Spouse-assisted coping skills training in the management of osteoarthritic knee pain

OBJECTIVE

To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain, psychological disability, physical disability, pain-coping, and pain behavior in patients with osteoarthritis (OA) of the knees.

METHODS

Eighty-eight OA patients with persistent knee pain were randomly assigned to 1 of 3 conditions: 1) spouse-assisted pain-coping skills training, (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement (CST), or 3) an arthritis education-spousal support (AE-SS) control condition. All treatment was carried out in 10 weekly, 2-hour group sessions.

RESULTS

Data analysis revealed that at the completion of treatment, patients in the spouse-assisted CST condition had significantly lower levels of pain, psychological disability, and pain behavior, and higher scores on measures of coping attempts, marital adjustment, and self-efficacy than patients in the AE-SS control condition. Compared to patients in the AE-SS control condition, patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies.

CONCLUSION

These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients.

[Differentiated thyroid cancer in Arabs in northern Israel]

Prognostic factors and survival rate of 53 Arabs with differentiated carcinoma of the thyroid treated here were reviewed. Papillary carcinoma was diagnosed in 35 (66%) and follicular carcinoma in 18 (34%): the female/male ratio was 2.3/1 and the median age 32. Age, gender, tumor size, histology and tumor stage were important prognostic factors. The 20-year actuarial survival rate of the entire group was 96%. The probable reason for the high survival rate was the low median age.

Hawaiian-style "talkstory": psychosocial assessment and intervention during and after pregnancy

Standard health care services generally limit the psychosocial assessment and management provided for women during and after pregnancy. Recommendations for improving prenatal care include the need for evaluating different approaches for addressing culturally sensitive care. In an innovative prenatal and postpartum program developed by public health nurses in Hawaii, the use of local "talkstory" has been integrated successfully as a caregiving strategy for participating women from Asian and Pacific Islander ethnic groups. This article describes the use of talkstory for delivering psychosocial care and its application in the design of health care services for pregnant women in the general population.

Interpretation by radiologists of orthopedic total joint radiographs: is it necessary or cost-effective?

OBJECTIVE

To examine the necessity and cost-effectiveness of interpretation by radiologists of orthopedic radiographs obtained for patients who undergo total hip or knee replacement.

DESIGN

A prospective study. Serial preoperative and postoperative x-ray films of the joint in patients scheduled to undergo total hip or knee joint replacement during one calendar year were interpreted by both radiology and orthopedic department staff and compared. Intraoperative findings were used to confirm the radiologic interpretation. The follow-up was 1 year.

SETTING

A university teaching hospital.

INTERVENTIONS

Primary or revision total hip or knee replacement.

MAIN OUTCOME MEASURES

Differences in interpretation of radiographs by radiologists and orthopedic surgeons for any of the four procedures. A change in orthopedic management.

RESULTS

For preoperative radiographs, there were no discrepancies between the radiologists and orthopedic surgeons with respect to primary joint replacement. For 100 revision procedures there were 15 discrepancies, but in all cases the orthopedic surgeon's interpretation proved to be correct. For the postoperative radiographs, there were no discrepancies in the group of revision hip replacements. For the other three groups there were a total of six discrepancies and in all cases the orthopedic surgeon's interpretation was correct. In two cases conditions were present that were not recognized by staff from either the radiology department or orthopedic department.

CONCLUSION

Interpretation by radiologists of total joint radiographs in patients who undergo primary or revision total hip or knee replacement arthroplasty is not necessary or cost-effective.

Spouse-assisted coping skills training in the management of osteoarthritic knee pain

OBJECTIVE

To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain, psychological disability, physical disability, pain-coping, and pain behavior in patients with osteoarthritis (OA) of the knees.

METHODS

Eighty-eight OA patients with persistent knee pain were randomly assigned to 1 of 3 conditions: 1) spouse-assisted pain-coping skills training, (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement (CST), or 3) an arthritis education-spousal support (AE-SS) control condition. All treatment was carried out in 10 weekly, 2-hour group sessions.

RESULTS

Data analysis revealed that at the completion of treatment, patients in the spouse-assisted CST condition had significantly lower levels of pain, psychological disability, and pain behavior, and higher scores on measures of coping attempts, marital adjustment, and self-efficacy than patients in the AE-SS control condition. Compared to patients in the AE-SS control condition, patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies.

CONCLUSION

These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients.

An evaluation of the impact of social interaction skills training for facially disfigured people

Facially disfigured people can experience significant psychological problems, commonly relating to difficulties in social interaction. The effect of social interaction skills workshops on the psychological well-being of 64 facially disfigured participants is described. Participants completed the Hospital Anxiety and Depression Scale (HAD), the Social Avoidance and Distress Scale (SAD) and an open-ended questionnaire, before a workshop and at 6 weeks and 6 months follow-up. The high levels of anxiety evident prior to the workshop fell significantly 6 weeks post-workshop (HSD = 1.297, P < 0.01) and remained significantly lower at 6 month follow-up (HSD = 1.563, P < 0.01). Similarly, SAD scores fell significantly at 6 weeks (HSD = 1.89, P < 0.05) and again at 6 month follow-up (HSD = 2.26, P < 0.01). 6 weeks post-workshop, participants reported feeling more confident in the company of strangers (HSD = -1.266, P < 0.01) and about meeting new people (HSD = -1.159, P < 0.01). This increase in confidence was maintained at 6 months (HSD = -1.068 and -1.042 respectively, P < 0.01 for both). 61% of those who experienced problems before the workshop reported a positive change in these situations. The potential of these workshops as an addition to surgical intervention is discussed.

The effects of implementing program consequences with a group of individuals who engaged in sensory maintained hand mouthing

This study evaluated whether a multicomponent treatment package could be successfully implemented with individuals who engage in self-injurious hand mouthing maintained by sensory consequences in the context of both individual and small group settings. Three ambulatory individuals with profound mental retardation participated on an individual basis followed by treatment within a group setting. Generalization of the intervention results to the natural living environment was then analyzed. Using an ABAB experimental design, the effectiveness of brief response interruption followed by the introduction of a preferred leisure item to reduce hand mouthing during 15-min intervention sessions was analyzed. Results of these experiments showed that the intervention could be successfully implemented during individual and small group sessions and during group sessions conducted in the natural environment. The benefits and limitations of this intervention strategy and future research are discussed.

Prostatic adenocarcinoma labelled with a monoclonal antibody and polyclonal serum: a quantitative assessment

OBJECTIVE

To investigate the detection of tissue prostate-specific antigen (PSA) using a monoclonal antibody or polyclonal serum in patients with localized prostate cancer.

PATIENTS AND METHODS

Fifteen samples of prostatic tissue from patients with localized prostate cancer were assessed for PSA using monoclonal antibodies and polyclonal serum. The intensity and area of chromogen precipitation in several microscopic fields was determined using image analysis.

RESULTS

There were significant differences in the intensity and distribution of PSA labelling in the tumour between the methods; polyclonal serum was more sensitive in detecting PSA in tissue sections. Notably, there was a focal "possible clonal' pattern of negative labelling with the monoclonal antibody, which contrasted with the positivity of the polyclonal marker.

CONCLUSIONS

The loss of PSA expression in some poorly differentiated cancers may represent the loss of specific epitopes rather than loss of the entire protein.

Treatment of metastatic adrenal cortical carcinoma with etoposide (VP-16) and cisplatin after failure with o,p'DDD. Clinical case reports

A 42-year-old woman with liver metastasis from adrenal cortical carcinoma was treated with mitotane (o,p'DDD) for 11 months with a minimal response. Mitotane was stopped because of severe adverse effects. Thereafter a combination of cisplatin and etoposide was given every 3 weeks. A partial response was achieved after five chemotherapy courses. Following this chemotherapy, the patient had a surgical excision of the liver metastasis and entered into a complete remission for 17 months. Etoposide plus cisplatin may be an active combination for the treatment of adrenal cortical carcinoma.

Intensive short cause chemotherapy followed by radiotherapy of locally advanced nasopharyngeal carcinoma

BACKGROUND

We designed a protocol with the goal of improving the disease free and overall survival of patients with previously untreated Stage IV nasopharyngeal carcinoma (NP(C)). The regimen consisted of intensive induction chemotherapy followed shortly thereafter by radiation therapy.

METHODS

Between March 1986 and March 1992, 27 patients with T3-4, N2-3, M0 squamous cell carcinoma of the nasopharynx were treated with 2 cycles of chemotherapy, using cisplatin, 100 mg/m2 intravenously, on Day 1, and 5-fluorouracil (5-FU), 1000 mg/m2 per day continuous infusion, on Days 2-5. The second cycle was given on Day 16 and was followed by radiotherapy (RT), 70 Gray, given on Day 31.

RESULTS

The objective response rate to chemotherapy was 93%, with a 37% complete response (CR) rate and a 56% partial response (PR) rate. The overall CR rate after RT was 85%. With a median follow-up of 60 months, the overall actuarial survival rate was 66%. Patients who had a CR after chemotherapy had a superior survival probability (100%). Toxicity was tolerable, without lethal complications.

CONCLUSIONS

This study demonstrates that cisplatin/5-FU chemotherapy given in an intensive schedule and followed shortly thereafter by radical RT can improve the CR rate and survival of patients with locally advanced NPC, with tolerable toxicity.

Tamoxifen in postmenopausal women a safety perspective

Tamoxifen is a synthetic antiestrogen with both agonist and antagonist properties. It is believed to act primarily through binding to estrogen receptors in breast cancer cells, acting as a competitive inhibitor of estrogen. Tamoxifen has a wide range of systemic effects, possibly acting on every estrogen target tissue in the body. Tamoxifen therapy is associated with a significant reduction in the risk of recurrence and death in postmenopausal women with early stage breast cancer. In addition, it has been shown to effectively suppress preclinical breast cancer, as evidenced by the decrease in second primary breast cancers in adjuvant trials. Tamoxifen is also the most widely used endocrine therapy for women with metastatic breast cancer. Tamoxifen, acting predominantly as an estrogen agonist in the liver, has generally favourable effects on serum lipids in postmenopausal women. In addition, tamoxifen has been shown to preserve bone mineral density and may even decrease the risk of osteoporosis in these women. Most patients treated with tamoxifen have minimal adverse effects. Vasomotor symptoms are the most commonly reported events. Less frequently, vaginal discharge or dryness, nausea and depression have been reported. A slight increase in thromboembolic events in postmenopausal women taking tamoxifen has been suggested in some adjuvant trials. Rarely, ocular toxicity and hepatotoxicity are found. The adverse effect of primary importance is the increased incidence of endometrial carcinoma. Several studies indicate that almost all of the tumours are of low histological grade and stage, similar to those seen with exogenous estrogen use. The relative risk of endometrial cancer in women taking tamoxifen is about 2 to 4 times higher than for postmenopausal women not taking tamoxifen. The benefits of tamoxifen outweigh the risks in almost all postmenopausal women with estrogen receptor-positive early stage breast cancer and in all women with metastatic breast cancer. Should tamoxifen prove to be an effective chemopreventive agent for breast cancer, the risks and benefits of treatment will have to be more carefully assessed for this setting.

[Experience with conservative therapy in primary breast cancer: experiences Northern Israel Oncology Center, 1981-1990]

Between 1981 and 1990, 346 patients with primary breast cancer were treated using breast conservation. Mean age was 55 +/- 13 years and median follow-up 53 months. 36.5% were in pathological Stage I, 55% in Stage II, and 4% in Stage III, while 4.5% were in clinical Stages I-II. 60% of the lesions were excised with good margins, 12% with close margins (0.5 cm), 2.5% with macroscopic residuals, 7.5% with microscopic residuals and 18% with margins that could not be determined. Level II lymph node dissection was performed in 334 patients (97%). Adjuvant therapy (combination of chemotherapy and/ or hormones) was given to 223 (64%). Radiotherapy, usually 50-55 Gy tangential photon irradiation to the whole breast, was given to 335 (97%); electron or photon "boost" to the tumor bed was given to 234 (70%); most patients received 20 Gy. Most node-positive patients received 50 Gy to the lymphatic drainage system. A year after completion of radiotherapy cosmetic results were rated as good in 195/212 (92%), moderate in 17/212 (8%), but in none as poor. 5-year actuarial survival was 90% for Stage I and 81% for Stage II disease. 24 (7%) developed breast recurrence, 8 of whom (2%) also had distant metastases; 5 (1.5%) developed supraclavicular lymph node metastases and 59 (17%) distant metastases. Predictors of poor survival or local recurrence were: age under 40 years, premenopausal status, multifocality, and blood/lymph vessel infiltration by tumor cells. The satisfactory level of local control achieved is attributed to the high doses of radiation administered in high-risk lesions (up to 70 Gy total tumor dose).

Preoperative concurrent chemoradiotherapy for unresectable Stage III nonsmall cell lung cancer

PURPOSE

We carried out a Phase II trial in an attempt to improve resectability and survivability of inoperable Stage III A and III B nonsmall cell lung cancer (NSCLC) patients by implementing a neoadjuvant chemoradiotherapy treatment program.

METHODS AND MATERIALS

Thirty-six patients with locally advanced Stage III NSCLC received neoadjuvant therapy consisting of 50.4 Gy in 5.5 weeks concurrent with two cycles of chemotherapy, using cisplatin and etoposide. No postsurgical consolidation therapy was given.

RESULTS

Assessment at 3 to 6 weeks after treatment suggested that 26 (72%) patients had been rendered resectable. Toxicities were common but usually tolerable; however, one toxic death occurred. Of 24 patients who proceeded to thoracotomy, complete resection was achieved in 20 (56%). There were two surgically related deaths. Surgical-pathological staging showed downstaging in 18 patients, including complete sterilization of the tumor in 3 (8%). The median survival for all 36 patients is 15 months, but at the time of analysis, median survival of resectable patients had not been reached. The actuarial 2-year survival is 39% for all study groups, 57% for resectable patients, and 16% for the remaining (p < 0.005).

CONCLUSIONS

While this preoperative neoadjuvant appears to improve survival of patients with Stage III NSCLC, comparison with previous reports of other similar trials indicate a superior survival advantage in association with higher doses of radiotherapy.

Clinical characteristics of non-Hodgkin's lymphoma as a second primary tumor: a population-based survey

Data from 29,845 patients with lymphomas, 981 of whom had lymphoma as a second primary tumor, registered in the Surveillance Epidemiology and End Results (SEER) program in the U.S.A. between 1973 and 1986 were analyzed. The characteristics of the 274 patients with lymphoma as a second tumor who had received chemotherapy and/or radiotherapy for their primary tumor (SEP PT) were compared with 675 patients with second primary lymphomas who had no prior treatment (SEP NT) and with patients with single lymphomas (SIP). Patients with SEP PT disease had a significantly higher percentage of intermediate and high-grade tumors (80%) compared to those with SEP NT or SIP tumors (73% and 72%, respectively). The survival of all patients with SIP tumors did not differ from those with SEP tumors, but the median survival of those with SEP PT disease was shorter than for SEP NT disease. This was most probably due to the high percentage of intermediate and high-grade lymphomas in the SEP PT group. This was statistically significant in the group treated by combined chemotherapy and radiotherapy but not in those treated by a single modality alone. These findings relating to a worse prognosis in patients with SEP PT lymphoma are in line with our previous observations of a poor survival in patients with other multiple primary tumors.

Hypertension and sleep apnea in black South Africans. A case control study

Despite relatively consistent findings that patients with hypertension have higher than anticipated prevalences of sleep apnea/hypopnea (SAH), inadequately controlled factors such as age and obesity have been implicated as possibly accounting for these findings. All-night polysomnograms were performed on 20 hypertensive black South Africans, a group with increased risk for this disease. They were matched with a control group of black subjects in respect of age, gender, body mass index (BMI), neck circumference and scores on a sleep questionnaire. While the groups failed to differ significantly in terms of demographic variables, nor in regard to 8/9 anthropometric measures, the hypertensive group had a significantly higher apnea/hypopnea index (AHI) (P = .01), longer duration of AH (P = .01) and lower mean minimum arterial oxygen saturation levels (P = .005). Of the anthropometric measures, only age and neck circumference were found to be cofactors for AHI and were accounted for in the analysis. Five of the hypertensive patients and two of the controls had an AHI > 10, giving a prevalence odds ratio of 3 (95% confidence interval: 0.66-14.50). The present study appears to be the first in black African subjects and with prevalence findings largely comparable to those obtained in other ethnic groups. There was a trend for more severe SAH to occur in this subgroup of five hypertensives (AHI = 14-30) than in controls (maximum AHI = 12). While data are lacking to link antihypertensive medication to SAH in humans, further study is necessary before discarding this factor.

Realism and children's early grasp of mental representation: belief-based judgements in the state change task

In a standard deceptive box procedure, children aged around 3 years typically fail to acknowledge their own prior false beliefs. For example, they judge incorrectly that they had initially thought a Smarties tube contained pencils after discovering these to be the actual content. Wimmer and Hart (1991) showed that children were more likely to answer correctly in a variant of this task known as a "state change", procedure. In this task, they saw that a container held its expected content (so the initial belief was true) before this was exchanged for something atypical. This appears to offer powerful evidence suggesting that children who fail the standard task do not understand about belief. However, we argue against this view. In a series of 4 experiments, we show that when children see the expected contents before these are swapped for something atypical, this not only makes it easier to report their own and a puppet's initial true belief but also a puppet's current false belief. The results are consistent with the "reality masking hypothesis", according to which facilitation is due to the belief option being linked with a physical counterpart in the state change procedure.

[Malignant salivary gland tumors]

Records of 60 patients with primary salivary gland tumors were retrospectively analyzed. Most were European Jews, 60% were males, and the average age was 57 years. The parotid gland was the most frequent site of origin (76%). The main presenting symptom was painless swelling. Pain or facial palsy were rare and associated with poor prognoses. The most common types were mucoepidermoid, adenocystic, adenocarcinoma and malignant, mixed carcinomas (in descending order of frequency). Squamous cell carcinoma was the most prevalent histologic type. Most patients presented at an advanced stage. Treatment was mainly surgical and postoperative radiotherapy was given to those with advanced disease. Most recurrences occurred within 3 years of initial treatment. Actuarial 10-year survival for all patients was 40%. Superior survival rates were achieved in women, probably due to less aggressive malignancies. Low grade mucoepidermoid carcinoma had a favorable prognosis, whereas anaplastic carcinoma had the worst. Other significant prognostic factors included stage and grade of disease.

Gastrin sensitivity of primary human colorectal cancer: the effect of gastrin receptor antagonism

The purpose of this study was to determine the effect of the gastrin receptor antagonist, CR2093, on basal and gastrin-stimulated growth of primary human colorectal adenocarcinomas and to relate this to gastrin receptor expression. Tumour cells, derived from surgical specimens by enzymatic disaggregation, were grown on matrices of type I collagen and irradiated fibroblasts. Gastrin receptor expression was measured by using a mouse monoclonal antibody directed against the gastrin receptor and an avidin-biotin immunocytochemical method. Increased growth in the presence of gastrin-17 (used at physiological concentrations and as assessed by [3H] thymidine uptake) was shown in 16/34 (47%) tumours. CR2093 significantly reversed this stimulated growth (P < 0.05, one way analysis of variance) in 9/16 (56.3%) of the tumours and inhibited the basal growth of 11/34 (32.4%). Basal growth inhibition was reversed by gastrin-17 in 82% (9/11) of tumours. Gastrin receptor expression was widespread, but was not related to the degree of growth response to gastrin, and there was no significant correlation between intensity of receptor expression and inhibition of basal growth by CR2093. In conclusion, both gastrin-stimulated and basal growth of primary human colorectal can be inhibited by gastrin receptor antagonism, but gastrin receptor expression does not predict the sensitivity of tumours to (i) the proliferative effects of gastrin or (ii) the inhibitory effects of a gastrin receptor antagonist on basal growth. Antigastrin agents may have clinical value in the treatment of gastrin-sensitive colorectal tumours, and gastrin receptor expression may be related to endogenous gastrin production by colorectal tumour cells.