The point of no return: beyond sexual functioning to sexual health assessment in oncology nursing

Disseminating research findings in a meaningful way is often a challenge. The topic of sexual health creates an even greater challenge. The work that numerous teams conducted within our research department had profound effects that altered the way in which we were practising cancer care. The Schering Lectureship provided the forum for our patients' collective voices to be heard. Artists in the world of music who crossed the spectrum from classical to country helped us to focus. The sexual health message was entwined in their words. That message became a personal interpretation we had not been able to convey with words alone. Through the songs, each nurse found his/her own meaning. To our surprise, this lectureship became a powerful medium for patients to speak out and nurses to learn. The nurses conducting the sexual health studies thank CANO and Schering Canada. To each oncology nurse who spoke about the message heard, please know that your words touched our hearts. While it has been a challenge to put this lectureship into a manuscript, it is hoped the written words will convey a similar message.

Influencing nurses' knowledge, attitudes, and practice in cancer pain management

The purpose of this study was to explore the effects of an education intervention on nurses' knowledge, attitudes, and practice in pain assessment and management over 3 months. The education intervention program was designed to change knowledge and influence the attitudes of registered nurses through a values clarification process using a conceptual framework based on a theory of reeducation. Participants in this descriptive, exploratory study were 53 nurses from six oncology units. Data were collected on their knowledge, attitudes, documentation practices, and analgesic choices in defined patient situations. The intervention was effective in changing the knowledge, attitudes, and behaviors of nurses in the study, but the effect was not maintained over time. Study findings suggest that further educational and organizational support is needed for effective practice in pain assessment and management. Further research should explore education programs that will maintain new knowledge over time. In addition, assessment of the effect that new knowledge has on the achievement of improved pain relief for patients should be explored in the future.

Funding Australia's basic biomedical research of 1993 and 1994

The meshing of two databases of scientific publications--the Wellcome Trust's Research Outputs Database, and the Research Evaluation and Policy Project's database of Australian publications--allows a detailed analysis of the funding agencies providing external (as opposed to intramural) support for Australia's basic biomedical research. This analysis shows the success Australian researchers are having in attracting funding from overseas, and the high citation rates achieved by publications with external funding.

Deletion of chromosome 18 with cardiomyopathy

A female child is described with deletion of chromosome 18 and cardiomyopathy. The clinical features and treatment of the case are described, and the literature of chromosome 18 reviewed.

Conceptualizing sexual health in cancer care

This qualitative study was designed to describe women's experiences with changes in sexual function related to physical comfort, sexual satisfaction, and feelings of intimacy post-treatment for gynecological cancer. The 17 women who participated in this study described sexuality as a much broader construct. Contrary to existing literature, sexual functioning was found to be one aspect that contributed to the view of the self as a sexual being, but the women's perceptions were not limited to this single dimension. The identification of multidimensional components to be considered in developing a conceptual model to describe sexual health are presented. This study indicates that sexuality should be viewed as a health issue that has an impact on quality of life.

Nurses' knowledge, experiences, and attitudes concerning living wills

A random sample of 974 registered nurses in Nova Scotia were surveyed during the 1995-96 registration year to determine their understanding of living wills legislation; their experiences, roles, and attitudes related to living wills; and their perceptions of the barriers to and resources for using living wills in their practice. Responses from 157 nurses indicated that they were unfamiliar with the Medical Consent Act, the Hospitals Act, and the Powers of Attorney Act. Although they revealed that they had a positive attitude towards living wills, and they identified nurses as the appropriate health professional to initiate discussions about living wills with patients, very few had any actual experience in this role. Respondents rated their understanding of living wills as low, and many indicated that they were uncomfortable discussing the topic with clients. Respondents saw both the individual nurse and the practice environment as barriers to the use of living wills, and they clearly indicated the need for interdisciplinary educational strategies to facilitate the use of living wills in their nursing practice.

Antithrombins Wibble and Wobble (T85M/K): archetypal conformational diseases with in vivo latent-transition, thrombosis, and heparin activation

The inherent variability of conformational diseases is demonstrated by two families with different mutations of the same conserved aminoacid in antithrombin. Threonine 85 underlies the opening of the main beta-sheet of the molecule and its replacement, by the polar lysine, in antithrombin Wobble, resulted in a plasma deficiency of antithrombin with an uncharacteristically severe onset of thrombosis at 10 years of age, whereas the replacement of the same residue by a nonpolar methionine, antithrombin Wibble, gave near-normal levels of plasma antithrombin and more typical adult thromboembolic disease. Isolated antithrombin Wibble had a decreased thermal stability (Tm 56.2, normal 57.6 degreesC) but was fully stabilized by the heparin pentasaccharide (Tm 71.8, normal 71.0 degreesC), indicating that the prime abnormality is a laxity in the transition of the main sheet of the molecule from the 5- to 6-stranded form, as was confirmed by the ready conversion of antithrombin Wibble to the 6-stranded latent form on incubation. That this transition can occur in vivo was shown by the finding of nearly 10% of the proband's plasma antithrombin in the latent form and also, surprisingly, of small but definitive amounts of latent antithrombin in normal plasma. The latent transition will be predictably accelerated not only by gross mutations, as with antithrombin Wobble, to give severe episodic thrombosis, but also by milder mutations, as with antithrombin Wibble, to trigger thrombosis in the presence of other predisposing factors, including the conformational stress imposed by the raised body temperatures of fevers. Both antithrombin variants had an exceptional (25-fold) increase in heparin affinity and this, together with an increased inhibitory activity against factor Xa, provides evidence of the direct linkage of A-sheet opening to the conformational basis of heparin binding and activation.

Canadian nurses' views on assignment of publication credit for scholarly and scientific work

A total of 184 Canadian nurses who were expected to publish scholarly and/or scientific work or whose roles provide for socialization of nurses in academic endeavours, research, and publication were asked to respond to 42 scenarios. This study replicated, with some modifications, surveys conducted in 1981, 1985, and 1987 to determine the views of American nurses on assignment of publication credit. The scenarios in the present survey required judgements about how authorship and footnote credit should be allocated among groups involved in research and academic writing; in some scenarios all the individuals were nurses (in both clinical and academic settings), while other scenarios featured collaboration between nurses and other health-care professionals or focused on interactions between nursing professors and students. While consensus of greater than 80% was achieved for only 7 of the 42 scenarios (modal responses), the respondents' written comments revealed 2 recurrent themes: that credit should be based entirely on contribution, rather than status; and that, as much as possible, authorship and footnote acknowledgement should be discussed and resolved before contentious issues arise. There was widespread agreement on these 2 principles. However, there was disagreement concerning collaborative academic work, particularly concerning the forms of collaboration that merit authorship credit and the forms that are sufficiently acknowledged through footnoting. Both the model responses and the areas of disagreement are discussed.

Engineering secondary metabolism in maize cells by ectopic expression of transcription factors

Manipulation of plant natural product biosynthesis through genetic engineering is an attractive but technically challenging goal. Here, we demonstrate that different secondary metabolites can be produced in cultured maize cells by ectopic expression of the appropriate regulatory genes. Cell lines engineered to express the maize transcriptional activators C1 and R accumulate two cyanidin derivatives, which are similar to the predominant anthocyanin found in differentiated plant tissues. In contrast, cell lines that express P accumulate various 3-deoxy flavonoids. Unexpectedly, P-expressing cells in culture also accumulate phenylpropanoids and green fluorescent compounds that are targeted to different subcellular compartments. Two endogenous biosynthetic genes (c2 and a1, encoding chalcone synthase and flavanone/dihydroflavonol reductase, respectively) are independently activated by ectopic expression of either P or C1/R, and there is a dose-response relationship between the transcript level of P and the degree to which c2 or a1 is expressed. Our results support a simple model showing how the gene encoding P may act as a quantitative trait locus controlling insecticidal C-glycosyl flavone level in maize silks, and they suggest how p1 might confer a selective advantage against insect predation in maize.

Engineering secondary metabolism in maize cells by ectopic expression of transcription factors

Manipulation of plant natural product biosynthesis through genetic engineering is an attractive but technically challenging goal. Here, we demonstrate that different secondary metabolites can be produced in cultured maize cells by ectopic expression of the appropriate regulatory genes. Cell lines engineered to express the maize transcriptional activators C1 and R accumulate two cyanidin derivatives, which are similar to the predominant anthocyanin found in differentiated plant tissues. In contrast, cell lines that express P accumulate various 3-deoxy flavonoids. Unexpectedly, P-expressing cells in culture also accumulate phenylpropanoids and green fluorescent compounds that are targeted to different subcellular compartments. Two endogenous biosynthetic genes (c2 and a1, encoding chalcone synthase and flavanone/dihydroflavonol reductase, respectively) are independently activated by ectopic expression of either P or C1/R, and there is a dose-response relationship between the transcript level of P and the degree to which c2 or a1 is expressed. Our results support a simple model showing how the gene encoding P may act as a quantitative trait locus controlling insecticidal C-glycosyl flavone level in maize silks, and they suggest how p1 might confer a selective advantage against insect predation in maize.

Localization by fluorescence in situ hybridization (FISH) of human mitochondrial polymerase gamma (POLG) to human chromosome band 15q24-->q26, and of mouse mitochondrial polymerase gamma (Polg) to mouse chromosome band 7E, with confirmation by direct sequence analysis of bacterial artificial chromosomes (BACs)

Cloned cDNAs for the human mitochondrial DNA polymerase gamma (POLG) were identified by homology with the yeast mitochondrial DNA polymerase catalytic subunit (MIP). Fluorescence in situ hybridization (FISH) of human and mouse bacterial artificial chromosomes (BACs), hybridized by radioactively labeled POLG cDNAs, mapped to human chromosome band 15q24-->q26, as well as to mouse chromosome band 7E. Direct sequencing of the BAC DNA without subcloning confirmed the presence of both human POLG and mouse mitochondrial DNA polymerase gamma (Polg) in the respective BACs.

Mapping Australia's basic research in the medical and health sciences

The Institute for Scientific Information indexes most of the major international basic research journals in science in the Science Citation Index (SCI). Australia's presence in the medical and health sciences journals in the SCI and the citations its published research receives in these journals show that Australia's basic medical research has high international "visibility". Mapping the source of the most highly "visible" Australian medical research articles shows high impact research coming from several different sectors (research institutes, universities, hospitals, etc.), but with a concentration in the member institutions of the Australian Association of Medical Research Institutes (AAMRI). Published research from the AAMRI is cited at a rate two-thirds higher than the Australian average for medical and health sciences.

Effects of insulin and insulin-like growth factors I and II on the growth of equine fetal and neonatal chondrocytes

The effects of insulin and insulin-like growth factors (IGFs) I and II on fetal and foal chondrocytes were investigated in vitro. Chondrocytes from the lateral trochlear ridge of the distal femur were obtained from 2 fetuses (280 and 320 days gestation) and one 4-day-old foal and cultured. Membrane proteins consistent with type 1 and type 2 IGF receptors were demonstrated by radioligand cross linking and equilibrium binding analysis. It was demonstrated that both IGF-I and IGF-II acted as mitogens for isolated equine chondrocytes when present as the sole mitogenic factor in monolayer culture. It was further shown that whereas insulin was able to promote the survival and expansion of cell populations of chondrocytes in culture there was significantly reduced mitogenic stimulation compared to the IGFs. These results suggest that the role of insulin in growth cartilage may be to promote chondrocyte survival, or to suppress differentiation/apoptosis. This supports the hypothesis that relative hyperinsulinaemia may be a contributory factor to equine dyschondroplasia (osteochondrosis). Understanding of contributory, and possibly triggering factors such as this may allow the development of modified methods of husbandry which minimise the risk of disease in populations with a known predisposition.

Aggregates of a beta-amyloid peptide are required to induce calcium currents in neuron-like human teratocarcinoma cells: relation to Alzheimer's disease

We report that human hNT cells display neuron-like calcium channel activation. Patch-clamp experiments show that exposure of hNT cells to the Alzheimer-related amyloid peptide beta AP(25-35) induces large and irreversible inward calcium currents at -80 mV in whole cell mode, with a linear current-voltage relationship. This behavior is suggestive of ionophore formation. An analogous peptide with scrambled sequence has no effect. These ionophore effects by the beta AP(25-35) peptide, the first report in a human cell-line, are very rapid effects. The currents are large and stable, and are blocked by Al3+ but not by Cd2+. Filtration removes a peptide aggregate from the amyloid peptide beta AP(25-35) solution and thereby abolishes the inward current. The residual soluble peptide has no effect. These data suggest that the initial step of the neurotoxic effect of beta AP(25-35) may be due to the insertion of the aggregated peptide into the cellular membrane as a Ca2(+)-carrying ionophore. The relevance of calcium-mediated cell death, especially in Alzheimer's disease, is discussed.

Quality of life and the cancer experience: the state-of-the-knowledge

PURPOSE/OBJECTIVES

To address the state-of-the-knowledge concerning quality of life (QOL) issues and the cancer experience from theoretical, research, clinical, and educational perspectives.

DATA SOURCES

Published books and articles and a panel of experienced QOL experts who convened at the Oncology Nursing Society's State-of-the-knowledge Conference on Quality of Life in February 1995.

DATA SYNTHESIS

Despite the evolution and support of QOL in oncology nursing practice, education, and research, there remains gaps in theory, research, and practice related to QOL. This article explores these gaps in knowledge and recommends future directions for QOL theory, research, education, and practice.

CONCLUSIONS

Further conceptual work and resolution of QOL methodologic issues to guide clinical practice and education are warranted. The impact of cultural variables and precancer life experiences on patients' perceptions of QOL also must be addressed.

NURSING IMPLICATIONS

Oncology nurse clinicians, educators, and researchers must continue to work collaboratively to enhance the knowledge base regarding QOL and to improve the nursing care provided to individuals with cancer.

Salpingectomy improves the pregnancy rate in in-vitro fertilization patients with hydrosalpinx

The objective of this study was to assess the impact on pregnancy outcome of excising hydrosalpinx(ges) in patients with repeated in-vitro fertilization (IVF) failures. A group of 15 patients who had previously undergone failed IVF attempts and had unilateral or bilateral hydrosalpinx was subjected to an operative laparoscopy with excision of the affected tube(s). Of these, 10 patients underwent a unilateral salpingectomy and five had a bilateral salpingectomy. Stimulated cycles of IVF and/or cryo-thaw cycles were then carried out post-salpingectomy and the results were compared to those of pre-salpingectomy cycles. There was no statistically significant difference between the number of mature eggs retrieved, peak oestradiol concentrations, number of days to human chorionic gonadotrophin administration, or number of pre-zygotes frozen in the stimulated cycles pre- versus post-salpingectomy. Pre-salpingectomy, 15 patients underwent 38 stimulated cycles and eight patients underwent 14 cycles with cryopreserved-thawed embryos, achieving one pregnancy from a fresh transfer that resulted in a miscarriage. Post-salpingectomy, eight patients underwent 12 stimulated cycles, achieving five clinical pregnancies (two miscarriages and three ongoing pregnancies, i.e. either delivered or a pregnancy > or = 20 weeks), and nine patients underwent 10 cycles with cryopreserved-thawed embryos, achieving four clinical pregnancies (one miscarriage and three ongoing). We conclude that excision of hydrosalpinx(ges) improves the pregnancy potential after IVF, and that new and repeat IVF patients should be counselled accordingly.

The incidence of multiple gestations after in vitro fertilization is dependent on the number of embryos transferred and maternal age

OBJECTIVE

To determine if the incidence of multiple gestations after IVF differs significantly depending on the number of embryos transferred and maternal age.

DESIGN

Retrospective analysis of IVF database.

SETTING

Tertiary care academic center.

PATIENTS

One thousand eight hundred sixty-seven patients undergoing IVF with up to four embryos transferred during 1986 through 1993.

MAIN OUTCOME MEASURES

The rate of singleton and multiple gestations > 20 weeks estimated gestational age (EGA).

RESULTS

The incidence of triplet gestations > 20 weeks EGA among patients < or = 34 years of age with three versus four embryos transferred was 0.3% (1/335) versus 2.4% (15/662), respectively. The incidence of twin gestations > 20 weeks EGA among patients < or = 34 years of age with two versus four embryos transferred was 1.3% (3/234) versus 7.4% (46/622), respectively. Also among patients < or = 34 years of age, the incidence of singleton gestations > 20 weeks EGA with two versus three embryos transferred was 12.8% (30/234) versus 15.8% (53/335); with two versus four embryos was 12.8% (30/234) versus 17.2% (107/622); and with three versus four embryos was 15.8% (53/335) versus 17.2% (107/622), respectively.

CONCLUSIONS

In women < or = 34 years of age undergoing IVF-ET, the transfer of four versus three and four versus two embryos significantly increased the incidence of triplet and twin gestations, respectively, without significantly improving the chance of singleton conception. This implies that a policy of transferring only three embryos should be considered in this age group (realizing that such a policy may merit modulation if pretransfer embryo selection is used.).

Novel inherited mutations and variable expressivity of BRCA1 alleles, including the founder mutation 185delAG in Ashkenazi Jewish families

Thirty-seven families with four or more cases of breast cancer or breast and ovarian cancer were analyzed for mutations in BRCA1. Twelve different germ-line mutations, four novel and eight previously observed, were detected in 16 families. Five families of Ashkenazi Jewish descent carried the 185delAG mutation and shared the same haplotype at eight polymorphic markers spanning approximately 850 kb at BRCA1. Expressivity of 185delAG in these families varied, from early-onset breast cancer without ovarian cancer. Mutation 4184delTCAA occurred independently in two families. In one family, penetrance was complete, with females developing early-onset breast cancer or ovarian cancer and the male carrier developing prostatic cancer, whereas, in the other family, penetrance was incomplete and only breast cancer occurred, diagnosed at ages 38-81 years. Two novel nonsense mutations led to the loss of mutant BRCA1 transcript in families with 10 and 6 cases of early-onset breast cancer and ovarian cancer. A 665-nt segment of the BRCA1 3'-UTR and 1.3 kb of genomic sequence including the putative promoter region were invariant by single-strand conformation analysis in 13 families without coding-sequence mutations. Overall in our series, BRCA1 mutations have been detected in 26 families: 16 with positive BRCA1 lod scores, 7 with negative lod scores (reflecting multiple sporadic breast cancers), and 3 not tested for linkage. Three other families have positive lod scores for linkage to BRCA2, but 13 families without detected BRCA1 mutations have negative lod scores for both BRCA1 and BRCA2.

Quantitation of PCR products with chemiluminescence

Quantitative PCR and reverse transcription PCR (RT-PCR) are widely used in biomedical, industrial and other research applications to determine the number of RNA or DNA molecules of a specific type and/or sequence in a sample of interest. We have developed an assay system to accurately quantitate PCR products that utilizes solid-phase capture and an enzyme-linked chemiluminescent detection method. The entire assay is performed in a single tube or microplate well. Biotinylated PCR products are quantitated by capture onto a streptavidin-coated surface, followed by hybridization of an internal fluorescein-labeled oligonucleotide probe and subsequent detection with an anti-fluorescein-alkaline phosphatase conjugate and CSPD chemiluminescent substrate. Light signal is measured in a luminometer. The assay sensitivity enables accurate quantitation of target DNA because the measurement is performed on product generated during the exponential phase of amplification. The broad dynamic range of the assay, which is greater than three orders of magnitude of PCR product concentration, simplifies the determination of the number of amplification cycles necessary for accurate quantitation of target molecules. The PCR-Light system is an ultrasensitive, non-isotopic and rapid assay for PCR product detection that also has general application to solution hybridization assays and other quantitation methods.

Differences in the anatomic distribution of immediate-early gene expression in amygdala and angular bundle kindling development

Kindling is a model in which fleeting changes of neuronal activity produce a lifelong modification of neuronal structure and function in the mature nervous system. Immediate-early genes (IEGs) such as c-fos have been implicated as a causal link in the chain of molecular events coupling fleeting pathologic activity to lasting hyperexcitability. Identification of the brain structures exhibiting IEG expression during the evolution of kindling is necessary to guide investigations of the phenotypic consequences. We used in situ hybridization histochemistry to identify the structures exhibiting expression of multiple IEGs during the evolution of amygdala kindling and compared this to the pattern following angular bundle kindling. The principal findings included that: (1) generalized limbic and clonic motor (class 5) kindled seizures evoked by stimulation of one amygdala induced the expression of IEGs in a small subset of limbic structures with remarkable symmetry between the two hemispheres; (2) the anatomic extent of seizure-evoked expression of c-fos mRNA expanded progressively following focal limbic and motor (classes 0-3) seizures during the development of amygdala kindling; c-fos mRNA was detected first ipsilaterally in AM, ACO, and PC and with higher-class seizures in hippocampal formation and homologous structures contralaterally, and (3) class 5 seizures evoked by stimulation of two different sites in the limbic system (amygdala or angular bundle) induced IEG expression in distinct but partially overlapping anatomic structures. We propose that synaptic activation of glutamate receptors contributes to the expression of these diverse IEGs throughout the forebrain. The findings provide a constellation of anatomic structures in which to investigate the structural and functional consequences of IEG expression.

Reduced pregnancy outcome in patients with unilateral or bilateral hydrosalpinx after in vitro fertilization

In a retrospective study, we compared 118 patients with hydrosalpinx and 157 patients with bilateral salpingectomy entering an established in vitro fertilisation programme between 1988 and 1992. Patients with unilateral or bilateral hydrosalpinx had a lower clinical pregnancy rate, a higher miscarriage rate, and a lower ongoing pregnancy rate than patients with absent Fallopian tubes.

Trisomy 22 and intersex

Complete trisomy 22, with or without mosaicism, has been reported as a distinct syndrome. In this report an infant is described who was externally male but with female rudimentary internal organs and whose karyotype was 47,XX+22.