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Biomedical subjects

M E O'Rourke

Publications and source records attributed to M E O'Rourke.

At least 19 recordsLinked to original sources
PubMed2001

Expectant management of prostate cancer.

OBJECTIVES: To discuss the role of expectant management in the treatment of clinically localized prostate cancer. DATA SOURCES: Published research and review articles, textbooks, and pending research publications. CONCLUSIONS: Expectant management is a viable option for the treatment of clinically localized prostate cancer in carefully selected men. IMPLICATIONS FOR NURSING PRACTICE: Nursing personnel along with physicians must work together to develop coping strategies for these men to deal with the continual uncertainty of this treatment program.

Decision Making↗
PubMed2001

Decision making and prostate cancer treatment selection: a review.

OBJECTIVES: To review the issues surrounding decision making regarding prostate cancer treatment. DATA SOURCES: Journal articles, abstracts, and selected findings from one prospective grounded theory research study. CONCLUSIONS: Multiple factors are involved in the selection of prostate cancer treatment, such as individual disease-specific data, age, personal values, vicarious and personal cancer experiences, and the physician-patient relationship. IMPLICATIONS FOR NURSING PRACTICE: Accurate information regarding each treatment option delivered by experts in their respective fields is necessary for informed decision making. A more multidisciplinary approach regarding discussion of treatment options is needed. Nurses play a pivotal role in facilitating discussion among family members and assisting patients to make a decision that balances their personal values with accurate information regarding treatment outcomes.

Aged↗
PubMed2001

Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol.

International guidelines recommend that antihypertensive drug therapy should normalize not only diastolic (DBP) but also systolic blood pressure (SBP). Therapeutic trials based on cardiovascular mortality have recently shown that SBP reduction requires normalization of both large artery stiffness and wave reflections. The aim of the present study was to compare the antihypertensive effects of the very-low-dose combination indapamide (0.625 mg) and perindopril (2 mg) (Per/Ind) with the beta-blocking agent atenolol (50 mg) to determine whether Per/Ind decreases SBP and pulse pressure (PP) more than does atenolol and, if so, whether this decrease is predominantly due to reduction of aortic pulse wave velocity (PWV) (automatic measurements) and reduction of wave reflections (pulse wave analysis, applanation tonometry). In a double-blind randomized study, 471 patients with essential hypertension were followed for 12 months. For the same DBP reduction, Per/Ind decreased brachial SBP (-6.02 mm Hg; 95% confidence interval, -8.90 to -3.14) and PP (-5.57; 95% confidence interval, -7.70 to -3.44) significantly more than did atenolol. This difference was significantly more pronounced for the carotid artery than for the brachial artery. Whereas the 2 antihypertensive agents decreased PWV to a similar degree, only Per/Ind significantly attenuated carotid wave reflections, resulting in a selective decrease in SBP and PP. The very-low-dose combination Per/Ind normalizes SBP, PP, and arterial function to a significantly larger extent than does atenolol, a hemodynamic profile that is known to improve survival in hypertensive populations with high cardiovascular risk.

Adolescent↗
PubMed2001

Amelioration of arterial properties with a perindopril-indapamide very-low-dose combination.

BACKGROUND: Epidemiological studies have shown that increased arterial stiffness and wave reflections, major determinants of systolic and pulse pressure, are associated with morbidity and mortality. Therapeutic trials based on cardiovascular mortality have recently shown that reduction of systolic blood pressure (SBP) requires normalization of both large-artery stiffness and wave reflections. AIMS: To compare the antihypertensive effects of the very-low-dose combination of perindopril (2 mg) and indapamide (0.625 mg) (one or two tablets per day) with the beta-blocking agent atenolol (50 mg; one or two tablets per day) in order to determine whether the combination decreased SBP and pulse pressure more than did atenolol, and whether this decrease occurred in relation to a reduction in arterial stiffness [aortic pulse wave velocity (PWV)] or a decrease in the intensity of, or delay in, wave reflections (augmentation index, measured by applanation tonometry) or a combination of both. MATERIAL AND METHODS: This was a double-blind randomized study in 471 individuals with essential hypertension followed for 12 months. Arterial pressure was measured in the brachial artery (mercury sphygmomanometer) and in the carotid artery (applanation tonometry). RESULTS: For the same reduction in diastolic blood pressure (DBP), the combination of perindopril and indapamide decreased brachial SBP and pulse pressure significantly more than did atenolol (adjusted differences between groups -6.2 +/- 1.5 and -5.5 +/- 1.0 mmHg, respectively; P < 0.001). This difference was even more pronounced for the carotid than for the brachial artery. Whereas both antihypertensive agents similarly decreased PWV, only the combination significantly attenuated wave reflections. CONCLUSION: Normalization of SBP, pulse pressure and arterial function--a haemodynamic profile known to improve survival significantly in hypertensive populations at high cardiovascular risk--was achieved to a greater extent with a very-low-dose combination of perindopril and indapamide than with atenolol.

Antihypertensive Agents↗
PubMed2000

Urinary incontinence as a factor in prostate cancer treatment selection.

Urinary incontinence is a common adverse effect associated with treatment for early stage prostate cancer. The influence of this factor on treatment selection decisions by patients and their partners has been explored only minimally in the literature. Data regarding the actual incidence of incontinence associated with prostate cancer treatment are confusing because of the lack of standardized definitions of incontinence. Radical prostatectomy is associated with higher rates of urinary adverse effects than is radiation therapy. Brachytherapy appears to be associated with a low risk of incontinence, whereas cryosurgery is associated with significant urinary adverse effects. Including incontinence, urethral sloughing, and bladder neck obstruction. The influence of these adverse effects on decision making regarding prostate cancer treatment selection is difficult to ascertain. Research indicates that both men and their partners appear to have difficulty processing information presented to them regarding the probability of urinary adverse effects and the degree to which these adverse effects may have an impact on their daily lives.

Humans↗
PubMed1999

Narrowing the options: the process of deciding on prostate cancer treatment.

Prostate cancer is a pressing health concern in the United States and one surrounded by continual controversy. Currently there is no consensus regarding the efficacy of routine screening, nor has one treatment modality been demonstrated as superior. Patients and spouses are asked to choose from several options: radical prostatectomy, radiation therapy, or the "watch and wait" approach. A grounded theory design was used to examine the actual treatment decision-making process as it occurred over time among 18 newly diagnosed prostate cancer patients and their wives in western North Carolina. Couples were interviewed conjointly and individually to explore their perceptions of the decision process. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis techniques. Couples negotiated decisions through their common and unique personal and family histories, biases, and individual coping styles. They narrowed the options based on these factors. Most couples received their counseling regarding treatment options exclusively from the surgeon who narrowed the options based on age and physiologic status. Most couples chose surgery believing it to be the only treatment promising cure. Distinct misconceptions about radiation therapy were noted. Concern about potential side effects did not deter men from selecting surgery, although men and their wives differed in their willingness to accept treatment "at any cost." Information regarding potential for cure and risk of recurrence were highly important factors in the decision process. The decision was incomparable with any other life decisions the couples had faced.

Aged↗