48 patients in whom mucositis developed, 10 (20.8%) received prophylactic colony-stimulating factors. Of 134 patients in whom mucositis did not develop, 46 (34.3%) received prophylactic colony-stimulating factors. This difference was statistically nonsignificant. CLINICAL IMPLICATIONS: Differences in the clinical factors investigated could not explain the lower prevalence of oral mucositis among the current patient cohort. The reason for the diminishing prevalence of this side effect remains unclear, and additional parameters, particularly detailed oral hygiene practices, should be evaluated. In the meantime, oncology clinicians should consider the teaching of patients and urging them to use good oral hygiene practices as necessary and potentially preventive measures against chemotherapy-induced mucositis.

Ambulatory Care↗

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A pilot study of the relationship between discomfort and agitation in patients with dementia.

People with dementia often have painful conditions that go unnoticed because of their communication problems. Signs of pain in this population may include agitation and observable behaviors associated with discomfort. Agitation, discomfort, and severity of dementia were evaluated in 33 Veterans Affairs nursing home patients using the Cohen-Mansfield Agitation Inventory, the Discomfort Scale, and the Global Deterioration Scale, respectively. Findings revealed statistically significant positive relationships between agitation and severity of dementia (r = 0.34, P = 0.01), discomfort and severity of dementia (r = 0.44, P = 0.01), and agitation and discomfort (r = 0.50, P = 0.003). In a multiple regression analysis, agitation was significantly associated with discomfort (R(2) =.14, P = 0.02) after controlling for dementia severity. These preliminary findings suggest that discomfort may be a source of agitation.

Aged↗

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Review of research studies that evaluated the impact of treatment for childhood cancers on neurocognition and behavioral and social competence: nursing implications.

ISSUES AND PURPOSE: Given the increasing incidence of childhood cancer, increasing survivor rates, and documented incidence of sequelae, nurses need evidence on which to base interventions for families at risk. The authors review and critique research studies that evaluated the impact of treatment for childhood cancers. Implications for nursing practice are discussed. CONCLUSIONS: Research to evaluate the effects of treatment on neurocognition and behavioral and social competency of children with cancer has produced conflicting results. Most studies found deleterious effects on all three areas associated with childhood cancer treatment. Some studies, however, found no differences between childhood cancer survivors and children on therapy compared to normative data or healthy controls. PRACTICE IMPLICATIONS: Knowledge of the short- and long-term impact of treatment for childhood cancer on neurocognition and behavioral and social competence allows nurses to design interventions that mitigate neurocognitive effects, decrease behavioral problems, and improve social competence.

Adolescent↗

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A question of "doing the right thing" or "doing the thing right".

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Hospices↗

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Mobile mammography: the technologist's role.

This article discusses the role of the radiologic technologist in a mobile mammography screening program targeted at the economically disadvantaged in Dade County, Fla. It describes the development of process, structure and outcome standards used to guide and evaluate both the program and the radiologic technologist within this setting, highlighting the technologists' valuable contributions to the program.

Allied Health Personnel↗

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The development and implementation of standards of care in a breast cancer screening program.

The development and implementation of process, structure, and outcome standards were an integral part of program development for a mobile mammography screening program that provides service for the economically disadvantaged through the collaborative effort of eight primary healthcare centers, the Dade County Health Department, and the University of Miami/Jackson Memorial Hospital. The standards are used to guide and evaluate the screening program's operation and to provide the framework for additional program components (e.g., developing performance appraisals and quality assurance and risk management programs, establishing policies and procedures, and serving as the foundation for education and research projects). Examples of standards are provided to assist others in developing a systematic and ongoing evaluation plan for mobile mammography screening.

Breast Neoplasms↗

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Reflections and reactions to nursing's image in the media.

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Attitude to Health↗

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Clinical care practice guidelines: can they improve the quality of patient care.

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Guidelines as Topic↗

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Small cell lung cancer: pathophysiologic mechanisms and nursing implications.

PURPOSE/OBJECTIVES: To review current incidence and treatment perspectives for small cell lung cancer (SCLC). DATA SOURCES: Published articles, book chapters, American Cancer Society materials. DATA SYNTHESIS: SCLC constitutes 20%-30% of lung cancer cases and accounts for 40,000 deaths annually. Characterized by rapid cell division, SCLC is very sensitive to radiation and chemotherapy; however, long-term survival rates are very low. A number of paraneoplastic syndromes are associated with this disease, thereby increasing the medical and nursing management challenges. CONCLUSIONS: Because SCLC usually is diagnosed late in the disease process and survival rates are poor, quality of life and palliation of metastatic symptoms (e.g., pain, breathing difficulties) are important focuses of care. Smoking deterrence and cessation programs, as well as early detection of lesions, are key to reducing incidence and mortality. IMPLICATIONS FOR NURSING PRACTICE: Nursing care focuses on promoting comfort and preventing and managing disease and treatment complications. Nursing diagnoses include ineffective airway clearance, impaired gas exchange, pain, altered nutrition, activity intolerance, and ineffective coping. A patient care standard is presented.

Age Factors↗

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Temporal dissociation of recovery from antinociceptive and motor effects following intrathecal administration of a selective mu-opioid agonist.

In this series of studies, the antinociceptive and motor side effects associated with intrathecal administration of the selective mu-opioid agonist, DAMGO, were evaluated in the same rat. The Randall-Selitto paw-withdrawal test was used to measure mechanical nociceptive threshold, and an accelerating Rotarod treadmill was used to evaluate motor coordination. In the first experiment (N = 48), intrathecal administration of DAMGO produced dose-dependent increases in mechanical nociceptive thresholds that correlated with decreases in motor coordination. In the second experiment (N = 8), intrathecal administration of naloxone (5 micrograms) reversed both the antinociceptive effects and the motor deficits produced by 5 micrograms of intrathecal DAMGO. In the third experiment (N = 13), following administration of the highest dose of DAMGO (5 micrograms) as part of a cumulative dose response curve, paw-withdrawal and motor coordination testing were continued at 45-minute intervals for a period of 225 minutes. DAMGO-induced deficits in motor coordination recovered significantly sooner than nociceptive responses. These data provide support for the suggestion that the motor as well as antinociceptive effects of spinal opioids are mediated through an action at an opioid receptor, but that these two effects may be mediated by different mechanisms.

Analgesics↗

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Differences in pain knowledge in cancer patients with and without pain.

PURPOSE: The authors determined: 1) whether there were differences in knowledge about pain between oncology outpatients with and without cancer-related pain and 2) whether there were relationships between selected patient characteristics (age, gender, education, Karnofsky performance status, pain intensity, and pain duration) and the knowledge about pain of oncology outpatients with cancer-related pain. DESCRIPTION OF STUDY: Three hundred sixty-nine oncology outpatients completed several self-report questionnaires including a demographic questionnaire, a pain experience scale that measured knowledge about pain and pain management, the Karnofsky performance scale, and descriptive numeric rating scales that measured pain intensity and pain duration. RESULTS: Patients with cancer-related pain knew significantly more about pain and its management than pain-free patients (P < 0.004). However, in both groups, mean knowledge scores were below 60%. Older patients with cancer-related pain had less knowledge about pain than younger patients (P < 0.0001). In addition, patients with cancer pain who had more education and those with higher reported pain intensity scores had more knowledge about pain and pain management. Finally, women with cancer pain had more knowledge than men about pain and pain management. CLINICAL IMPLICATIONS: Results of this study suggest that oncology patients with and without pain need more education about pain and effective pain management strategies.

Adult↗