Whose interest are we serving? Voogd, C
British journal of school nursing,
03/2009, Letnik:
4, Številka:
2
Journal Article
I have just read yet another article heralding long-acting reversible contraception (LARC) as the miracle solution to reducing teenage pregnancies and abortions. I do not doubt that these methods ...could be effective. It is also clear that there can be compliance problems linked to the oral contraceptive pill. What I am led to question, however, is whose interest we are serving by promoting these methods to young people.
Objectives: In this study we tried to determine if a combined treatment of psychomotor therapy and marital counselling was suitable for treatment of the fibromyalgia syndrome. Methods: Fifty ...fibromyalgia patients were treated, after psychological and medical screening, with group psychomotor therapy combined with marital counselling for couples. Fifty fibromyalgia patients participated as non-treatment controls. The treatment goal was to help the patient learn to cope with the disabilities of the syndrome. The therapy consisted of psychomotor and behavioral therapy techniques to enhance relaxation, assertiveness and learning to differentiate between the complaints of the syndrome and other bodily and emotional sensations. Results: The patients 70% reported to be satisfied with regard to self-confidence and methods to enhance relaxation. Many patients 66% reported improvement in their ability to deal with the disabilities. The drop-out percentage was rather high; 33%. These data were not confirmed by the assessment material SCL-90R and UCL, which were applied prior to directly after, and 6 months after treatment. There were no significant differences compared to the non-treatment controls. Conclusions: The current treatment program was not sufficient to enhance significant and durable changes in fibromyalgia patients. Further modification of the treatment program and research seems to be necessary.
To understand impediments to receiving and reporting timely follow-up care for abnormal Pap tests among Hispanic women.
Descriptive, qualitative.
A federally funded cancer screening clinic in urban ...South Texas.
11 Mexican/Mexican-American women over 40 years old who appear in clinic records as "lapsed" in follow-up and 5 clinic staff members.
Semistructured, qualitative interviews regarding staff and patient concepts about cancer, cancer screening, and follow-up. Abstraction of patients' clinic charts.
Factors associated with women being classified as "lapsed" in follow-up care for abnormal Pap tests.
Only two patients had no follow-up, while nine eventually had follow-up, either elsewhere or after several missed appointments. Contrary to expectations, poor knowledge, lack of social support, and lack of availability of care were not factors impeding follow-up. Reluctance to be examined by a male practitioner, lack of flexibility in scheduling clinic appointments, and poor staff communication regarding appointments and the seriousness of the condition were all influences negatively affecting follow-up behavior. Nevertheless, these women went to significant lengths to comply with follow-up recommendations.
The classification of patients' follow-up behavior as "lapsed" was not attributable to culturally based beliefs and attitudes, nor lack of knowledge and motivation, but was primarily the result of institutional features such as scheduling and record-keeping practices and policies.
More thorough evaluation of actual behaviors would ensure more accurate assessment of follow-up behavior in this group. More female practitioners, better communication of appointments and of the seriousness of the condition, and more flexible scheduling options would reduce the difficulty these Hispanic patients encountered in having timely follow-up care.
Objective The present study was designed to evaluate the effects of early angiotensin converting enzyme (ACE) inhibition on left ventricular enlargement in patients with anterior wall infarction ...following reperfusion therapy. Methods Seventy-one consecutive patients with an anterior wall myocardial infarction were randomly allocated to enalapril (n=36) or placebo (n=35). All patients received either thrombolytic therapy (n=46) or underwent primary coronary angioplasty (n=25). Medication was started within 48 h admission to hospital and continued for 48 weeks. The process of left ventricular remodelling was assessed with two-dimensional echocardiography at 3 weeks and 1 year after the acute onset, and was related to the severity of the residual stenosis of the infarct-related artery. Results Baseline left ventricular ejection fraction was 39·2±8·7%. During the study period, left ventricular end-diastolic volume index increased from 48·2±9·9 ml. m−2 to 54·6±12·2 ml. m−2 at 3 weeks, and to 59·4±170 ml. m−2 after 1 year in control patients (P<0·001). In the enalapril-treated patients, left ventricular end-diastolic volume index increased from 50·0±16·1 to 57·7±19·3 ml. m−2 at 3 weeks, and to 61·9±22·7 ml. m−2 after 1 year (P<0·001). Both at 3 weeks and after 1 year, no overall differences in left ventricular volumes were observed between the enalapril and the placebo group (both ns). However, patients with a residual stenosis severity of ≥70% in the infarct-related artery (n=43) showed significant attenuation of remodelling by enalapril (n=22) when compared to placebo (n=21). In patients on enalapril, left ventricular end-diastolic volume index increased from 470±130 to 53·7±17·7 ml. m−2 compared to 48·0±9·6 to 60·3±16·3 ml . m−2 in control patients (P<0·03). Also diastolic filling parameters were significantly improved in patients with ≥70% residual stenosis. Conclusion In patients with an anterior wall infarction and a severe residual infarct-related coronary artery stenosis following reperfusion, treatment with enalapril prevents the process of left ventricular remodelling. As left ventricular dilatation is an early process we suggest that treatment with ACE inhibition should be started as soon as possible in this group of patients.
To the Editor:
Cristofanilli et al. (Aug. 19 issue)
1
assume that the circulating epithelial cells detected by the CellSearch System are tumor cells. This may be the case in most of the blood samples ...examined, but a formal proof was not attempted. A recent study showed a cytogenetic relationship — that is, clonality — between circulating epithelial cells and the corresponding primary tumor cells.
2
It seems mandatory that a molecular genetic characterization of circulating tumor cells be performed to validate a highly sensitive test such as the CellSearch assay.
To the Editor:
Cristofanilli and colleagues state that the number of . . .
The mesodiencephalic and cerebellar afferents in the rostral medial accessory and principal olive of the cat and rat were studied following anterograde transport of tritiated leucine combined with ...anterograde transport of wheat germ agglutinin coupled horseradish peroxidase in the same animals. In all studied areas at least one-third of the labelled glomeruli appeared to contain both mesodiencephalic and cerebellar terminals. In many of these cases it was found that the terminals from both afferent systems contacted the same dendritic spines. Therefore, these olivary spines may be, as will be discussed, well suited for being involved in a timing process.
To assess the effect of oestrogen (ER) and progesterone (PgR) receptors on the prognosis of patients with operable breast cancer and the decision to treat these patients with adjuvant tamoxifen.
...Retrospective.
Eight community hospitals in the Southeast Netherlands.
Using the registry of the Comprehensive Cancer Centre South, 2862 breast cancer patients were identified with stage I, II or IIIA tumours, treated during the period 1984-1992.
ER and PgR status were known for 2393 (84%) and 1761 (62%) patients respectively. From 1991, over 80% of the postmenopausal, lymph node positive patients had received tamoxifen, irrespective of the steroid receptor status. Of all lymph node negative patients fewer than 3% received adjuvant systemic treatment. Among the lymph node negative patients the steroid receptor status was not a significant predictor of survival. Among the lymph node positive patients whose tumours were both ER-negative and PgR-negative, a 2.8-fold increased risk of death was found during the first four years after primary treatment. The risk of death was not increased if only the ER or only the PgR status was negative.
This study shows that ER and PgR receptors are significant prognostic factors for survival in breast cancer patients with involved axillary lymph nodes. The prognostic effect appeared to be restricted to the first four years after primary treatment. Selection of patients for endocrine treatment should be based on the steroid receptor status, considering the importance of the steroid receptors for predicting the response to endocrine treatment.
We studied changes in staging and treatment of patients with early breast cancer (TNM stage I and II) in eight community hospitals in southeast Netherlands between 1984 and 1991 and related these ...changes to the guidelines for the management of breast cancer drawn up by the regional Breast Cancer Study Group. Since 1984, the proportion of patients that underwent breast-conserving therapy (local tumour excision, axillary dissection, and irradiation of the breast) increased from 26% to 53%. Although the mean number of axillary lymph nodes examined by the pathologists increased significantly, the proportion of patients with positive lymph nodes remained unchanged. The proportion of patients with involved axillary nodes receiving any form of adjuvant systemic therapy increased from 49% to 82%. Therapeutic policy initially varied significantly from one hospital to another but gradually became more uniform. We conclude that, except for elderly patients, treatment of early breast cancer corresponded increasingly to the guidelines of the regional Breast Cancer Study Group.
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