Defining and measuring unintended pregnancy: issues and concerns

PURPOSE: The authors describe a proactive model of psychosocial care for patients undergoing blood or marrow transplantation and their families. DESCRIPTION OF PROGRAM: This program for blood or marrow transplantation patients, developed at the Center for Cancer Treatment and Research, Richland Memorial Hospital, and the University of South Carolina School of Medicine in Columbia, South Carolina, involves pretransplant comprehensive psychosocial assessment; development and implementation of an individual psychosocial treatment plan; monitoring and medical management of neuropsychiatric problems; and psychotherapeutic sessions with a psychiatrist. These functions are achieved through the use of a multidisciplinary psychosocial team and ongoing consultation-liaison with the entire blood or marrow transplantation team. CLINICAL IMPLICATIONS: This positive, proactive model demonstrates significant benefit to patients, families, and the blood or marrow transplantation healthcare team. Benefits of this model are derived from psychosocial assessment during work-up, subsequent planning, and communication with the entire team, thus allowing early identification of problems and avoiding escalation and the likelihood of negative outcomes. Less energy is exerted and less resources expended when problems are resolved with early intervention rather than with intensive interventions during transplant. The psychosocial staff members develop strong relationships with patients and families before transplant, increasing the power of interventions and receptivity of the patient. The blood or marrow transplantation team benefits from the ongoing presence of psychosocial staff and the consistency of approaches offered by team members. An integral part of this approach is teaching psychosocial care to all staff members and modeling approaches to problems. Other blood or marrow transplantation centers and centers providing other intensive anticancer therapies may benefit by adapting this model into the day-to-day care of their patients.     

Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer

BACKGROUND: Options for women at high risk for breast cancer include surveillance, chemoprevention, and prophylactic mastectomy. The data on the outcomes for surveillance and prophylactic mastectomy are incomplete. METHODS: We conducted a retrospective study of all women with a family history of breast cancer who underwent bilateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. The women were divided into two groups - high risk and moderate risk - on the basis of family history. A control study of the sisters of the high-risk probands and the Gail model were used to predict the number of breast cancers expected in these two groups in the absence of prophylactic mastectomy. RESULTS: We identified 639 women with a family history of breast cancer who had undergone bilateral prophylactic mastectomy: 214 at high risk and 425 at moderate risk. The median length of follow-up was 14 years. The median age at prophylactic mastectomy was 42 years. According to the Gall model, 37.4 breast cancers were expected in the moderate-risk group; 4 breast cancers occurred (reduction in risk, 89.5 percent; P<0.001). We compared the numbers of breast cancers among the 214 high-risk probands with the numbers among their 403 sisters who had not undergone prophylactic mastectomy. Of these sisters, 38.7 percent (156) had been given a diagnosis of breast cancer (115 cases were diagnosed before the respective proband's prophylactic mastectomy, 38 were diagnosed afterward, and the time of the diagnosis was unknown in 3 cases). By contrast, breast cancer was diagnosed in 1.4 percent (3 of 214) of the probands. Thus, prophylactic mastectomy was associated with a reduction in the incidence of breast cancer of at least 90 percent. CONCLUSIONS: In women with a high risk of breast cancer on the basis of family history, prophylactic mastectomy can significantly reduce the incidence of breast cancer.     

Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients

BACKGROUND: Hemodialysis using high flux membranes today is a commonly used therapy. The primary advantage is the larger spectrum of molecules removed with these membranes, and the mechanism of removal is in part due to a phenomenon of filtration and backfiltration along the length of the hollow fibers. We hypothesized that increasing the filtration and backfiltration fluxes by modifying the structure of the dialyzer could enhance the convective transport of various solutes. METHODS: A modified high flux dialyzer was compared to the standard model in terms of pressure profiles, filtration-backfiltration rates and solute clearances. The modification consisted on the placement of a O-ring around the fiber bundle to create a resistance for the flow of the dialysis solution external to the fibers. The study on filtration fluxes was carried out using a scintigraphic method previously described, and solute clearances were studied during ultrafiltration-controlled hemodialysis sessions. RESULTS: Utilizing a net filtration condition proximal to zero, the rates of proximal filtration and distal backfiltration in the experimental dialyzer were significantly enhanced in comparison with the standard dialyzer. The pressure drop in the dialysate compartment could be increased significantly, thus permitting an increase in the positive transmembrane pressure in the first half of the dialyzer and a parallel increase in the negative transmembrane pressure in the second half of the dialyzer. This resulted in a significant enhancement of the convective transport of middle-large solutes as demonstrated by the increase in vitamin B12 and inulin clearances. CONCLUSIONS: This approach suggests that changes in design of the dialyzer may affect its performance. The use of internal filtration is suggested to improve convection and dialyzer efficiency for larger solutes without the requirement for high volumes of replacement fluid, as is the case for current hemodiafiltration techniques.     

Multicultural issues and ethical concerns in the delivery of nursing care interventions

Targeted mutagenesis was used to investigate the roles of the CsmA and CsmC proteins of the chlorosomes of the green bacteria Chlorobium tepidum and Chlorobium vibrioforme 8327. Under the photoautotrophic growth conditions employed, CsmA is required for the viability of the cells but CsmC is dispensable. The absence of CsmC caused a small red shift in the near-infrared absorption maximum of bacteriochlorophyll d in whole cells and chlorosomes, but chlorosomes were assembled in and could be isolated from the csmC mutant. The doubling time of the csmC mutant was approximately twice that of the wild-type strain. Fluorescence emission measurements suggested that energy transfer from the bulk bacteriochlorophyll d to another pigment, perhaps bacteriochlorophyll a, emitting at 800-804 nm, was less efficient in the csmC mutant cells than in wild-type cells. These studies establish that transformation and homologous recombination can be employed in targeted mutagenesis of Chlorobium sp. and further demonstrate that chlorosome proteins play important roles in the structure and function of these light-harvesting organelles.     

Ethics of psychological research: New policies; continuing issues; new concerns.

The implementation over the past year within Canadian universities of the new Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS) usher in a new era in the oversight of the ethics of psychological research in Canada. Although these new policies apply to all human research, our interest is how they apply to psychology, primarily to deception, undergraduate subject pools, and other continuing concerns. Why have the granting agencies decided that government regulation of research ethics is necessary and what is the relationship between federal regulations and discipline codes? The history of the Canadian Psychological Association's involvement in protecting psychology's interests in the final revisions to the TCPS is recounted. In spite of what has been achieved, many psychologists feel that the TCPS has created new concerns for the discipline. Although there is the potential for startup problems, it is in our collective and individual best interests to make the policy work, thereby ensuring that escalation of government regulation or legislation will not be pursued. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hydrocephalus in children: neurosurgical and neuroimaging concerns

The neuroimaging of hydrocephalus from the perspective of the pediatric neurosurgeon is discussed. Processes with new developments in therapy and imaging are described, including congenital causes of hydrocephalus, unilateral hydrocephalus, trapped fourth ventricle, and benign external hydrocephalus.     

Intravenous therapy: current practice and nursing concerns

The field of intravenous (i.v.) therapy has been subject to major change, with increasing numbers of nurses taking on the high profile, technical aspects of care. The transfer of previously medicalized tasks such as cannulation has been welcomed by nurses who are keen to develop practical skills in order to embrace the concept of holistic patient care. This literature review aims to clarify the role of the nurse in i.v. therapy, exploring cannulation as a specific issue. Legal and professional aspects are discussed in terms of extended/expanded practice and practical aspects in terms of i.v. access and maintenance. Discussion focuses on a team approach to the management of i.v. therapy. Finally, the nursing process is applied to an i.v. therapy scenario. Exploration of the nursing issues enables practitioners to justify the expansion of individual practice in order to deliver holistic care and improve standards of service. The review concludes that nurses cannot afford to lose sight of the caring component of their role as a result of immersion in the culture of technical skill acquisition.     

P scale and psychosis: Continued concerns.

Notes that the reply by H. J. Eysenck (see record 1978-20108-001) to D. V. Bishop's (1977) criticism of the Psychoticism scale of the Eysenck Personality Questionnaire relies heavily for its rebuttal on information contained in a new book by the Eysencks (H. J. Eysenck and S. B. Eysenck, 1976) that was not available to Bishop for her critique. This new additional evidence did not, however, provide the present author with reassurance regarding the usefulness and validity of the P scale. It is argued that because of the extraordinary skewness of the P score distribution, high P scores can be a function simply of attention fluctuation, the error of measurement is especially large for high P scores, and the internal-consistency reliability of the P scale is inflated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient commitment: Additional concerns.

The E. P. Mulvey et al (see record 1987-32366-001) evaluation of involuntary commitment to outpatient treatment of the chronic mentally ill gave inadequate attention to the social systems of clients in the community and underestimated the complexity of implementing a policy of involuntary outpatient commitment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with mastectomy: Another view.

Responds to T. Silverman-Dresner and L. C. Restaino's (1979) article on feelings commonly experienced by women undergoing mastectomy. Contrary to Silverman-Dresner and Restiano, the author contends that it is not the presence of a lump that generates anxiety, but fear of the unknown, anticipation of pain, disfigurement, and death itself that generates anxiety. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surface spectroscopy of apatitic materials: limitations and concerns

The use of x-ray photoelectron spectroscopy for the study of biological materials has provided mixed results. The experimental difficulties associated with the application of this technique to the study of biological materials include the effects of ultra-high vacuum, x-ray exposure, surface charging, and, for insulating materials, the inherent lack of an intrinsic energy reference. Since most biological materials are insulators, the lack of an intrinsic energy reference complicates one's ability to draw direct comparisons between different studies. In this paper, the results from two different apatites are compared with the results obtained from the use of two conventional techniques for referencing binding energies. The results presented here are referenced only to the Pt Fermi level; no further energy modifications are performed. A comparison with the results of other investigators indicates a large difference in binding energies for all involved core levels. These results indicate that, in the study of insulating materials with x-ray photoelectron spectroscopy, it is essential that all data be acquired under exacting conditions on the same experimental system.     

Nurses preparing for change: their needs and concerns

As a result of decreased lengths of stay and cost-containment initiatives, fewer nurses are needed in acute care settings. The trend for community-based health care is broadening employment opportunities for nurses to work in community settings. As nurses are considering options to base their practice in community settings, it is important to understand their concerns about making this transition. The results of a qualitative study conducted to examine the concerns and educational needs of acute care nurses related to working in the community are reported. Clinical, professional, and intrapersonal skills important for a successful transition to community-based practice are identified and discussed.     

Perioperative renal dysfunction and cardiovascular anesthesia: concerns and controversies

In patients with renal disease undergoing cardiovascular surgery, perioperative management continues to be a challenge. Traditional answers have turned into new questions with the introduction of new agents and the redesign of old techniques. For ARF prevention, early recognition of pending deleterious compensatory changes is critical. Theoretically, therapeutic intervention designed to prevent ischemic renal failure should be designed to preserve the balance between RBF and oxygen delivery on one hand and oxygen demand on the other. Maintenance of adequate cardiac output distribution to the kidney is determined by the relative ratio of renal artery vascular resistance to systemic vascular resistance. Indeed, it should not be surprising to learn that norepinephrine (despite its vasoconstricting effect) has been reported to have no deleterious renal effects in patients with low systemic vascular resistance. Until recently, strategies for the treatment of ARF have been directed to supportive care with dialysis (to allow tubular regeneration). Various therapeutic maneuvers have been introduced in an attempt to accelerate the recovery of glomerular filtration, including dialysis, nutritional regimens, and new pharmacologic agents. A recent small prospective trial of low-dose dopamine in the prophylaxis of ARF in patients undergoing abdominal aortic aneurysm repair showed no benefit in those patients receiving dopamine. Conversely, the effects of intravenous atrial natriuretic peptide in the treatment of patients with ARF appear to offer benefit in patients with oliguria. Among 121 patients with oliguric renal failure, 63% of those who received a 24-hour infusion of atrial natriuretic peptide required dialysis within 2 weeks compared with 87% who did not. Whether this effect will be borne out in the future remains to be determined. The administration of epidermal growth factor after induction of ischemic ARF in rats has been shown to enhance tubular regeneration and accelerate recovery of kidney function. Human growth factor administration has been shown to increase GFR 130% greater than baseline in patients with chronic renal failure, but no data for clinical ARF have been reported. In addition, there have been significant improvements in dialysis technology in the treatment of ARF. Modern dialysis uses bicarbonate as a buffer as opposed to acetate, which reduces cardiovascular instability, and has more precise regulation of volume removal. Dialysate profiles and temperatures improve hemodynamics and reduce intradialytic hypotension. Techniques of hemodialysis without anticoagulation have reduced bleeding complications. Finally, dialysis membranes activate neutrophils and complement less with the biocompatible membranes used today that reduce recovery time and dialysis treatment. Evidence indicates that activation of complement and neutrophils by older dialysis membranes caused a greater incidence of hypotension, adding to ischemic renal injury. It remains to be determined whether early and frequent dialysis with biocompatible membranes, as well as other therapeutic interventions, will increase the survival of patients with perioperative ARF.     

Choosing reconstruction after mastectomy: a qualitative analysis

Recent epidemiological studies have identified plasma triglyceride as a risk factor for atherogenesis. We have generated a mouse transgenic line that carries a recessive mutation designated lpd (lipid defect). Homozygous lpd mice develop as runts and die by age 10-15 days with striking liver pathology characterized by the presence of numerous lipid-containing vacuoles and extensive accumulation of triglycerides. Cloning of the mutant insertion locus and the wild-type lpd locus have revealed a duplication of host genomic sequences at the site of integration. Mapping of the lpd locus with the Jackson Laboratory BSS interspecific backcross panel of (C57BL/6JEi x SPRET/Ei) F1 x SPRET/Ei placed the lpd locus to the distal part of chromosome 16. These observations suggest that the transgene disrupts a putative gene at the lpd locus and that lpd is a novel locus related to triglyceride metabolism. The lpd mutant mice may serve as models for human disorders of fatty livers or hypertriglyceridemia.     

Isoprene: background and issues

Isoprene monomer is derived from petroleum cracking and is used in the manufacturing of polyisoprene, butyl rubber and a variety of copolymers. It is also the monomeric unit of naturally occurring terpenes (e.g. lycopenes, the pigmentation in tomatoes). Isoprene occurs in tobacco smoke and it is released by a wide range of plants and mammals (including man). Portion of the isoprene present in the atmosphere is therefore from natural origin. Isoprene is chemically closely related to butadiene. Both substances are being used in similar industrial processes and because of the structural analogy, it is often speculated that the toxicological properties of isoprene must resemble those of butadiene. In fact, the acute toxicity of isoprene is very similar and also the biotransformation to mono- and diepoxides is qualitatively alike. There is however a difference; isoprene is asymmetric and therefore more metabolic enantiomers are possible. Pharmacokinetic studies have demonstrated species differences (as with butadiene) in the maximum metabolic elimination rate: in mice this was determined to be at least three times higher than in rats which implies a species sensitivity in isoprene metabolism in the mouse. Both isoprene and its major metabolites were tested for mutagenic activity in Salmonella strains. Only the diepoxide was found to be positive in TA100. In in vivo cytogenetic tests in mice, no chromosomal aberrations were observed but an increase in SCEs and micronuclei was evident. As is the case with butadiene there are clear indications from long-term rat/mice inhalational studies with isoprene of a species difference in tumour response. Based on cytogenetic findings and tumorigenicity data it is clear that isoprene is less potent than butadiene. Such observations are important and useful to reduce uncertainties in risk-characterisation procedures (e.g. occupational exposure standard setting; EU existing chemicals regulations).     

Simple mastectomy and pectoral node biopsy

Evidence is presented to support the view that biopsy of the pectoral and axillary tail nodes obtained at simple (total) mastectomy gives a reliable estimate of axillary node status. The technique is described.     

Psychologists and societal concerns.

Analyzed the session topics of the American Psychological Association (APA) convention from the 1950s to the 1970s. Topics generally addressed scientific and professional matters, although there was a trend from almost exclusive focus on nonsocietal topics in the 1950s to a greater concern for societal problems in the 1970s. Even with this increased responsiveness to societal issues, the predominant interest of APA members is defined in scientific and professional terms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)