Identity loss and maintenance: commonality of experience in cancer and dementia

This paper examines parallel thematic findings from two qualitative studies exploring the experience of disease as it relates to cancer and dementia. The original studies examined the experiences of 16 individuals with cancer and 20 with dementia, and the impact of these first hand experiences and those of their principal family carers. The paper presents findings linked to the common or shared concepts of identity loss and maintenance as expressed by both the affected individual and the family carer.

Current awareness in geriatric psychiatry

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley &amp: Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Books, Reviews &amp: Symposia; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

Comparison of orbital colour Doppler findings with computed tomography angiography

Colour Doppler imaging (CDI) of orbital vessels is noninvasive but may be fallacious, while computed tomography (CT) angiography displays a visual outline of orbital vessels. We compared clinical findings of the two methods in 33 patients with a wide variety of clinical conditions. It was not possible to visualize the central retinal arteries with CT angiography, but it was possible to show the intracranial carotid, which CDI could not. Changes in the ophthalmic arteries on CDI usually showed changes in calibre on CT angiography. Patients with unexplained or gross visual loss often showed marked abnormalities on CT scanning, not entirely consistent with the clinical picture. Several patients showed marked ectasia of the intracranial carotid along with variable clinical findings. Findings on CT angiography complement and augment those on CDI, and are likely to be more clinically valuable in the future.

A randomized phase II trial of interferon-alpha2b versus 5-fluorouracil after trabeculectomy

PURPOSE

The aim of the present study was to investigate the safety and potential efficacy of subconjunctival interferon-alpha2b (IFN-alpha), either alone or in combination with 5-fluorouracil (5-FU), in reducing the risk of failure of glaucoma surgery

METHODS

A prospective, masked randomized phase II study was undertaken in which patients received three subconjunctival injections per week for 3-4 weeks postoperatively. Three treatments were compared: (i) IFN-alpha (1 x 10(6)IU per dose); (ii) 5-FU (5 mg per dose); and (iii) alternating IFN-alpha and 5-FU (BOTH). The primary outcome measures were: (i) rate of successful control of intra-ocular pressure without further surgery; and (ii) the incidence of side effects.

RESULTS

Fifty-seven patients undergoing glaucoma surgery with an increased risk of failure were evaluated, including 23 patients (40%) undergoing trabeculectomy combined with extracapsular cataract extraction as well as other conventional high-risk groups. With 53 patients (93%) completing 2 years follow up,there was no significant difference in success rates among the three groups. Intra-ocular pressure was controlled without further surgery in 79% of patients (95% confidence interval (CI): 61, 97%) receiving IFN-alpha, in 89% of patients (76, 100%) receiving 5-FU and in 89% of patients (76, 100% receiving BOTH. Side effects were similar among the three groups.

CONCLUSIONS

These results are consistent with a beneficial effect of IFN-alpha2b given either alone or in combination with 5-FU after glaucoma filtering surgery. However, the lack of a clear and substantial benefit over conventional anti-fibrotic therapy does not support the further clinical evaluation of these treatments.

A population needs assessment profile for dementia

The Tayside Profile for Dementia Planning is an instrument designed to obtain data for population needs assessment and planning. It provides a brief tool to collect a minimum dataset by non-specialists. Third-party informants-informal carers or involved professionals-are used as data sources. The key concept is the use of a descriptive profile rather than a summative score or categorization. The profile consists of a set of needs indicators, information on current service response and demographic and background data. Key levels of dependency are measured by time interval dependency. Validity, reliability, acceptability and usability are satisfactory, with the crucial exception that informal carers and professionals appear to perceive needs differently. Further research is needed to assess which type of informant provides the more useful data.

Identifying older people with dementia: the effectiveness of a multiservice census

A census of all relevant services in an area can be used to identify people with mental impairment suggestive of dementia. Two censuses in Tayside, Scotland, were used to test the effectiveness of this method. False positives accounted for 12% of returns. After excluding false positives, by comparison with expected dementia prevalence based on EURODEM, 66% of all sufferers and 50% of those living in the community were identified by the censuses. By pro-rating for non-response, the proportion of sufferers known to services was estimated as 72%. The characteristics of those not known to services are unclear and further research is needed on this. The cost of a census in an area of 250,000 population is under pounds 3000. A multiservice census offers a simple, inexpensive, practicable method of constructing a sample frame for population needs assessment.

Comparison of Fastpak with full-threshold 24-2 glaucoma field tests

BACKGROUND AND OBJECTIVES

The authors noted an underestimation of the mean deviation for field testing using the Fastpak (Humphrey Instruments, San Leandro, CA) strategy, and set out to define the extent of this difference.

PATIENTS AND METHODS

Sixty-seven eyes of 35 glaucomatous patients were examined. Patients received full-threshold 24-2 tests before and after the Fastpak strategy was used, each test on a different day. For some patients, another full-threshold test was performed using a different birth date in order to obtain a result uninfluenced by prior data.

RESULTS

The mean deviation (MD) was significantly underestimated by Fastpak compared with the full-threshold tests. The time taken for Fastpak was almost identical to that taken for full-threshold tests. Short-term fluctuation (SF) appeared to have very little reliability statistically, and, consistent with this, there was a greater concordance among pattern standard deviation (PSD) data than among corrected pattern standard deviation (CPSD) data.

CONCLUSION

Fastpak was an effective method for charting the visual field, but did so with greater variation than full-threshold tests. It significantly underestimated the MD, and this was not a fatigue effect. Fastpak was no faster than full-threshold testing in advanced glaucoma. CPSD was a less consistent reading than PSD in these glaucomatous patients.

Ondansetron prevents postoperative nausea and vomiting in women outpatients

Three doses of intravenous (i.v.) ondansetron, 1 mg, 4 mg, and 8 mg, were compared to placebo for their antiemetic effect and safety. The drugs or placebo were administered in a double-blind manner, prophylactically to 589 women undergoing elective outpatient surgical procedures under nitrous oxide opioid-based general endotracheal anesthesia. In the postanesthesia care unit, the number of emetic episodes, periodic assessments of nausea severity using an 11-point scale (0 = no nausea; 10 = worst nausea), vital signs, and adverse events were collected by an independent observer for 2 h. Upon discharge, identical information, with the exception of vital signs, was collected from the patients' diary and via phone call. One pre- and two poststudy blood specimens for hematology and chemistries were evaluated. During the initial 2 h, patients receiving any dose of ondansetron had significantly better complete response rates (no emesis) than those receiving placebo. Over the 24-h study period, patients who received either 4 mg or 8 mg ondansetron continued to have significantly greater complete response rates. Adverse events were minor, and ondansetron-treated patients had profiles similar to those of the placebo. Heart rate, blood pressure, respiratory rate, and laboratory safety variables were not different among the groups. Ondansetron did not prolong awakening time. This study indicates that ondansetron is a safe and effective prophylactic antiemetic for women who have outpatient surgery under nitrous oxide opioid-based general anesthesia.

Differential effects of fluticasone propionate on allergen-evoked bronchoconstriction and increased urinary leukotriene E4 excretion

Allergen challenge is associated with an increased excretion of urinary leukotriene E4. The source of this increase is unknown, although the lack of effect of inhaled beta-agonists and sodium cromoglycate suggests that airway mast cells may not be involved. We investigated this further using a new and topically potent inhaled glucocorticoid, fluticasone propionate (FP). A group of 10 mild atopic asthmatic subjects (6 males; FEV1 > 60% of predicted; PC20 histamine < or = 8 mg/ml; and on inhaled beta 2-agonists only) were studied before and after a 2-wk period of FP (1,000 micrograms/day) or placebo administered by metered-dose inhalers as two puffs twice per day through a large-volume spacer. Treatments were assigned in a double-blind crossover fashion separated by a 3-wk washout period. The PC20 histamine was measured at the start and end of each treatment when subjects also received a bronchial allergen challenge. Urine was collected for 4 h after allergen challenge for determination of LTE4 using HPLC-RIA, and 2 h later the PC20 histamine measurement was repeated. The 2-wk treatment with FP significantly inhibited both early and late responses to allergen: the maximum % fall in FEV1 during the early (0 to 2 h) and late response (2 to 6 h) was 32.6 +/- 3.4 and 19.6 +/- 5.2, respectively, following placebo versus 19.5 +/- 4.5 and 3.6 +/- 2.6 following FP (both p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanical and radiation isocenter coincidence: an experience in linear accelerator alignment

As part of the commissioning procedure of a linear accelerator at our cancer center, the defining laser lines were aligned with the optical and radiation isocenter of the linac. When a mechanical checkout jig was set up at the same point, a discrepancy of 4 mm resulted when the gantry was moved from 0 degrees to 180 degrees. Extensive measurements, some with custom-designed devices, confirmed the observations and provided an explanation. Even though the mechanical isocenter is within the specified tolerance of 1-mm radius, the clinically observable discrepancy of 4-mm results from the noncoincidence of the mechanical and radiation isocenters. The clinical significance of the final setup is discussed and future commissioning procedures are recommended.

Assessment of the safety of chemicals administered intravenously in the neonatal rat

A 3-day-old neonatal rat model for the safety assessment of various drugs, chemicals, and nutrients administered intravenously is described. This model was used to assess the safety of di(2-ethylhexyl) phthalate (DEHP), cyclohexanone, and a 3:1 mixture of medium and long-chain triglyceride emulsions following subchronic administration using the intravenous route. The administration of DEHP at dosage of 164.8 mg/kg for 18 consecutive days resulted in a small but statistically significant increase in liver weight and SGOT activity. However, no conclusive histopathological alternations could be discerned between livers from DEHP and normal saline (control) animals. No effects were observed among neonates treated with cyclohexanone at dosages up to 25 mg/kg for 18 consecutive days. Because of technical difficulties emanating from high dosage volumes, the administration of lipid emulsion mixture lasted 9 consecutive days only. Except for transient ataxia and sedation, no adverse effects were observed among neonates that received 3:1 medium- and long-chain triglyceride emulsion for 9 consecutive days beginning on day 3 postpartum. No adverse effects were observed among neonates receiving the lipid emulsions for 7 consecutive days beginning on day 12 postpartum.

Radiation protection aspects of a new high-energy linear accelerator

The Therac-25 is a new 25-MeV linear accelerator manufactured by Atomic Energy of Canada, Ltd. The first two units have recently been installed in Toronto, Ontario and Halifax, Nova Scotia. Calculations and measurements of primary and secondary radiation levels were made. Neutron dose-equivalent rates were measured inside and outside the room. The maximum leakage rate at 1 m from the accelerator target was 0.4% Sv per peak photon Gy. The tenth value layer for neutrons from the Therac-25, at the entrance to a one-legged maze was found to be 5.5 cm of polyethylene. Measurements were done to estimate daily technologist exposure due to induced activity in the treatment room.