Biomedical subjects
Publications and source records attributed to R Steeves.
This article describes a research project aimed at delivering an intervention to bereaved family members living in the community. The issues covered are access to subjects, recruitment and retention of subjects, and random assignment to control and experimental groups.
PURPOSE/OBJECTIVES: To describe ethical issues determined to be highly important to oncology nurses and to discuss strategies by which the Oncology Nursing Society (ONS) can address these priority concerns. DATA SOURCES: Survey on oncology nurses regarding ethical issues; nursing literature. DATA SYNTHESIS: Nine priority ethical issues of oncology nurses are identified. Past, current, and future ONS activities that address these priority issues are discussed. IMPLICATIONS FOR NURSING PRACTICE: ONS must support activities to increase the knowledge, confidence, and involvement of oncology nurses in discussions and decision making related to the ethical issues. CONCLUSIONS: The top three priority ethical issues for oncology nurses are assisted suicide, end-of-life decisions, and pain management. Efforts should be made to increase ethics expertise among the ONS membership.
PURPOSE: To describe oncology nurses' perceptions of the meaning of their work using particularly relevant anecdotes. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degrees in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared). METHODS: Phenomenological; content analysis of interviews. FINDINGS: Nurses described three roles, each characterized by a set of activities: (a) maintaining the values of the healthcare establishment as characterized by monitoring, acting on patients' behalf, protecting patients, and bringing patients into line, (b) participating in patients' experiences as characterized by "being there" for patients, being with dying patients, and, in a sense, becoming part of patients' families, and (c) reconciling healthcare values and the experiences of patients as characterized by teaching and telling the truth. CONCLUSIONS: Nurses not only demonstrated self-confidence, courage, emotional strength, and a desire to be empathetic but also displayed an unexamined belief that they understood their patients' experiences, were isolated in their work, and experienced difficulty dealing with suffering. IMPLICATIONS FOR NURSING PRACTICE: Future research should establish whether nurses' understanding of their patients' experiences correlates with patients' accounts of those experiences and whether nurses' sense of isolation is indicative of a pattern of inadequate supportive resources.
PURPOSE: To describe the method used in a multisite study of the meaning of oncology nursing from the oncology nurses' perspectives. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared). METHODS: Phenomenological; content analysis of interviews. FINDINGS: Nurses' experiences in caring for people with cancer have many similarities despite the differences among these nurses or their work settings. These similarities are described in this supplement. IMPLICATIONS FOR NURSING PRACTICE: Many nurses said they had not described their experiences to interested listeners before. Providing these descriptions helped the nurses to see their work in new ways and led some of them to make changes in their personal and professional lives.
PURPOSE: To describe oncology nurses' perceptions of the rewards and difficulties of their work. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared). METHODS: Phenomenological; content analysis of interviews. FINDINGS: Nurses described sources and origins of both job stress and satisfaction. The three most important sources of rewards were patients, co-workers, and new skills. These sources of rewards also were described as sources of difficulties. Additional sources of difficulties include lack of competent administrators, lack of time, and life stresses. IMPLICATIONS FOR NURSING PRACTICE: Nurses' experiences with work are shaped by both common and very individual and personal realities. Aspects that are rewarding also are difficult, and individual experiences and perceptions change the meaning of work and the needs that nurses have. Considering the findings in the context of nurses' lives may yield more fruitful approaches to providing support and resources that nurses need to be able to provide effective care for patients and their families.
These Hyperthermia Quality Assurance guidelines are a result of a joint workshop of the Hyperthermia Committee of the American College of Radiology and the Hyperthermia Physics Center, which is the national quality assurance program under Contract No. N01-CM-37512 with the National Cancer Institute. Hyperthermia technology presently lacks the kind of standardization in equipment, treatment procedures, patient monitoring, and treatment documentation available in radiotherapy. Therefore, preventing unacceptable variability in treatment data demands a strong commitment to in-house quality control procedures and to centralized quality assurance reviews in cooperative multi-institutional trials. This paper presents a set of test procedures necessary to ensure proper operation of equipment, suggests a frequency for such tests, and also includes guidelines on quality control procedures to be used during treatment to improve the safety, effectiveness, and reproducibility of hyperthermia treatments. A set of forms are presented to indicate the minimum data, albeit incomplete, that must be collected for acceptable documentation of treatment. These guidelines should be valuable not only to the new entrants in the field but also to those participating in multi-institutional cooperative hyperthermia trials. They have been approved by the Hyperthermia Committees of American College of Radiology, American Society for Therapeutic Radiology and Oncology, Radiation Therapy Oncology Group and the American Association of Physicists in Medicine.
During the past two years, the CSHP Research Committee was given the tasks of evaluating the present status of hospital pharmacy research and developing positive recommendations for future action. In order to determine the specific needs and interests of Canadian hospital pharmacists, a survey of the CSHP membership was conducted in April of 1987. Two hundred and twenty-two members (13.1%) responded to the survey. Fifty-six percent (124) of the respondents had completed one or more research projects and 30 percent (66) served as supervisors of at least one research study. Clinical drug studies, particularly DUR and pharmacokinetic projects, were the focus of most of the present research efforts. In addition to DUR and pharmacokinetics, the most popular "wish to do" research topics included pharmaceutics, cost benefit/analysis and other pharmacy practice research topics. The survey respondents indicated a strong desire for CSHP to sponsor research similar to the Workload Measurement Study. The Canadian Society of Hospital Pharmacists was also requested to provide educational programs and other methods of information dissemination for training in the field of research methodology.
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Autologous marrow recovery without engraftment of donor marrow was observed after bone marrow transplantation (BMT) for two patients with acute lymphoblastic leukemia. Each had received marrow from a haploidentical mixed lymphocyte culture (MLC) reactive donor after pretransplant conditioning with total body irradiation and high-dose cyclophosphamide. To minimize graft-vs-host disease, the marrow was depleted of T cells in vitro by treatment with a monoclonal anti-T-cell antibody and complement. Two weeks after each transplant, reactive lymphocytes were noted transiently in the blood of each patient. Analysis of karyotype, HLA type, and in vitro MLC responsiveness proved the lymphocytes to be of host, not donor, origin. MLC studies showed rapid proliferative responses specifically to stimulating cells from the BMT donor, indicating in vivo sensitization to donor antigens. Return of hematopoietic function was markedly delayed, but it eventually normalized after several months, without evidence of chimerism. These studies confirm that some immune and hematopoietic stem cells of host origin survive the high-dose chemoradiotherapy used as transplant conditioning. Because these immune cells are specifically reactive to donor alloantigens, more potent suppression of host immunity may be needed to prevent nonengraftment of T-cell-depleted, HLA-mismatched bone marrow.
Disease-free intervals of 2 to 3 years after treatment of histiocytic lymphoma are generally thought to represent cures; flat survival curves beyond 3 years in several studies support this notion. Four case reports of histiocytic lymphoma recurrences 25, 10, 9 and 6 years, respectively, after the initial diagnosis are presented. Histologic confirmation comparing primary and recurrent disease is presented. The potential biological significance of such patient reports is discussed.
The in vitro antiproliferative effects of interferons (IFN) against the human bladder carcinoma cell lines T24, RT4, HT1197, and 647V were evaluated at temperatures ranging from 37-41 degrees. At 37 degrees, the antiproliferative activities of IFN, either naturally produced or produced by recombinant DNA technology, were different against different cell lines. An increase in temperature markedly enhanced the antimitotic effect of IFN for all cells. For example, T24 cells grown at 37 degrees and treated with 200 units naturally produced IFN-alpha or IFN-beta per ml for 7 days were inhibited 50 to 60%. No change in cell proliferation occurred in untreated T24 cells grown at 39.5 degrees. Treatment with 200 units IFN-alpha or IFN-beta per ml at 39.5 degrees inhibited these cells 80 to 90%. Similar results were obtained with IFN produced by recombinant DNA technology and purified to homogeneity. Colony formation by the RT4 cell line, at 37 degrees, was decreased less than 10% with 200 units IFN-alpha per ml and 63% by 200 units IFN-beta per ml. At 39.5 degrees, colony formation by untreated RT4 cells was inhibited 48%. Treatment with IFN-beta at 39.5 degrees did not result in an enhancement of the antiproliferative effect; however, treatment with IFN-alpha enhanced the inhibition from less than 10% to 98%. These results suggest that a supraadditive relationship exists between antiproliferative effects of IFN and temperature elevation. The differences seen between IFN-alpha and IFN-beta may be due to the different stabilities of these two molecules. In order to probe the mechanism of the enhanced antiproliferative effect, activity of an IFN-induced enzyme, 2'-5'-oligoadenylate synthetase, was measured. IFN-alpha treatment resulted in significantly greater 2'-5'-oligoadenylate synthetase induction at 39.5 degrees than at 37 degrees. Thus, two cellular effects resulting from IFN were augmented by increased temperature.
Erythroleukaemia, until now defined by morphological criteria, has been observed in mice infected with several distinct virological entities, including the polycythaemia-inducing strains of Friend virus complex (FV-P), the anaemia-inducing strains of Friend and Rauscher virus complex (FV-A and RV-A, respectively) and various helper-independent virus isolates derived from the FV-A or RV-A complexes. Whereas erythroleukaemia develops rapidly (within 2-3 weeks) in mice infected with any strain of FV or RV, the helper-independent virus alone is pathogenic in mice only if they are infected neonatally. We now describe how two biological markers can be used to distinguish among the otherwise confusing array of virus-induced erythroleukaemias in mice. The evidence suggests that there are three different classes of this disease: (1) those (S+E+) from which both defective spleen focus-forming virus (SFFV) and erythropoietin-independent, erythroid colony-forming units (CFU-EI) can be recovered, (2) those (S+E-) from which only SFFV (but not CFU-EI) can be recovered, and (3) those (S-E-) from which neither SFFV nor CFU-EI can be recovered. There is a consistent association between the type of virus used to induce the erythroleukaemia and the class of the disease induced.
A target cell assay based on the formation of infectious centers (IC) was used to characterize the Fv-2resistance gene of mice. Dose-response curves were obtained for the number of IC generated from incubated mixtures of bone-marrow cells and Friend virus (FV). The hemopoietic stimulus of bleeding increased the frequency of potential "target" cells capable of forming IC in DBA/2 but not in D2.Fv-2r mice; however, even without the bleeding stimulus D2.Fv-2r mice contained fewer target cells in their bone marrow than DBA/2 mice. During the first 48 h postinfection a massive dose of FV overcame the inhibitory effect of the FV-2r gene as measured by the release of FV from the spleen. However, the concentration of IC recoverable from the spleens of these infected mice was still much lower in the D2.Fv-2r strain. When irradiated F1 hybrid hosts were used as recipients for the proliferation of infected donor cells, splenic IC were not generated as efficiently from infected bone-marrow cells of D2.Fv-2r origin as from those of DBA/2 origin. However, the amounts of SFFV recoverable were approximately the same. Similarly, after in vitro infection there was no great difference between the amounts of SFFV released from bone-marrow cells of DBA/2 and D2.Fv-2r mice. We conclude that the primary effect of the Fv-2r gene may be to inhibit the formation and proliferation of IC in vivo, and that SFFV replication could be inhibited secondarily.
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Explore the source record for details and available documents.