Colorectal cancer. Part 4: Specialist nurse roles

The key nurse specialists involved in the management of colorectal cancer include the colorectal nurse specialist, the stoma therapist and the chemotherapy nurse specialist. The specialist nurse must integrate management, consultation, research and education functions alongside the clinical role. The specialist nurse provides expert advice and information and support and helps the person to live with their diagnosis of cancer.

Colorectal cancer. Part 3: Patient care

Treatment for colorectal cancer will almost inevitably result in toxicity. Roy's model is ideal to enable nurses to monitor patients' physical and psychological condition. Patients need information about toxicity so that they report it promptly.

A programme management model for the Nova Scotia telemedicine network

Sustainable telemedicine networks are not the norm but rather the exception. Unless a formal programme management model is in place, telemedicine cannot be integrated successfully into the mainstream of modern health care. Critical factors in achieving sustainable telemedicine have been identified. The programme management model developed for the Nova Scotia Telemedicine Network incorporated the following tools: a telemedicine self-assessment indicator, service modelling, technical design and integration, application development and validation, scheduling, ongoing network management and evaluation.

Colorectal cancer. Part 2: Treatment

Treatment choice for patients with colorectal cancer will depend on the stage of disease and the patient's prognosis at the time of presentation. The primary treatment for potentially curable cancer is surgical resection. Radiotherapy is often used in conjunction with surgery, while chemotherapy may be used in all stages of the disease.

Colorectal cancer. Part 1: Epidemiology, aetiology, screening and diagnosis

Colorectal cancer causes significant mortality and morbidity in industrialised countries. Screening populations at an average risk of developing colorectal cancer by faecal occult blood testing can significantly reduce mortality. Nurses have a crucial role to play in educating the public about the warning signs of colorectal cancer and promoting uptake of screening.

Feelings of oncology patients about being nursed in protective isolation as a consequence of cancer chemotherapy treatment

This qualitative research explores the feelings of oncology patients nursed in protective isolation following high-dose chemotherapy. Five patients described their feelings about the isolation experience during audio-taped interviews lasting between a half and one hour. Tapes were transcribed and analysed, with emergent themes considered in relation to the other interviews and to the literature. The research findings indicate that cancer patients have specific concerns with regard to their experience in the isolation environment, which fall into four distinct categories of: 'being shut in'; 'coping with the experience'; 'being alone'; and 'maintaining contact with the outside world'. In addition, patients have concerns with regard to the experience of having cancer, that impinge upon the isolation experience. These are: 'having cancer'; 'suffering chemotherapy'; 'knowing what to expect'; and 'developing relationships with the health professionals'. The core variable is 'something that I have to go through'. The nature of the relationship between the categories led to the development of an integrative model for exploring the feelings of cancer patients nursed in isolation. Most of the informants coped well with the isolation experience and described feeling supported by the nursing staff. Their overriding concern in fact, reflected a desire to receive information about their disease and reassurance regarding their treatment. Being in isolation appears to inhibit communication about these issues.

Analysis of linked human epsilon and gamma transgenes: effect of locus control region hypersensitive sites 2 and 3 or a distal YY1 mutation on stage-specific expression patterns

Stage-specific expression of the human beta-like globin genes is controlled by interactions between regulatory elements near the individual genes and additional elements located upstream in the Locus Control Region (LCR). Elucidation of the mechanisms that govern these interactions could suggest strategies to reactivate fetal (gamma) or embryonic (epsilon) genes in individuals with severe hemoglobinopathies. This study extends an earlier analysis of a transgenic construct, HS3epsilon gamma, testing: (A) the effect of substitution of HS2 for HS3 on stage-specific expression of the epsilon and gamma genes and, (B) the role of an evolutionarily conserved YY1 binding site in transcriptional regulation of the gamma gene. The data show that both HS3epsilon gamma and HS2epsilon gamma can individually support embryonic expression of epsilon and fetal expression of Agamma. Thus, the cis regulators of distinct expression patterns for epsilon and gamma are likely to reside near the genes, rather than in specific hypersensitive sites of the LCR. Alterations in Agamma expression patterns observed in transgenic lines carrying a construct with a mutation in a conserved YY1 binding site at -1086 indicate that this site might function to facilitate active transcription of the gamma gene in fetal life.

Identification of a putative transcription factor gene (WBSCR11) that is commonly deleted in Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a complex developmental disorder involving the hemizygous deletion of genes on chromosome 7q11.23. The cardiovascular aspects of the disorder are known to be caused by haploinsufficiency for ELN, but the genes contributing to the other features of WBS are still undetermined. Fifteen genes have been shown to reside within the WBS deletion, and here we report the identification and cloning of an additional gene that is commonly deleted. WBSCR11, which was identified through genomic DNA sequence analysis and cDNA library screening, was positioned toward the telomeric end of the WBS deletion. The gene is expressed in all adult tissues analyzed, including many regions of the brain. The predicted protein displays homology to another gene from the WBS deletion, GTF2I, which is known to be a transcription factor. We postulate that WBSCR11 is also a transcription factor and may contribute to the spectrum of developmental symptoms found in WBS.

Comparison of the effectiveness of levofloxacin and amoxicillin-clavulanate for the treatment of acute sinusitis in adults

In this comparative trial, outpatients with acute sinusitis were randomly assigned to receive levofloxacin (500 mg orally once daily) or amoxicillin-clavulanate (500/125 mg orally 3 times daily) for 10 to 14 days. The success rates (cured and improved) 2 to 5 days after the end of treatment were 88.4% for the 267 clinically evaluable patients who received levofloxacin and 87.3% for the 268 clinically evaluable patients who received amoxicillin-clavulanate. Drug-related adverse events occurred in a smaller percentage of patients in the levofloxacin treatment group (7.4%) than in the amoxicillin-clavulanate treatment group (21.2%). The most common of these were nausea, diarrhea, vaginitis, and abdominal pain for levofloxacin-treated patients and diarrhea, vaginitis, nausea, genital moniliasis, abdominal pain, vomiting, and flatulence for amoxicillin-clavulanate-treated patients. The results of this study show that once-daily administration of levofloxacin is as effective and better tolerated than amoxicillin-clavulanate administered 3 times daily for treating acute sinusitis in adult outpatients.

Self-assessed health-related quality of life in men being treated for prostate cancer with radiotherapy: instrument validation and its relation to patient-assessed bother of symptoms

OBJECTIVES

To develop a psychometrically valid and clinically useful questionnaire to assess health-related quality of life (HRQOL) in patients with prostate cancer (PCa) undergoing external beam radiotherapy. The most important factors in three dimensions (bowel function [BF], urinary function [UF], and sexual function [SF]) were identified by patient survey.

METHODS

Three HRQOL dimensions were assessed using Likert-type questions. Responses were analyzed by factor analysis to create HRQOL scales. Reliability and validity of the scales were assessed. Because patients can suffer symptoms yet not report their lives to be affected, the scales were compared with patient-reported bother.

RESULTS

Two scales were identified within each dimension: BF, urgency and daily living; UF, urgency and weakness of stream; and SF, interest/satisfaction and impotence. Cronbach's alpha for the scales ranged from 0.63 to 0.94, and item-scale correlations and item-scale divergence correlations supported scale validity. Rising median scores correlated with rising levels of perceived bother.

CONCLUSIONS

The questionnaire is a suitable tool for assessing HRQOL in three distinct dimensions for patients undergoing radiotherapy for PCa. Six dimensions of HRQOL were found to be related to bother, suggesting important relationships to be monitored for patients. Urgency of bowel movements, urgency of urination, and level of interest/satisfaction in sex correlated most strongly with bother.

Patient-focused care: primary responsibilities of research nurses

This article provides a critical analysis of the concept of patient-focused care, and discusses its significance to the provision of nursing care in the UK today. Empowerment, as a component of patient-focused care, is addressed within the article in relation to government-led initiatives designed to afford certain rights to health consumers. It focuses specifically on the roles, responsibilities and concerns of the clinical research nurse in relation to patient-focused care and concludes that true patient-focused care will not happen until physicians, nurses and patients are educated and their attitudes changed.

Race and clinical outcome in patients with carcinoma of the uterine cervix treated with radiation therapy

OBJECTIVES

The aim of this study was to examine factors underlying differences in outcome between African-American (AA) and Caucasian (C) patients undergoing radiation therapy (RT).

METHODS

Patient, tumor, treatment characteristics, and the outcome of 316 AA and 94 C cervical cancer patients who underwent RT were compared. Median follow-up was 72.4 months.

RESULTS

AA patients had a trend to a poorer 8-year cause-specific survival (47.9 vs 60.6%) (P = 0.10) compared to C patients with a significant difference seen in stage IIB-IVA disease (34.3 vs 59.5%) (P = 0.04). Several factors correlated with poor outcome were present in the AA group including lower mean hemoglobin levels during RT (P = 0.001), lower median income (P = 0.001), and less frequent intracavitary RT (P = 0.09). In addition, while uncommon in C patients, health problems were major reasons for treatment protraction and inability to undergo intracavitary RT in the AA patients. Multivariate analysis demonstrated that race was not an independent prognostic factor after controlling for difference in patient, tumor, and treatment factors.

CONCLUSIONS

AA cervical cancer patients possess multiple factors that adversely impact upon the efficacy of RT. These findings may add further insight into the observed differences in outcome of cervical cancer patients based on race.

Caring for the technology dependent child--a case study

Children who are dependent on medical technology present unique challenges for families and health professionals who attempt to care for them at home. The medical and nursing needs of these children challenge and stretch the financial, social and emotional capacities of parents in ways that service providers do not fully understand. Case management is a collaborative parent/nurse model of community nursing practice that has been implemented to meet the needs of children and families with complex special needs where the care goes across primary and secondary care settings. The aim of case management is to facilitate communication and coordination of services between the multi-disciplinary team and the family to achieve desirable goals. This case study describes the special needs of a technology dependent child and the impact of chronic illness on both child and family. From a deeper understanding of the parent's perspective, implications for nursing practice are discussed.

Cocaine decreases cortical cerebral blood flow but does not obscure regional activation in functional magnetic resonance imaging in human subjects

The authors used functional magnetic resonance imaging (fMRI) to determine whether acute intravenous (i.v.) cocaine use would change global cerebral blood flow (CBF) or visual stimulation-induced functional activation. They used flow-sensitive alternating inversion recovery (FAIR) scan sequences to measure CBF and blood oxygen level-dependent (BOLD) sensitive T2* scan sequences during visual stimulation to measure neuronal activation before and after cocaine and saline infusions. Cocaine (0.6 mg/kg i.v. over 30 seconds) increased heart rate and mean blood pressure and decreased end tidal carbon dioxide (CO2). All measures returned to baseline by 2 hours, the interinfusion interval, and were unchanged by saline. Flow-sensitive alternating inversion recovery imaging demonstrated that cortical gray matter CBF was unchanged after saline infusion (-2.4 +/- 6.5%) but decreased (-14.1 +/- 8.5%) after cocaine infusion (n = 8, P < 0.01). No decreases were detected in white matter, nor were changes found comparing BOLD signal intensity in cortical gray matter immediately before cocaine infusion with that measured 10 minutes after infusion. Visual stimulation resulted in comparable BOLD signal increases in visual cortex in all conditions (before and after cocaine and saline infusion). Despite a small (14%) but significant decrease in global cortical gray matter CBF after acute cocaine infusion, specific regional increases in BOLD imaging, mediated by neurons, can be measured reliably.

Hostility, sodium consumption, and cardiovascular response to interpersonal stress

OBJECTIVE

Previous studies have reported poorer health behaviors in high vs. low hostile subjects. The role of stress in these observed differences has not been explored although interpersonal stress does increase cardiovascular response in high hostiles. Given evidence that stress may induce increased salt-intake, this study examined the role of hostility and interpersonal stress in increasing sodium consumption in addition to cardiovascular reactivity.

METHOD

Sixty-nine male undergraduates were categorized into high (HiHo) and low hostile (LoHo) groups based on Buss-Durkee Hostility Inventory scores. Subjects engaged in either a math task with harassment, math task without harassment, or a control/rest condition. Sodium intake was assessed posttask by having subjects ingest a sodium-free soup that was presented with a saltshaker without any comments. Cardiovascular measures were also recorded.

RESULTS

HiHo subjects consumed more salt than LoHo subjects irrespective of experimental condition. HiHo subjects who were harassed also exhibited greater cardiac output, systolic blood pressure, and forearm blood flow than did HiHo nonharassed, HiHo control, or LoHo subjects.

CONCLUSION

HiHo subjects exhibited increased salt-intake, although evidence for stress-induced salt-intake was not obtained. Nonetheless, the combination of salt and stress may contribute to the cardiovascular hyperreactivity and risk for cardiovascular disease in hostile individuals.

Multicenter, randomized study comparing levofloxacin and ciprofloxacin for uncomplicated skin and skin structure infections

BACKGROUND

The fluoroquinolone, levofloxacin, is active against most common pathogens in skin and skin structure infections.

METHODS

The efficacy, tolerability, and safety of levofloxacin and ciprofloxacin were compared in a randomized, open-label, multicenter trial of patients with uncomplicated skin and skin structure infections. Of 469 patients treated, 231 received levofloxacin (500 mg qd) and 238 were given ciprofloxacin (500 mg bid).

RESULTS

Overall clinical success rates (cured plus improved) for levofloxacin and ciprofloxacin were 98% and 94%, respectively (95% confidence interval [CI], -7.7, 0.7). Overall microbiologic eradication rates by patient were 98% in the levofloxacin group and 89% in the ciprofloxacin group (95% CI, -14.5, -2.7), whereas eradication rates by pathogen were 98% and 90%, respectively (95% CI, -12.6, -3.7). The eradication rate for Staphylococcus aureus was 100% in the levofloxacin group and 87% in the ciprofloxacin group (95% CI, -20.2, -5.1). Treatment-emergent adverse events were comparable, with drug-related adverse events reported in 6% of levofloxacin patients and 5% of ciprofloxacin patients.

CONCLUSIONS

Levofloxacin is as effective and safe as ciprofloxacin in the treatment of uncomplicated skin and skin structure infections.

Dynamic echo-planar imaging of the breast: experience in diagnosing breast carcinoma and correlation with tumor angiogenesis

PURPOSE

To correlate quantitative echo-planar magnetic resonance (MR) imaging measures of gadopentetate dimeglumine tumor uptake with histologic diagnoses and microvessel density (MVD) and to compare dynamic echo-planar imaging of breast lesions with conventional dynamic MR imaging techniques.

MATERIALS AND METHODS

The study group comprised 63 patients (aged 13-70 years) with 71 breast lesions who underwent conventional and echo-planar MR imaging. The T1 values, change in gadopentetate dimeglumine concentration, and extraction-flow products were calculated with the echo-planar imaging data and were correlated with histologic findings and MVD estimates. Extraction-flow product data normalized to pectoral muscle gadopentetate dimeglumine concentration in invasive cancers was also correlated with MVD.

RESULTS

On average, cancer T1 values were shorter than benign values, but there was substantial overlap between the two groups. Cancers had higher extraction-flow products than benign lesions (P < .001). Sensitivity, specificity, positive predictive value, and negative predictive value were 83%, 79%, 67%, and 90%, respectively. Receiver operating characteristic analysis showed improved performance with extraction-flow products than with percentages of signal intensity change. Among the invasive cancers, there was no significant correlation between extraction-flow product and MVD.

CONCLUSION

The T1 value remains important in more precise quantitative estimation of gadopentetate dimeglumine uptake in breast tumors, which helps improve the specificity of dynamic imaging. Tumor MVD affects the contrast medium enhancement of breast lesions, but other factors contribute.

Intravenous therapy: current practice and nursing concerns

The field of intravenous (i.v.) therapy has been subject to major change, with increasing numbers of nurses taking on the high profile, technical aspects of care. The transfer of previously medicalized tasks such as cannulation has been welcomed by nurses who are keen to develop practical skills in order to embrace the concept of holistic patient care. This literature review aims to clarify the role of the nurse in i.v. therapy, exploring cannulation as a specific issue. Legal and professional aspects are discussed in terms of extended/expanded practice and practical aspects in terms of i.v. access and maintenance. Discussion focuses on a team approach to the management of i.v. therapy. Finally, the nursing process is applied to an i.v. therapy scenario. Exploration of the nursing issues enables practitioners to justify the expansion of individual practice in order to deliver holistic care and improve standards of service. The review concludes that nurses cannot afford to lose sight of the caring component of their role as a result of immersion in the culture of technical skill acquisition.

From beyond to within their grasp: the rudiments of analogical problem solving in 10- and 13-month-olds

Four experiments were conducted to assess infants ability to solve isomorphic problems and to explore the nature of early representations. Ten- and 13-month-olds attempted to solve problems that required combining 2 subgoals to bring a toy (goal object) within reach. A problem-series paradigm was used in which 3 tasks differing in surface features but sharing common goal structures and similar solutions were presented. The results indicate that 13-month-olds transferred a modeled solution strategy across isomorphic problems, whereas 10-month-olds did so only after experiencing either multiple source problems or high perceptual similarity between problems. Comprehension of the relations between solution actions and outcome, and between tools and target object, appeared critical to transfer. The results suggest that 1-year-olds can construct relatively abstract and flexible mental representations and that analogical problem solving may be 1 of the major accomplishments during the 1st year of life.

From beyond to within their grasp: the rudiments of analogical problem solving in 10- and 13-month-olds

Four experiments were conducted to assess infants ability to solve isomorphic problems and to explore the nature of early representations. Ten- and 13-month-olds attempted to solve problems that required combining 2 subgoals to bring a toy (goal object) within reach. A problem-series paradigm was used in which 3 tasks differing in surface features but sharing common goal structures and similar solutions were presented. The results indicate that 13-month-olds transferred a modeled solution strategy across isomorphic problems, whereas 10-month-olds did so only after experiencing either multiple source problems or high perceptual similarity between problems. Comprehension of the relations between solution actions and outcome, and between tools and target object, appeared critical to transfer. The results suggest that 1-year-olds can construct relatively abstract and flexible mental representations and that analogical problem solving may be 1 of the major accomplishments during the 1st year of life.

Case mix type as a predictor of nursing workload

In the current health care service, the need to measure nursing workload has become the subject of major debate. Attempts have been made to relate workload and nurse staffing, however, despite there being systems for this there appears to be no single recognized formula. Case mix groups have been advocated as a useful tool for measuring nursing workload, particularly in Canada where work continues. Case mix groups work on the basis that patients who are clinically similar and use equivalent resources are grouped using procedure and diagnostic codes. The retrospective study examines the relationship between case mix, resource utilization and nursing effort to determine whether future workload could be predicted using these parameters. The sample included 798 patients and 30 nurses over the period 1993-1994 with analysis of data from the Patient Administration System (PAS) and TEAMWORK, which purports to measure nurse workload. Results showed that there was little relationship between nursing workload and case mix grouping and recommendations are made for future research.

Reducing bias in language assessment: processing-dependent measures

One potential solution to the problem of eliminating bias in language assessment is to identify valid measures that are not affected by subjects' prior knowledge or experience. In this study, 156 randomly selected school-age boys (31% majority; 69% minority) participated in three "processing-dependent" language measures, designed to minimize the contributions of prior knowledge on performance; and one traditional "knowledge-dependent" language test. As expected, minority subjects obtained significantly lower scores than majority participants on the knowledge-dependent test, but the groups did not differ on any of the processing- dependent measures. These results suggest that processing-dependent measures hold considerable promise for distinguishing between children with language disorders, whose poor language performance reflects fundamental psycholinguistic deficits, and children with language differences attributable to differing experiential backgrounds.