Thalidomide for night sweats in patients with advanced cancer.
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Adenocarcinoma↗
Biomedical subjects
K Calder
Publications and source records attributed to K Calder.
The addition of an audiocassette recording of a consultation to written recommendations for patients with advanced cancer: A randomized, controlled trial.
BACKGROUND: Communication between physicians and advanced cancer patients is frequently difficult. Patients often report poor levels of satisfaction with communication. The purpose of this study was to assess the impact on patients' recall of and overall satisfaction with their consultation by the addition of an audiocassette recording of a consultation to written recommendations. METHODS: Sixty patients with advanced cancer were randomized to either receive a tape recording of their consultation or receive no tape in addition to written recommendations in this randomized, double-blind trial. Patients gave their global ratings of the clinic, were tested for their recall of information given, and responded to questions about the utilization and role of the cassette in influencing family communication. RESULTS: The addition of the audiocassette to written communications significantly increased patient satisfaction with the clinic (8.7 +/- 1.7 vs. 7.7 +/- 2.0 on a scale of 0-10; P = 0.04) and significantly improved recall of the information given during the consultation (88% +/- 8.7% vs. 80% +/- 15.5%; P = 0.02). Patients expressed a high level of satisfaction with the audiocassette. Patients listened to the tape a median of 2 (range 1-4) times, whereas family members and friends listened to the cassette a median of 2 (range 1-3) times. CONCLUSIONS: The addition of an audiocassette recording of an outpatient consultation to written recommendations for patients with advanced cancer is capable of increasing both the overall patient recall of the visit and satisfaction with the outpatient clinical setting. Patients expressed a high level of satisfaction with the audiocassette.
Aged↗
Thalidomide in patients with cachexia due to terminal cancer: preliminary report.
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Aged↗
A randomized controlled trial of local injections of hyaluronidase versus placebo in cancer patients receiving subcutaneous hydration.
BACKGROUND: Most cancer patients develop reduced oral intake or dehydration before death. Subcutaneous hydration (SCH) can be safe and effective. SCH is frequently administered using hyaluronidase to improve fluid absorption. The objective of this study was to determine the effects of hyaluronidase on patient comfort during bolus SCH. PATIENTS AND METHODS: Twenty-one cancer patients requiring parenteral hydration were administered a 500 cc bolus of two-thirds dextrose (5%) and one-third normal saline solution subcutaneously at 08:00 and 16:00 hours during day 1 and day 2. On day 1 patients were randomized on a double-blind basis to receive 150 units of hyaluronidase versus placebo as a bolus into the site of infusion immediately before starting each one-hour infusion. During day 2 patients were crossed over to receive the alternate treatment at a new infusion site. Visual analogue scales (0 = best, 100 = worst) for pain and swelling at the infusion site were completed by each patient. In addition, investigators blindly assessed the site of infusion for the presence of edema, rash, and leakage. RESULTS: No significant differences were observed for pain, swelling, edema, rash or leakage between the placebo and the hyaluronidase scores. After completion of the two days of the study, patients blindly chose hyaluronidase in 1 (5%) case, placebo in 5 (24%) cases, and no preference in 15 (71%) cases (P < 0.01). There was no treatment or interaction effect for pain, except for a period effect (P = 0.045) for the morning bolus administration. There were no treatment, period, or interaction effects for any of the other variables. CONCLUSIONS: Our results suggest that hyaluronidase is not necessary for routine bolus SCH. It may still be useful for a minority of patients who are not able to tolerate infusion well due to swelling or pain.
Cross-Over Studies↗
Cancer pain management and the role of social work: barriers and interventions.
Quality of life has become increasingly important in the management of cancer, because patients with the disease are surviving longer. Although effective therapies exist, more than half of all cancer patients suffer unrelieved pain during illness and treatment. Undertreated and unnecessary pain represents a failure of the multidisciplinary team, including the social worker, to respond appropriately to the needs of cancer patients. This article increases social workers' awareness of the prevalence of cancer-related pain, identifies the barriers that undermine effective pain relief, and develops a model for social work intervention. Skills such as communication, assessment, problem solving, and psychological support are explored in detail.
Health Knowledge, Attitudes, Practice↗
Predictive testing for Huntington disease: social characteristics and knowledge of applicants, attitudes to the test procedure and decisions made after testing.
An investigation has been made of the social characteristics and knowledge and experience of Huntington disease (HD) for the first 80 individuals considering presymptomatic testing (applicants) at the medical genetics centres in Edinburgh and Glasgow and of attitudes to the test procedure and decisions made after testing for those who received a result. Sixty-one percent of applicants were female and 31% were over 40 years old. Almost all had a symptomatic parent but 38% did not know HD was in their family until they were over 25 years old and 48% had never received genetic counselling. Thirty-eight percent of applicants first heard of the test at the genetic clinic, 20% from a relative and 20% from the media, but none had received information from their GP. Thirty-one applicants did not have the test because they voluntarily withdrew (17 individuals), their family structure was unsuitable or no informative result was possible (11 individuals), or they were diagnosed clinically as being affected (3 individuals). Those who voluntarily withdrew did not differ significantly from the 49 who received a result in social characteristics or knowledge and experience of HD. Twenty-two individuals were found to be at increased risk (IR) (> 50% of becoming affected) and 27 to be at decreased risk (DR) (< 50% of becoming affected). There was a median period of 9 months between entering the test procedure and receiving a result and the main criticism of the procedure was that it took too long to complete and several individuals experienced considerable anxiety while awaiting their result.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Beyond informed consent.
The issue of informed consent ranks among the most heavily debated topics in health care. Nearly all health professionals, at some time in their practice, encounter situations in which they question their own involvement and responsibility in obtaining a consent for medical treatment. Such situations are becoming increasingly common for nurses as the structure of the health care system changes and nurses' roles become more diversified. Nurses are wise to try to understand the principles involved in informed consent and to recognize the potential for dilemmas involving ethics and hospital policies.
Humans↗
Patient advocacy in cancer pain relief: the Cancer Care model.
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Health Promotion↗
Access to screening mammography: patient concerns about insurance.
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Breast Neoplasms↗
Quality improvement: a new approach to quality assurance.
The use of programs to help administrators and staff of health care facilities assess and monitor the quality of services provided is not new. For years, quality assurance (QA) programs have provided generalized sets of standards against which hospitals and other agencies measure their performance. Recently, there has been a trend towards quality improvement (QI) programs which advocate a more proactive response to quality concerns and emphasize a decentralized use of assessment and evaluation findings to continuously improve the care provided. QI is recognized as holding great opportunities for the enhancement of professional nursing practice and the improvement of patient care. In this paper, the process and design of QI was described and the advantages of this approach were recognized.
Consumer Behavior↗
Induction of nitrate reductase and membrane cytochromes in wild type and chlorate-resistant Paracoccus denitrificans.
An experimental system has been devised for induction of nitrate reductase in suspensions of wild type Paracoccus denitrificans incubated with limited aeration in the presence of azide, nitrate or nitrite. Azide promoted maximum synthesis of enzyme, accompanied by formation of excess b-type cytochrome; the level of enzyme attained with nitrate was less and c-type cytochrome predominated in the membrane. The nitrate reductase was solubilized with deoxycholate from membranes of azide-induced cells and was identified as a major polypeptide Mr = 150,000 by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Mutants strains lacking nitrate reductase activity were isolated on the basis of resistance to chlorate and mutant M-1 was examined in detail. When incubated in the cell suspension system M-1 formed a membrance protein Mr = 150,000 similar to that attributed to nitrate reductase in the wild type. Maximum formation of the protein by M-1 occurred without inducer and it was accompanied by synthesis of excess b-type cytochrome. The observations with wild type and M-1 indicate that nitrate reductase protein and b-type cytochrome are co-regulated and that the active enzyme has a role in regulating its own synthesis.
Azides↗
Effects of molybdenum and tungsten on induction of nitrate reductase and formate dehydrogenase in wild type and mutant Paracoccus denitrificans.
Molybdenum is required for induction of nitrate reductase and of NAD-linked formate dehydrogenase activities in suspensions of wild type Paracoccus denitrificans; tungsten prevents the development of these enzyme activities. The wild type forms a membrane protein Mr150,000 when incubated with tungsten and inducers of nitrate reductase and this is presumed to represent an inactive form of the enzyme. Suspensions of mutuant M-1 did not develop nitrate reductase or formate dehydrogenase activities but the membrane protein Mr150,000 was formed under all conditions tested, including without inducers and without molybdenum. Analysis of membranes, solubilized with deoxycholate, by polyacrylamide gel electrophoresis under nondenaturing conditions showed that the mutant protein had similar electrophoretic mobility to the active nitrate reductase formed by the wild type. Autoradiography of preparations from cells incubated with 55Fe showed that the mutant and wild type proteins contained iron. However, in similar experiments with 99Mo, incorporation of molybdenum into the mutant protein was not detectable. We conclude that mutant M-1 is defective in one or more steps required to process molybdenum for incorporation into molybdoenzymes. This failure affects the normal regulation of nitrate reductase protein with respect to the role of inducers.
Aldehyde Oxidoreductases↗