Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Introduction  Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective  To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods  In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results  Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p  < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion  We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Inhibition and kinetic studies of cellulose- and hemicellulose-degrading enzymes of Ganoderma boninense by naturally occurring phenolic compounds

AIM

Ganoderma sp, the causal pathogen of the basal stem rot (BSR) disease of oil palm, secretes extracellular hydrolytic enzymes. These play an important role in the pathogenesis of BSR by nourishing the pathogen through the digestion of cellulose and hemicellulose of the host tissue. Active suppression of hydrolytic enzymes secreted by Ganoderma boninense by various naturally occurring phenolic compounds and estimation of their efficacy on pathogen suppression is focused in this study.

METHODS AND RESULTS

Ten naturally occurring phenolic compounds were assessed for their inhibitory effect on the hydrolytic enzymes of G. boninense. The enzyme kinetics (V_max and K_m ) and the stability of the hydrolytic enzymes were also characterized. The selected compounds had shown inhibitory effect at various concentrations. Two types of inhibitions namely uncompetitive and noncompetitive were observed in the presence of phenolic compounds. Among all the phenolic compounds tested, benzoic acid was the most effective compound suppressive to the growth and production of hydrolytic enzymes secreted by G. boninense. The phenolic compounds as inhibitory agents can be a better replacement for the metal ions which are known as conventional inhibitors till date. The three hydrolytic enzymes were stable in a wide range of pH and temperature.

CONCLUSION

These findings highlight the efficacy of the applications of phenolic compounds to control Ganoderma.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study has proved a replacement for chemical controls of G. boninense with naturally occurring phenolic compounds.

Pilonidal sinus involving the nasal bridge: a rare manifestation

Pilonidal sinus is very commonly associated with the sacrococcygeal area, but its presence within the head and neck is still unknown to many. Once diagnosed, it is easy to treat and should, therefore, be kept in mind as a possibility when coming across a discharging sinus swelling. We share our experience of two cases of pilonidal sinus presenting over the nasal bridge and their management.

Toluidine blue: yet another low cost method for screening oral cavity tumour margins in third world countries

OBJECTIVE

To use toluidine blue intra-operatively to identify tumour involved margins after the removal of oral cavity squamous cell carcinoma, and to compare the findings with those of final histopathology.

METHODS

The study was conducted at the Aga Khan University Hospital from December 1, 2009, to March 14, 2010, and comprised 56 consecutive patients with biopsy-proven squamous cell carcinoma of oral cavity regardless of grade and stage of tumour. Intra-operatively toluidine blue was used on the resected tumour margins and the staining patterns were assessed. Results were then compared with the final histopathology report.

RESULTS

A total of 11(19.64%) margins were positive with toluidine blue staining out of which 8 (14.28%) were false positive. Sensitivity and specificity was found to be 100% and 84.9% respectively with a positive predictive value of 27.2%; a negative predictive value of 100%; and diagnostic accuracy of 85.71%.

CONCLUSION

Toluidine blue costs only Rs25 (USD 0.30) and takes only 5 minutes for application and interpretation. It can be used with significant confidence in smaller lesions (T-l and T-II) as an alternative to frozen sections in developing countries where facilities are unavailable. Its use in larger lesions (T-lll and TIV) remains the topic of controversy and awaits a multi centre trial with a larger cohort.

Utility of clinical examination and CT scan in assessment of penetrating neck trauma

Managing penetrating injuries adequately and effectively depends a great deal on proper assessment of the injury. This study carried out was done at The Aga Khan University Hospital to assess the role of clinical examination and CT scan imaging in evaluation of penetrating neck injuries. A total of 68 students were included, with ages ranging from 3 to 74 years. The involved zones and the injured structures were noted. Results showed a high sensitivity of clinical examination in assessing vascular (81%) and airway trauma (77%), with a low sensitivity for esophageal trauma (34%). For CT scan the sensitivity was 90% for vascular trauma, 83% for airway trauma and 53% for esophageal injuries. Clinical findings and CT scan imaging are important assessment tools for evaluation of penetrating neck traumas, with a high sensitivity for vascular and airway injuries.

Dermatofibrosarcoma protuberans: an unusual case of neck swelling

Dermatofibrosarcoma protuberans (DFSP) is a relatively intermediate to low grade malignant tumour with high proclivity for local recurrence if excised inadequately. It is a locally aggressive tumour and despite sharing some histological features with fibrohistiocytic tumours, it tends to grow in a more infiltrative manner. We are reporting this rare tumour in a 30-year-old woman where the diagnosis of DFSP was confirmed histologically and by positive immunomarkers at immunohistochemistry.

Malignant peripheral nerve sheath tumour of maxilla

Malignant peripheral nerve sheath tumour (MPNST) is a very rare entity in head and neck with high rate of recurrences and local invasiveness. This tumour is usually found in lower extremities and only 10-12% occur in head and neck region. The diagnosis is considered as the most elusive and difficult among soft tissue sarcomas because of its non specific presentation, both clinically as well as pathologically. This difficulty has now been overcome by immunohistochemistry. We report here a case of MPNST in a 50 years old male with a localized right maxillary growth.

Diagnostic accuracy of fine needle aspiration cytology in parotid lesions

Objective. Histopathology of parotid gland tumors is extremely varied and complex due to heterogeneous cellular composition. Preoperative diagnostic tools include fine needle aspiration cytology, the role of which remains controversial. The aim of this paper is to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland tumors. Methods. We retrospectively reviewed charts of 129 patients who underwent parotidectomy for parotid lesions at Aga Khan University Hospital from 2002 to 2010. We compared the results of preoperative FNAC with final histopathological diagnosis. Results. Concordance with histological results was observed in 86%, specificity was 98%, sensitivity was 84%, and diagnostic accuracy was 94%. Conclusion. Our results demonstrate that preoperative cytology in parotid lesions is fairly accurate and useful in diagnosing benign from malignant and in planning appropriate approach for treatment.

Harmonic scalpel versus electrocautery tonsillectomy: a comparative study in adult patients

OBJECTIVE

To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.

METHODS

Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.

RESULTS

The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes; p<0.05). The mean intra operative blood loss was less in HS group (EC 3.43 +/- 3.42 ml Vs HS 2.40 +/- 2.74 ml; p =0.10). Post operative pain was significantly lower in harmonic scalpel group as compared to electrocautery group on 1st, 2nd and 3rd postoperative day (p < 0.05). From 3rd postoperative day onwards, although harmonic scalpel group was slightly better in terms of pain on visual analog scale but it was not statistically significant. Secondary haemorrhage after tonsillectomy was less in HS (EC 10% Vs HS 3%; p=0.61).

CONCLUSION

Except lesser pain score in early postoperative period, the harmonic scalpel does not provide a major benefit over the more traditional method of electrocautery tonsillectomy.

Parotidectomy: a review of 112 patients treated at a teaching hospital in Pakistan

OBJECTIVE

The purpose of this study was to analyze the clinical presentation, histopathology and complications following parotid surgery.

METHODS

We retrospectively reviewed the charts of 112 patients who underwent parotidectomy from January 2000 to February 2010. Data including age, sex, clinical signs and symptoms, histology and complication were collected from medical records.

RESULTS

Of the total, 82 (74%) had benign lesions, 30 (36%) had malignant tumors. The most common benign tumor was pleomorphic adenoma (57%), and the most common malignant tumor was mucoepidermoid carcinoma (16%). Analysis of the correlation between fine-needle aspiration cytology and final histology revealed that fine-needle aspiration sensitivity, specificity and accuracy to 86.6%, 97.6% and 94.6% respectively. The most common complication following parotidectomy was transient facial nerve palsy (18.7%).

CONCLUSION

Superficial parotidectomy is associated with a decrease incidence of transient facial nerve dysfunction compared with that of total parotidectomy. High grade or advanced tumour is a predictor of poor outcome which may require adjuvant therapy.

Use of psychoactive drugs among patients visiting outpatient clinics in Karachi, Pakistan

INTRODUCTION

This study was conducted to determine the proportion of usage of psychoactive drugs, and to identify factors associated with its use among patients visiting outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

METHODS

A cross-sectional study was conducted involving 461 adult (age 18 years and above) patients, who were surveyed by using interviewer-administered questionnaires. All interviews were conducted by a medical students. Out of the total number of participants, 242 (52.5 percent) were males and 219 (47.5 percent) were females.

RESULTS

In all, 118 (25.6 percent) of the respondents were using some sort of psychoactive drugs, however, only 20 (4.3 percent) study subjects were diagnosed with any psychiatric illness. Factors found to be significantly associated with usage of psychoactive drugs included belonging to the female gender (p-value equals 0.019), older (more than 50 years) age (p-value is less than 0.001), being married (p-value equals 0.004), having formal schooling of up to 12 years (p-value equals 0.001) and physical inactivity (p-value equals 0.004). In addition, those whose family members were using psychoactive drug(s) or who suffered from non-communicable diseases were more likely to use psychoactive drugs in comparison to others (p-value is less than 0.001).

CONCLUSION

The use of psychoactive drugs is quite common in our patients regardless of having any psychiatric disease. Efforts are required to control and prevent the abuse of these drugs. Education and awareness programmes for doctors and patients may help to prevent the inappropriate use of psychoactive drugs. Regulatory intervention to control use of these drugs is also recommended.

A case of pulmonary sarcoidosis, not tuberculosis

The case of sarcoidosis of the lungs is described in a 50 years old female who presented with symptoms similar to pulmonary tuberculosis. As she showed no improvement on anti-tubercular therapy, sarcoidosis was suspected and confirmed by endobronchial biopsy and she responded well to treatment.

Association of iron deficiency anaemia in children of 1-2 years of age with low birth weight, recurrent diarrhoea or recurrent respiratory tract infection--a myth or fact?

AIMS AND OBJECTIVE

To investigate for the presence or absence of any association between low birth weight, recurrent diarrhoea or recurrent acute respiratory infections with iron deficiency anaemia in Pakistani children aged 1-2 years.

METHODOLOGY

From July 1993 to July 1995 a case control study was conducted at the Community Health Centre (CHC). Fifty cases and 100 controls were included. Informed consent was taken from mothers for the blood tests of their children and a questionnaire was administered to them. Data obtained from the completed questionnaires was analyzed by chi-square and t-tests.

RESULTS

There was no statistically significant difference in low birth weight (p = 0.712), recurrent diarrhoea or respiratory infections between anaemic and non-anaemic children at 1-2 years age (OR of 1.71 and 1.48 respectively).

CONCLUSION

This study does not uphold the belief that low birth weight, recurrent diarrhoea or respiratory infections have a causal association with iron deficiency anaemia in 1-2 years children.

Is there a value of mantoux test and erythrocyte sedimentation rate in pre-employment screening of health care workers for tuberculosis in a high prevalence country?

SETTING

Pre-employment screening of health care workers (HCWs) is practiced widely. Research needs to be carried out to evaluate the screening procedure in developing countries.

OBJECTIVE

To evaluate the efficacy of Mantoux test and erythrocyte sedimentation rate (ESR) for the diagnosis of active tuberculosis (TB), in pre-employment screening of HCWs, in a high prevalence country.

DESIGN

Pre-employment screening of all new employees was reviewed from June to September 2000. The screening consisted of history, physical examination, blood and urine tests, Mantoux test and a chest radiograph. Patients with clinical, laboratory or radiological features suggestive of active TB were referred to a specialist.

RESULTS

Out of 207 employees, a Mantoux reaction of > or = 10 mm and ESR of > or = 25 mm/first hour was noted in 90 (43.5%) and 21 (10.1%), respectively. One person had symptoms suggestive of TB and was already on anti-tuberculosis therapy at the time of screening. All other employees were asymptomatic. Based on radiographic findings, four (2%) cases were referred and one was given anti-tuberculosis therapy. An additional 48 (23.1%) employees were referred on the basis of positive Mantoux or elevated ESR; none were found to have active TB.

CONCLUSION

In high prevalence countries use of Mantoux test and ESR in pre-employment screening of HCWs is not recommended for detection of active TB.

The relationship of socio-demographic factors with iron deficiency anaemia in children of 1-2 years of age

OBJECTIVE

To investigate associations between different socio-demographic factors with iron deficiency anaemia in Pakistani children of 1-2 years of age.

METHODOLOGY

A case control study, with 50 cases and 100 controls, was conducted at the Community Health Centre, an outpatient clinic of the Aga Khan University, Karachi, Pakistan, between July 1993-July 1995. Informed consent was taken from mothers for their children's blood tests and a questionnaire was administered to them. The data was analyzed using chi-square, t-tests and logistic regression.

RESULTS

The numbers of pregnancies, live births and living children were more among cases than controls but the differences were not statistically significant. Although father's education did not show a significant association (OR 1.35, 95% CI 0.22-8.33), maternal education was significantly associated with the children's anaemic status (OR 3.55, 95% CI 1.40-9.02). The difference in monthly incomes between families of cases and controls was the most significant variable among all those studied (p-value 0.006).

CONCLUSION

This study showed that while lack of maternal education and low monthly family incomes are both significantly associated with the development of childhood anaemia, low monthly income is most significant.

ACC/AHA guidelines as predictors of postoperative cardiac outcomes

PURPOSE

Recently, the American College of Cardiology - American Heart Association (ACC-AHA) published guidelines and an associated algorithm for preoperative cardiovascular evaluation of patients undergoing non-cardiac surgery. Our purpose was to (i) test guideline's ability to predict adverse cardiac events within seven days after surgery, (ii) determine whether medical clinical predictors or surgical risks was a better predictor of cardiac events.

METHODS

Retrospective review of 119 cardiology and anesthesia consultations over 15 mo, ending March 31, 1998. Patients were classified into their respective medical clinical predictor and surgical risk groups, as outlined in ACC-AHA guidelines. Associations between the medical predictor and surgical risk scores and adverse cardiac outcomes were quantified via multiple logistic regression analysis. Two outcomes were employed. Outcome I, included: myocardial infarction/ischemia; angina; congestive heart failure, arrhythmia or death. Outcome 2 expanded the definition to include "cancellation of surgery due to cardiac risk" as a negative cardiac outcome.

RESULTS

Diabetes, Canadian Cardiovascular Class (CCS) III or IV angina, and MI within six months before surgery were strongly associated with the two cardiac outcomes. For outcome 1 and 2, medical predictors and surgical risks, considered simultaneously, performed with a sensitivity of 93% and specificity of 46-51%. When considered separately, major clinical medical predictors had a sensitivity of 87-89%, while surgical risks showed a specificity of 89% in predicting the two outcomes.

CONCLUSION

Medical predictors in ACC-AHA classification scheme were highly sensitive whereas surgical risks were more specific in predicting adverse post-operative cardiac events. Prospective study is needed to confirm these observations.

Evaluation of Traditional Classroom Teaching Methods Versus Course Delivery Via the World Wide Web

Higher education is moving with deliberate speed to an electronic classroom. Much has been published on faculty experiences with World Wide Web (WWW) course delivery. However, little research exists on the evaluation of these methods. The purpose of this study was to evaluate students' perceptions of two approaches to teaching: classroom and WWW modules. Classroom methods were rated significantly higher in relation to content, interaction, participation, faculty preparation, and communication. Technical skills were rated higher for WWW modules. Critical thinking and time allotted for assignments were not significantly different between classroom and WWW instruction. Open-ended comments were rich and supported both positive and negative aspects of classroom and WWW-based modules. Implications call for creativity in course development, course redesign and orientation, active communication with students, support for technical problems, faculty development, and university-wide planning through partnerships.

Promotion of advance care planning in the nonhospitalized elderly

Factors that influence the execution or lack of execution of advance directives in 162 nonhospitalized older adults were examined. Significant results were found, and implications for geriatric nurses are presented.

Predictors of quality of life in women: hormone therapy self-efficacy and health-promoting behaviors

Osteoporosis and coronary heart diseases (CHD) are two major health problems that affect postmenopausal women. The literature emphasizes that prevention of osteoporosis and/or CHD through the practices of health-promoting behaviors and hormone therapy usage can improve quality of life (QOL) for women. The purpose of this study was to examine the impact of health-promoting behaviors and hormone therapy self-efficacy on QOL. The sample contained 210 women between the ages of 45 and 84 years of age, who completed three instruments developed specifically for this study. The majority of the participants perceived moderate satisfaction with their life as a whole, performed many health-promoting behaviors, and perceived slight confidence in their ability to continue hormone therapy. Among current users of hormones, hormone therapy self-efficacy beliefs explained 31% of the variance in QOL. Among non-users of hormones, health-promoting behaviors explained 7% of the variance in QOL. In the entire sample, health-promoting behaviors explained 10% of the variance in QOL. There were significant differences between current users of hormones and non-users of hormones in QOL and in health-promoting behaviors. The study has implications for intervention and for future research.

The hormone replacement therapy self-efficacy scale

This study describes the initial development and psychometric evaluations of an instrument to measure self-efficacy in hormone replacement therapy (HRT) use. The development of the scale was based upon Bandura's self-efficacy construct. The sample was 116 women who were 50 years old and above and who were current or past users of HRT. Factor analysis was used to develop construct validity and Cronbach's alpha was used to compute reliabilities. Factor analysis isolated two factors, efficacy beliefs in HRT (EBs-HRT) and outcome expectations in HRT (OEs-HRT). The developed tool contains 14 items, eight items compose the EBs-HRT subscale and six items make-up the OEs-HRT subscale. The two subscales and total instrument were found to have good internal reliabilities. Implications for HRT intervention using the developed tool are discussed.

Nocturnal enuresis in children

This common condition can be managed by the general practitioners. The key answer to nocturnal enuresis is nocturnal self-awakening and recently more emphasis is given on this which is an area of greatest promise. Behavioural modification in conjunction with an enuretic alarm also teaches this skill and has the highest cure rate and the lowest relapse rate. Enuretic alarms can be used any time from age 5 onwards. But drugs are only indicated when there is need for short term dryness e.g. when the child has to be away from home.

Providing culturally sensitive care to Egyptians with cancer

PURPOSE

This article describes key aspects of Egyptian culture and provides intervention strategies that oncology practitioners may use to provide quality care to Egyptian immigrants and Egyptian-American oncology patients.

OVERVIEW

The growing diversity of the United States population challenges oncology professionals to provide culturally appropriate care. Egyptian immigrants and Americans of Egyptian descent comprise a unique population whose cultural and religious beliefs impact on decision making and behaviors related to cancer diagnosis and treatment. This population is overwhelmingly Muslim, although a sizeable minority are members of Eastern Christian sects. Dietary restrictions, social conduct, and religious observance are among the areas that require understanding by health providers.

CLINICAL IMPLICATIONS

Learning about patients' perspectives on health and illness, in light of their cultural values and beliefs, will allow health professionals to enhance the quality of assessments and interventions and provide culturally appropriate care.

Cancer prevention and early detection among Egyptians

Although cancer is frequently not perceived as a significant health problem in developing countries, cancer death in developing countries is higher than in developed countries. Therefore, cancer prevention and early detection in developing countries is becoming a universal challenge to health care providers. The purpose of this exploratory study was to identify knowledge, attitudes, and behaviors related to cancer prevention and early detection among Egyptians. Data were collected from 99 people, and the design was descriptive and correlational, using a self-administered survey. Results showed that the Egyptians surveyed had some knowledge about warning signs of cancer as well as prevention and early detection strategies. In addition, results indicated a significant difference between males and females in warning signs of cancer as well as prevention and early detection methods. Participants were less likely to believe their lifestyle behaviors affect their chances of developing cancer. Current practices undertaken included dietary behaviors, abstinence from smoking, check-up for minor suspicious symptoms, and annual complete physical examinations. Barriers to undertaking practices included factors related to lack of preventive resources, lack of information about preventive strategies, family financial concerns, and specific attitudes toward cancer. The study findings indicate the need for providing people with information to help them make decisions regarding undertaking cancer prevention and early detection practices.

Health promotion and osteoporosis prevention among postmenopausal women

BACKGROUND

Although there is a plethora of literature about osteoporosis, little is known about the attitudinal variables that may predict osteoporosis-preventive behaviors (OPBs) among postmenopausal women. This study examined the relationship between variables from the Health Promotion Model (HPM) and OPBs of calcium intake, exercise participation, and taking of estrogen/hormone replacement therapy (ERT/HRT).

METHODS

One hundred women completed measures of benefits and barriers to calcium intake, exercise participation, ERT/HRT usage; self-efficacy; control of health; importance of health; and health status. Participants also reported their actual calcium intake, exercise participation, and use of ERT/HRT:

RESULTS

Participants consumed an average of 1,243 mg of calcium from milk, yogurt, calcium-rich foods, and supplements; 81% participated in weight-bearing and resistant training exercise but on an irregular basis; and 31% were users of ERT/HRT at the time of data collection. There were significant relationships between some of the HPM variables and calcium intake and exercise participation. There was a significant difference between past and current users of ERT regarding benefits and barriers to taking hormones. Hormone users reported higher calcium intake and greater exercise participation than nonusers.

CONCLUSION

There is early evidence that variables of the HPM are associated with OPBs. After continued testing, intervention programs for osteoporosis prevention may use variables of the HPM as a theoretical base for behavior changes.

A comparison of American and Egyptian cancer patients' attitudes and unmet needs

The purpose of this descriptive study was to compare and contrast similarities and differences in statements made by American and Egyptian cancer patients who expressed their attitudes toward cancer and reported their unmet needs. A total of 61 American and 66 Egyptian patients, who were receiving chemotherapy or radiotherapy, or a combination of the two treatments at the time of data collection, participated in the study. The American sample was drawn from patients at a large midwestern hospital, whereas the Egyptian sample was drawn from patients at the largest university hospital in Cairo, Egypt. Data were collected through a structured interview method in both patient populations. Analyses of responses showed five categories of attitudes for the American patients: (a) fighting spirit and adaptation, (b) fear/anxiety/disbelief, (c) hope, (d) passivity in plan of care, and (e) faith. For Egyptian patients, seven categories emerged: (a) stoicism and fatalism, (b) dependency, (c) compliance with the medical regimen, (d) anxiety/fear/insecurity, (e) powerlessness, (f) hope and optimism, and (g) family support. American cancer patients reported their unmet needs as (a) information, (b) needs related to treatment side effects, and (c) psychological support. Egyptian cancer patients reported their unmet needs as (a) relief from dependency, (b) relief from physical symptoms, and (c) information. These findings have implications for international oncology nursing, and imply the need for further research to determine if attitudes and unmet needs affect coping effectiveness and quality of life among cancer patients.

Preparing student nurses for patient education

Patient education is an integral part of the nurse's responsibility. Furthermore, public awareness of health issues has greatly increased public demand for information from health professionals. The author presents some teaching strategies that can be used by nurse educators to prepare students for their future role as teachers.

Postmenopausal women. Factors in osteoporosis preventive behaviors

Osteoporosis is a serious health hazard mainly affecting postmenopausal and elderly women. Osteoporotic fractures are one of the leading causes of morbidity and death in the elderly population. Prevention of further loss of bone mass in postmenopausal women can be achieved if women take estrogen replacement therapy, consume adequate levels of calcium, exercise regularly, and practice healthy lifestyle behaviors. Elderly women need to follow the same strategies as postmenopausal women with more emphasis on prevention of falls.

Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients

The purpose of this study was to identify stressors, level of stress, coping strategies, and coping effectiveness in Egyptian female mastectomy patients. A total of 64 women who had had mastectomies participated in the study. Coping effectiveness was measured by McNett's Coping Effectiveness Questionnaire (MCEQ). Factor analysis and reliability measures were established on MCEQ using the study sample. Data were collected using a structured interview method. Participants were also asked about age, education, and time since mastectomy. These data were examined in an effort to predict coping effectiveness. The participants reported five stressors: hope for cure, treatment effectiveness, fear of the unknown, progression of the disease, and pain. The treatment effectiveness stressor had the highest mean level of stress. There was a significant difference in the level of stress among the five stressors. Coping strategies reported were categorized into four groups: faith, compliance with the medical regimen, seeking information and social support, and self-distraction. Coping effectiveness was significantly and positively correlated with age and time since mastectomy, which accounted for 35% of the variance in coping effectiveness. Findings suggest that continuing assessments of Egyptian mastectomy patients' needs, further research studies, and an intervention program to ameliorate cancer-related anxiety and to help cancer patients cope effectively may be helpful.

Teaching early breast cancer detection strategies

Breast cancer is the most common cancer occurring among women. Currently, breast cancer can be detected early and treated effectively if all asymptomatic women participate in the screening program. Screening strategies include a mammogram, medical examination of the breast, and breast self-examination. This article describes the nurse's role in promoting and decreasing barriers to these strategies for early detection of breast cancer.

Teaching osteoporosis prevention

The role of nutrition is critical in the prevention of osteoporosis. Teenagers and women, who consume adequate calcium throughout life and consider nutritional factors that may impair their bodies' use of calcium, can do much to prevent the onset of osteoporosis. The nurse's role in this prevention is described.

Effect of psychoeducational intervention on anxiety among Egyptian bladder cancer patients

This study examined the effect of psychoeducational preparation 1-2 days prior to surgery on postoperative state anxiety among Egyptian bladder cancer patients with urinary diversion. The theoretical rationale was based upon the Betty Neuman Health-Care Systems Model. State anxiety was measured by the A-state form of the State Trait Anxiety Inventory. A total of 30 patients were assigned randomly to experimental and control groups. Fifteen patients were included in each category. Preoperatively, the total sample was interviewed about their "worries" at that time, and data from this qualitative part were categorized into three subconcepts. Results revealed that their main anxieties are related to stress associated with being cancer patients followed by stress related to the impact of surgery on their bodies and on their social and marital life. Results from the quantitative part of the study showed that psychoeducational preparation lowered significantly state anxiety on the third day postoperatively and before discharge for those patients who had the intervention.