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Biomedical subjects

D K Mayer

Publications and source records attributed to D K Mayer.

At least 19 recordsLinked to original sources
PubMed2005

Preliminary psychometric evaluation of the Child Health Ratings Inventory (CHRIs) and Disease-Specific Impairment Inventory-Hematopoietic Stem Cell Transplantation (DSII-HSCT) in parents and children.

PURPOSE: To describe the initial results of the Child Health Ratings Inventory (CHRIs), 20-item generic health-related quality of life (HRQL) instrument and the 10-item disease-specific (DS) module, the Disease Specific Impairment Inventory-Hematopoietic Stem Cell Transplantation (DSII-HSCT), for children and adolescents, ages 5-18 years and their parents following HSCT. STUDY DESIGN: Using cross sectional design, 122 children with a median age of 11 years (range 5.0-18 years) completed the questionnaire (CHRIs + DSII-HSCT) with research assistance. Seventy-four parents independently completed a parallel version of the questionnaire; health care providers assigned a global clinical severity rating. RESULTS: The generic core includes four domains: physical, role, and emotional functioning, and energy. The DS module has three domains: worry, hassles, and body image. The Cronbach's alpha for parents and for older children (8 years and over) exceeded 0.70 for all generic and DS domains. While the range of alpha coefficients was lower for younger children, ages 5-7 year, only the alpha coefficient for one domain (energy) was less than 0.70. The instrument satisfactorily discriminated between clinically important groups: those early in the transplant process (< 6 months) versus those later (> 12 months) and by provider-assigned clinical severity ratings. CONCLUSION: results suggest that the CHRIs generic core and its DSII-HSCT module is a promising measure of HRQL after pediatric HSCT. Although parent and child reports were moderately correlated and revealed complementary results, the unique perspectives of both raters provide a more complete picture of HRQL. Longitudinal application is underway to further characterize the measurement properties of the CHRIs and to determine the instrument's responsiveness and sensitivity to change over time in this vulnerable population.

Adolescent↗
PubMed2005

School re-entry after a cancer diagnosis: physician attitudes about truth telling and information sharing.

BACKGROUND: School re-entry for children with cancer hallmarks a return to age-appropriate activities; a process fraught with adjustment challenges. The paediatric oncologist is in a pivotal role of setting the tone and providing direction to the child, family, and other members of the health care and school team about this process. Understanding physicians' attitudes and behaviours regarding school re-entry will provide insight into these practices. METHODS: A four-part survey (general attitudes, patient factors, work cultures and respondent characteristics) was developed and mailed to the members of US and Japanese paediatric oncology professional societies. Japanese (n=362) and US (n=350) paediatric oncologists comprised the study sample; the average respondent was a male in his mid-forties providing clinical care>or=5 hours/week practising for about 15 years. Responses to a hypothetical scenario reflecting the range of how school re-entry issues for a child on treatment may be handled was the outcome variable in this report. RESULTS: US physicians (284/350, 84.5%) endorsed telling everyone (the school officials and classmates) about a child's diagnosis and treatment to facilitate the transition back to school. In contrast, only 93/359 (25.9%) of the Japanese respondents endorsed telling everyone. Japanese physicians were more likely to endorse telling everyone if they believed it was the physician's responsibility to tell children the truth at diagnosis (P<0.001), if they did not believe that awareness of cancer dashes hope (P=0.002), and were not influenced by type of cancer the child had (P=0.003). CONCLUSIONS: Differences in US and Japanese paediatric oncologist responses in return to school issues may reflect larger cultural issues such as: benefits and disadvantages to telling the child that he/she has cancer; hospitalization practices; and the availability of school re-entry programs. More needs to be learned about how children, their families and schools prefer to have re-entry issues handled during and after treatment and how these approaches affect the child's re-entry into school.

Adolescent↗
PubMed2001

Impact of pharmacy practices on the cost of colony-stimulating factor use in pediatric stem cell transplantation: an institution-based analysis.

PURPOSE: An evaluation of colony-stimulating factor (CSF) use in pediatric stem cell transplantation (SCT) was conducted to identify potential cost-efficiencies while preserving institutional standards of patient care. METHODS: Clinical and pharmacy records of the 55 SCTs performed during fiscal year 1995 were reviewed. Material costs per vial and per microgram, exclusive of preparation or overhead costs, were used. The best costing strategy was defined as the least expensive stocking and dispensing practice to deliver the drug actually used during the study period. RESULTS: CSFs were used in 35 of 55 transplants; 68% of usage was protocol-mandated to enhance engraftment; the remainder was associated with life-threatening complications of SCT. All use was consistent with published evidence-based guidelines. Changes in stocking and dispensing practices would result in an overall annual savings of $48,162 (fiscal year 1995 dollars), a 39% decrease in cost without a change in clinical application. CONCLUSIONS: Our analysis demonstrates that stocking and dispensing practices place significant fiscal burden in the care of pediatric-aged patients and must be carefully considered. This analysis presents a model for evaluating all components of drug cost from a global perspective, highlighting a need for examination of pharmacy and manufacturing as well as clinical practices.

Adolescent↗
PubMed2000

Perspectives on cancer patient education.

OBJECTIVES: To provide an overview on cancer patient education. DATA SOURCES: Literature related to demographic and health care trends, patient education, health literacy, and cancer patient information needs. CONCLUSIONS: Cancer patients need information related to diagnosis, treatment, side effects, self-care needs, and effects on work and relationships. Planned patient teaching includes a variety of teaching strategies and written materials, and contributes to better patient outcomes. Inadequate health literacy and other barriers present challenges to providing effective patient education. IMPLICATIONS FOR NURSING PRACTICE: More research is warranted in developing assessment tools and effective health education techniques and in measuring outcomes and costs related to patient education. The education needs of cancer patients will not drastically change in the next century. How nurses meet those needs, however, will change as we apply new learning theories and technologies of teaching.

Audiovisual Aids↗
PubMed2000

Balancing efficacy with cost: antiemetic control in the pediatric stem cell transplant (SCT) population.

We studied the practice patterns regarding intravenous (i.v.) ondansetron in children receiving stem cell transplants (SCT) at The Children's Hospital, Boston to identify cost efficiencies. The pharmacy provided information on material and preparation costs on 36 patients who received i.v. ondansetron during 41 SCT in 1995. We examined the effects of frequency, duration, and route of administration on costs. There were 498 days of ondansetron administration costing $49,083 (95$). Tremendous variation existed in frequency and duration with one third receiving i.v. ondansetron once daily, despite published evidence of equivalence of once a day and divided dosing. A switch to once daily i.v. dosing for all patients would have resulted in >/=28% savings. The median duration of use was 11 days (range 1-48); placing a cap for 7-10 days based on the length of SCT conditioning regimens, would produce savings of 48-60% over current use. By shifting administration route from i.v. to oral, a savings of 67% over current use, without a cap on duration, would be realized. Identifying areas for cost savings can be achieved after thorough analysis of all the component costs. We demonstrated that significant cost reductions could be realized by simple changes in prescribing practices without jeopardizing efficacy. These savings are achieved by standardizing dosing interval, route of administration and duration of treatment without altering daily dosage or access to an effective antiemetic. Bone Marrow Transplantation (2000) 25, 553-557.

Adolescent↗
PubMed1999

Overcoming multidrug resistance: valspodar as a paradigm for nursing care.

PURPOSE/OBJECTIVES: To review the mechanisms of multidrug resistance (MDR) in human cancer and the clinical use of MDR modulators to overcome or reverse P-glycoprotein (P-gp)-mediated MDR. DATA SOURCES: Current literature, ongoing clinical trials, and clinical experience. DATA SYNTHESIS: Agents, such as valspodar, that block the activity of P-gp can reverse or overcome MDR caused by overexpression of P-gp. The MDR modulator valspodar (PSC 833; Novartis Pharmaceuticals Corporation, East Hanover, NJ) is examined as a model for establishing nursing guidelines for this new class of therapeutic agents. CONCLUSIONS: The dose of some chemotherapy agents must be modified with concurrent valspodar administration. Studies examining the safety and efficacy of valspodar as a prototype of MDR modulators provide the basis for establishing nursing care guidelines. IMPLICATIONS FOR NURSING PRACTICE: Nursing care for the administration of valspodar includes understanding patient selection, criteria, dosing, and administration; side-effect management; patient monitoring and follow-up; and patient education.

ATP Binding Cassette Transporter, Subfamily B↗
PubMed1997

Bone metastases: Part I--Pathophysiology.

Many cancers (especially breast, prostate, and lung cancers) metastasize to the bone. The most frequent site of bone involvement is the axial skeleton (i.e., cranium, ribs, spine, and pelvis). The sequelae of bone metastases include pain, hypercalcemia, pathologic fractures, and spinal cord compression. As patients survive for longer periods, effective management of bone metastases becomes critical to maintaining or improving quality of life. Controlling pain, preventing fractures and oncologic emergencies, and promoting mobility and function are the outcomes of successful management. Use of a clinical algorithm can assist the nurse in identifying bone metastases and managing the clinical sequelae. Knowledge of the pathophysiology and the ability to assess bone metastases will contribute to the nurse's ability to manage the clinical problems and to improve the quality of life of patients with cancer.

Bone Neoplasms↗
PubMed1997

Bone metastases: Part II--Nursing management.

Nurses play a crucial role in identifying bone metastases and managing clinical sequelae, such as pain. Understanding the metastatic process is necessary for delivering effective nursing care. Part I of this article described the pathophysiology and assessment. Part II will provide an overview of the nursing management of the sequelae of bone metastases, including pain, pathologic fractures, spinal cord compression, hypercalcemia, and anemia. Risk factor identification can lead to prevention and early detection of these clinically significant problems. Clinical management of bone metastases will contribute to the nurse's ability to improve the quality of life of patients with cancer.

Bone Neoplasms↗
PubMed1992

Hazards of chemotherapy. Implementing safe handling practices.

Over the last decade, concerns about the hazards of handling cytotoxic chemotherapeutic agents increased as various studies were published. Analysis of these data suggest possible carcinogenic, teratogenic, and mutagenic risk for health professionals (predominantly nurses and pharmacists) that handle these drugs. However, the research is inconclusive. The nature of the problem, along with methodologic issues, may make it difficult or impossible to provide definitive data on the type and degree of risk for those exposed to chemotherapeutic agents. Guidelines and recommendations have been published by various groups including the Occupational Safety and Health Administration, the American Society of Hospital Pharmacists, the Oncology Nursing Society, and others. In essence, they recommend that only health professionals with specialized training should prepare or administer chemotherapeutic agents. In addition, equipment, unused drugs, and human excreta should be treated as chemically hazardous waste and disposed of according to the individual facility's policies and procedures. These guidelines should provide protection for those involved in preparing chemotherapy for administration, regardless of where this is done. Studies have shown differences in the degree and type of procedures followed and between existing procedures and actual practice. Some of these differences are based on the site of care (e.g., hospital [also influenced by bed size], private practice, or home care). Issues involved in implementing reasonable approaches to lower the relative risk for health-care professionals that handle cytotoxic chemotherapy will be discussed.

Antineoplastic Agents↗
PubMed1991

Prevention, early detection, and management of oncologic emergencies.

The prevention and early detection of oncologic emergencies is critical in caring for the person with cancer. Although many will not develop an oncologic emergency during the course of their illness, the approach outlined in this paper will contribute significantly to the prevention and relief of suffering in those individuals who may develop them.

Cardiovascular Diseases↗
PubMed1991

Obstacles to implementing cancer clinical trials.

There are numerous obstacles to implementing and conducting clinical trials. Patient accrual and the costs of clinical trials are difficult problems for researchers. Additional obstacles to implementing clinical trials are patient-related, physician-related, and nurse-related barriers.

Clinical Trials as Topic↗
PubMed1990

Biotherapy: recent advances and nursing implications.

Nurses have and will continue to play a crucial role in the development and application of new BRM agents and products. Joint ventures between the National Cancer Institute, traditional academic centers, and private industry have produced new partnerships expanding the number and types of biologic research studies being conducted in various patient care settings. Nursing's contributions in these new ventures are significant and ongoing. If not directly involved in studying and administering BRM agents, the nurse will be involved in the education and counseling of persons who may participate in this new cancer treatment modality. Nurses will need to be familiar with BRM because many people will query them about this new field. Dr. Ehrlich concluded his address in 1900 by stating: "We no longer find ourselves lost on a boundless sea, but that we have already caught a distinct glimpse of the land which we hope, nay, which we expect, will yield rich treasures for biology and therapeutics." Are we there yet?

Clinical Trials as Topic↗
PubMed1986

Diagnosis and management of intestinal obstruction in individuals with cancer.

Small bowel obstructions, which account for two-thirds of all intestinal obstruction, are caused by adhesions, hernias and cancer. Large bowel obstructions are usually the result of a malignancy, but may also be caused by diverticulitis or volvulus. Previously treated individuals with a known diagnosis of advanced cancer originating in the pelvis are at highest risk for developing intestinal bowel obstruction. Since 30 percent of Americans will develop cancer in their lifetimes, and colorectal cancer is the most common type, this represents a significant population at risk to be followed by nurse practitioners. The pathophysiology, assessment and management of an individual with a bowel obstruction is reviewed. Morbidity and mortality in this population is high. Wound healing problems, including infection, dehiscence, evisceration and fistula formation, contribute significantly to the morbidity and can cause long-term problems. In today's health care system, it's likely that patients will be discharged from the hospital earlier after bowel surgeries. Therefore, nursing care focusing on wound management is outlined.

Humans↗