Computerized quality-of-life screening in an oncology clinic

PURPOSE

The purpose of these studies was to assess the feasibility and reliability of computerized quality-of-life screening for patients attending an outpatient breast cancer clinic. The screening program involved a computerized administration of the European Organization for Research and Treatment of cancer QUality of Life Questionnaire (EORTC QLQ-C30). The computer software generated a screening report that clinic staff members used in the clinical encounter to assist in identifying quality-of-life problems.

DESCRIPTION OF STUDY

Two studies are reported. In study I, 36 patients and either their nurses or physicians evaluated the feasibility of the screening program using questionnaires developed for this study. In study II, a separate sample of 50 patients completed both the computerized and paper-and-pencil versions of the QLQ-C30 to assess reliability and consistency of responding.

RESULTS

The results of study I indicate that the patients found the computerized administration to be an acceptable means of providing staff members with information on day-to-day functioning. Clinic nurses and physicians indicated that the report was useful in identifying problematic quality-of-life domains. The results of study II indicate that the computerized administration is highly correlated with the paper-and-pencil version and has similar internal consistency. Discrepancies in responses were identified, but were at an acceptable level.

CLINICAL IMPLICATIONS

The results of these studies indicate that computerized quality-of-life screening is feasible and may provide reliable data for research and quality assurance studies. Staff evaluations suggest that the written report may provide clinic staff members with a tool for identifying quality-of-life concerns in which individual patients are experiencing difficulty. Potential benefit to patients include productive use of waiting room time, greater efficiency in the assessment process, and an improved likelihood that nurses and physicians will recognize and attend to quality-of-life deficits. The valid, reliable, and efficient identification of important patient quality-of-life concerns allows multidisciplinary team members to focus meaningfully their clinical efforts within their respective areas of responsibility.

Role of nuclear factor-kappa B in atherogenesis

Transcription factors of the nuclear factor-kappa B (NF-kappa B)/Rel family have an important function in the regulation of a variety of genes involved in the inflammatory and proliferative responses of cells. Recent studies strongly indicate that the inducible transcription factor NF-kappa B is involved in the pathogenesis of atherosclerosis. Activated NF-kappa B is present in the fibrotic thickened intima-media and atheromatous areas of the atherosclerotic lesion, within smooth muscle cells, macrophages and endothelial cells, whereas little or no activated NF-kappa B can be detected in vessels lacking atherosclerosis. A variety of molecules have been identified in the atherosclerotic environment that are able to activate NF-kappa B in vitro. Furthermore, an increased expression of numerous genes known to be regulated by NF-kappa B has been found in the atherosclerotic lesion. Possible functional implications for activated NF-kappa B in atherogenesis are discussed here. The activation and role of NF-kappa B in atherosclerosis may provide a model for the involvement of the transcription factor in human chronic inflammatory disease.

Perception of medical symptoms according to gender of reporting person and type of symptom

Two hundred and eight male and female participants were given unanticipated memory and recognition tasks with which to recall and recognize medical symptoms, described on audiotapes by male and female individuals. Half of the presented symptoms were among those typically experienced by males; half were among those experienced mostly by females. Both memory and recall were better when the audiotaped reporting persons was male. Gender orientation of symptoms (male versus female orientation) was not associated with better recall or recognition, nor was the factor of subject gender. Although neither "male" nor "female" symptoms were seen generally as more serious overall, an interaction effect showed that symptoms were seen as more serious, especially in the case of the male audiotape, when they were incongruous with the gender of the reporting person. Some possible implications of the results are outlined. More research is required to assess the differential perception of medical and other types of symptoms.

Gender and support for mental health research in Ontario: 1992-94: a summary

Based on early research by Stark-Adamec (1981), the question was explored as to whether current mental health funding appeared to be more relevant to male or female concerns, or to neither specifically. Three data sets, consisting of a total of 117 grants and 43 Fellowships awarded by the Ontario Mental Health Foundation from 1992-1994, were coded in terms of these concerns. For both Grants and Fellowships, a high proportion were coded as being primarily concerned with neither gender specifically. Some additional data, in terms of DSM III-R categories and grant committee memberships, were also explored, with, in general, similar findings. From one perspective, therefore, these findings do not support the notion of "gender bias." From another perspective, however, it does lend current support to Stark-Adamec's earlier findings that the mental health concerns of women remain poorly represented in mental health funding. Some discussion, as well as implications and limitations of the findings, are outlined.

Responses of perioperative nurses to organ procurement surgery

For many hospitals, organ retrieval surgery has become a reality. Organ retrieval surgery is an emotive procedure, fraught with ethical and moral dilemmas (Barzizza, 1990; Kawamoto, 1992). Perioperative nurses who participate in the procurement phase of organ donation are subject to emotions that could be potentially difficult. There is a need for greater understanding of perioperative nurses and their responses to procurement surgery. Increased knowledge of the procedure of organ procurement surgery, in addition to greater emotional support and follow-up can only serve to improve perioperative nurses' belief in themselves as an important link in the process of organ donation, procurement and transplantation.

Nurses' accounts of cardiopulmonary resuscitation

The relationship between theory and practice has received considerable attention within the nursing literature. This paper uses qualitative data from debriefing interviews with nurses following episodes of cardiopulmonary resuscitation (CPR) to illustrate the complexities of translating sanitized theory into the messiness of practice. The interplay of affect and cognition on both learning from experience and on professional practice are explored. The feelings engendered by the CPR event and the labour required for their management form the second and major part of the paper. These are explored by examining the realities of a CPR event with its accompanying threat of death; success and failure, dignity versus indignity and the place of appropriate emotions throughout.

Activated transcription factor nuclear factor-kappa B is present in the atherosclerotic lesion

Nuclear factor-kappa B (NF-kappaB)/Rel transcription factors play an important role in the inducible regulation of a variety of genes involved in the inflammatory and proliferative responses of cells. The present study was designed to elucidate the implication of NF-kappaB/Rel in the pathogenesis of atherosclerosis. Activation of the dimeric NF-kappaB complex is regulated at a posttranslational level and requires the release of the inhibitor protein IkappaB. The newly developed mAb alpha-p65mAb recognizes the IkappaB binding region on the p65 (RelA) DNA binding subunit and therefore selectively reacts with p65 in activated NF-kappaB. Using immunofluorescence and immunohistochemical techniques, activated NF-kappaB was detected in the fibrotic-thickened intima/media and atheromatous areas of the atherosclerotic lesion. Activation of NF-kappaB was identified in smooth muscle cells, macrophages, and endothelial cells. Little or no activated NF-kappaB was detected in vessels lacking atherosclerosis. Electrophoretic mobility shift assays and colocalization of activated NF-kappaB with NF-kappaB target gene expression suggest functional implications for this transcription factor in the atherosclerotic lesion. This study demonstrates the presence of activated NF-kappaB in human atherosclerotic tissue for the first time. Atherosclerosis, characterized by features of chronic inflammation and proliferative processes, may be a paradigm for the involvement of NF-kappaB/Rel in chronic inflammatory disease.

Practice development units: progress update

Following a previous Nursing Standard article about the Seacroft Hospital practice development unit (1), this article describes the progress which has been made since. The author describes some of the problems the unit has encountered, explains how staff have managed change and analyses the implications for the PDU model which have arisen from those developments.

The evolution of practice

This paper describes the development, role and functions of a nursing clinical practice group. In the first section, the transition of the clinical practice group from a low-key, management-led and reactive group, to one which is clinically led, high-profile and proactive, influencing and shaping nursing decisions within the unit in which it operates is described. In the second, the focus is on the approach of the clinical practice group to issues surrounding the Scope of Professional Practice using this to illustrate the group's proactive nature and its potential for bringing about and supporting change in practice.

Views of mixed sex wards: a survey of patients, carers and nurses

This paper describes the design and implementation of a survey carried out at Wharfedale General Hospital, related to the potential development of mixed sex wards. The survey of patients, carers and ward nurses, carried out in December 1992, demonstrated a general consensus of views on mixed sex ward options, and identified a number of key areas which need to be addressed before both sexes can be nursed satisfactorily on wards which have historically been used for males or females only. The recommendations arising from the survey are now being taken up by the hospital managers for further action.

Effects of the mental illness label in 1993: acceptance and rejection in the community

Effects of the mental illness label in obtaining community accommodation were examined, in a sample of 160 individuals advertising rooms or flats for rent in two Canadian cities, Windsor and London, Ontario, and in Detroit, Michigan. Telephone calls, for half the sample, made simple enquiries as to availability; for the other half, similar enquiries were made by an individual ostensibly receiving psychiatric treatment but soon to require accommodation. In the latter condition, rooms were significantly more likely to be described as unavailable. Comparisons are made to similar, previous research, and to current perspectives about community reactions to stigmatizing conditions.

Evaluation of the dietary intake of homebound elderly and the feasibility of dietary supplementation

OBJECTIVE

The dietary intake of elderly subjects receiving home care services (n = 145) was studied to assess the adequacy of their intake, and their ability to maintain normal body weight. In a second part of the study, the feasibility of providing nutrient supplements to underweight subjects or those with important recent weight loss was evaluated.

METHOD

For the survey, three 24-hour recalls, height, weight and lifestyle habits were evaluated in a home interview and two follow-up telephone contacts. The effects of dietary supplementation of 14 subjects at risk of malnutrition (underweight or with substantial weight loss) over 12 weeks were evaluated.

RESULTS

Mean energy intake for the entire group was low (males 1546 kcal; females 1152 kcal) and on average barely covered estimated resting energy expenditure. Recent weight loss was negatively correlated with energy intake among underweight subjects (R = -0.64; p < 0.001). Dietary supplementation resulted in an average increase in daily intake of 390 kcal with an average weight gain of 1.27 kg over the 12-week period. Weight change was directly associated with measures of functional status; hand-grip strength (r = 0.75; p = 0.002) and general well-being score (r = 0.46; p = 0.095).

CONCLUSION

Homebound elderly were at high risk of inadequate protein and energy intake. Dietary supplementation in high risk individuals was well tolerated and led to modest weight gain and improvements in general well-being.

Gender and support for mental health research

Grants awarded by the Ontario Mental Health Foundation (OMHF) between 1986 and 1991 were analyzed for their relevance to male and female mental health topics following earlier research by Stark-Adamec in 1981. OMHF fellowships and scholarships, 1986 to 1991, National Health Research and Development Program funding, 1989 to 1990 and 1990 to 1991 funding by the Medical Research Council were also examined. Essentially, funding focused on neither gender; issues concerning gender and mental health were seldom involved in research funded by these agencies.

Developmentally regulated expression of three slow isoforms of myosin heavy chain: diversity among the first fibers to form in avian muscle

At least three slow myosin heavy chain (MHC) isoforms were expressed in skeletal muscles of the developing chicken hindlimb, and differential expression of these slow MHC isoforms produced distinct fiber types from the outset of skeletal muscle myogenesis. Immunohistochemistry with isoform-specific monoclonal antibodies demonstrated differences in MHC content among the fibers of the dorsal and ventral premuscle masses and distinctions among fibers before splitting of the premuscle masses into individual muscles (Hamburger and Hamilton Stage 25). Immunoblot analyses by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of myosin extracted from the hindlimb demonstrated the presence throughout development of different mobility classes of MHCs with epitopes associated with slow MHC isoforms. Immunopeptide mapping showed that one of the MHCs expressed in the embryonic limb was the same slow MHC isoform, slow MHC1 (SMHC1), that is expressed in adult slow muscles. SMHC1 was expressed in the dorsal and ventral premuscle masses, embryonic, fetal, and some neonatal and adult hindlimb muscles. In the embryo and fetus SMHC1 was expressed in future fast, as well as future slow muscles, whereas in the adult only the slow muscles retained expression of SMHC1. Those embryonic muscles destined in the adult to contain slow fibers or mixed fast/slow fibers not only expressed SMHC1, but also an additional slow MHC not previously described, designated as slow MHC3 (SMHC3). Slow MHC3 was shown by immunopeptide mapping to contain a slow MHC epitope (reactive with mAb S58) and to be structurally similar to a MHC expressed in the atria of the adult chicken heart. SMHC3 was designated as a slow MHC isoform because (i) it was expressed only in those muscles destined to be of the slow type in the adult, (ii) it was expressed only in primary fibers of muscles that subsequently are of the slow type, and (iii) it had an epitope demonstrated to be present on other slow, but not fast, isoforms of avian MHC. This study demonstrates that a difference in phenotype between fibers is established very early in the chicken embryo and is based on the fiber type-specific expression of three slow MHC isoforms.

Training Special Olympics athletes: a pilot study

An individualized fitness program had no significant effect on the development of selected strength and endurance measures of 5 Special Olympics athletes.

Aggression in Alzheimer's disease

Aggression is a distressing, potentially harmful and challenging behaviour for nurses and carers to confront. This article explores the psychological and physiological theories of aggression in Alzheimer's disease, and arrives at the conclusion that greater understanding, acceptance and management skills are required of professionals and carers looking after such individuals.

The eosinophilia-myalgia syndrome: the Los Alamos Conference

On June 12 and 13, 1990 the Los Alamos National Laboratory in cooperation with the New Mexico Department of Health and Environment, the Centers for Disease Control (CDC), the Food and Drug Administration (FDA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) hosted a conference on the eosinophilia-myalgia syndrome. Fifty presentations covered a variety of important issues which are summarized herein.

The nature of the proteins lost from isolated rat skeletal muscle during experimental damage

Sodium dodecyl sulfate-polyacrylamide gel analysis of the incubation media surrounding isolated rat soleus muscles has been used to determine the nature of the proteins lost from skeletal muscle during damage. Following various forms of experimental trauma only selected proteins are lost to the medium when compared to the protein composition of the muscle cytosol. The proteins released do not appear to be released in a size dependent manner and their release is partly inhibited by an absence of calcium in the extracellular medium. alpha-Tocopherol entirely prevents the release of cytosolic enzymes induced by intracellular calcium overload.

Receptor-controlled calcium discharge in frog heart cells

A brief account is given of previous work concerned with the effects which ATP (P2-'purinergic') and alpha-adrenaline receptors have on the activity of the sarcoplasmic reticulum (SR) in frog heart atrial cells. More recent experiments made with single atrial trabeculae are also described which suggest, among other things, that ATP and alpha-adrenaline receptors both facilitate the process by which an action potential induces SR calcium discharge in atrial heart cells. The facilitatory effect involved is considerable; at high (greater than or equal to 2 microM) ATP doses, SR calcium discharge seems to be increased about 14-fold and, quite possibly, more than this. Results obtained with different levels of [Ca2+]o during ATP action suggest that the process of calcium-induced calcium release plays little part in the facilitatory process. Its putative mechanism is briefly discussed.

A cytosolic protein activator of cardiac sarcolemmal phosphoinositide phospholipase C

Ca2+ dependent polyphosphoinositide phospholipase C (PLC) activity in cardiac sarcolemma hydrolyzed both endogenous and exogenous phosphatidylinositol 4-phosphate (PIP) and phosphatidylinositol 4,5-bisphosphate (PIP2) with an associated increase in inositol bisphosphate (IP2). Dialyzed cytosol and certain fractions of cytosol isolated by anion exchange or gel filtration chromatography activated sarcolemmal PLC activity by approx. 100%. The PLC activator eluted with an apparent molecular weight of 160 Kdal on a Sephacryl 300 column and was destroyed by heat or trypsin treatment. Exogenous 3H-PIP2 was not hydrolyzed by cytosolic fractions containing sarcolemmal PLC activator. These studies demonstrate that the polyphosphoinositide PLC in cardiac sarcolemma is regulated by a cytosolic protein.