11/66. The significant unmet needs of cancer patients: probing psychosocial concerns.'Significant unmet needs' are those needs that patients identify as both important and unsatisfied. In this article we ask whether the overall needs of cancer patients are actually being met. We believe that the range of unmet need, and the kinds of patients who are more likely to claim unmet need, should be carefully identified. The needs responses of a series of 295 cancer patients in a cross-sectional survey were analysed. The majority expressed the opinion that information and good relationships with health care professionals were important, and few expressed dissatisfaction with these aspects of need. Similarly, needs items about support from family and friends were largely rated as important and satisfied. For a sizeable minority of patients, items of significant unmet need cluster around aspects of managing daily life, emotions, and social identity. The distribution of significant unmet needs is not random but is more likely to be experienced by patients who are younger, have a long-standing illness or disability, do not own/have use of a car, and/or have no religious faith. Furthermore, significant unmet needs relate to patients' ability to talk freely to a carer about the cancer, the degree to which the cancer interferes with social activities, and whether financial difficulties are experienced. Most of the significant unmet need is beyond the remit of services primarily designed for the treatment of disease. We consider whether multidisciplinary cancer teams can be expected to deal with all aspects of the cancer experience.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
12/66. When cultures clash: physician, patient, and family wishes in truth disclosure for dying patients.We describe two cases involving male foreign nationals (a Chinese and a Georgian) treated in a U.S. hospital. Both patients had terminal illnesses, and both cases involved clashes between families and the treating physicians, which occurred because of differing cultural beliefs about truth disclosure. Based on the specific backgrounds of these two patients, we discuss ethical and cultural considerations and make suggestions for physicians who care for ethnically diverse patients.- - - - - - - - - - ranking = 4324.4419278675keywords = disclosure (Clic here for more details about this article) |
13/66. Understanding peripheral neuropathy in patients with cancer: background and patient assessment.PN is a troublesome symptom that frequently occurs in patients with cancer and is associated with certain neurotoxic chemotherapeutic agents. By understanding the basic principles of PN and recognizing the potential toxicities of specific chemotherapy drugs, nurses can take an active role in minimizing their occurrence. nursing assessment is critical to early identification of toxicities and successful intervention. nurses need to educate their patients regarding potential drug side effects and review safety issues that may put them at risk for injury. patients need to be instructed to report symptoms of PN to their nurses and physicians. Healthcare professionals, in turn, need to assess neurologic function on a routine basis, monitor those at risk, and intervene when appropriate. Ultimately, PN can be recognized as a significant symptom, such as pain or fatigue. Current treatment options include both pharmacologic and nonpharmacologic therapies, and the success of the treatment often depends on the cause. research is needed to find better and more effective therapies for PN. The Neuropathy association is a national organization that offers patients with PN the chance to contact others to share experiences and information to help them to cope with symptoms, increase public awareness of the problem, and promote the development of better therapies. This organization provides a newsletter, information booklets, and activities for members and can be contacted at 800-247-6968 or www.neuropathy.org.- - - - - - - - - - ranking = 2keywords = information (Clic here for more details about this article) |
14/66. hyperparathyroidism, humoral hypercalcemia of malignancy, and the anabolic actions of parathyroid hormone and parathyroid hormone-related protein on the skeleton.So what have we learned from the Takeuchi case? It has been 80 years since malignancy-associated hypercalcemia was described. It has been 45 years since HHM was first described. It has been 15 years since PTHrP was identified, and 12 years since PTHrP immunoassays became available for clinical research. We now know almost everything about HHM in pathophysiological terms, and we can reproduce the cardinal features of the syndrome in laboratory animals and humans. The Takeuchi case reminds us that we still have a few things to learn about HHM. Specifically, "Why is the regulation of 1,25(OH)2D different in patients with HHM and HPT?" and "Why is normal osteoblast-osteoclast coupling dysregulated in HHM?" or more fundamentally, "What regulates osteoblast-osteoclast coupling, and why is it deranged in HHM?" Given the rate of accumulation of new information about HHM, about the anabolic effects of PTH and PTHrP, and about osteoblast-osteoclast coupling over the past 10 years, there is reason to be optimistic that the answers to these questions will soon become clear.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
15/66. Dual-modality PET/CT tomography for clinical oncology.diagnosis and follow-up in clinical oncology are traditionally based on computed tomography (CT). In recent years, however, functional imaging using positron emission tomography (PET) has been recognized as an important imaging modality and adjunct to CT that provides complementary metabolic information in many oncology applications. To overcome the challenges of aligning independently acquired PET and CT image sets several ad hoc concepts of integrating PET and CT imaging in a single device have been proposed. This article comments on the development of the first combined dual-modality PET/CT prototype at the University of Pittsburgh, and illustrates commercial advances to dual-modality PET/CT tomography. The current PET/CT designs from the major manufacturers comprise a commercial CT scanner in tandem with a commercial PET scanner. While the level of physical integration is actually less than that of the original prototype it is fair to assume that current PET/CT models may serve as intermediate solutions towards near-future design concepts that aim at greatly reduced costs of the dual-modality tomographs and offer a greater level of physical integration. The goal of the next generation of PET/CT systems is to design and build a device specifically for imaging the function and anatomy of cancer in the most informative and effective way without necessarily conceptualizing it as combined PET and CT scanners. Such a concept of a diagnostic imaging device relates more to a disease management approach rather than the usual division into medical specialities such as radiology and nuclear medicine.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
16/66. Adjuvant ketamine analgesia for the management of cancer pain.OBJECTIVE: To review the clinical literature evaluating the utilization of intravenous ketamine for the management of cancer-related pain, to summarize the data that suggest ketamine is an appropriate adjuvant method of providing analgesia and to report a case of successful pain management using ketamine in a patient with recurrent testicular cancer at our institution. DATA SOURCES: Primary literature was identified through a medline search (1966-March 2002), and additional information was obtained through secondary and tertiary sources. DATA SYNTHESIS: The available data suggest that supplementation of morphine with ketamine improves analgesia in patients with cancer, and also provides insight to the controversy regarding the efficacy and adverse effects of various ketamine doses. At subanesthetic doses, ketamine may be beneficial at reducing opioid requirements and related adverse effects. CASE SUMMARY: A 34-year-old white man with recurrent testicular cancer was admitted with radiating neuropathic pain of the legs and lower back. The patient was suspected to also be experiencing opioid adverse effects; therefore, alternative analgesic options were warranted. ketamine was successful in reducing patient-reported pain and was also well tolerated. CONCLUSIONS: ketamine is an adjuvant analgesic for the treatment of cancer-related pain when other agents either fail or are intolerable. Accordingly, there are several factors that may prevent adequate pain control with opioid use; therefore, alternative analgesic options should be considered. Promise exists for ketamine as a contemporary analgesic in the appropriate patient.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
17/66. Surgical management of parietal lobe epilepsy.parietal lobe seizure foci are difficult to localize unless there is an MRI lesion or contralateral sensory aura. Rapid network projection often makes scalp EEG and semiology misleading. However, seizure control can be achieved with reasonable success when concordant information guides the physician to a parietal ictal onset. Perhaps the most important messages that this small surgical series provides is that of neurologic outcome. The parietal lobe is a highly convergent cortical region and a major network way station. Except for primary sensory phenomena and language, one cannot temporarily ablate parietal cortical association area within a presumed epileptogenic region and predict the visuospatial, cognitive, and neurologic outcome. Therefore, data demonstrating that one can resect regions of parietal cortex and not cause serious dysfunction are helpful. The mild morbidity encountered in this group of patients would not be necessarily predicted if the same region of normal parietal lobe was resected. Therefore, one must consider cortical plasticity and functional redistribution as possible reasons for this, particularly when most of these substrates are of developmental origin.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
18/66. hyperalgesia: an emerging iatrogenic syndrome.Clinical reports suggest that opioids, intended to abolish pain, can unexpectedly produce hyperalgesia. This paradoxical effect may be mechanistically related to tolerance induced by increasing doses of opioids. Two case reports illustrate a syndrome characterized by increasing pain pursued by escalating opioid doses, which results in a worsening of the clinical picture. Several experimental data may help explain the course of this challenging clinical condition. In escalating opioid doses rapidly, a risk of opioid-induced hyperalgesia should be recognized, as higher doses of opioids may stimulate rather than inhibit the central nervous system by different mechanisms. Alternative procedures should be taken into consideration to break this cycle, should it occur. More data are needed to detect this condition, as currently no diagnostic information on specific markers, clinical or biochemical, exists.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
19/66. The utility of ancillary studies in pediatric FNA cytology.We evaluated the diagnostic contribution of adjunct studies performed on aspirated material in the work-up of pediatric fine-needle aspiration (FNA) biopsies. Ancillary studies were performed on 54 of 136 (39.7%) pediatric FNA biopsies during a 5-year period. In 23 (16.9%) cases, immunocytochemical (ICC) studies, consisting of immunoperoxidase staining of direct smears and/or cell blocks or flow cytometric immunophenotyping, were performed. The studies were adequate in 14 cases (60.9%), suboptimal in five cases (21.7%), and inadequate in four cases (17.4%). Of the adequate and suboptimal cases, the ICC data helped to narrow the differential diagnosis or classify the disease process in eight cases (42.1%), confirmed cytologic impression in nine cases (47.4%), and gave contradictory results in two cases (10.5%). Adequate material for electron microscopy (EM) was obtained in 14/19 cases (73.7%). Ultrastructural studies were diagnostic, or helped classify the disease process in five cases (35.7%), confirmed the cytologic impression in four cases (28.6%), helped exclude diagnostic considerations in three cases (21.4%), and were judged to be non-contributory in two cases (14.3%). Cytogenetic studies revealed six of seven cases (all neoplasms) to have abnormal karyotypes. Special stains for organisms performed on smears from 25 cases including Ziehl-Neelsen, Gomori methenamine silver (GMS), Gram, and Warthin-Starry (WS) were negative except for 1/16 GMS and 4/9 Gram stains. In summary, we found that with appropriate case selection, ancillary studies performed on aspirated material can provide useful information in pediatric FNA cytology.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
20/66. Failure to master early developmental tasks as a predictor of adaptation to cancer in the young adult.The ability of young adults to adapt to living with a cancer diagnosis and to negotiate the healthcare system is influenced by their level of maturity. If adolescent developmental tasks have been unresolved or pathologically resolved, they are likely to be reenacted during the various stages of the malignancy. Retrospective review of case histories that illustrate the diverse ranges of adaptation to life-threatening illness indicates that success or failure in achieving ego autonomy and continuity in adolescence significantly influences the young adult's capacity to cope with the malignancy. Psychosocial assessment of the young adult patient and spouse, with attention to childhood, adolescent, and family history, will assist the oncology nurse in predicting the individual's capacity for adapting to the illness and complying with treatment. This developmental information will allow clinicians to modify interventions to compensate for earlier stage deficits.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
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