Alternative pharmacotherapy. Patterns of patient use and family physician practice.

BACKGROUND: The use of alternative pharmacotherapies is rapidly increasing. Many persons who use purchased or prepared alternative medications are also cared for by family physicians. We describe patient usage of alternative pharmacotherapies and examine how family physicians handle this in medical practice. METHODS: We recorded data from structured interviews of 178 patients in an academic family medicine practice in a midsized southern city. We then examined the medical records of each participant who reported using some form of alternative pharmacotherapy to determine whether there was discussion of this use with the physician. RESULTS: Approximately one third of the patients reported using some form of alternative pharmacotherapy for 1 year or less, learning about alternative medications mostly from the media, and being generally satisfied with the results. Eighty-four percent of the patients reported not having been asked by their physician about their use of these drugs on the day of their office visit, and more than half reported never having been asked about their use of them. Medical record reviews indicated that for the most part physicians did not document having discussed or making recommendations about the use of alternative pharmacotherapies at any point in their relationship with the patient. CONCLUSIONS: Since many of their patients are using alternative pharmacotherapies, family physicians are encouraged to learn more about what their patients use, to institute easy system-wide changes to facilitate discussion about this use with their patients, to document alternative drugs used, and to give recommendations regarding them.

Quality of life in breast cancer survivors: implications for developing support services.

PURPOSE/OBJECTIVES: Quality of life (QOL) is becoming more important in regard to breast cancer as treatment advances extend the period of survivorship. The purpose of this article is to share the results of a cancer center's attempt to evaluate the QOL needs of breast cancer survivors in order to provide improved supportive-care services. DESIGN: Descriptive mailed survey. SETTING: A medical center in southern California. SAMPLE: A random sample of breast cancer survivors (N = 298). METHODS: Breast cancer survivors completed a mailed survey that included major outcome variables of QOL and pain. Subjects were stratified by three age groups: younger than 40 years, 40-60 years, and older than 60 years. MAIN RESEARCH VARIABLES: QOL subscales (physical, psychological, social, and spiritual well-being) and overall QOL score and pain as assessed by the Brief Pain Inventory. FINDINGS: Results indicated continued physical demands of breast cancer, including fatigue and pain, as well as psychological burdens related to fear of breast cancer recurrence and anxiety. The social well-being domain indicated some unique aspects of QOL when applied to breast cancer survivorship such as the fear of breast cancer in female relatives. The spiritual well-being domain illustrated the unique QOL aspects of life-threatening illness such as living with uncertainty and maintaining hope. Breast cancer survivors also reported positive aspects and life changes after successfully facing breast cancer. CONCLUSIONS: Breast cancer survivors experience many demands of illness across the physical, psychological, social, and spiritual domains. IMPLICATIONS FOR NURSING PRACTICE: The study's findings can be useful in directing cancer centers' efforts to provide comprehensive care for breast cancer survivors. Nurses play a critical role in leading these efforts for supportive-care services intended to improve the QOL of breast cancer survivors.

A structured nondrug intervention program for cancer pain.

The management of cancer pain has been a primary focus in the authors' program of oncology nursing research. A study currently in progress entitled, "Assessment and Management of Pain for Elderly Cancer Patients at Home," applies knowledge of the authors' earlier work in an educational nursing intervention for patients with cancer and their family care-givers in the home. The program consists of three parts: (1) an overview of pain, (2) pharmacologic management of pain, and (3) nondrug interventions for pain. The nondrug component of this program is particularly unique in providing structured implementation of nonpharmacologic techniques, which are often neglected in pain management. Five categories of nondrug intervention are used including heat, cold, massage/vibration, distraction, and relaxation. The purpose of this article is to report on the development and initial results of the nondrug portion of a pain education program.

Oxygen affects human endothelial cell proliferation by inactivation of fibroblast growth factors.

The fibroblast growth factors (FGF), including endothelial cell growth factor (ECGF)/acidic FGF and basic FGF, are important modulators of endothelial cell replication in vitro and in vivo. Premature infants and adults with lung injuries are often treated with high levels of inspired O2, which can be necessary for survival but potentially injurious to developing lungs and in tissue repair following injury. Human umbilical artery and vein endothelial cells were grown in ECGF- or FGF-supplemented Medium 199 and exposed to ambient levels of O2 from 10 to 95%. Endothelial cell growth, measured by [3H]thymidine incorporation, was inhibited by increasing levels of O2 and ceased above 50% O2. Vein endothelial cells could recover from up to 24 h of hyperoxic exposure when given fresh medium, but not after 48 h. Artery-derived cells were more sensitive to O2 than were vein-derived cells. Complete medium without endothelial cells, preincubated 24 h in 95% O2, lost its ability to support cell growth under normoxic conditions. Exposing individual medium components to high O2 demonstrated that purified natural ECGF and recombinant acidic or basic FGF were all inactivated by O2. Human recombinant superoxide dismutase prevented FGF inactivation. O2 inactivation of essential growth factors could thus have major consequences for lung development or repair of injured capillaries in infants or adults inspiring high levels of O2.

Production of lymphocyte chemokinetic activity by stimulated alveolar macrophages.

While the presence of a lymphocytic parenchymal infiltrate is characteristic of several lung diseases, the mechanisms responsible for the focal accumulation of lymphocytes within the lungs remain unclear. Since alveolar macrophages secrete several substances that affect lymphocyte function, we examined supernatants of stimulated, cultured guinea pig alveolar macrophages for their ability to alter lymphocyte motility. Guinea pigs were immunized by footpad injection of ovalbumin (OVA) emulsified in complete Freund's adjuvant. Fourteen days later, alveolar macrophages were obtained by bronchial lavage or teasing the lung parenchyma, enriched by adherence to plastic, and incubated for 3 and 24 hours in culture medium alone or medium containing either latex beads, OVA, or human serum albumin (HSA). Conditioned medium was harvested and assayed for chemoattractant activity against rat splenic lymphocytes in modified Boyden chambers. Regardless of stimulus, there was no evidence of enhanced lymphocyte motility above control values in supernatants harvested at 3 hours. At 24 hours, alveolar macrophages from OVA-sensitized guinea pigs stimulated with latex or OVA generated significant amounts of lymphocyte migration stimulating activity (LCA) (250 +/- 25 and 247 +/- 24 percent of control migration, respectively) compared to cells incubated in medium alone or with HSA (162 +/- 23 and 147 +/- 14 percent, respectively). Antigen recognition appears to be related to the presence of cytophilic anti-OVA antibody on the surfaces of alveolar macrophages of sensitized guinea pigs. LCA is resistant to neuraminidase, chymotrypsin, and heating to 56 degrees C, and was chemokinetic for T-lymphocytes. it elutes from Sephadex G-100 in two regions: one at approximately 67,000 d, and a second at approximately 15,000 d. These studies indicate that following systemic immunization, the guinea pig alveolar macrophage can react to specific antigen or phagocytosis of inert particulates by secreting a chemokinetic factor for T-lymphocytes, and may play a role in the pathogenesis of some types of antigen-induced lung disease.

Effect of L-azetidine 2-carboxylic acid on growth and proline metabolism in Escherichia coli.

The effects of L-azetidine 2-carboxylic acid on growth and proline metabolism in a proline-requiring auxotroph of Escherichia coli are described. The homologue inhibited growth of the wild type and it, alone, did not substitute effectively for proline as a growth supplement for the mutant. In medium containing 0.05 mM proline, the addition of increasing amounts of homologue progressively inhibited growth of the wild type but stimulated growth of the mutant at homologue: proline ratios of 10 : 1 and 50 : 1. This suggested that the homologue exerted a "sparing effect" on proline in the mutant. The incorporation of L-[U-14C]proline and L-[3H]azetidine 2-carboxylic acid into hot trichloroacetic acid-insoluble material in the mutant was measured. Amino acid analysis of the insoluble material from cells incubated with radiolabeled proline alone revealed that proline was partially degraded and metabolized to other amino acids prior to incorporation into protein. The addition of unlabeled homologue to the incubation medium significantly reduced proline catabolism, suggesting that the homologue exerted a sparing effect on proline in this mutant. In medium containing unlabeled proline and radiolabeled L-azetidine 2-carboxylic acid, the homologue was incorporated both intact and partially degraded prior to incorporation into protein. Alanine was the major L-azetidine 2-carboxylic acid catabolite.