Quantity or quality?

The aim of nursing as a profession is to deliver a high quality service based on reliable and valid research findings. As a result, there is an urgent need to address the methodological issues arising from the quantitative-qualitative debate and the nature and resolution of the perceived theory-practice gap. Billy Kelly and Ann Long examines the key issues.

Impact on an accident and emergency department of Glasgow's new primary care emergency service

OBJECTIVE

To determine the impact, in terms of new attendance figures and types of patients attending, on a city centre accident and emergency (A & E) department following the establishment of out-of-hours primary care emergency centres (PCECs) in Glasgow.

METHODS

A questionnaire survey of A&E patients attending out-of-hours at Glasgow Royal Infirmary A&E department, a city centre department with approximately 68,000 new annual attendances, one week before (Group A), twelve weeks after (Group B) and one year after (Group C) the introduction of PCECs. Main outcome measures were attendance numbers within working hours and out-of-hours, reason for A&E attendance, duration of presenting condition, whether primary care services were contacted and awareness of the new primary care emergency centres.

RESULTS

In respect of out-of-hours attendances, 612 questionnaires were completed for group A, 715 for group B and 645 for group C. There was no significant difference in the type of presenting complaints between the groups, i.e. illness or injury. The majority of patients presented within 24 hours of the onset of their condition (82%, 79% and 80% of patients in groups A, B and C respectively). There was a reduction in those attending with conditions of more than one week's duration (8% in group A, 7% in group B and 5% in group C). There was a decrease in the number of patients who considered their problem to be non-urgent (27% in group A, 22% in group B and 16% in group C). Prior to the introduction of the PCEC service 18% of patients (108) had contacted their GP before attending, compared with only 9% (63) of group B and 9% (57) of group C patients. Of these patients there was a significant decrease in the number of patients attending following GP referral. Of the patients who had not contacted the primary care services only 35% (201) knew of the introduction of PCECs 12 weeks later, increasing to 52% (291) after one year (p < 0.01). Significance calculations were performed using a Difference of Proportion Test with a 99% significance level.

CONCLUSIONS

Our results suggest that the new PCEC service has not had a significant impact on the number or type of patients attending this A&E department, with fewer self-referred patients contacting primary care services after its introduction. Following the introduction of the PCECs there was a trend towards more patients attending A&E following telephone advice although amongst self-referred A&E patients there remained a large proportion who claimed to be unaware of the new service 12 weeks after, and one year after, the introduction of PCECs. Continued evaluation of the effect on A&E of the new centres will be required to plan future resources for the provision of emergency care.

Predictors of bereavement outcome for family carers of cancer patients

AIMS

The psychological outcome of family carers after bereavement is an important issue in evaluating palliative care services. Palliative care services have the potential to provide preventive psychosocial intervention to family carers prior to bereavement, but are faced with the need to identify those who may have greatest risk of adverse outcome. This prospective study examines predictors of psychological outcome for family carers of cancer patients following bereavement based on factors identified at referral to a palliative care agency.

METHODS

Cancer patients and their family carer were consecutively recruited and assessed on a range of clinical and psychological measures at referral to a palliative home care service in a metropolitan centre (Time 1). Carers were again assessed following the death of the patient, on average at 4 months post-bereavement (Time 2), using measures of bereavement symptoms and psychological morbidity.

RESULTS

178 carers were assessed on both occasions. The chief predictors of carer psychological symptoms and severity of grief at follow-up were psychological symptom scores at the time of referral (Time 1). Factors also measured at Time 1 were significant predictors of symptoms and grief scores at Time 2: greater number of adverse life events, carer's coping responses, past bereavement and separation experiences, the relationship with the patient, and greater severity of patient's illness at the time of palliative care referral.

CONCLUSIONS

The findings indicate clinical risk factors for adverse short-term bereavement outcome that can be identified in family carers during palliative care treatment, that have implications for identifying the psychological needs of carers, and that form a potential basis for interventions to enhance the psychological outcome for family carers.

Preserving moral integrity: a follow-up study with new graduate nurses

The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.

Posttraumatic stress disorder in response to HIV infection

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Suicidal ideation, suicide attempts, and HIV infection

A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human immunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n = 85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n = 79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV-positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a lifetime history of infection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and highlight the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.

Nutritional depletion in staged spinal reconstructive surgery. The effect of total parenteral nutrition

STUDY DESIGN

A prospective randomized study evaluating nutritional depletion in spine surgery patients.

OBJECTIVE

To determine whether use of total parenteral nutrition (TPN) in patients undergoing staged spinal reconstructive procedures could affect their nutritional parameters or decrease their complication rates.

SUMMARY OF BACKGROUND DATA

Several studies have shown that nutritional depletion occurs after major spinal surgery and that patients undergoing staged spinal surgery may be at particular risk of nutritional loss and its complications.

METHODS

Forty adult patients undergoing staged spinal reconstructive surgery were randomized as to whether they received TPN postoperatively. Nutritional parameters, including skin fold measurement and albumin, pre-albumin, transferrin, and total lymphocyte counts, were obtained pre-operatively and at regular intervals.

RESULTS

Five patients did not complete the study, leaving 35 patients for analysis. There was a significant decrease in incidence of albumin and pre-albumin depletion for the patients who did not receive TPN compared with those who did receive TPN (P < 0.025, P < 0.006, respectively). Patients with depleted albumin or pre-albumin counts were more likely to develop other postoperative infectious complications such as pneumonia or urinary tract infections (P < 0.035). There were no statistically significant differences in wound complications in this small patient study. There were no complications secondary to use of the TPN.

CONCLUSIONS

For complex patients requiring staged anterior/posterior surgery, TPN appears to significantly lessen the decrease in nutritional parameters. Because depletion of nutritional parameters appears to correlate with an increased likelihood of perioperative infectious complications, use of TPN may result in a decrease of such complications in these patients.

Psychiatric disorder in HIV infection

OBJECTIVE

This study aimed to investigate rates of psychiatric disorder in human immunodeficiency virus (HIV) infection, in an Australian sample of homosexual and bisexual men.

METHOD

A cross-sectional study of a total of 65 HIV sero-negative (HIV-) and 164 HIV sero-positive men (HIV+) (79 CDC stage II/III and 85 CDC stage IV) was conducted in three centres. Lifetime and current prevalence rates of psychiatric disorder were evaluated using the Diagnostic Interview Schedule Version IIIR (DIS-IIIR).

RESULTS

Elevated current and lifetime rates of major depression were detected in both HIV negative and HIV positive homosexual/bisexual men. Lifetime rates of alcohol abuse/dependence were significantly elevated in HIV positive men (CDC group IV) when compared with HIV negative men. Among the HIV positive group the majority of psychiatric disorders detected were preceded by a pre-HIV diagnosis of psychiatric disorder. Major depression represented the disorder most likely to have first onset after HIV infection diagnosis.

CONCLUSIONS

Lifetime rates of major depression were elevated in this sample of HIV-negative and HIV-positive men. In the HIV-positive men, psychiatric disorder was significantly associated with the presence of lifetime psychiatric disorder prior to HIV infection diagnosis. The findings indicate the importance of evaluation of psychiatric history prior to HIV infection and the clinical significance of depressive syndromes in this population.

A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease

OBJECTIVE

To determine the validity and reliability of a rapidly administered neurocognitive screening battery consisting of 4 brief tests (Enhanced Cued Recall, Temporal Orientation, Verbal Fluency, and Clock Drawing) to distinguish between patients with probable Alzheimer's disease (AD) and healthy control subjects.

SUBJECTS

Sixty successive referrals to the Memory Disorders Clinic at Southwestern Vermont Medical Center, Bennington, who were diagnosed as having probable AD and 60 community-dwelling volunteers of comparable age, sex distribution, and education.

DESIGN

Interrater and test-retest reliability, intergroup comparisons between patients with AD and control subjects on the 4 individual tests, and determination of probability of dementia for patients with AD and control subjects using the entire battery of tests.

SETTING

Outpatient care.

MAIN OUTCOME MEASURE

Comparison of the probability of dementia on the 7 Minute Screen with the criterion standard of clinical diagnosis established by examination and laboratory studies.

SECONDARY OUTCOME MEASURES

Test-retest and interrater reliability (correlation coefficients), time for administration.

RESULTS

Mean time of administration was 7 minutes 42 seconds. Mean scores for patients with AD and control subjects on all 4 individual tests were significantly different (for each, P<.001). When the 4 tests were combined in a logistic regression, the battery had a sensitivity of 100% and a specificity of 100%. A series of 1000 repeated random samples of 30 patients with AD and 30 control subjects taken from the overall sample of 60 patients with AD and 60 control subjects had a mean sensitivity of 92% and a mean specificity of 96%. The battery was equally sensitive to patients with mild AD as demonstrated by correctly classifying all 13 patients with AD using Mini-Mental State Examination scores of 24 or higher. Neither age nor education was a statistically significant factor when added as a covariate. Test-retest reliabilities for individual tests ranged from 0.83 to 0.93. Test-retest reliability for the entire battery was 0.91. Interrater reliability for the entire battery was 0.92.

CONCLUSIONS

The 7 Minute Screen appears highly sensitive to AD and may be useful in helping to make initial distinctions between patients experiencing cognitive changes related to the normal aging process and those experiencing cognitive deficits related to dementing disorders such as AD. It has reasonable interrater and test-retest reliability, can be administered in a brief period, and requires no clinical judgment and minimal training.

A Native American community initiative to prevent diabetes

The increasing prevalence of obesity and diabetes in the Mohawk Community of Akwesasne led to the formation of an advisory group who's mission was to increase community awareness and strengthen the infrastructure necessary to create a community coalition to promote healthy lifestyles. The methodology used to reach these goals included: obtaining an understanding of the community's knowledge, attitudes and behaviors about diabetes, diet and exercise using semi-structured interviews and focus groups; analyzing data from a case control study of diabetes and it complications using a medical record review; exploring methods for evaluating energy expenditure in children; and identifying influential community members and organizations. In the last 50 years people had become less physically active and high fat, high caloric foods were more available. Community members were concerned about health and the well-being of their children, had knowledge about healthy lifestyles but lacked confidence and social support for bringing about desired changes. A strong association was documented between diabetes, smoking cigarettes, high blood cholesterol and vascular disease in this community. Approximately 100 persons participated, several hundred received the results in presentations to 17 community organizations, two public fora, letters to participants and articles in local newspapers. Fifty persons and 29 businesses or organizations regarded as strong advocates of healthy lifestyles were identified. From these a community coalition was formed and has initiated programs to reduce dietary fat and increase physical activity in young children.

Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care?

BACKGROUND

The content of discharge prescriptions/summaries to improve communication about medication provided at discharge has been the subject of recent studies. To date, the authors are not aware of any literature that assesses the need for primary care health professionals to receive information on reasons for drug therapy changes incurred during hospital admission. Owing to increased emphasis on seamless care, patient education, and increased accountability for drug costs, general practitioners (GPs) and community pharmacists may consider the receipt of information on the reasons for drug therapy changes incurred during hospital admission to be an essential requirement.

AIM

To determine whether GPs and community pharmacists want, and receive, information on the reasons for drug therapy changes implemented by secondary care. The preferred method of acquiring this information is also investigated.

METHOD

A questionnaire was posted to all GPs and community pharmacists within the catchment area of Glasgow Royal Infirmary University NHS Trust. Data were collected between June 1995 and July 1995.

RESULTS

Replies were received from 71 (64%) GPs and 33 (80%) community pharmacists. Of the respondents, 96% of GPs and 94% of community pharmacists would like information on one or more reason types for drug therapy changes, but the majority do not receive the desired information. Ninety per cent of GPs and 85% of community pharmacists seek this information of facilitate continuity of patient care. The preferred method of receiving the information is by postal delivery via a modified hospital discharge prescription.

CONCLUSION

The existing hospital discharge prescription requires modification to facilitate the completion of the reasons for drug therapy changes. The issue of patient-held cards requires consideration. These factors may facilitate continuity of patient care on hospital discharge.

Penetration of cryotherapy in treatment after shoulder arthroscopy

Fifteen patients undergoing shoulder arthroscopy had indwelling temperature probes placed in the glenohumeral and subacromial spaces. All shoulders underwent diagnostic arthroscopy and debridement of the subacromial space. Cryotherapy was delivered to the shoulder via a Cryo/Cuff (AirCast, Summit, NJ) and temperatures were monitored for 90 minutes. Ten shoulders received cryotherapy and 5 were used as controls. Before cryotherapy, temperature averaged 34 degrees C in the glenohumeral joint and 31 degrees C in the subacromial space. No significant difference was seen between the temperatures recorded in the cold therapy and control groups for either the glenohumeral or subacromial space. In all cases, the subacromial space averaged 1 degree cooler than the glenohumeral joint at the conclusions of arthroscopy. These slowly equalized to an average of 35 degrees postoperatively. The present study shows that surface-applied cryotherapy does not penetrate either the glenohumeral joint or the subacromial space. Attention must be turned elsewhere to delineate how cryotherapy works.

Is dynamin really a ‘pinchase’?

The motivation for this article was a recent conversation with an author of a major cell-biology textbook who was gratified that the problem of ?pinching off? membrane vesicles from donor membranes had been solved.It was now known, the author claimed, that the large GTPase dynamin was a ?pinchase? severing the necks of budding vesicles.We are concerned that this appealing speculation has been prematurely elevated to cell-biological dogma.Furthermore, by seeing dynamin exclusively as a pinchase we might fail to recognize alternative functions.In this article, we review briefly the evidence that dynamin is a pinchase, discuss some problems with that speculation and show that other possible functions for dynamin may be at least as appealing.

Impact of the in-house trauma surgeon on initial patient care, outcome, and cost

BACKGROUND

The purpose of this study is to evaluate the effect of having attending trauma surgeons with added qualifications in surgical critical care present for the initial resuscitation at a regional trauma center.

METHODS

This study is a retrospective review of patients admitted between August of 1994 and December of 1995 from our trauma registry. The patients were categorized by the call preference of the admitting physician as in-house (IH) or call-back from home (CB), day of admission (weekend vs. weekday), time of admission (AM VS. PM), and a value of the injury severity scale < or = 15 or > 15. Demographics, admission vital signs, Injury Severity Scale, Glasgow Coma Score, and elapsed time to diagnostic, therapeutic, and/or operative interventions were studied. The effect on intensive care unit length of stay, mortality, and hospital cost for resuscitation were also studied.

RESULTS

The study population consisted of 1,043 patients. The IH and CB groups each included two attending surgeons. IH significantly reduced the average time to completion of diagnostic peritoneal lavage (22 vs. 34 minutes; p < 0.05), therapeutic intervention (21 vs 38 minutes; p < 0.05), and transport to the operating room (206 vs. 312 minutes; p < 0.05) during the AM compared with CB. There was no difference in these times for the PM admissions. There was no significant difference in intensive care unit length of stay. Among patients with severe head and thoracoabdominal injury (Abbreviated Injury Score > 4 and 3, respectively) there was no difference in mortality. Analysis of cost for emergency room resuscitation in severely injured patients (Injury Severity Score > or = 15), seen during weekdays, was significantly less when evaluated by IH (IH = $5,097 vs. CB = $6,779; p < 0.05).

CONCLUSIONS

During the initial resuscitation of patients with severely injured during the weekdays, IH significantly reduced the cost, and elapsed time to diagnostic testing, therapeutic intervention, and to the operating room, respectively. IH reduced fatalities compared with CB.

Hospital nursing: 'it's a battle!' A follow-up study of English graduate nurses

The purpose of this follow-up study, conducted 4 years after the initial study, was to elicit the recollections of English graduate nurses regarding their first year as qualified nurses in hospital nursing. The method was qualitative, specifically a grounded theory approach was used. The design was retrospective. The initial study took place when informants were in their final year before graduation. The follow-up study began after informants had been practising for between 3 and 4 years. Data were collected through semi-structured, in-depth, audio-taped interviews and were analysed through the constant comparative classification of patterns and themes. Research questions were: 'what do graduates nurses recall about their first year of practice in hospital nursing?' and 'what do they perceive as the difficulties of maintaining their standards?' Findings revealed the core variable as role stress. The stressful experience of living up to their individual perceptions of the role of being a graduate nurses was related to the influence of educational socialization, self-expectations, and nursing management expectations.

Speaking up: a moral obligation

As we rush around attending to the essentials of our lives (family, friends, clients, employers), what is left? Nursing Forum invites readers to engage in thoughts and activities that may awaken an untouched place. We hope these writings will kindle your personal involvement in something that was previously avoided--because of bias, fear, or uneasiness--in order to stretch your mind and spirit. The purpose of this paper is to explore the act of speaking up as a moral obligation and its relationship to moral courage and habit. The difficulties of speaking up and the consequences of silence are examined. The benefits of speaking up are raising self-respect, gaining courage, forming good habits and passing on that legacy.

Optical lateral inhibition networks that use self-linearized self-electro-optic-effect devices: theory and experiment

The self-linearized self-electro-optic-effect-device (SL-SEED) phenomenon observed with a quantum-well modulator and photodiode serial combination is one of the few practical routes to optical subtraction. A family of optical lateral inhibition architectures based on the SL-SEED that incorporate optical feedback is introduced and their operation confirmed in simulation. A successful experimental demonstration based on these ideas, performing edge-contrast enhancement by lateral inhibition, is described. System interconnections are both optical and electrical, with nonlocal interconnections being made optically by the use of diffractive elements.

Splenectomy in cancer surgery: diminishing indications?

The diminishing enthusiasm towards performing splenectomy (SPL) either as an integral part of surgical cancer management (SCM), or for staging/management (ST) of lymphoma, warranted our assessment of the extent of this trend in a minority population. We retrospectively analysed all SPL submitted to Surgical Pathology for histological processing over a 24-year period (1/1/70-12/31/93) at the Howard University Hospital, a predominantly African-American institution. Of the 446 SPL performed during the period, sixty-nine (15.5%) were performed as part of SCM/ST. Seventy-five per cent (52/69) were for solid intra-abdominal cancers (SIC) and 25% (17/69) for lymphoma. As a group, the patients were older, 71% over 40 years old) and showed a male predominance (61% males). Sixty-two per cent (43/69) of the SPL were performed in the decade 1970-1979. In the following decade 1980-1989, the frequency with which SPL was performed, had dropped to 33% (23/69). Four years into the current decade, 1990-1993, only 5% (3/69) of the SPL were performed for SCM/ST. These findings suggest that in African-Americans, the performance of SPL in ST/SCM has been declining over the years, which is in agreement with the current growing trends in cancer treatment i.e. to avoid unnecessary operations, limit morbidity, preserve important organs, maintain immunocompetence of the patient and to utilize advanced imaging techniques in ST/SCM.

A comparison of the psychosocial aspects of AIDS and cancer-related bereavement

OBJECTIVE

This study compares the psychological symptoms and bereavement distress of individuals bereaved by AIDS with a group bereaved by a cancer death, and addresses the question of whether an AIDS death is associated with a higher rate of adverse psychosocial factors that may increase risk of psychological morbidity in the bereaved individuals.

METHOD

AIDS (n = 28) and cancer (n = 30) bereaved individuals (all within 3 months of the bereavement) completed measures of psychological morbidity and measures addressing a range of other adverse factors, e.g., number of losses, levels of social support and stigma.

RESULTS

The cancer and AIDS bereaved were essentially similar on all psychological symptom measures. The AIDS group reported lower levels of social support in response to the bereavement than cancer bereaved individuals; a greater number of bereavements, were more likely to conceal the cause of death from significant others including their own family and perceived, in some instances, a greater level of rejection from others. The AIDS group reported higher levels of social support from friends than from family.

CONCLUSIONS

At three months following bereavement, AIDS and cancer bereaved were similar in levels of distress. While this may change with the progress of grief over time, it suggests essentially similar early bereavement responses. Those bereaved by AIDS reported a range of other adverse factors such as a greater number of losses, lower social support, stigma, and less open disclosure of the cause of death.

Cultural factors in dialysis and renal transplantation among aborigines and Torres Strait Islanders in north Queensland

Australian Aborigines experience end-stage renal disease at 10 times the national average. Although contributing physiological factors have been widely discussed, there has been little research into cultural factors affecting treatment and outcomes. This paper discusses folk and lay understandings of renal physiology and disease aetiology, and social and cultural factors in dialysis and transplantation, in a group of Aboriginal and Torres Strait Island renal transplant recipients. The implications for service delivery include the need for improved and clear information regarding renal disease and treatment and for culturally appropriate and acceptable support systems. Beliefs that continued alcohol consumption and poor nutrition were major reasons for kidney failure and separation from kin and country emerged as significant factors affecting treatment and leading to poor outcomes.

Quality of life in chronic fatigue syndrome

Whilst the debilitating fatigue experienced in patients suffering from Chronic Fatigue Syndrome (CFS) results in a subjective marked impairment in functioning, little research has investigated the impact of this disorder on quality of life. Forty-seven subjects with a confirmed diagnosis of CFS and 30 healthy controls were compared using the Sickness Impact Profile (SIP). A subgroup of subjects were interviewed regarding the impact CFS has had on their social and family relationships, work and recreational activities. Results from both the SIP and the interview revealed that CFS subjects had significantly impaired quality of life, especially in areas of social functioning. These findings highlight the importance of addressing the social isolation and loss of role functioning experienced by CFS sufferers.

The Howard University Hospital Transplant and Dialysis Support Group: twenty years and going strong

This article discusses group therapy as part of a multidisciplinary approach to the management of the various psychological and physical rehabilitation concerns posed by kidney and liver transplant candidates and recipients at Howard University Hospital in Washington, DC. The group's history, format, intervention foci, and roles of clinicians and patients attending the group are described and evaluated. Given the relative paucity of research literature in this area, the authors offer recommendations for empirical evaluation of the benefits of multidisciplinary group psychotherapy in ameliorating physical and emotional suffering and prolonging life among transplant patients.

Psychological responses to malignant melanoma. An investigation of traumatic stress reactions to life-threatening illness

A cross-sectional study of 95 individuals with malignant melanoma was conducted to investigate posttraumatic stress responses to a diagnosis of melanoma and to validate the use of the Impact of Event Scale (IES) as a measure of the response to the trauma of life-threatening disease. The diagnosis and progression of malignant disease are likely to present a range of acute and chronic trauma to the individual and the individual's family. The findings suggest that the IES is a reliable and valid measure of this distress, with scores varying according to disease progression and prognostic status of nonmetastatic disease patients. This indicates the importance of clinical attention to the specific symptoms that may best reflect the traumatic impact of life-threatening illness and its progression, and the applicability of posttraumatic stress syndromes in understanding the psychological distress of this clinical population.

Energy expenditure and body fat distribution in Mohawk children

OBJECTIVE

Epidemiologic studies suggest that Native Americans, including the Mohawk people, have a high prevalence of obesity, diabetes, and cardiovascular risk. However, current information on alterations in related variables such as energy metabolism and body composition in Native Americans is almost exclusively limited to already obese Pima adults living in the Southwest. The aim of this study was to characterize energy metabolism and body composition in young Mohawk children (17 girls, 11 boys; aged 4 to 7 years) as compared to Caucasian children (36 girls, 34 boys; aged 4 to 7 years). Total energy expenditure was measured by doubly labeled water, postprandial resting energy expenditure by indirect calorimetry, and activity energy expenditure was derived from the difference between total and resting energy expenditure. Fat and fat free mass were estimated from bioelectrical resistance, and body fat distribution was estimated from skinfolds and circumferences.

RESULTS

There were no significant effects of ethnic background or sex on body weight, height, or body mass index. Fat free mass was significantly higher in boys and fat mass was significantly higher in girls, with no effect of ethnic background. Chest skinfold thickness, the ratio of trunk skinfolds:extremity skinfolds, and the waist:hip ratio were significantly higher in Mohawk children by 2.5 mm, 0.09 units, and 0.03 units, respectively, independent of sex and fat mass. Total energy expenditure was significantly higher in Mohawk children compared to Caucasian (100 kcal/day in girls, 150 kcal/day in boys), independent of fat free mass and sex, due to a significantly higher physical activity-related energy expenditure.

CONCLUSION

These data suggest that: 1) body fat is more centrally distributed in Mohawk relative to Caucasian children, and this effect is independent of sex and body fat content; 2) Mohawk children have a greater total energy expenditure than Caucasian children, independent of fat free mass, due to greater physical activity-related energy expenditure.

Comparative skin phototoxicity in mice with two photosensitizing drugs: benzoporphyrin derivative monoacid ring A and porfimer sodium (Photofrin)

Benzoporphyrin derivative monoacid ring A (BPD-MA) and Photofrin (porfimer sodium) are photodynamic anticancer agents. The chemical structures of the two regioisomers of BPD-MA are 9-methyl trans-(+/-)-18-ethenyl-4,4 alpha-dihydro-3,4- bis(methoxycarbonyl)-4 alpha, 8,14,19-tetramethyl-4,4 alpha-dihydro-3,4- bis(methoxycarbonyl)-4 alpha, 8,14,19-tetramethyl-23H,25H-benzo(b)porphine- 9,13-dipropanoate and 13-methyl-trans-(+/-)-18-ethenyl-4,4 alpha-dihydro-3,4- bis(methoxycarbonyl)-4 alpha, 8,14,19-tetramethyl-23H,25H-benzo(b)porphine- 9,13-dipropanoate. Photofrin (a registered trademark of American Cyanamid Co.) is a polyporphrin oligomer containing ester and ether linkages. The ability of BPD-MA or Photofrin to cause skin phototoxicity was investigated in mice exposed to simulated sunlight (light) 3, 24, or 48 hr after receiving a single intravenous injection of vehicle or 2, 10, or 20 mg/kg of BPD-MA or Photofrin. The data were from two studies conducted using male and female CD1 mice (approximately 7 weeks old). The hair of the dorsal thoracic area was clipped 24 hr prior to exposure to light. Mice were exposed to light for 5 min. The clipped area of skin was the primary site for the evaluation of phototoxicity. Mice were observed for 2 weeks after treatment. There were no significant findings in controls or in mice given 2 mg/kg of BPD-MA. When mice were exposed to light 3 hr after dosing, both BPD-MA (10 or 20 mg/kg) and Photofrin (2, 10 or 20 mg/kg) caused phototoxicity. Death occurred in all mice given 20 mg/kg of BPD-MA or Photofrin, and in the majority of mice given 10 mg/kg of Photofrin.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe psittacosis during pregnancy and suppression of antibody response with early therapy

A cluster of 3 cases of psittacosis occurred among members of one family. The initial case was a pregnant woman who presented with extensive multilobar infiltrates and severe respiratory distress necessitating mechanical ventilation. Her respiratory failure worsened during 36 h of erythromycin therapy. Improvement coincided with the termination of pregnancy and the initiation of doxycycline treatment. The remaining patients developed milder illness. Serologic assessment of the affected subjects suggests that early treatment may suppress antibody response.

Hyperaemia in rat neocortex produced by acute exposure to methylenedioxymethamphetamine

Cerebral blood flow and glucose utilization were measured in rat neocortex, hippocampus and striatum following methylenedioxymethamphetamine injection (5 mg/kg, i.v.), using the tracers [14C]iodoantipyrine and [14C]2-deoxyglucose, respectively. In control rats, blood flow was coupled to glucose metabolism, but in methylenedioxymethamphetamine-treated rats, marked hyperperfusion was measured in frontal and parietal cortex with no change in glucose use. This suggests that methylenedioxymethamphetamine has the potential to disrupt cerebrovascular control.