The debate about prostate cancer screening: what nurses need to know

OBJECTIVES

Special challenges and unique opportunities for nurses in the 21st century related to prostate cancer screening are reviewed.

DATA SOURCES

Current health care literature pertaining to prostate cancer screening issues.

CONCLUSIONS

Decisions that weigh the immediate risks of incontinence and erectile dysfunction against the long-term potential risk of death from advanced cancer must be made with conflicting values and incomplete data.

IMPLICATIONS FOR NURSING PRACTICE

With their expertise in patient education nurses are in a unique position to communicate the risks and benefits of prostate cancer screening in a manner in which patients can understand. A sample nursing care plan is presented for shared decision making.

Predicting breastfeeding duration using the LATCH breastfeeding assessment tool

The authors tested the validity of the LATCH breastfeeding assessment tool, controlling for intervening variables in 133 dyads. LATCH scores, mother's evaluation of an index feed, and intended duration of breastfeeding were assessed postpartum and followed 6 weeks. Women breastfeeding at 6 weeks postpartum had higher LATCH scores (mean +/- SD = 9.3 +/- 0.9) than those who weaned (mean +/- SD = 8.7 +/- 1.0), due to only one measure, breast/nipple comfort. Women who weaned before 6 weeks reported lower breast/nipple comfort (1.5 +/- 0.5) than those who were still breastfeeding at 6 weeks (1.7 +/- 0.5, P < .05). Total LATCH scores accounted for 7.3% of variance in breastfeeding duration. Total LATCH scores positively correlated with duration of breastfeeding (n = 128; r = .26, P = .003) and to mothers' scores (n = 132; r = .58, P = .001). Correlations among LATCH measures ranged from .02 to .51. The LATCH tool is a useful identifies the need for follow-up with breastfeeding mothers at risk for early weaning because of sore nipples.

[Social welfare in the care of chronically ill psychiatric patients]

The article shows the development of the long-stay departments at the psychiatric hospitals in Eastern Germany from the perspective of a local government. Against the apparently increasing scepticism of concepts of de-institutionalisation, the example of the city Leipzig is used to show how the process of reintegrating residents of long-stay institutions can be supported, and how decentralized out-patient psychosocial services--which can also be used by the community inhabitants--can be built up at the same time. Reference is also made to the well-developed out-patient services and clearly structured treatment offers for the inpatient sector which have already existed in the city before the political changes in Eastern Germany. Further, the role of the local Social Welfare Office in the realization of de-institutionalisation projects will be outlined.

Analysis of prostate seed loading for permanent implants

The goal of radioactive seed implantation in prostate cancer is to treat the tumor to the necessary dose while minimizing the dose to adjacent normal structures. The uniform and peripheral loading schemes used in the past have serious limitations. However, with the availability of three-dimensional treatment-planning systems, it has become possible to do custom volume loading based on volumetric ultrasound imaging of the gland. As a result, the dose distributions are more uniform, and the doses to the urethra and rectum are maintained in a safe range.

Telemedicine in the Malaysian Multimedia Super Corridor: towards personalized lifetime health plans

The Malaysian Telemedicine initiative advocates a paradigm shift in healthcare delivery patterns by way of implementing a person-centred and wellness-focused healthcare system. This paper introduces the Malaysian Telemedicine vision, its functionality and associated operational conditions. In particular, we focus on the conceptualisation of one key Telemedicine component i.e. the Lifetime Health Plan (LHP) system--a distributed multimodule application for the periodic monitoring and generation of health-care advisories for all Malaysians. In line with the LHP project, we present an innovative healthcare delivery info-structure--LifePlan--that aims to provide life-long, pro-active, personalised, wellness-oriented healthcare services to assist individuals to manage and interpret their health needs. Functionally, LifePlan based healthcare services are delivered over the WWW, packaged as Personalised Lifetime Health Plans that allow individuals to both monitor their health status and to guide them in healthcare planning.

[The operating room of the future]

Advances in computer technology will revolutionize surgical techniques in the next decade. The operating room (OR) of the future will be connected with a laboratory where clinical specialists and researchers prepare image-guided interventions and explore the possibilities of these techniques. The virtual reality is linked to the actual situation in the OR with the aid of navigation instruments. During complicated operations the images prepared preoperatively will be corrected during the operation on the basis of the information obtained peroperatively. MRI currently offers maximal possibilities for image-guided surgery of soft tissues. Simpler techniques such as fluoroscopy and echography will become increasingly integrated in computer-assisted peroperative navigation. The development of medical robot systems will make possible microsurgical procedures by the endoscopic route. Tele-manipulation systems will also play a part in the training of surgeons. Design and construction of the OR will be adapted to the surgical technology, and include an information and control unit where preoperative and peroperative data come together and from where the surgeon operates the instruments. Concepts for the future OR should be regularly adjusted to allow for new surgical technology.

Family-centered care: facing the new millennium. Interview by Elizabeth Ahmann

In an interview with the column editor, Beverley Johnson, President and Chief Executive Officer of the Institute for Family-Centered Care, shares her views on the state of family-centered care (see Table 1). A notable achievement over the past several decades has been the acknowledgment of family-centered care as the standard of care for children with special health care needs. Today there is a growing momentum to more broadly apply the principles of family-centered care in both pediatric and adult care settings, and much work needs to be done to build on the strong foundation that has been laid. Changing attitudes and practice, changing how families are viewed and how care is provided, developing collaborative approaches, and emphasizing the importance of relationships--changing in these ways the very culture of health care--will be necessary to make family-centered care a full reality. Many of these changes need to begin during the process of educating medical and nursing students. Health care institutions can support these changes by incorporating principles of family-centered care into personnel policies and practices, ensuring the hiring and support of individuals with family-centered skills and attitudes, and rewarding family-centered practice. Many of these changes can also be supported by research on the relationships between family-centered care and health care utilization, lengths of stay, and health care outcomes. The interview concludes as follows: "What is good for families and patients is often good for the health care system as well. Family-centered care is a winning proposition for all concerned."

Evidence-based dental plans: dentistry's future is now

Evidence-based dental practice is defined in terms of systematically collected and analyzed data on treatment outcome. By making this the common ground among dentists, patients, insurers, and others, it is possible to improve both the effectiveness and cost-efficiency of oral health care.

Holding on to success: a case study in mental health care reform

This article analyzes the changes experienced by a mental health care organization in response to environmental threats and fluctuating expectations. On a general, more theoretical level, the article demonstrates how processes of environmental selection as well as organizational adaptation shape organizational forms. On a concrete, applied level, those administrative practices are articulated that can help ensure that reform efforts are successful. Administrators also must be aware of the inertial forces operating upon stable organizational forms and work to ensure that the organization remains vital and open to change.

New frontiers in integrated care

A combination of extended life expectancy and the graying of America is resulting in a rapidly growing industry known as assisted living. Based on a Scandinavian model for senior housing, assisted living first emerged in America during the mid 1980s. The concept is still so new that states that license these facilities do not agree on a precise definition. It is generally considered a residential alternative between independent retirement living and total institutionalized skilled care.

Computer-based quality control in high-dose chemotherapy and bone marrow transplantation

High-dose chemotherapy with autologous and allogeneic blood stem cell transplantation has become a standard therapy for hematological malignancies and solid tumors. To ensure quality of treatment and adherence to internationally approved protocols, the use of computer systems has been introduced in some oncology centers. Most software packages cannot be used automatically by other institutions because of different treatment strategies and medications. To overcome this problem, we designed a software system based on an Oracle database, which allows the user to develop his own therapy blocks and assemble them to generate specific therapy plans. The system supports the daily work of the physicians by suggesting medications based on changes in the vital parameters or the clinical chemistry. Parameters can be given upper and lower limits whose surpassing leads to treatment suggestions by the system. All quantitative variables may be depicted in a graphical way. The system is connected to external laboratory devices. Export of data to international registries is possible. Until now, 43 patients have been transplanted with the help of this system. There is a high degree of acceptance among the nursing staff and the physicians. The system can be transferred to other centers, if the local hardware and network capacities meet the minimal requirements.

Treatment planning 2000: an esthetically oriented revision of the original implant protocol

Soft and hard tissue ridge deformities are prevalent in areas of tooth loss and trauma and can compromise esthetic outcomes. Only a full understanding of the severity of the dimensional defects, the reconstructive techniques available, and the functional and esthetic needs of the final implant restoration will allow the design of a treatment approach that will achieve the desired outcome. This article emphasizes the synergistic relation of the osseous, gingival, and restorative triad in treatment planning. In addition, a systematic approach to the enhancement of this triad, in the partially edentulous patient, is outlined as part of a revised protocol for achieving optimal esthetics in implant therapy.