Acute B cell lymphoblastic leukaemia and human immunodeficiency virus infection (HIV)

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The impact and management of cancer-related fatigue on patients and families

Fatigue has been identified as both a chronic and recurrent problem for individuals diagnosed with and treated for cancer, yet there is little information on how to manage the impact of fatigue. Describing what happens to individuals and their families as a result of fatigue and identifying what individuals do to manage or reduce the impact of fatigue are essential elements in determining multidimensional nursing interventions. The purpose of this pilot study was to examine the impact of fatigue on individuals with cancer of the lung and their families, and explore how they managed as a result of the fatigue. A semi-structured interview guide was used with 22 lung cancer patients and 14 family members six weeks post completion of radiation therapy. Results indicated that fatigue was not reported as a major concern by many of the participants in this study. For those who did experience fatigue, it was considered an inconvenience and a frustration that had to be dealt with for a limited time period. Some patients appeared to gradually adjust and accommodate to the fatigue and were not really aware of the changes that took place over time. Over half of the family members felt more of the impact of fatigue than did their loved ones. Family subtly assumed or took over responsibilities and activities the patient could no longer perform. The symptom of fatigue has been well documented in the cancer experience as both a chronic and recurrent problem for individuals diagnosed with and treated for cancer. The emphasis of previous work has been on deriving a conceptual definition of fatigue, achieving consensus on a definition, and developing theoretical frameworks to guide further study of this complex construct. Fatigue has been conceptualized as a multidimensional phenomenon, attributable to multiple causes and having a negative effect on quality of life (Piper, 1993; Tiesinga, Dasson, & Halfens, 1996). Describing what happens to individuals and their families as a result of fatigue and identifying what individuals do to manage or reduce the effects caused by the fatigue are essential elements in determining multidimensional nursing interventions.

An appraisal of the use of secondment within a large teaching hospital

INTRODUCTION

This study was undertaken in a large teaching hospital in Sheffield. It explores the use of secondment as a vehicle for practice, service and career development.

AIM

To provide us with an understanding of the ways in which we utilize secondment opportunities, with a view to developing good practice guidelines that will help both the individual and the organization to maximize the potential in each secondment post.

METHOD

A survey of nursing staff who had been on secondment during the previous year. Questionnaires were used to gather data from the senior nurse in each specialty directorate to develop an organizational (seconder) perspective and 20 secondees to provide an individual (secondee) perspective.

RESULTS

Nurses tended to be seconded from clinical roles into specialist clinical roles or non-clinical roles, predominantly in areas of research, audit, practice development and teaching. Seconded posts were new roles for individuals and the majority were relocated to new work environments. Secondment was overwhelmingly seen as an opportunity, allowing individuals to develop new skills and knowledge, progress their career and gain a broader strategic perspective. However, there were a number of barriers to progress: lack of role definition for the organization and the individual; uncertainty about the future; falsely raised hopes that secondments would be extended; uncertainty about status; and difficulties adjusting to a new environment and culture within unrealistically short timeframes.

CONCLUSIONS

Secondment use has become widespread throughout the National Health Service (NHS) and is a very positive and popular vehicle for staff and service development. The potential benefits are high but must be offset against the risks. This paper introduces an organizational risk assessment matrix which can be used to inform the development of effective secondment ventures.

Current trends in managing chronic middle ear disease

Major advances in reconstruction continue to be made in the treatment of chronic middle ear disease, while little prophylaxis is available and indications for intervention remain in many cases controversial. This reflects our lack of knowledge of the true causes of these diseases.

Cyathostome fecal egg count trends in horses treated with moxidectin, ivermectin or fenbendazole

Commercial preparations of fenbendazole (Safe-Guard, Intervet), ivermectin (Eqvalan, Merial) or moxidectin (Quest, Fort Dodge) were administered once to horses scheduled for routine parasiticide treatment. In total, 93 horses from six cooperating farms were used in the study. Computer generated, random allocation of horses to treatment group was conducted at each farm. Fecal egg counts were determined for all horses on trial days 0, 56, 84 and 112, with corresponding calendar dates that were unique to each farm. Only strongyle egg counts from animals which were positive at day 0 were used for analysis of variance and comparisons. Counts for the three treatment groups were similar at day 0, moxidectin<ivermectin<fenbendazole for days 56 and 84, and moxidectin<ivermectin=fenbendazole on day 112 (P<0.05). Reductions of geometric mean egg counts from day 0 levels were 99.1, 97.6 and 94.9% for moxidectin, 16.4, -27.0 and -32.0% for fenbendazole and 85.9, 24.2 and -8.1% for ivermectin on trial days 56, 84 and 112, respectively. Adverse reactions to treatment were not observed for any of the parasiticides.

The treatment of juvenile arthritis

Until recently, two different classification systems for juvenile arthritis (JA) were utilised, each with its own terminology and subclassification. It has been recognised that particularly within the polyarticular and pauciarticular groups, many distinct subsets exist each with a different prognosis. As a result, a new classification system for JA has been developed. It is hoped that this will allow more accurate assessment of incidence and aetiology of the various subtypes in future generations and in time will allow therapy to be targeted at those most likely to achieve benefit. Since there is a new classification system for JA, the vast majority of published clinical studies were performed using the old classification system. For the purposes of this review, unless otherwise stated, the American College of Rheumatology classification will be used. This is outlined in Table 1 with clinical features of the major subtypes described in Table 3. This review will cover current best practice and discuss future directions for research using the recent advances in the treatment of rheumatoid arthritis (RA) as a model.

Comparative study of intramuscular gold and methotrexate in a rheumatoid arthritis population from a socially deprived area

OBJECTIVE

To compare the risk-benefit ratio of intramuscular gold (gold sodium thiomalate (GST)) and methotrexate (MTX) in a population with rheumatoid arthritis (RA) from a deprived area.

METHODS

Patients with active RA were randomly assigned to open treatment with GST or MTX. Clinical and laboratory assessment was performed at 0, 12, 24, and 48 weeks. Results were analysed on an intention to treat basis.

RESULTS

141 patients were recruited-72 were randomly allocated to GST and 69 to MTX. There were no statistically significant differences found in either the clinical or demographic variables at baseline. At 48 weeks 31 (43%) patients continued to receive GST and 43 (62%) MTX. The median MTX dose achieved was 10 mg. Gold caused significantly more withdrawals for toxicity (43% GST v 19% MTX, p=0.0026, log rank test). Both groups experienced a significant improvement in erythrocyte sedimentation rate, C reactive protein, Ritchie Articular Index, and pain score by 24 weeks (p<0.001, Friedman test). Although a trend towards an improved Health Assessment Questionnaire (HAQ) score and global wellbeing was seen in both groups, this did not reach statistical significance. No differences in efficacy were found when the two groups were compared (Mann-Whitney).

CONCLUSION

GST and low dose MTX showed equivalent efficacy, but toxicity was more common in patients treated with GST. GST, although more toxic, remains a useful alternative for patients in whom MTX is contraindicated.

The hip or not

Pathologies within the ileopsoas compartment can present as hip pain and as such can be mistaken for diseases of the hip joint. Radiological investigations are useful in helping to differentiate between these pathologies.

Walking ability as a measure of treatment effect in early rheumatoid arthritis

OBJECTIVE

To assess the clinical usefulness of a prototype walkmat system in patients with early rheumatoid arthritis (RA).

SUBJECTS

Twenty-four subjects with early RA and symptomatic forefoot disease requiring therapy with second-line drugs were recruited.

DESIGN

Each subject underwent clinical assessment together with gait analysis on the contact sensitive walkmat system and Kistler forceplate before and after six months of treatment with second-line drugs. Two subjects were lost to follow-up.

RESULTS

There was the expected improvement in disease activity in response to therapy. Significant differences were also demonstrated in defined gait parameters that indicated improved weight-bearing and enhanced forefoot propulsion.

CONCLUSION

Medical therapy improved walking ability in patients with RA and the walkmat system provided a useful adjunct to existing outcome measures in the assessment of lower limb function.

Development of fiber optic and electrochemical pH sensors to monitor brain tissue

This article describes fiber optic and electrochemical pH sensors that could become part of a therapeutic arsenal to quickly and aggressively treat stroke victims as well as people who have suffered brain trauma. The fiber optic sensor design was based on the immobilization of a pH-sensitive dye, seminaphthorhodamine-1 carboxylate (SNARF-1C), onto the end of a 125-microm-diameter silica optical fiber using the sol-gel method. A miniature bench-top fluorimeter system was developed for use with the optical fiber to obtain pH measurements. The electrochemical sensor was based on sputter-coated iridium oxide thin films. Linear and reproducible responses for both sensors were obtained in human blood with pH varying between 6.8 ato 8.0, which encompasses the clinically relevant range. In vivo studies were also performed and results indicated that both types of sensors tracked pH with very little drift.

Provider encouragement of breast-feeding: evidence from a national survey

OBJECTIVE

To examine the influence of provider encouragement on breast-feeding among women of different social and ethnic backgrounds in the United States.

METHODS

A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone. The responses of the 1229 women interviewed were included in the analysis. Respondents were asked to recall whether their physicians or nurses had encouraged or discouraged them from breast-feeding. The effects of provider encouragement on breast-feeding initiation and duration were evaluated by multivariate logistic regression. The sample was then stratified to allow subset analyses by race and ethnicity, education, income class, age group, and marital status.

RESULTS

More than one-third (34.4%) of respondents did not initiate breast-feeding. Three-fourths (73.2%) of women reported having been encouraged by their physicians or nurses to breast-feed; 74.6% of women who were encouraged initiated breast-feeding, compared with only 43.2% of those who were not encouraged (P < 0.001). Women who were encouraged to breast-feed were more than four times (relative risk 4.39; 95% confidence interval 2.96, 6.49) as likely to initiate breast-feeding as women who did not receive encouragement. The influence of provider encouragement was significant across all strata of the sample. In populations traditionally less likely to breast-feed, provider encouragement significantly increased breast-feeding initiation, by more than threefold among low-income, young, and less-educated women; by nearly fivefold among black women; and by nearly 11-fold among single women.

CONCLUSION

Provider encouragement significantly increases breast-feeding initiation among American women of all social and ethnic backgrounds.

NMDA receptor antagonist AP5 and nitric oxide synthase inhibitor 7-NI affect different phases of learning and memory in goldfish

The present study investigated the amnestic effects of N-methyl-D-aspartate (NMDA) receptor antagonist AP5 and nitric oxide (NO) synthase inhibitor 7-NI in avoidance conditioning in goldfish. The results showed that both AP5 and 7-NI, without impairing performance processes, produced anterograde amnesia when given before training. Furthermore, 7-NI produced retrograde amnesia when given immediately following training while AP5 did not. Thus, AP5 and 7-NI affected different phases of learning and memory.