1/9. Risk in numbers--difficulties in the transformation of genetic knowledge from research to people--the case of hereditary cancer.Difficulties in communicating diagnostic information are exacerbated when the 'diagnosis' is a 'genetic risk' for cancer. The risk estimation demanded in this situation differs from other types of probability estimations. Observations of participants in 45 consultation sessions between physicians and potential patients were conducted at a clinic for hereditary cancer to explore the communication of genetic information. Thirty-three sessions were audiotaped, transcribed verbatim and analyzed, along with notes from the other sessions. A dominant theme was found to be numerical discussion of risk. Further analysis resulted in the description of problems for practitioners in the process of translating scientific knowledge into clinical management. Problems in providing information include unclear aims of the consultation sessions, mixing various types of background information and probabilities, recognizing how low the predictive values are, and difficulties in communicating the relationship between probability and conclusions. Problems in communicating information about the genetic risk for cancer are of at least two types: dilemmas arising from uncertainties implicit in the nature of the information itself and difficulties in communicating information in a manner that those concerned can interpret. These issues need clarification, so that information with far-reaching consequences can be made as clear and comprehensible as possible for those involved.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
2/9. Suffering: a relatively unexplored phenomenon among family caregivers of non-institutionalized patients with cancer.Suffering is a phenomenon with physical and emotional components. Although several studies have drawn attention to the needs of, and demands placed on families who provide care for patients with a diagnosis of cancer at home, few have discussed the suffering which many of these caregivers experience. This paper will illustrate the phenomenon of suffering as seen in the responses made by family caregivers of patients with cancer. Eighty-three family caregivers drawn from a probability sample of patients with a diagnosis of cancer were interviewed in their homes to determine needs they encountered in their caregiving roles. The caregivers consisted of 43 males and 40 females, with mean ages of 53 and 54 years respectively. Families not only identified their needs, they also indicated several areas which were for them sources of suffering. The findings revealed that family suffering often stemmed from fear of loneliness; uncertainty about the future (their own and that of the patients); lifestyle disruption; communication breakdown; lack of support; and their sense of helplessness. These findings suggest that health professionals, particularly nurses, who work with families in their homes, must be alert and sensitive to cues and circumstances which could indicate suffering, and in so doing, take the necessary steps to ameliorate their situation.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
3/9. Gastrointestinal graft-versus-host disease in recipients of autologous hematopoietic stem cells: incidence, risk factors, and outcome.Graft-versus-host disease (GVHD) is seen in skin, intestinal mucosa, and liver after autologous stem cell transplantation. We reviewed 681 consecutive patients to estimate the probability of gastrointestinal (GI) GVHD, response to treatment, risk factors for development, and effect on survival. GI GVHD was defined by persistent symptoms, mucosal abnormalities at endoscopy, and histology showing apoptotic crypt cells with or without lymphoid infiltrates. The proportion of patients with GI GVHD was 90/681 (13%). nausea and vomiting occurred in 90% and diarrhea in 40%. The mean time to developing symptoms was day 15, that to histologically proven diagnosis was day 42, and that to starting prednisone treatment was day 45 after stem cell infusion. Treatment with a short course of prednisone effected durable responses in 79% of patients, and an additional 18% responded to a second course of prednisone. A multivariable logistic regression model demonstrated that the combined factor of a diagnosis of breast cancer or hematologic malignancy and female sex was statistically significantly associated with the probability of GI GVHD (P = .003). survival in patients with GI GVHD was not statistically different than that in those without GVHD. We conclude that women with breast cancer or hematologic malignancy are more likely to develop GI GVHD after autologous transplantation, and that treatment with prednisone was effective.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
4/9. Nonconvulsive status epilepticus due to ifosfamide.OBJECTIVE: To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide. CASE SUMMARIES: Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1-5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy. DISCUSSION: The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration. CONCLUSIONS: Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
5/9. Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part I--Description of treatment.This paper describes a novel method of behaviour therapy applied to cancer-prone and coronary heart disease-prone patients in a prophylactic manner, to reduce the probability of their dying of cancer or coronary heart disease. The treatment can also be applied to patients already suffering from cancer in order to prolong their lives. The methods used are described in considerable detail, together with the rationale leading to their adoption. In Part II of this paper are the results of several studies showing that the methods are surprisingly successful in preventing death in cancer-prone and coronary heart disease-prone probands, and prolonging life in patients already suffering from terminal disease.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
6/9. Changes of stapedius reflex and hearing threshold in patients receiving high-dose cisplatin treatment.The value of stapedius reflex (SR) measurement in the clinical management of the ototoxic side-effect of cisplatin was examined in 24 patients who had received a dose of 100-120 mg/m2. The main finding was a frequent but inconsistent deterioration of the SR threshold (SRT) at 3 and/or 4 kHz, usually with a moderate rise of the hearing threshold (HT) in the frequency range 3-8 kHz. A hearing loss exceeding 60 dB HL is detected with high probability as an SRT deterioration. None of the patients showed any influence on the SRT before the HT rise could be detected. The SR test cannot replace pure-tone audiometry for the identification of cisplatin ototoxicity. The pathological SR results observed in this study indicated a cochlear lesion. It was not possible to identify those patients most susceptible to ototoxic changes from the pretreatment results of the SR test.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
7/9. Evaluation of CT images, tumour response and prognosis after thermoradiotherapy for deep-seated tumours.Thermoradiotherapy was applied for the treatment of deep-seated tumours in 41 patients. Low-density area (LDA) on CT images which appeared or expanded within the tumour after treatment was evaluated. Derived conclusions are as follows: (1) of 41 patients, LDA newly appeared or expanded in 24; (2) change of density was related closely with size of a tumour, histological characteristics of the tumour and heating condition; (3) histologically, LDA consisted of coagulation necrosis and tumour cells at the peripheral wall were highly degenerated; (4) a greater extent of LDA indicated the increasing possibility of local control; (5) probability of survival for patients with an increase of LDA was significantly superior to those without changes of LDA; (6) LDA may be a good landmark for judgement of the prognosis of a patient treated by thermoradiotherapy; and (7) new criteria of treatment effectiveness including density changes were proposed.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
8/9. The chromosomes and causation of human cancer and leukemia. XIX. Common markers in various tumors.Most human cancers are associated with abnormal (marker) chromosomes. In past and present studies banding analysis have uncovered a much larger number of markers in cancer cells than was seen with standard (Giemsa) staining. Furthermore, common markers of identical morphology and origin were found in tumors of related or unrelated tissues or organs, suggesting that in all probability such markers, although present in cancers of diverse nature, may indicate a common etiology, either related to the causation of the cancers, to the progression of the tumors, or to the predilection of certain chromosomes to undergo morphologic changes leading to marker formation. Even though some markers were common to different tumors, the bulk of the markers in the cancers studied could not be identified with certainty and their nature varied from tumor to tumor.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |
9/9. Psychological response of patients cured of advanced cancer.Psychologic testing was performed in 22 patients with advanced cancer (breast, endometrium, testis, lymphoma) who had undergone a complete remission that had been maintained for 5 to 20 years since the last therapy. The reaction to the probability of being cured was measured. The patients' overall attitude was very positive towards life and the future. They had a greater appreciation of time, life, people, and interpersonal reactions. They were less concerned about the nonessentials of life. It appeared that recovery from advanced cancer was a good experience for character development.- - - - - - - - - - ranking = 0.5keywords = probability (Clic here for more details about this article) |