Readability, suitability and comprehensibility in patient education materials for Swedish patients with colorectal cancer undergoing elective surgery: a mixed method design

OBJECTIVE

To characterize education materials provided to patients undergoing colorectal cancer surgery to gain a better understanding of how to design readable, suitable, comprehensible materials.

METHOD

Mixed method design. Deductive quantitative analysis using a validated suitability and comprehensibility assessment instrument (SAM+CAM) was applied to patient education materials from 27 Swedish hospitals, supplemented by language technology analysis and deductive and inductive analysis of data from focus groups involving 15 former patients.

RESULTS

Of 125 patient education materials used during the colorectal cancer surgery process, 13.6% were rated 'not suitable', 76.8% 'adequate' and 9.6% 'superior'. Professionally developed stoma care brochures were rated 'superior' and 44% of discharge brochures were 'not suitable'. Language technology analysis showed that up to 29% of materials were difficult to comprehend. Focus group analysis revealed additional areas that needed to be included in patient education materials: general and personal care, personal implications, internet, significant others, accessibility to healthcare, usability, trustworthiness and patient support groups.

CONCLUSION

Most of the patient education materials were rated 'adequate' but did not meet the information needs of patients entirely. Discharge brochures particularly require improvement.

PRACTICE IMPLICATIONS

Using patients' knowledge and integrating manual and automated methods could result in more appropriate patient education materials.

Indirect hydrogen analysis by gas chromatography coupled to mass spectrometry (GC-MS)

Gas chromatography (GC) is an analytical tool very useful to investigate the composition of gaseous mixtures. The different gases are separated by specific columns but, if hydrogen (H2 ) is present in the sample, its detection can be performed by a thermal conductivity detector or a helium ionization detector. Indeed, coupled to GC, no other detector can perform this detection except the expensive atomic emission detector. Based on the detection and analysis of H2 isotopes by low-pressure chemical ionization mass spectrometry (MS), a new method for H2 detection by GC coupled to MS with an electron ionization ion source and a quadrupole analyser is presented. The presence of H2 in a gaseous mixture could easily be put in evidence by the monitoring of the molecular ion of the protonated carrier gas.

Innovative method for carbon dioxide determination in human postmortem cardiac gas samples using headspace-gas chromatography-mass spectrometry and stable labeled isotope as internal standard

A novel approach to measure carbon dioxide (CO2) in gaseous samples, based on a precise and accurate quantification by (13)CO2 internal standard generated in situ is presented. The main goal of this study was to provide an innovative headspace-gas chromatography-mass spectrometry (HS-GC-MS) method applicable in the routine determination of CO2. The main drawback of the GC methods discussed in the literature for CO2 measurement is the lack of a specific internal standard necessary to perform quantification. CO2 measurement is still quantified by external calibration without taking into account analytical problems which can often occur considering gaseous samples. To avoid the manipulation of a stable isotope-labeled gas, we have chosen to generate in situ an internal labeled standard gas ((13)CO2) on the basis of the stoichiometric formation of CO2 by the reaction of hydrochloric acid (HCl) with sodium hydrogen carbonate (NaH(13)CO3). This method allows a precise measurement of CO2 concentration and was validated on various human postmortem gas samples in order to study its efficiency.

Virus vectors for gene delivery to the nervous system

A number of virus vectors have been developed for gene delivery to the nervous system. Virus vectors still provide the most efficient means of gene delivery, and this is critical as only a small volume of inoculum can be used without damaging neurons. Each of the four types of vectors currently in use have their advantages and disadvantages. Highest titers can be achieved with herpes virus and adenovirus vectors, with retrovirus and adeno-associated virus (AAV) vectors currently yielding lower titers. The transgene capacity of each from highest to lowest is: herpes virus (30 kb), adenovirus (8-10 kb), retrovirus (7-8 kb) and AAV (4.5 kb). All can infect a broad range of cell types in the nervous system, including neurons, glia and endothelial cells. Herpes, adenovirus and AAV vectors can deliver genes to postmitotic, as well as mitotic cells, while retrovirus vectors depend on cell mitosis for gene delivery. Herpes virus can assume a stable extrachromosomal configuration in the nuclei of some neurons (termed latency), while both retrovirus and AAV can integrate into the cell genome. Both integrate at random sites, but AAV can also integrate at a specific chromosomal location. Adenovirus neither assumes a stable state nor integrates, still its genome can persist and be expressed in the host cell for some time (up to a month or so). Stability of gene expression is a problem for all the vectors, due in part to the use of viral promoters which tend to be down-regulated by the host cell over a month or so. Both herpes virus vectors and adenovirus vectors have some toxicity in their current configurations, while retrovirus and AAV tend to be associated with less neuropathogenicity. Many developments in vectors should be occurring over the next few years that should increase the potential of these vectors for therapeutic gene delivery.

Polychlorinated naphthalenes (PCNs) in Irish foods: Occurrence and human dietary exposure

The concentrations of selected polychlorinated naphthalene (PCN) congeners (PCNs 52, 53, 66/67, 68, 69, 71/72, 73, 74 and 75) were determined in 100 commonly consumed foods, in the first study on occurrence of these contaminants in the Republic of Ireland. Congener selection was based on current knowledge on PCN occurrence and toxicology, and the availability of reliable reference standards. The determinations were carried out using validated analytical methodology based on 13C10 labelled internal standardisation and measurement by HRGC-HRMS. The results showed PCN occurrence in the majority of studied foods--milk, fish, dairy and meat products, eggs, animal fat, shellfish, offal, vegetables, cereal products, etc. ranging from 0.09 ng kg(-1) whole weight for milk to 59.3 ng kg(-1) whole weight for fish, for the sum of the measured PCNs. The most frequently detected congeners were PCNs 66/67, PCN 52, and PCN 73. The highest concentrations were observed in fish, which generally showed congener profiles that reflect some commercial mixtures. The data compares well with other recently reported data for Western Europe. The dioxin-like toxicity (PCN TEQ) associated with these concentrations is lower than that reported for chlorinated dioxins or PCBs in food from Ireland. The dietary exposure of the Irish adult population to PCNs was calculated following a probabilistic approach, using the full dataset of occurrence and current consumption data. The estimates of dietary intakes at approximately 0.14 pg TEQ kg bw(-1) month(-1) for adults on an average diet, reflects the relatively lower occurrence levels.

Adherence to medication among chronic patients in Middle Eastern countries: review of studies

This paper reviewed studies that have investigated adherence to medication among patients with chronic conditions in Middle Eastern countries. A comprehensive literature search yielded 19 relevant studies. These focused on the extent and predictors of nonadherence to medication across different conditions, including hypertension, chronic obstructive pulmonary disease, asthma, diabetes, depression, schizophrenia and epilepsy. Estimated rates of nonadherence to medication ranged from 1.4% to 88%. This review confirms the existence of nonadherence as a problem among patients with chronic diseases and examines our understanding about the reasons and variables affecting patients' adherence to their medication in the Middle Eastern countries. However, the studies employed a wide range of methods, sometimes with limitations. Further work to determine the prevalence and causes of patients' nonadherence to medication in Middle Eastern countries is needed in order to recommend the best interventions to improve adherence.

THE INFLUENCE OF THE PLASMA COLLOIDS ON THE GRADIENT OF CAPILLARY PERMEABILITY

The influence of osmotic conditions on the gradient of capillary permeability disclosed by the distribution into mammalian muscle of vital dyes has been tested experimentally. The percentage of circulating blood proteins was increased in rabbits by the injection of compatible plasma, or of compatible serum concentrate obtained by means of a new method of ultrafiltration which has proved both rapid and effective. It was found that when this had been done and the circulatory conditions had stabilized themselves, the gradient of capillary permeability still existed, though its effective extent was less than under normal circumstances. When the percentage of circulating blood proteins was reduced, on the other hand, by repeated bleedings with return of the cells, either as such or suspended in the protein-free fluid obtained by dialysis of serum, the extent of the gradient of capillary permeability was broadened and dye passed out into the tissue more readily than usual from the capillary as a whole. In contrast to these findings injection of a very hypertonic dextrose solution during the period when dye was escaping had no perceptible effect on the gradient of capillary permeability. The observed phenomena cannot be explained by a flow of dye-stained fluid into or out of the blood vessels. The gradient of capillary permeability exists independently of osmotic conditions, though its extent can be markedly influenced by altering the amount of circulating blood proteins. A considerable proportion of the dye used to study the gradient is adsorbed upon these proteins, as subsidiary experiments have shown. This happening provides a sufficient cause for the differences observed in the extent of the gradient when the percentage of proteins is increased or diminished. The evidence like that of previous papers indicates that the cause for the gradient is to be found in a structural differentiation along the capillary, such that the barrier offered by its wall progressively diminishes on the way to the venule. Most current estimates of the effective osmotic pressure of the blood proteins fail to take into account the existence of local differences in permeability along the capillary.