Caring for patients with brain tumor: the patient and care giver perspectives.

BACKGROUND: Patients with brain tumors form a heterogeneous group in terms of clinical presentation and pathology. However, the impact of the disease on patients' families is often more homogenous and frequently quite profound. A considerable body of literature is available on the management of brain tumors and recently, the National Institute for Clinical Excellence has developed guidelines on the care of brain tumor patients that should improve the overall outcome for the patient from both the disease and psychological aspects. OBJECTIVES: An increasing number of studies have attempted to address the impact of the disease on the care givers and relatives of these patients, but few have considered the problem simultaneously from both the patient's and care giver's perspective. In this study, we analyzed the psychosocial and general health of brain tumor patients and related this to the care givers. MATERIALS AND METHODS: This is a questionnaire-based postal survey of 168 patients and their relatives. We examined how the health and psychological well-being of the caregiver may affect the quality of care. RESULTS: There is significant physical, social, and psychosocial morbidity associated with caring for brain tumor patients. Patients worry about their care givers and this constitutes additional stress for the patient. CONCLUSIONS: No constructive and lasting improvement can be made to the quality of life of patients with brain tumor until the health and welfare of their care givers are factored into the care package. With better service to the patient, it is hoped that the burden of care will lighten for the care givers.

Crowding among hunter-gatherers: the Kung Bushmen.

Highly crowded living conditions exist among the !Kung Bushmen, hunter-gatherers who live on the edges of the Kalahari Desert in Botswana and South-West Africa. The !Kung appear to be crowded by choice, and biological indicators of stress are absent. Data indicate that residential crowding alone does not produce symptoms of pathological stress.

Post-treatment of a slaughterhouse wastewater: stability of the microbial community of a sequencing batch reactor operated under oxygen limited conditions.

Slaughterhouse wastewater is a complex effluent with an important content of organic nitrogen. After an anaerobic treatment where most of the organic matter is removed, the nitrogen, remains as ammonium and post-treatment of the effluent is necessary. Sequencing batch reactor (SBR) technology has been developed to completely remove nitrogen in one single reactor combining aerobic and anoxic stages. Under oxygen limited conditions only nitrite is produced with concomitant energy saving. The stability and diversity of the microbial community from a nitrifying denitrifying SBR operated under oxygen limited conditions were studied using molecular and respirometric methods. The AOB (ammonia oxidizing bacteria) community was relatively stable Nitrosomonas being the dominant genera although Nitrosospira and Nitrosococcus were detected in low proportions. Nitrite oxidizing bacteria were out competed during the operation under oxygen-limited conditions. After an increase of the DO in the reactor Nitrobacter spp were detected suggesting that they remained in the system. Changes in the AOB and denitrifying communities were observed after the DO increase. Sedimentation problems were detected during operation, this could be related to the predominance of Thauera spp detected by FISH and T-RFLP.

The envelope layers of mycobacteria with reference to their pathogenicity.

The review discusses current knowledge of the biosynthesis, composition and arrangement of the mycobacterial envelope, describes the biological activities of the constituents and considers how these activities may be relevant to the pathology of mycobacterial disease. The envelope possesses three structural components: plasma membrane, wall and capsule. Although the major biomolecules occurring in each of these parts are known, the distribution of numerous minor substances is poorly understood; an attempt has been made to assign them to particular positions on rational grounds. The plasma membrane appears to be a typical bacterial membrane but, though vital to the mycobacterium, probably plays little part in pathological processes. The wall partly resembles a Gram-positive wall, but is unusual in having a layer of lipid (mycolate esters) which is probably arranged to form a permeability barrier to polar molecules. The capsule, whose chemical composition has only recently been recognized, consists of polysaccharide and protein with traces of lipid; the arrangement of these components is imperfectly understood. Constituents of all parts of the envelope have biological activities which may be relevant. The likely importance of these activities in the overall effect of the envelope is considered.

The outer parts of the mycobacterial envelope as permeability barriers.

The permeability of mycobacteria to substances in their environment is controlled by the properties of their envelopes. Two special features are important: an outer lipid barrier based on a monolayer of characteristic mycolic acids and a capsule-like coat of polysaccharide and protein. The mycolate layer prevents entry of small hydrophilic molecules, which obtain access to the cell by way of pore-forming proteins resembling porins of Gram-negative bacteria. More lipophilic molecules can diffuse through the lipid layer. The capsule probably impedes access by macromolecules; in intracellular pathogenic species it forms the electron-transparent zone that separates the bacterium from the membrane of the host phagosome. The structure of the outer lipid barrier seems common to all mycobacteria, fast- and slow-growing, but the capsule is more abundant in slow-growing species, a group which includes all the important mycobacterial pathogens. Mycobacteria secrete proteins into their environment, which are likely to be important in the pathogenesis of mycobacterial diseases. Knowledge of how these proteins, and the polysaccharides of the capsule, cross the outer lipid barrier is minimal at present. It is likely that proper knowledge of mycobacterial permeability will enable new approaches to treatment of mycobacterial disease.

Single column high pressure liquid chromatographic determination of drugs in blood.

1. Analysis of anticonvulsants (phenobarbital, diphenylhydantoin and carbamazepine), theophylline and an antiarrhythmic agent (disopyramide) in blood using a simple high pressure liquid chromatography apparatus equipped with a reversed -- phase column is described. A simple extraction of plasma or serum with organic solvent is used to isolate the anticonvulsants and theophylline. Disopyramide is extracted with ether and is further purified by a back extraction into acid. 2. Hexanesulfonic acid -- methanol solutions are used for chromatography of the anticonvulsants and disopyramide while the mobile phase for theophylline is a NH4H2PO4 -- methanol mixture. Chromatographic analysis time for the drugs is approximately 15 minutes. The drugs are monitored by a UV detector at 254 nm except for theophylline which is measured at 280 nm. Quantitation is accomplished by comparison of peak heights with those of internal standards. Quantities of serum or plasma routinely used for analysis are: 200 ul for the anticonvulsants, 100 ul for theophylline and 0.5 ml for disopyramide. Detection limits are less than 1 ug/ml for these quantities.

Diet and medications giving positive ninhydrin reactions on TLC in a newborn urinary screening program.

During amino acid analysis of over 520,000 urine samples (provided by a urinary screening program), we often noticed different dietary compounds or medications giving positive ninhydrin reactions which could interfere with the interpretation of the thin layer chromatograms. Consequently, we have done an in vitro study of the chromatographic behaviour of the most frequently encountered artifacts in urine. We believe that the results of this work should make it easier for other laboratories doing similar analyses to recognize the presence of such compounds, thus facilitating the evaluation of their chromatograms.

An automated method for the determination of orotic acid in the urine of children being screened for metabolic disorders.

Urinary orotic acid is believed to be a valuable probe for early diagnosis of inborn errors of metabolism leading to hyperammonemia and increased pyrimidine synthesis. For the purpose of our urinary mass screening programme, we developed an automated colorimetric method which is reliable in the range of 1 to 50 micrograms/ml orotic acid and allows analyses at a rate of 160 samples per hour. Preliminary results are presented which illustrate that various disorders can be recognized by measuring orotic acid in urine.

Simple and rapid system for screening and identification of reducing sugars in urine.

As part of our screening programme for metabolic disorders we needed a rapid, simple, inexpensive means to detect reducing sugars in urine, with a simple but precise test for their identification. Our system comprises a bismuth reduction test for reducing sugars, with unidimensional thin layer chromatography on silica gel and color development with diphenylamine--aniline for definitive identification.

Glycosylated hemoglobins in Friedreich's ataxia.

In a study of glycosylated hemoglobins in Friedreich's Ataxia patients and in family members, the level was found to be higher in insulin dependent diabetics than in healthy non-diabetic control subjects (p < 0.01), but was similar to non-ataxic diabetic control subjects. Results for non-diabetic Friedreich's Ataxia patients and siblings were similar to those for non-diabetic control subjects while levels were slightly increased in the heterozygotes. It is concluded that in Friedreich's Ataxia patients and family members (apart from the insulin dependent diabetics), there was no hyperglycemia sufficient to be detected as an increase in glycosylated hemoglobins.

Purine metabolism in Friedreich's ataxia.

In a detailed investigation of nucleotide synthesis, interconversion and degradation, no difference was found between subjects with Friedreich's Ataxia and normal controls. It appears improbable that this disorder is related to a primary defect in purine metabolism.

Glucose tolerance and erythrocyte insulin receptors in Friedreich's ataxia.

Detailed in vivo and in vitro studies of glucose and insulin metabolism in Friedreich's ataxia patients and unaffected family members have further defined the extent of the abnormalities in carbohydrate metabolism. The high incidence of glucose intolerance and a hyperinsulinemic response to a glucose challenge in a high percentage of Friedreich's ataxia patients has been confirmed. An increased incidence of glucose intolerance among heterozygotes is suggested, while the siblings show a more normal distribution of diabetes and a nearly normal insulin response to the glucose tolerance test. Human growth hormone patterns are normal for all groups. Preliminary studies of insulin binding to erythrocytes suggest a difference in the binding characteristics among diabetic Friedreich's ataxia patients, while the binding in the non-diabetic Friedreich's ataxia group is similar to that of non-diabetic controls. Results from a small group of non-diabetic siblings suggest a normal insulin binding, while a tendency toward increased binding at low insulin concentrations among diabetic family members is noted.

Erythrocyte membrane lipids in Friedreich's ataxia.

In a study of the lipid composition of erythrocyte membranes in Friedreich's ataxia, the concentration of the major membrane components (phospholipids, cholesterol and protein) in ataxic patients, family members, and control subjects were found to be the same. The total fatty acid distribution was also normal. However, an altered distribution of phospholipid classes in erythrocytes was noted (an increase of PI + PS and a decrease of PE in Friedreich's ataxia patients).

Birth order, sibling investment, and fertility among Ju/'Hoansi (!Kung).

Birth order has been examined over a wide variety of dimensions in the context of modern populations. A consistent message has been that it is better to be born first. The analysis of birth order in this paper is different in several ways from other investigations into birth order effects. First, we examine the effect of birth order in an egalitarian, small-scale, kin-based society, which has not been done before. Second, we use a different outcome measure, fertility, rather than outcome measures of social, psychological, or economic success. We find, third, that being born late in an egalitarian, technologically simple society rather than being born early has a positive outcome on fertility, and fourth, that number of older siblings and sibling set size are even stronger predictors of fertility, especially for males.

The comparative bioavailability of cimetidine-alginate treatments.

The comparative bioavailability of cimetidine in cimetidine-alginate combinations has been investigated in twelve healthy volunteers in an open crossover study. Each volunteer received a single oral dose of a commercially available alginate-cimetidine combination tablet (Algitec) or cimetidine tablets (Tagamet), co-administered with a commercially available alginate reflux suppressant liquid or tablet (Gaviscon). No significant differences were observed between treatments for Cmax, tmax, AUC0-12 or AUC0- infinity. The study demonstrated equivalent bioavailability of cimetidine when administered separately with alginate products and as a fixed dose combination product.

The ideal and the real: some thoughts on theoretical developments in British nursing.

Two types of nursing theory are described: the realistic, whose purpose is to account for the complex reality of nursing; and the idealistic, whose purpose is to describe an idealized world of nursing as it 'ought to be'. It is argued that British nurses have overemphasized the importance of idealistic theory, and that this has retarded the development of our understanding of the real world of nursing. I recommend that the hermeneutical approach, as described by Gadamer (1989) might provide a base from which the balance might be redressed.

What are the implications of integration for nursing research and nursing education?

On 1 April of this year, the last of the colleges of health were integrated into higher education. In considering the impact of integration, we must not forget the changes that are already occurring in the university sector. One issue is of particular importance: the likelihood of the separation of departments within universities--and indeed, of entire universities themselves--into those that teach and undertake research, and those that only teach. These two factors, research and education, make appropriate headings under which to address my comments in this editorial.

Change in nursing and the introduction of the support worker.

Many changes have occurred in the British nursing profession over the last 15 years, including the introduction of the nursing process, the change in emphasis to holistic care, the contemporary focus on wellness rather than illness, models of nursing, primary nursing and Project 2000. These changes are discussed as the outcome of the interaction between groups of nurses of various ideological persuasions. Firstly, the ideologies of professionalism, bureaucracy and paramedicine are identified and described. Next, the historical relationship between these ideological groups is discussed. The paramedical ideology, as an expression within nursing of the controlling power of the medical profession, dominated nursing for many years. Its position was maintained through means that included the division of labour (as seen in task allocation) and the control of knowledge (as seen in a medically modelled nursing curriculum). More recently, however, the professionalists have gained the upper hand. In the paper, each of the changes identified above is seen as part of a strategy of professionalisation. The main thrust of this strategy has been to reunite the divided nursing function, and to redefine the nature of nursing knowledge through the development of nursing theory. The introduction of the support worker grade is an attempt to consolidate professionalist control by re-dividing nursing labour between the stages of the nursing process, with professional nurses being responsible for care planning, while support workers undertake its delivery. The professionalists can now be described as an occupational hegemony.

The spiritual dimension: why the absence within nursing curricula?

This article explores the complex barriers which may have prevented the formal integration of the spiritual dimension within programmes of nurse education in the UK. These barriers have been termed intrinsic (arising from within the educational institutions themselves) and extrinsic (reflecting society's and individuals' values, beliefs and cultural norms). It is argued that these barriers have slowed down curriculum innovation and change, preventing the spiritual dimension from receiving due recognition within programmes of nurse education.