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Results for “Disappointment”

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PubMed1999

Metabolic sequelae of cancers (excluding bone marrow transplantation).

The pathogenesis of cancer anorexia/cachexia is still unclear, partly explaining why its treatment remains disappointing. Anorexia plays a central role but cancer cachexia is more complex than chronic starvation. One of the key differences is the preferential mobilization of fat and the sparing of skeletal muscle in simple starvation compared to an equal mobilization of fat and skeletal muscle in cancer patients. An increase in basal energy expenditure also appears to play a contributory role in many patients. Cytokines, essentially but not exclusively tumor necrosis factor-alpha, play an essential pathogenic role and the syndrome can be compared to a low grade chronic inflammatory state. Parenteral nutrition could facilitate the administration of complete doses of chemotherapy or radiotherapy but no significant survival benefit or decrease in treatment-induced toxicity have been demonstrated in prospective randomized trials. The gut should have the preference for nutritional support. Percutaneous endoscopic gastrostomy is used more and more often in patients with a functionally intact gastrointestinal tract, especially in patients with head and neck cancer. Progestational drugs can to some extent stimulate appetite, food intake, energy level, increase weight and decrease the severity of nausea and vomiting. However, pharmacological treatment of cancer cachexia remains disappointing and more trials with anticytokine drugs, anabolic agents or polyunsaturated fatty acids should be conducted.

Adrenal Cortex Hormones↗

PubMedDate not supplied

What do patients expect from their first visit to a pain clinic?

OBJECTIVE: To examine patients' expectations of their first outpatient visit to a pain clinic. We asked patients what would be the most satisfying and the most disappointing outcomes of their visit and whether they expected changes in medication and further investigations to result from their consultation. DESIGN: Patients completed questionnaires and a structured interview to assess expectations before their clinic appointment. METHODS: Seventy-seven patients with chronic pain who were first time referrals to a regional pain clinic participated in the study. Patient expectations and questionnaires measuring depression and pain-related disability were completed prior to the pain clinic appointment. RESULTS: Most patients expected an explanation or an improved understanding of their pain problem. The most common satisfying outcome was relief or control of pain, and the most common disappointing outcome was being told nothing could be done. The majority of patients expected further medical investigations and changes to the prescribed medication. Depression and pain-related disability strongly influenced patient expectations. CONCLUSIONS: For patients attending pain clinics, the explanation of their pain problem is rated as important as the cure or relief of their pain. Improved understanding of patient expectations by pain clinic clinicians may lead to greater patient satisfaction and reduced treatment dropout.

Analgesics↗

PubMed2005

The treatment of advanced non-small cell lung cancer.

PURPOSE OF REVIEW: The management of advanced non-small cell lung cancer remains disappointing and difficult. At least 65% of patients present with either locally advanced inoperable disease (stage IIIB) or with distant metastases (stage IV disease). The average age of newly diagnosed lung cancer patients is approaching 68 years and they represent a difficult group to palliate without causing treatment-related symptoms. This article examines the current status of chemotherapy as a primary therapy and evaluates the treatments of choice in terms of efficacy, toxicity, survival, and impact on quality of life. In particular, it reviews the recommendations for chemotherapy in the elderly and for those with a poor performance status. The role of the newer growth factor-inhibiting agents is also discussed. RECENT FINDINGS: Chemotherapy prolongs the survival of patients with advanced non-small cell lung cancer compared with best supportive care alone by 3 to 6 months, with the newer generation of agents producing slightly better survival statistics and some improvement in quality of life. Better performance status patients always do better than those with a poor status, and they tolerate therapy better. The new growth-modifying agents do not as yet have a clear-cut role in therapy, but promise both to improve our understanding of how to inhibit tumor growth and to identify which patients may respond to these agents. SUMMARY: The treatment of advanced non-small cell lung cancer remains difficult and disappointing. New effective agents are urgently needed.

Aged↗

PubMed2003

Vertical versus Wise pattern breast reduction: patient satisfaction, revision rates, and complications.

A prospective, randomized study was designed to compare the outcome of inferior pedicle/Wise pattern reduction (group I) with medial pedicle/vertical pattern reduction (group II) in moderate resections averaging 500 g per breast. There were 105 women in group I and 103 women in group II. All surgical procedures were performed by the same plastic surgeon. Patient information recorded included age, body mass index, type of surgery, weight of specimen, need for surgical revision, and complications. Six months postoperatively the patients were asked to complete a questionnaire, which rated their satisfaction with the surgical outcome. The questionnaire used a 10-point response format ranging from very disappointed (score of 1) to very pleased (score of 10). The results demonstrated that there was no significant difference between the groups in age (31 +/- 12 versus 29 +/- 13 years), body mass index (26 +/- 4 versus 27 +/- 5), and amount of tissue excised (553 +/- 203 g versus 548 +/- 205 g). Group I required no surgical revisions, but in group II revisions for dog-ears were required in 11 percent. The rate of other complications was similar in both groups. Patients' evaluations of breast size, shape, symmetry, nipple sensation, symptom relief, ease of brassiere/clothing fitting, and overall satisfaction were not significantly different. The vertical mammaplasty was ranked significantly (p < 0.05) higher by patients in regard to scars (6 +/- 2 versus 3 +/- 3) and overall aesthetic results (8 +/- 1 versus 6 +/- 3). In the management of moderate macromastia, this study indicates that patients who have a vertical reduction are less disappointed with the scars but require a significantly higher rate of surgical revisions compared with patients who have a Wise pattern reduction.

Adult↗

PubMed1999

Splendours and miseries of the brain.

In this speculative essay, I examine two evolutionary developments underlying the enormous success of the human brain: its capacity to acquire knowledge and its variability across individuals. A feature of an efficient knowledge-acquiring system is, I believe, its capacity to abstract and to formulate ideals. Both attributes carry with them a clash between experience of the particular and what the brain has developed from experience of the many. Both therefore can lead to much disappointment in our daily lives. This disappointment is heightened by the fact that both abstraction and ideals are subject to variability in time within an individual and between individuals. Variability, which is a cherished source for evolutionary selection, can also be an isolating and individualizing feature in society. Thus the very features of the human brain which underlie our enormous evolutionary success can also be a major source of our misery.

Animals↗

PubMed1996

Couples' experiences of infertility: a phenomenological study.

If nurses are to work effectively with families in contemporary society, their practice activities must be appropriately informed. Families exposed to new technologies, such as in vitro fertilization (IVF) require care that is sensitive to their particular experience. Infertile couples have been the subject of a substantial body of research, however, most studies to date focus on the physiological effects of infertility and do not take into account the context in which the experience takes place, or the meanings that people assign to this experience. The purpose of this study was to examine in-depth the experience of couples undergoing IVF treatment for infertility. A phenomenological approach was adopted for the study. A purposive sample of six couples was selected for interview. Data were generated from taped interviews and the researcher's observational field notes. Data analysis was in accordance with the procedure outlined by Colaizzi (1978). Interview responses were categorized by examining the participants' transcripts and identifying significant statements and meanings. Themes which emerged from the statements were then identified, and cross-case comparisons were made to confirm or modify these themes. Four key themes emerged from the data: life changes; powerlessness; hope-disappointment cycle; and social isolation. All couples undergoing infertility treatment experienced life changes which included: lifestyle changes, various physical and emotional changes, and changes in their relationships. There was a perceived loss of control over many aspects of their lives. Couples also described a cycle, alternating feelings of hope and disappointment. Most of the couples reported feelings of social isolation associated with being infertile, that were intensified by having to deal with the inappropriate responses of others. Findings from this study will add to the knowledge base on infertility, and contribute to recommendations for improving the way nurses guide, counsel, and support infertile couples.

Adult↗

PubMed2004

Postponed or cancelled heart operations from the patient's perspective.

OBJECTIVES: The aim was to describe postponements or complete cancellations of planned cardiac operations at a Swedish hospital during 1999 and the reception the patients received from the staff in connection with this, from the inpatient's perspective. DESIGN: A qualitative descriptive design inspired by content analysis was used. Data were collected through questionnaires distributed to all 74 patients who had their heart operation cancelled. RESULTS: During analysis of the questionnaires, five categories of answers emerged describing the patients' perception of: organization, medical aspects, information, waiting time and staff reception. Overall, the patients reacted negatively to the postponement/cancellation in the form of anxiety and disappointment and fear of being affected by cardiovascular problems, but were generally satisfied with reception received from hospital staff. A number of concerns were revealed, however, with possible practical implications for the health-care system. CONCLUSION: An understanding of the disappointment and anxiety felt by patients because of the postponement/cancellation of heart surgery can help medical staff to improve the situation. An intervention program is suggested that includes a pre-admission clinic, a change in the planning and waiting list system and support via follow-up telephone calls or internet-based support system.

Adult↗

PubMed2004

The female partner's satisfaction with sildenafil citrate treatment of erectile dysfunction.

BACKGROUND: Data on female partners' satisfaction are scarce, although there have been many articles on patient satisfaction after sildenafil citrate treatment. The aim of this study was to evaluate the satisfaction of female partners of patients receiving sildenafil citrate for their erectile dysfunction (ED) and to assess the female partners' sexual function. METHODS: Ninety-eight patients with ED were treated. Their female partners were asked to answer a questionnaire we have prepared to evaluate the efficacy of treatment, sexual satisfaction and changes in quality of life. It also included a question about female sexual function. From the results, the relationship between their female partner's satisfaction and efficacy of treatment, as well as female sexual function, were assessed. RESULTS: Thirty (31%) questionnaires were returned to us for analysis. Effectiveness of the treatment was acknowledged by 90% of the partners. An improvement in their partner's quality of life was noticed by 60% of the women. The majority (66.7%) of the female partners were satisfied with sildenafil citrate treatment and 20% were disappointed. Moreover, 20% of the female partners were concerned about adverse events. Regarding female sexual function, some form of sexual dysfunction affected 46.7% of the women. Furthermore, a significant number (P = 0.0230) of the female partners disappointed with the treatment had some kind of sexual dysfunction. CONCLUSIONS: The results indicated that female partners reported relatively high levels of treatment satisfaction. Female partners' sexual function and anxiety regarding adverse events should be evaluated when their satisfaction with sildenafil citrate treatment is poor despite an improvement of erectile function.

Adult↗

PubMed1997

Newer approaches to regional cancer therapy through tumour immunology: is there a 'breakthrough'?

Eagerly awaited 'breakthroughs' in immunological treatment have in the past been disappointingly unsuccessful in changing the outlook for most patients with otherwise incurable cancers. Many hopeful agents have been studied in therapeutic trials but each in turn has proven to be largely disappointing. One of the latest products of immunological research, tumour necrosis factor (TNF) was found to be too toxic for systemic use but has been found to be highly effective in improving the results of treatment of melanoma when used in a closed-circuit perfusion system in combination with another chemotherapeutic agent. In the past the use of closed-circuit perfusion has been confined to limbs, but techniques have recently been developed to apply closed-circuit perfusion to liver, pelvic organs, and some abdominal regions including pancreas. The potential for studies of TNF in combination with chemotherapy in closed-circuit perfusion treatment of otherwise resistant cancers in these organs and tissue regions has been greatly expanded. In many cancer treatment centres in the past there has been a reluctance to use and to acknowledge the benefits of regional delivery of anti-cancer chemotherapy. The need for these techniques in the safe and effective use of TNF has further confirmed the importance of these methods in comprehensive cancer treatment centres, and the need for further studies and better understanding of the use of regional and closed-circuit perfusion methods.

Antineoplastic Agents↗

PubMed2005

The use of botulinum toxin type-B in the treatment of patients who have become unresponsive to botulinum toxin type-A -- initial experiences.

The increasing use of botulinum toxin type-A, especially for focal dystonia and spasticity has highlighted the issue of secondary non-responsiveness. Within the last few years botulinum toxin type-B (Myobloc/Neurobloc) has become commercially available as an alternative to type-A. This paper discusses our initial experience of botulinum toxin type-B in a total of 63 individuals who attended our botulinum clinic. Thirty-six patients had cervical dystonia and a secondary non-response to type-A toxin. Thirteen of these patients (36%) had a reasonable clinical response to Neurobloc and continue to have injections. The other 23 patients either had no response, or a poor response, or had unacceptable side effects and ceased treatment. A small number of people with blepharospasm, hemifacial spasm and foot dystonia also had a disappointing response to injection. Twenty patients with spasticity were also type-A resistant. Seven of these show some continuing response to type-B, without unacceptable side effects. These findings demonstrate that botulinum toxin type-B has a place in the management of patients who have become non-responsive to type-A, but overall the responses to type-B toxin were disappointing.

Antibodies↗

PubMed1989

Technical considerations for use of the gastroepiploic artery for coronary artery surgery.

Disappointing long-term results with saphenous vein graft (SVG) for coronary bypass and excellent long-term results with internal mammary artery (IMA) to coronary bypass have prompted a search and research for other alternative coronary bypass conduits. Experience with the radial artery was disappointing due to early failure of those grafts. Likewise, conduits of artificial materials and homograft veins have not produced acceptable long-term results.

Arteries↗

PubMed1998

Postpartum onset of panic disorder.

PURPOSE: To describe the experience of panic disorder in mothers during the postpartum period. The onset of panic disorder during the postpartum period has recently been reported. Clinicians are urged to differentiate between the more widely known presentation of postpartum depression and the newly reported postpartum panic disorder. DESIGN: Phenomenology. The purposive sample consisted of six women with panic disorder during the postpartum period. METHODS: In 1995, mothers were interviewed regarding their experiences with panic. The verbatim transcripts of these interviews were analyzed using Colaizzi's phenomenological method. In all, 214 statements regarding mothers' experiences of panic were extracted and clustered into six themes. FINDINGS: Panic during the postpartum period seriously complicated mothers' lives as they struggled to maintain their composure during panic attacks. As a result of recurring panic attacks, negative changes in women's lifestyles ensued stripping them of their self-esteem and leaving them to bear the burden of disappointing not only themselves, but also their families. CLINICAL IMPLICATIONS: Implications for nursing practice with mothers suffering from postpartum onset of panic disorder can be derived from each one of the six themes. Nurses can help women identify panic triggers to help prevent further panic attacks. Also, nursing interventions can target the guilt mothers experience over repeatedly disappointing themselves and their families.

Depression, Postpartum↗

PubMed1995

Refractive and visual results and patient satisfaction after excimer laser photorefractive keratectomy for myopia.

A study of excimer laser photorefractive keratectomy was performed on 108 patients. Variation in individual refractive outcome was noted, particularly for the higher levels of correction. At 12 months, of those with up to 3 dioptres of myopia, 93% were within 1 dioptre of emmetropia, 100% achieved an acuity of 6/12 unaided, 69% were very pleased with their result, and 10% were very disappointed. Of those with between 3.1 and 6 dioptres of myopia, the respective figures were 75%, 73%, 65%, and 11%. For those with over 6 dioptres of myopia the respective figures were 46%, 58%, 38%, and 23%. Some patients were disappointed despite having achieved good unaided visual acuity. Forty seven per cent of patients lost at least one Snellen line of best corrected acuity. Glare was a problem for some of the time in over 60%. Perceived distortion of vision was a problem for all of the time in 11% to 31% of cases depending on the initial level of myopia. In some cases the refraction continued to change between 12 months and 20 months.

Adult↗

PubMed1988

Doctors' drinking habits and consumption of alcohol.

Alcohol consumption and drinking habits among Finnish doctors were studied as part of a survey of stress and burnout. A questionnaire containing 99 questions or groups of questions was sent to all 3496 practising doctors aged under 66 randomly selected from the registry of the Finnish Medical Association. Altogether 2671 doctors (76%) responded; this sample was representative of the Finnish medical profession. The average weekly consumption of alcohol during the past year and various aspects of drinking behaviour were assessed, and the presence or absence of symptoms and diseases often encountered among heavy drinkers and addicts was determined. The data were analysed separately for men and women, for those aged less than or equal to 40 and greater than 40, and for the men with high and low alcohol consumption and with high and low scores on the index of drinking habits. Selected variables related to work, stress, and coping were correlated with alcohol consumption and drinking behaviour. The median consumption of alcohol among male doctors was 4876 g (6.2 litres) and among female doctors 2226 g (2.8 litres) of absolute alcohol per person per year and was higher in those aged over 40. Beer was most commonly drunk by men and wine by women. Increased alcohol consumption was associated with older age, disappointment with career, heavy smoking, use of benzodiazepines, stress and burnout symptoms, suicidal thoughts, general dissatisfaction, and diseases related to alcohol. Drinking habits were heavier among doctors working in community health centres, those taking long sick leaves, younger doctors disappointed with their careers or the atmosphere at work, and older doctors immersed in their work. Alcohol consumption among doctors seems to be higher than that of the general population in Finland, and heavy drinking seems to be associated with stress and burnout.

Adult↗

PubMed2001

Transrectal ultrasound in the diagnosis of prostate cancer: state of the art and perspectives.

OBJECTIVES: Transrectal ultrasound (TRUS) is an important tool in diagnosing prostate cancer. However, specificity and sensitivity of conventional grey-scale TRUS for the detection of prostate cancer are disappointingly low. New ultrasound modalities are designed to overcome the disappointing results and improve the use of ultrasound in the diagnosis of prostate cancer. This work is a review of the recent literature, combined with own experiences. METHODS: The papers were collected using a Medline search, combined with some papers by author selection. The terms used for the Medline search included among other things: transrectal ultrasound, prostate, prostate cancer, prostate biopsies, colour Doppler ultrasound, power Doppler ultrasound, contrast ultrasound. The authors used their own experiences for illustrations of various techniques. RESULTS AND CONCLUSIONS: Although several modalities show a significant improvement in sensitivity and specificity for the detection of prostate cancer, none of the TRUS modalities discussed can replace prostate biopsies as a definitive diagnostic. Several techniques, especially contrast ultrasound, show definitive promise. However, two valid conclusions can be made from the data presented. First: with today's technology, none of the TRUS modalities discussed can replace systemic biopsies in the early detection of prostate cancer. Second: none of the discussed TRUS modalities has found a definitive place in routine clinical practice.

Forecasting↗

PubMed2004

Bone-marrow-derived cells for enhancing collateral development: mechanisms, animal data, and initial clinical experiences.

Initial animal studies of single angiogenic agents, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), generated enthusiasm for the concept that these agents might enhance collateral development and thereby provide alternative therapies for patients with vascular disease not amenable to traditional revascularization. The enthusiasm, apparently justified by the subsequent results of small nonrandomized phase-I clinical trials, was then tempered by the subsequent disappointing results of randomized clinical trials. In light of these disappointing results, investigators have pursued alternative strategies in an attempt to improve tissue perfusion. One such strategy is the utilization of bone marrow-derived cell therapy. This review discusses mechanistic pathways mediating the effects of such cell therapy, summarizes the animal and early clinical experience, and speculates on the potential of genetic manipulation of bone marrow-derived cells in an attempt to further enhance their potency.

Age Factors↗

PubMed1987

Falling off the couch.

The patient's therapeutic regression intensifies certain unconscious meanings of the analytic couch. In addition to representing the analysis or the analyst in general, the couch can represent the unconscious, or it may take on the symbolic significance of the analyst's or mother's arms, lap, breasts, or womb. When the genetic roots of the patient's transference include substantial experiences of disappointment, narcissistic injury, and mistrust, the theme of falling from the couch may emerge as a dream, an association, or even an enactment. This theme usually implies the presence of a deepening but mistrustful transference, based on earlier disappointments by the patient's primary objects. Falling off the couch may be associated with being dropped as an infant, rolling out of bed as a child, birth, miscarriage, castration, death, termination, defending against passive wishes, punishment for sexual or aggressive transgressions, escaping an attack, descending into the unconscious, or wanting to be picked up and comforted.

Accidental Falls↗

PubMed1998

Aggression: its relation to desire and self-interest.

Aggression continues to be a problematic, ill-defined concept for most contemporary analysts. Questions about the nature and origin of aggression remain unanswered. On the one hand, aggression is conceived of as an instinctual drive; on the other, it is thought to originate as an instrument of reaction to external sources of frustration and environmental failures to meet developmental needs. Aggression has also been dichotomized as either the benign activity of assertiveness, or the darker destructive force of hostility, believed by many to arise from separate motivational systems. There is a problem with the view of aggression as largely an ad hoc reaction to deprivation or other environmental shortcomings leading to disappointment and frustration. This view understates the importance of the original expansive demands for pleasurable satisfaction made by the individual upon the environment. Desire itself seems to be responsible for an inward vulnerability to external sources of disappointment and frustration, so that what is not desired cannot be effectively frustrated. Though the prototypical object of aggression is taken to be an external source of frustration, danger, and narcissistic injury, the mobilization of aggression more accurately reflects a susceptibility to the disturbing pressure of psychic stimuli that are the inner desire for satisfaction. Aggression contributes its force to various constructive or destructive purposes, from love to mastery to vengeance. Its most immediate aims, primarily narcissistic, are not concerned with the needs of others. Aggression also makes important contributions to maintaining psychic equilibrium, to the psychic organization's stake in instinctual gratification, to ego function, and to superego operation.

Aggression↗