Biomedical subjects
William Evans
Publications and source records attributed to William Evans.
Bibliography. Health communication.
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Pre-registration diploma student nurse stress and coping measures.
The aim of this study is to examine the stress experiences and coping abilities of student nurses. A survey design was employed to examine the stress experiences of Diploma student nurses in a large Dublin Teaching Hospital. A questionnaire was utilized that measured and explored five specific constructs pertinent to student nurse stress. These included clinical stress, academic stress, coping, emotions and personal factors which assist students nurses during periods of stress. Findings showed that examinations, the level and intensity of academic workload, the theory-practice gap and poor relationships with clinical staff were the leading stressors identified. Emotional reactions to stress included feeling exhausted and upset under pressure. Students adopted short-term emotion focused coping strategies when attempting to deal with stress. A sense of achievement, and determination, were personal factors, which assisted students to continue in the event of stress being present. Content analysis of the open questions shed further light in relation to the stress phenomenon, particularly in relation to clinical stress. The provision of adequate support services from a clinical and academic perspective, a lecture-practitioner model of education delivery, and curriculum changes which focus on developing student self awareness skills are the suggested study recommendations.
Human embryo research in the news: scientific versus ethical frames?
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Hematopoietic and immunomodulatory effects of lytic CD45 monoclonal antibodies in patients with hematologic malignancy.
The CD45 antigen is present on all cells of the hematopoietic lineage. In some rodent models, lytic CD45 monoclonal antibodies (MAbs) induce complete marrow aplasia. In others, only transient myelolymphodepletion are observed, which are nonetheless sufficient to permit engraftment with fully allogeneic stem cells after otherwise ineffective doses of radiation. The in vivo effects of unconjugated cytolytic CD45 MAbs on myeloid and lymphoid cells in humans are unknown, so it is unclear if they could contribute in a similar way to conventional ablative or to nonmyeloablative preparative regimens used for stem cell transplantation (SCT). We therefore assessed the safety, myeloreductive activities, and lymphoreductive activities of the unconjugated rat anti-human CD45 MAbs, YTH25.4 and YTH54.12, in subjects who were to undergo SCT for advanced hematologic malignancy. The MAb pair bind to contiguous but nonoverlapping epitopes on CD45 and work synergistically to fix complement and recruit cellular lytic mechanisms. The MAbs were given in increasing doses up to 1600 microg/kg during 4 days, after which the patients began their conventional transplantation preparative regimen. The maximum tolerated dose of these MAbs, 400 microg/kg/d, produced marked reduction in circulating lymphoid and myeloid cells while largely sparing marrow progenitors. In 2 of 3 patients who had active leukemia at the time of study, the MAbs reduced the percentage of leukemic blast cells in bone marrow. Seven of 14 patients are disease free 610 to 1555 days post-SCT. The in vivo myeloreductive and lymphoreductive properties of lytic CD45 MAb in humans, therefore, closely parallel the activity seen in a murine model and, therefore, may be of similar value.
Persistence of lymphoblasts in bone marrow on day 15 and days 22 to 25 of remission induction predicts a dismal treatment outcome in children with acute lymphoblastic leukemia.
We determined the prognostic importance of morphologically identifiable persistent disease at day 15 and days 22 to 25 of remission induction in childhood acute lymphoblastic leukemia (ALL). Among 546 patients entered on 2 consecutive protocols, 397 patients had evaluable bone marrow (BM) examinations on day 15 (+/- 1 day) and 218 on days 22 to 25 (+/- 1 day). Fifty-seven patients (14%) had persistent lymphoblasts (> or = 1%) in the BM on day 15 and 27 patients (5.5%) had persistent lymphoblasts on days 22 to 25. The 5-year event-free survival (EFS) was significantly worse for patients with lymphoblasts on day 15 (40% +/- 6%) or on days 22 to 25 (4% +/- 3%) as compared to those without lymphoblasts on these dates (78% +/- 2% and 76% +/- 2%, respectively, P <.001 for both comparisons). A worse prognosis was observed even for patients with a low percentage of lymphoblasts (ie, 1%-4%) at either day 15 (5-year EFS = 56% +/- 8%) or days 22 to 25 (5-year EFS = 0%) compared to those without morphologically identifiable persistent lymphoblasts at these times (P <.001 for both comparisons). The prognostic impact of persistent lymphoblasts on both dates remained significant after adjusting for other known risk factors, including treatment protocol, age, white blood cell count, DNA index, cell lineage, and central nervous system status, and National Cancer Institute/Rome criteria simultaneously. Hence, persistence of lymphoblasts (even 1%-4%) on day 15 of remission induction was associated with a poor prognosis and on days 22 to 25 signified a particularly dismal outcome; these very high-risk patients require novel or more intensive therapy to improve outcome.
Nutritional status of teenage female competitive figure skaters.
OBJECTIVE: To assess the nutritional status of female competitive figure skaters during preseason, competitive season, and off-season. SUBJECTS: Eighteen female competitive figure skaters, age range 14 to 16 years, from the New England region. STATISTICS: Data was analyzed by repeated measures analysis of variance, Duncan Multiple Range Tests, one-sample t tests, and confidence intervals. DESIGN: Nutrient intakes were determined from 3-day diet records. Body composition was assessed through heights, weights, and underwater weighing. Blood samples were drawn for analysis of selected indexes of nutritional status. RESULTS: Height and weight did not differ significantly among the seasons. Body fat was 1.1 kg higher off-season compared with preseason. Energy intake over the 3 seasons did not vary significantly (mean preseason: 1,678 kcal/day; competitive season, 1,630 kcal/day; off-season: 1,673 kcal/day) (P>.05). During the competitive season 78%, 50%, and 44% of the skaters had intakes less than 67% of RDA for folate, iron, and calcium, respectively. Most of the biochemical indexes of nutritional status were within normal limits. CONCLUSIONS: The results indicate that teenage female skaters have relatively low energy intake and inadequate intakes of certain nutrients, which may account for some of the observed seasonal variations in blood markers of nutritional status. These findings point to the need for nutrition education for these athletes, especially during their competitive season when nutritional status may be compromised.
Development and evaluation of a decision aid for patients with stage IV non-small cell lung cancer.
Although guidelines for treating stage IV non-small cell lung cancer suggest that the patient's values should be considered in decision-making, there are no practical tools available to assist them with their decision-making. OBJECTIVE: To develop and evaluate a decision aid that incorporates patient values. DESIGN AND SAMPLE: (1) Before/after evaluation with patients referred to a regional cancer centre. (2) Mailed survey of thoracic surgeons and respirologists in Ontario. INTERVENTION: An audio-tape guided individuals to review a booklet describing stage IV non-small cell lung cancer, its impact and possible coping strategies, treatment options, benefits and risks, and examples of the decision-making of others. Patients then used a worksheet to consider and communicate personal issues involved in the choice, including: personal values using a 'weigh-scale'; questions; preferred role in decision-making; and predisposition. MEASURES: (1) Patient questionnaires eliciting knowledge, the decision, decisional conflict and acceptability of the decision aid. (2) Physician questionnaires eliciting attitudes toward the decision aid. RESULTS: (1) Twenty of 30 patients used the aid in decision-making. Users thought that the aid was acceptable and significantly improved their knowledge about options and outcomes (P < 0.001), and reduced their decisional conflict (P < 0.001). (2) The majority of the 29 physicians who reviewed the decision aid found it acceptable, were comfortable providing it to patients and said that they were likely to use it. CONCLUSION: The decision aid is a useful and acceptable adjunct to personal counselling.