The association between diabetes medication and weight change in a non-surgical weight management intervention: an intervention cohort study

AIM

To compare weight change in a lifestyle-based weight management programme between participants taking weight-gaining, weight-neutral/loss and mixed diabetes medications.

METHODS

Electronic health records for individuals (≥ 18 years) with Type 2 diabetes who had been referred to a non-surgical weight management programme between February 2008 and May 2014 were studied. Diabetes medications were classified into three categories based on their effect on body weight. In this intervention cohort study, weight change was calculated for participants attending two or more sessions.

RESULTS

All 998 individuals who took oral diabetes medications and attended two or more sessions of weight management were included. Some 59.5% of participants were women, and participants had a mean BMI of 41.1 kg/m² (women) and 40.2 kg/m² (men). Of the diabetes medication combinations prescribed, 46.0% were weight-neutral/loss, 41.3% mixed and 12.7% weight-gaining. The mean weight change for participants on weight-gaining and weight-neutral/loss diabetes medications respectively was -2.5 kg [95% confidence interval (CI) -3.2 to -1.8) and -3.3 kg (95% CI -3.8 to -2.9) (P = 0.05) for those attending two or more sessions (n = 998). Compared with those prescribed weight-neutral medications, participants prescribed weight-gaining medication lost 0.86 kg less (95% CI 0.02 to 1.7; P = 0.045) in a model adjusted for age, sex, BMI and socio-economic status.

CONCLUSIONS

Participants on weight-neutral/loss diabetes medications had a greater absolute weight loss within a weight management intervention compared with those on weight-gaining medications. Diabetes medications should be reviewed ahead of planned weight-loss interventions to help ensure maximal effectiveness of the intervention.

Process evaluation of a cluster-randomised controlled trial of multi-component weight management programme in adults with intellectual disabilities and obesity

BACKGROUND

Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full-scale clinical trial of the TAKE 5 multi-component weight management programme.

METHODS

The study was a 12-month pilot cluster-randomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed-methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context.

RESULTS

The study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers.

CONCLUSIONS

The extensive process evaluation illustrated that a full-scale trial of a multi-component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity.

Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment

The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2)  = 0.094, P < 0.001 and r(2)  = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P < 0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.

Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years?

AIM

Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years.

METHOD

A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software.

RESULTS

Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01).

CONCLUSION

There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.

Abstract S6-8: Hedgehog Ligand Overexpression Predicts Poor Outcome in Breast Cancer and Is a Potential Therapeutic Target for Metastatic Disease

Background: The Hh signalling pathway plays an important role in a number of malignancies, and accumulating data suggest it contributes significantly to the development and progression of breast cancer. However, there is scant data regarding the clinical significance of its dysregulation in breast cancer and its functional effects in breast cancer models.

Methods: We investigated the clinical significance of the expression of Hh pathway components using immunohistochemistry in a well-characterised cohort of 279 patients with invasive ductal carcinoma (IDC) to determine its prognostic significance. A murine mammary cancer allograft model based on the M6 cell line, derived from the C3/SV40T transgenic mouse was used to determine the effects of Shh overexpression on tumour growth in vitro and in vivo. Finally, the therapeutic potential of Hh blockade using the monoclonal antibody 5E1 was also explored in two mouse mammary carcinoma models; the M6 allograft model and the highly metastatic 4T1 cell line in immunocompetent Balb/C mice.

Results: High Hh ligand expression was observed in 34% of IDC and was associated with increased risk of breast cancer recurrence (HR 1.95, p=0.0004) and breast cancer specific death (HR 2.3, p=0.0002). High Hh expression was also associated with the basal-like subtype (p=0.004). Overexpression of Hh ligand in M6 cells transplanted to fat pads of immunodeficient mice resulted in a 4 fold increase in tumor volume (p= 0.006) and was associated with upregulation of the canonical Hh target genes Gli1 and HHIP. However, Shh promoted peritumoral lymphatic invasion in 4/5 mice compared to only 1/5 in the vector control group and was associated with a significantly shorter time to the development of metastatic disease (p=0.0004). M6 cells overexpressing Hh ligand showed no change in proliferation, self renewal or migration in vitro, suggesting a requirement for stromal interaction in Hh-dependent tumor promotion. Finally, we found that the enhanced tumor growth conferred by Hh ligand overexpression could be blocked by administration of a neutralizing antibody to Hh ligand. Furthermore, using a metastatic mammary carcinoma isograft model (4T1) that endogenously expresses Hh ligand, we demonstrate that Hh blockade resulted in smaller lung metastatic deposits (p=0.045).

Conclusions: We found that high Hh ligand is associated with a poor prognosis in IDC. Overexpression of Hh ligand promotes murine mammary tumor growth, which requires stromal interaction, as well as lymphatic vessel invasion. Finally, we demonstrate that blockade of the Hh ligand is a potential therapy in metastatic breast carcinoma.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr S6-8.

Hypertableau Reasoning for Description Logics

We present a novel reasoning calculus for the description logic SHOIQ^+---a knowledge representation formalism with applications in areas such as the Semantic Web. Unnecessary nondeterminism and the construction of large models are two primary sources of inefficiency in the tableau-based reasoning calculi used in state-of-the-art reasoners. In order to reduce nondeterminism, we base our calculus on hypertableau and hyperresolution calculi, which we extend with a blocking condition to ensure termination. In order to reduce the size of the constructed models, we introduce anywhere pairwise blocking. We also present an improved nominal introduction rule that ensures termination in the presence of nominals, inverse roles, and number restrictions---a combination of DL constructs that has proven notoriously difficult to handle. Our implementation shows significant performance improvements over state-of-the-art reasoners on several well-known ontologies.

Truncated form of VACM-1/cul-5 with an extended 3' untranslated region stimulates cell growth via a MAPK-dependent pathway

We have sequenced a 4.9kb clone (KLB22) which shares 99% sequence homology with the rabbit vasopressin-activated calcium mobilizing (VACM-1) protein. The 5' terminus sequence of KLB22 cDNA (nucleotides 1-1961) is continuous and overlapping with nucleotides 1226-3186 of the VACM-1 cDNA sequence. The 3'UTR of KLB22 cDNA extends beyond the 3'UTR of VACM-1 by 2999nt. KLB22 cDNA encodes a 497 amino acid protein, which putatively begins at Met 284 of the 780 amino acid VACM-1 protein. The in vitro translation of KLB22 cDNA yields a 59kDa protein. When expressed in cos-1 cells, the truncated VACM-1 protein localizes to the nucleus. KLB22 cDNA transfected cells show increased growth rates and increased levels of phosphorylated MAPK when compared to the vector or to VACM-1 cDNA transfected cells. Finally, in vivo, KLB22 protein expression is tissue specific and can be detected in kidney and in heart atrium. These results suggest that truncated VACM-1 cDNA (KLB22) increases cell proliferation through a MAPK pathway.

When your client has had an accident

Accident victims often experience difficulty finding meaning and logic in their accident. Confusion and depression are frequently emotions that will be felt until resolution occurs. In many cases other individuals assist in this struggle for resolution. The nurse often has opportunity to provide suggestions and support as the client struggles to find meaning.

E-mail triage

This article describes how hospital managers can use principles of triage when sending and receiving e-mail. It also discusses when e-mail should not be used, and when personal communication should occur.

Relationship between glutathione S-transferase M1, P1 and T1 polymorphisms and early onset prostate cancer

There is evidence suggesting that polymorphic variations in the glutathione S-transferases (GSTs) are associated with cancer susceptibility. Inter-individual differences in cancer susceptibility may be mediated in part through polymorphic variability in the bioactivation and detoxification of carcinogens. The GSTs have been consistently implicated as cancer susceptibility genes in this context. The GST supergene family includes several loci with well characterized polymorphisms. Approximately 50% of the Caucasian population are homozygous for deletions in GSTM1 and approximately 20% are homozygous for deletions in GSTT1, resulting in conjugation deficiency of mutagenic electrophiles to glutathione. The GSTP1 gene has a polymorphism at codon 105 resulting in an Ile to Val substitution which consequently alters the enzymatic activity of the protein and this has been suggested as a putative high-risk genotype in various cancers. We investigated the relationship between GST polymorphisms and young onset prostate cancer in a case-control study. GSTM1, GSTT1 and GSTP1 genotypes were determined for 275 prostate cancer patients and for 280 geographically matched control subjects. We found no significant difference in the frequency of GSTM1 or GSTT1 null genotypes between cases and controls. GSTP1 genotype was, however, significantly associated with prostate cancer risk: the Ile/Ile homozygotes had the lowest risk and there was a trend in increasing the risk with the number of 105 Val alleles: Ile/Val odds ratio (OR)= 1.30 (95% FCI 0.99-1.69), Val/Val OR = 1.80 (95% FCI 1.11-2.91); Ptrend = 0.026. These results suggest that the GSTP1 polymorphism may be a risk factor for developing young onset prostate cancer. We also found that carrying more than one putative high-risk allele in the carcinogen metabolizing GST family was associated with an elevated risk for early onset prostate cancer (OR 2.48, 95% FCI 1.22-5.04, Ptrend = 0.017).

Your best preparation for a good day's work: a good night's sleep

Contrary to the manner in which a great many people seem to regard sleep, sleep is not a waste of time. Inadequate sleep, let alone chronic sleep deprivation and actual sleep disorders, leads to diminished quality of work and loss of productivity. As far as caregivers are concerned, inadequate sleep can affect dangerously their ability to function in critical situations. On the other hand, adequate sleep is needed if one is to function at one's potential best and sufficient sleep is also an effective hedge against the encroachment of job stresses. For one who is occasionally unable to get sufficient sleep, there are steps to be taken to improve the ability to rest. A good night's sleep invariably precedes a good day's work.

High risk genes predisposing to prostate cancer development-do they exist?

There is evidence for genetic predisposition to prostate cancer. However, prostate cancer genes have been more difficult to find than genes for some of the other common cancers, such as breast and colon cancer. The reasons for this are discussed in this article and it is now becoming clear that prostate cancer is probably due to multiple genes, many of which are moderate or low penetrance. The advances in the Human Genome Project and technology, especially that of robotics, will help to overcome these problems. Prostate Cancer and Prostatic Diseases (2000) 3, 241-247

Moving from Illness to wellness: an important goal of home care

For many clients in home care with chronic illness the real work of getting well involves learning to adjust to chronic illness and to disability. Learning to adjust to disability by maximizing the abilities and qualities that are present can mean overcoming otherwise very significant problems while still maintaining a high quality of life. Home care providers play an important role in helping clients and their families optimize functioning to do the real work of getting "well."

The effective voice mail message

When used effectively, voice mail is an indispensable and powerful tool for the busy health services manager. On the other hand, misused or abused, voice mail can handicap the manager and cause frustration to all individuals involved in the communication interaction. By following guidelines for effective use of voice mail, the manager can maximize this important communication modality and enhance business finesse.

Getting Your Nursing Program in the "News"

Getting in the news usually needs to be a planned event with intentional actions and strategies. In most cases, news from the nursing program needs to be an administrative or faculty goal with a strategy for how this will occur. There must be a commitment to ensure that timely information is provided so that a news item can actually become reality. Most importantly, when newspapers and the media are provided with this information in a news release it must be written in a style that piques the interest of the editor and causes it to be selected as news (Perloff, 1997). If time is taken to interact with reporters and to understand how the media works, it can provide support to achieve the goals and outcomes of a nursing program.

Self-talk for the licensed practical/vocational nurse

There are varied opinions on the commonness of self-talk. Some feel self-talk is engaged in more by persons who feel insecure and question their performance (Cauchon, 1994). Others feel self talk is a process people use continually to describe and interpret the world, accurate or inadequate as the case may be. (Hansen, Rhode, and Wolf-Wilets, 1991; Braiker, 1989). Regardless of how much self-talk the Licensed Practical/Vocational Nurse is aware of in interactions with clients, staff, and intraphysically, it is important to assess thoughts for their logic or illogic. Illogical thoughts should be replaced by positive words of encouragement which will in turn raise the client's, staff members or Licensed Practical Nurse's feeling of self concept and level of self-confidence. Making self-talk positive is always good professional practice.

A dilemma of modern technology: managing e-mail overload

In an amazingly short time, electronic mail (e-mail) has become one of the most powerful and useful communication mediums in the health care workplace. However, while e-mail has added new dimensions to the communication system, which are advantageous, a concomitant effect is e-mail overload. By implementing e-mail management technique, strategies information overload can be controlled and effective productivity promoted.

Luck: what the nurse should know about it and how it affects nursing situations

Luck permeates every aspect of human behaviour. Thus, luck is an aspect of nursing care and client belief of which the nurse should be aware. Beliefs about luck will influence client compliance with recommendations for actions as well as influence actions the client selects in relation to health. Beliefs about luck will also influence actions the nurse may take when responding to clients.

Androgen receptor polymorphisms: association with prostate cancer risk, relapse and overall survival

Several reports have suggested that one or both of the trinucleotide repeat polymorphisms in the human androgen receptor (hAR) gene, (CAG)n coding for polyglutamine and (GGC)n coding for polyglycine, may be associated with prostate cancer risk; but no study has investigated their association with disease progression. We present here a study of both hAR trinucleotide repeat polymorphisms not only as they relate to the initial diagnosis but also as they are associated with disease progression after therapy. Lymphocyte DNA samples from 178 British Caucasian prostate cancer patients and 195 control individuals were genotyped by PCR for the (CAG)n and (GGC)n polymorphisms in hAR. Univariate Cox proportional hazard analysis indicated that stage, grade and GGC repeat length were individually significant factors associated with disease-free survival (DFS) and overall survival (OS). The relative risk (RR) of relapse for men with more than 16 GGC repeats was 1.74 (95% CI 1. 08-2.79) and of dying from any cause, 1.98 (1.13-3.45). Adjusting for stage and grade, GGC effects remained but were not significant (RR(DFS)= 1.60, p = 0.052; RR(OS)= 1.65, p = 0.088). The greatest effects were in stage T1-T2 (RR(DFS)= 3.56, 95% CI 1.13-11.21) and grade 1 (RR(DFS)= 6.47, 95% CI 0.57-72.8) tumours. No differences between patient and control allele distributions were found by odds-ratio analysis, nor were trends with stage or grade evident in the proportion of short CAG alleles. Non-significant trends with stage and grade were found in the proportion of short GGC alleles. The (GGC)n polymorphism in this population is a significant predictor of disease outcome. Since the (GGC)(n) effect is strongest in early-stage tumours, this marker may help forecast aggressive behaviour and could be used to identify those patients meriting more radical treatment.

What every health care professional should know about AIDS

As more and more clients with acquired immunodeficiency syndrome (AIDS) are encountered in health care agencies, it is important that the health care professional be well informed with current facts and information on treatment. Supportive care by the health professional is essential to assist the client in maintaining maximum quality of life and a sense of self-esteem and self-efficacy. It is important for the professional to be aware not only of the supportive care needed by clients but also of the safeguards necessary in such a high-risk profession.

Using humor to reduce stress and improve relationships

This article offers a variety of methods for the nurse manager to incorporate humor into the workplace. Humor is defined in the article, and the benefits of humor are described. These benefits include reducing stress and aggression, building relationships, enhancing problem solving, improving negotiating, personal survival, physical healing, and emotional healing. Humor can be used to reduce stress in the nurse manager's personal life as well as in the work environment.

The 'super nurse' syndrome

The authors describe the dynamics of the "super nurse" syndrome and provide nurse managers experiencing this syndrome with strategies to assist them. The article discusses the roles of nurse educators, hospital development staff, mentors, and social support networks. The authors hope to prevent the "super nurse" syndrome from affecting new graduates, through proper education of nurse educators, mentors, and nurse managers who assist the new graduates in problem solving and adjusting to being a "real nurse."

When the nurse manager must help staff cope with change

The authors describe the dynamics of change, barriers and resistance to change, and provide techniques for assisting staff cope with change. The nurse manager should provide support during change, intervene when change is a surprise, help staff find challenge in change, encourage staff to have courage and stamina while coping with change, and foster teamwork. Using these techniques enables the manager and staff to view change as a challenge and an opportunity rather than a threat.

Dilemma for the nurse manager: managing E-mail overload

Electronic mail is a powerful and useful communication medium in the health care workplace. Unfortunately, managing E-mail overload can present a problem for the nurse manager. Intentional strategies must be developed to handle this situation in order to maintain efficient use of managerial time. The objective of this article is to provide such strategies for the nurse manager.

Praise that matters

The authors provide strategies for nurse managers to reward with dignity, thus giving praise that matters. These strategies include treating employees with respect, focusing on the positive, designing recognition systems, expressing confidence in employees, providing opportunity for participative management, and promoting career development and advancement. Job satisfaction and personal worth of employees can be increased with use of these techniques.

Conquering loneliness

It is important to identify signs of clinical depression such as pessimism, refusal to eat, diminished concern about personal appearance, and reluctance to make decisions. Medical referral for clinical depression is imperative because there are medications and other interventions that can effectively alleviate the feelings of sadness and despair that accompany clinical depression. One must determine if loneliness is a symptom of depression or an emotional state that can be changed by one's own efforts. Whether the lonely person is the health care giver or a health care receiver, the ability to use creative strategies for coping with loneliness can turn loneliness into a more comfortable experience.

Rewarding with dignity

Job satisfaction affects employee morale, which in turn affects employee productivity. Therefore, managers need to learn about contributing factors and use the factors within their power to improve job satisfaction. Extrinsic rewards, such as a high salary and good work benefits, are important, but studies show that how a job makes an employee feel is the greatest determinant of job satisfaction. Managers can influence the emotional effect of work on an employee through, among other strategies, recognizing the employee's efforts, providing opportunities for the employee to participate in decision making, and allowing the employee to grow professionally.

Helping staff cope with change

Change seems to be the one constant in health care. This article examines how employees react to change and provides guidelines to help them and managers overcome barriers to change. These guidelines include providing support during change, using appropriate interventions, helping staff find the challenge in change, helping them find the stamina for change, and fostering teamwork.

Humor: no materiel manager should be without it

Humor has the potential to be positive or negative, character building or destructive. Many suggest that a sense of humor is necessary for good health, whether of an individual or an organization. This article presents ways in which managers can foster a "laughing with" (instead of "laughing at") attitude as a means of managing stress, enhancing teamwork, and maintaining employee satisfaction in the face of adversity.

Improving your bedside manner

Positive bedside manners are essential when caring for patients. Positive bedside manners should be utilized wherever patients and their significant others are encountered. Putting your best foot forward is the first step in establishing a therapeutic relationship. Attention to one's professional image is important if the client is to see the licensed practical/vocational nurse as someone that can be trusted. Next is actively communicating interest and concern. It is also important to communicate empathy and respect through words and actions. The LP/VN must practice attending skills in order for the patient to experience the physical and psychological presence of the nurse. Communicating availability and following up on requests promote the establishment of trust. It is important for the nurse to avoid defensiveness, maintain a professional manner, answer questions honestly, demonstrate integrity, maintain a positive attitude and practice intentional encouragement. All the characteristics will demonstrate a positive bedside manner and will communicate caring and concern to clients and their significant others.

Linkage analysis of chromosome 1q markers in 136 prostate cancer families. The Cancer Research Campaign/British Prostate Group U.K. Familial Prostate Cancer Study Collaborators

Prostate cancer shows evidence of familial aggregation, particularly at young ages at diagnosis, but the inherited basis of familial prostate cancer is poorly understood. Smith et al. recently found evidence of linkage to markers on 1q, at a locus designated "HPC1," in 91 families with multiple cases of early-onset prostate cancer. Using both parametric and nonparametric methods, we attempted to confirm this finding, in 60 affected related pairs and in 76 families with three or more cases of prostate cancer, but we found no significant evidence of linkage. The estimated proportion of linked families, under a standard autosomal dominant model, was 4%, with an upper 95% confidence limit of 31%. We conclude that the HPC1 locus is responsible for only a minority of familial prostate cancer cases and that it is likely to be most important in families with at least four cases of the disease.

Supporting clients with undiagnosed symptoms

An investigation for serious illness can be terrifying for the client. While diagnostic procedures are a high priority, a supportive interpersonal approach for the fear the client is experiencing is also a significant aspect of client care. The nurse is in the ideal position to provide such support and have a significant impact on the client's psychological state.

What the licensed practical/vocational nurse should know about pharmacological therapy for AIDS sufferers

Illnesses can rob persons of their dignity and pride. Nowhere has this been more apparent than with people who suffer from Acquired Immunodeficiency Syndrome (AIDS). Because AIDS is a progressive and debilitating disease whose fatal outcome seems hopeless, it is often hard for the sufferer to maintain a sense of human worth. Add to that a prevailing public prejudice that keeps the individual at an arm's length from the support of the community, and a grim picture is given. However, unknown to lay persons and professionals alike, this bleak picture is no longer so grim. With the advent of drug combination therapy treatments (taking several commonly prescribed anti-HIV drugs at the same time), new hope has been given. The purpose of this paper is to describe for the licensed practical/vocational nurse the different and various drugs used for therapy and their effects on the AIDS population. Particular emphasis is placed on the modern combination therapy programs that are being utilized. Current knowledge of AIDS treatment can enable the licensed practical/vocational nurse to increase a client's feelings of hope, self worth, and dignity.

Humor: don't manage people without it

Almost 400 years ago, the English writer and clergyman Robert Burton observed that "humor purges the blood, making the body young and lively, and fit for any manner of employment." Centuries later, Charles Darwin and Sigmund Freud interpreted laughter as a means of releasing surplus tension or mental anxiety. For radiology administrators, an understanding of humor and laughter from the historical, biological and psychological perspectives provides the basis for developing successful management strategies. Successful radiology administrators can incorporate humor into the workplace in a way that enhances the work environment for all. An enjoyable workplace and happy workforce ultimately enhance the radiology department's primary goal--providing quality patient care.

Helping the client with chronic disability achieve high-level wellness

Clients with chronic disability often define themselves in terms of their sick role. Today, many healthcare professionals and laypersons alike prefer to view the individual as a unified whole striving toward high-level wellness. Thus, a client may be diagnosed with a physical illness, a chronic illness, or a disability but may still work to attain high-level wellness by functioning in an integrated way with the environment. This article describes the client with chronic disability in relation to high-level wellness and provides techniques nurses can use to facilitate a client's positive adjustment.

Giving encouragement as a transformational leadership technique

Giving encouragement is not generally stated as a high priority role of health care supervisors. Traditionally, technical skills and productivity on the job were aspects that received the supervisor's primary focus. However, there is a growing appreciation that encouragement is a transformational leadership technique that is related to productivity on the job and to quality work. Use of encouragement is a leadership technique that fits in today's people-oriented work climate.

When a co-worker complains

"I'm not the only one working here! Why do I have to do everything nobody else wants to do? I get all the skut work around here. I'm really sick of it." What do you do when a co-worker complains? Complainers always seek out people who will listen. The listener must either agree, which makes the listener a complainer, or disagree, which often leads to an argument.

No germline mutations in the dimerization domain of MXI1 in prostate cancer clusters. The CRC/BPG UK Familial Prostate Cancer Study Collaborators. Cancer Research Campaign/British Prostate Group

There is evidence that predisposition to cancer has a genetic component. Genetic models have suggested that there is at least one highly penetrant gene predisposing to this disease. The oncogene MXI1 on chromosome band 10q24-25 is mutated in a proportion of prostate tumours and loss of heterozygosity occurs at this site, suggesting the location of a tumour suppressor in this region. To investigate the possibility that MXI1 may be involved in inherited susceptibility to prostate cancer, we have sequenced the HLH and ZIP regions of the gene in 38 families with either three cases of prostate cancer or two affected siblings both diagnosed below the age of 67 years. These are the areas within which mutations have been described in some sporadic prostate cancers. No mutations were found in these two important coding regions and we therefore conclude that MXI1 does not make a major contribution to prostate cancer susceptibility.

Using humor to cope with stress in home care

Home care and hospice nurses constantly face stressful situations with patients and caregivers, working from the field and meeting the expectations of the workplace and their own personal and family goals. This article explores the many ways humor can be used by the nurse in relieving stressors encountered every day.

A dose-response study of the effect of flutamide on benign prostatic hyperplasia: results of a multicenter study

OBJECTIVES

The objective of this study was to evaluate efficacy, safety, and dose-response profiles of four dosing schemes of flutamide over 24 weeks.

METHODS

Patients were randomized to receive one of the following five treatment regimens for a period of 24 weeks: placebo capsule, flutamide capsules 125 mg twice daily, 250 mg once daily, 250 mg twice daily, and 250 mg three times daily. Patients were then evaluated at baseline (0 weeks) and at 4, 6, 12, 18, and 24 weeks after the start of treatment, and 8 weeks after the end of treatment (32 weeks). Evaluation of efficacy was performed by noting changes in urine flow rate, residual urine volume, symptom score, prostate volume, and prostate-specific antigen level. A total of 372 patients were enrolled into the study at 32 centers (14 centers in the United States and 18 international centers).

RESULTS

Baseline peak urinary flow rate and percent change from baseline in maximum flow rate showed a dose-related increase at 4 and 6 weeks; this increase was significant in the 250 mg three times daily group. At later time points, no significant differences between the flutamide and placebo groups were observed, largely because of the decreasing number of evaluable patients. At 4 and 6 weeks, 25% of patients in the 250 mg three times daily group had more than 3 cc/s increase in uroflow compared to about 10% of placebo patients (P < 0.05). All flutamide-treated groups had a significant decrease in prostate volume from baseline to the last treatment visit compared to placebo and this reduction was dose related (in comparison to placebo: P < 0.05 for 125 mg twice daily and P < 0.001 for all other treatment arms). Median decrease for the flutamide-treated groups ranged from 6% to 23% at 12 weeks and from 14% to 29% at 24 weeks. All treatment groups showed a subsequent increase in prostate volume after treatment was stopped. Furthermore, there was a significant reduction in residual urine volume at 24 weeks only in the 250 mg three times daily group. It increased following cessation of therapy. Urinary symptoms at 6, 12, 18, and 24 weeks did not show any significant difference between placebo and any flutamide dose group. The most common adverse events were nipple and breast tenderness (42% to 52%), diarrhea (29% to 34%), and gynecomastia (14% to 19%). Each of these adverse events had a significantly higher incidence in all flutamide dose groups compared with placebo, but none appeared to occur in a dose-related fashion. Sixteen percent of patients in the placebo group and 25% to 39% of patients in flutamide groups were discontinued due to diarrhea (12% to 17%) or nipple and breast tenderness (4% to 8%). A total of 1% to 3% of patients in various treatment arms discontinued due to deranged liver enzymes (1% for placebo); and 1% to 4% due to impotence (1% for placebo).

CONCLUSIONS

Flutamide reduced the prostate volume in a dose-related fashion and resulted in an increase in peak flow rate at 4 weeks (3% for 250 mg three times daily, P value < 0.05), but the early positive effects did not maintain statistical significance due to an increasing number of dropouts due to adverse events. Effect on postvoid residual volume was observed only at the highest dose and at 24 weeks (median reduction, 23 mL, P < 0.05). Despite volume reduction and early improvement in peak flow rate, there were no significant differences in urinary symptoms among the placebo and flutamide groups. Higher incidences of diarrhea, breast tenderness, and gynecomastia, however, were the main limiting factors in this study and until these problems are overcome, the role of flutamide in the management of benign prostatic hyperplasia remains investigational.