Exploring the Needs and Concerns of Women with Early Breast Cancer during Chemotherapy: Valued Outcomes during a Course of Traditional Acupuncture.

Women diagnosed with breast cancer experience symptom clusters in addition to existential issues from a life-threatening diagnosis during chemotherapy. A complementary therapy, such as traditional acupuncture (TA) with its whole-person orientation, may help to modify these effects, alongside inducing other patient benefits. Exploring the needs and concerns of women and perceived benefits of TA would add to knowledge about its integrative treatment potential. Methods. A longitudinal qualitative study recruited fourteen women to receive up to ten sessions of TA during chemotherapy. They were interviewed before, during, and after chemotherapy. Two practitioners of TA delivered treatment and were interviewed before and after the study, and kept treatment logs and diaries. Interviews were recorded and transcribed, and the data were analysed using grounded theory. Findings. Both broad and specific benefits were reported by the women; a highly valued outcome was enabling coping through the alleviation of symptoms and increased well-being. Practitioners dealt with the presented symptom clusters facilitating outcome patterns, including and beyond individual symptom changes. Further research on TA as a flexible intervention able to respond to the changing needs and concerns of woman during chemotherapy along with the measure of such outcome patterns is warranted.

Depression: a psychiatric nursing theory of connectivity.

This paper presents a theory of connectivity, which was formulated from the findings of a Classical Grounded Theory study that was designed to capture a sample of people's perceptions of living with depression or caring for individuals with depression. Data were collected from: (1) a focus group consisting of people with depression (n = 7), of which five were patients in the community and two were nurses; (2) one-to-one interviews with patients in the community (n = 5) and nurses (n = 5), three of whom had experienced depression from both sides of the caring process; and (3) two 'happy accident' focus groups (n = 25; n = 18) comprising of healthcare workers with a shared understanding of depression. Purposeful sampling was used initially. Thereafter, in keeping with one of the key tenets of grounded theory, theoretical sampling was used until theoretical saturation occurred. Data were analysed using the constant comparative approach together with the NVivo qualitative analysis software package. The core category that emerged was 'connectivity' relating to the connections and disconnections, which people make in their lives. Six key categories emerged all of which were integrated with the core category. Hence, connectivity provided a significant platform for understanding and responding to the life experience of depression. They were: (1) life encounters on the journey to naming; (2) depression: What's in a name? The silent thief; (3) tentative steps to health care; (4) connective encounters and challenges; (5) connecting with self; and (6) self-connection maintenance. Subsequently, a theory, 'Depression: a psychiatric nursing theory of connectivity', surfaced from the overall findings. We argue that this theory of connectivity provides a framework that people working in the field of holistic treatment and care could use to better understand and respond to the life experience of people living with depression.

Early life experiences and their impact on our understanding of depression.

This paper presents part of a larger Grounded Theory study, which was designed to capture a sample of people's perceptions of living with or, caring for, individuals with depression. Data were collected from a focus group consisting of people with depression (n = 7). In-depth one-to-one interviews were undertaken with eight further respondents (n = 8). Purposeful sampling was used initially. Thereafter, in keeping with one of the key tenets of grounded theory, theoretical sampling was used. The emergent concepts were pursued until saturation occurred. The constant comparative approach was used to analyse the data together with the NVivo qualitative analysis software package. This paper focuses on the respondents' perceptions of the pre-diagnosis, depression encounter. The key category that emerged was 'the pre-diagnosis phase of depression and the now experience'. Five key themes surfaced within this category: (1) negative impact significant life events; (2) self-blame; (3) personal characteristics; (4) pre-diagnosis, depression unknowingness; and (5) pre-help seeking. The findings suggest that those in the field of human services need to better understand the lived experience of people with depression, in order to provide holistic treatment and care.

Naming of depression: nursing, social and personal descriptors.

This paper explores descriptors of depression and begins by exploring nursing descriptors including the nature of assessment and nursing diagnosis and progresses to underpin these major processes by considering social descriptors such as cultural and spiritual constructs. The role and influence of stigma is discussed and an examination of gender influences and experiences is undertaken. The paper concludes by examining personal descriptors in the literature. The overall aim of the paper is (1) to add to nursing knowledge by depicting the grounded realities of the experience of depression and (2) stimulate discussion on the need to provide holistic care pathways that are responsive to the uniqueness of this lived experience and finally to (3) encourage further research on key psycho-social factors associated with depression and the concurring advancement of nursing care. This paper has been completed in the context of an ongoing study into the grounded experience of 'Depression' and the development of a psychiatric nursing theory of connectivity.

Nursing people who are suicidal on psychiatric wards in Taiwan: action/interaction strategies.

Suicide is a major mental health problem in Taiwan. Estimations revealed that approximately 41% of people who committed suicide had a previous history of psychiatric inpatient care. To date, a suicide nursing care theory has not been developed. Consequently, the aim of this study was to formulate a suicide nursing care theory with the aim of enhancing and advancing the nursing care provided to people who attempt suicide or have suicidal thoughts. A qualitative approach using grounded theory was adopted. A total of 15 peoples who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding and the NUD*IST software program. A substantive theory of suicide nursing care was developed from the emergent findings. Four categories surfaced in the nursing care theory relating to the nurses' 'action/interaction strategies'. They were: the holistic assessment of people who are suicidal; providing protection; providing basic care; and providing advanced care. The findings from this study could be used to influence and advance nurse education and training, clinical practice, management and further research.

The effects of conjugated linoleic acid supplementation on immune function in healthy volunteers.

OBJECTIVE: To assess the effects of dietary supplementation using two isomeric blends of conjugated linoleic acid (CLA) on immune function in healthy human volunteers. DESIGN: Double-blind, randomised, placebo-controlled intervention trial. SUBJECTS AND INTERVENTION: A total of 55 healthy volunteers (n=20 males, n=35 females) were randomised into one of three study groups who received 3 g/day of a fatty acid blend containing a 50:50 cis-9, trans-11: trans-10, cis-12 CLA isomer blend (2 g CLA), and 80:20 cis-9, trans-11: trans-10, cis-12 (80:20) CLA isomer blend (1.76 g CLA) or linoleic acid (control, 2 g linoleic acid) for 8 weeks. RESULTS: Supplementation with the 80:20 CLA isomer blend significantly (P< or =0.05) enhanced PHA-induced lymphocyte proliferation. CLA decreased basal interleukin (IL)-2 secretion (P< or =0.01) and increased PHA-induced IL-2 and tumor necrosis factor alpha (TNF(alpha)) production (P< or =0.01). However, these effects were not solely attributable to CLA as similar results were observed with linoleic acid. CLA supplementation had no significant effect on peripheral blood mononuclear cells IL-4 production, or on serum-soluble intercellular adhesion molecule-1 (sICAM-1) or plasma prostaglandin E2 (PGE2) or leukotreine B4 (LTB4) concentrations. CONCLUSIONS: This study shows that CLA supplementation had a minimal effect on the markers of human immune function. Furthermore, supplementation with CLA had no immunological benefit compared with linoleic acid.

Human neuroepithelial cells express NMDA receptors.

L-glutamate, an excitatory neurotransmitter, binds to both ionotropic and metabotropic glutamate receptors. In certain parts of the brain the BBB contains two normally impermeable barriers: 1) cerebral endothelial barrier and 2) cerebral epithelial barrier. Human cerebral endothelial cells express NMDA receptors; however, to date, human cerebral epithelial cells (neuroepithelial cells) have not been shown to express NMDA receptor message or protein. In this study, human hypothalamic sections were examined for NMDA receptors (NMDAR) expression via immunohistochemistry and murine neuroepithelial cell line (V1) were examined for NMDAR via RT-PCR and Western analysis. We found that human cerebral epithelium express protein and cultured mouse neuroepithelial cells express both mRNA and protein for the NMDA receptor. These findings may have important consequences for neuroepithelial responses during excitotoxicity and in disease.

Functionalism and holism: community nurses' perceptions of health.

This paper reports the results of a study that was designed to explore and examine the perceptions of two groups of newly qualified community nurses about the factors they considered to be embedded within the concepts of health, health-enhancing behaviours at individual, family and community levels and their 'innermost self'. The research was exploratory in nature, and included two sample groups: group 1 comprised 16 newly qualified health visitors; group 2 comprised 16 newly qualified community mental health nurses. Purposive sampling was used and data were collected using semi-structured interviews. The group of health visitors perceived health in terms of physical fitness and functional states. At a global level they perceived the need to provide education on health matters. They gave generously to 'charities' and perceived the 'inner self' as 'that part that matters'. The group of community mental health nurses perceived health in terms of holism and being states. Their concept of health was related to listening to each individual's perception of what is 'right' and 'health-enhancing' for them. At a global level they considered the protection of the ozone layer and the promotion of a just and equitable society which focused on the reduction of poverty, to be key health-enhancing activities. They perceived their 'innermost self' to be 'that part of me that makes life worth living', and the soul. The findings have implications for developing new and creative approaches for teaching the holistic concept of health and healing. Educational activities could be designed which strive to ensure that nurses themselves have safe and health embracing opportunities for exploring all the elements that are embedded within the topic of health. Their role in facilitating holistic health promoting activities for all clients also needs to be addressed.

Developing a tool to measure holistic practice: a missing dimension in outcomes measurement within complementary therapies.

Despite the wide and continuing debate over the relevance of particular research methods to evaluate complementary therapies, less attention has been given to what outcome criteria and measures to use and/or whether these have a sufficient breadth in perspective. While complementary and alternative medicine researchers have paid heed to the importance of measuring the subjective experience of therapy users, they have left unmeasured the notion of holism, in particular, the measurement of the effect of the interaction between therapist and therapy user, and its underlying philosophy of health and healing. This paper reports on an exploratory, qualitative study aimed at developing a measure of holism and holistic practice. It draws out some key features requiring measurement and provides insight into the emerging measure. Further development work is needed before the measure can be used within research or routine practice.

Communication is the essence of nursing care. 1: Breaking bad news.

This is the first of two articles which support the assumption that effective communication is the foundation upon which nursing should stand. The articles are founded on an examination of an interaction analysis of a role play situation in the classroom where a group of 19 MSc nursing students presented a nursing scenario to their peers and feedback was later generated from the total group. At least seven minority ethnic groups, who were new to the country, were represented. The role play was later examined using theoretical frameworks to guide the analysis. This article provides analysis of the breaking of bad news, giving information through exploring, questioning and reassurance, touch, and, finally, empathy and humanism. The second article will explore and examine ethical issues, such as truth-telling and autonomy, that were also evidenced in the role play. Other themes were personal constraints such as family stress and counselling. This article begins by introducing readers to the role play situation. The number of communication concepts identified in this short 20-minute role play positively support the authors' argument that communication is the essence of nursing care.

Communication is the essence of nursing care. 2: Ethical foundations.

This is the second of two articles analysing the communication themes that emerged from a role play situation in the classroom where a group of MSc nursing students carried out a nursing role play. Feedback from the entire group of 19 students was obtained and discussed openly following the presentation of the scenario. The first article examined the following communication issues: breaking bad news; giving information through exploring, questioning, and reassurance; touch; and empathy and humanism (Vol 9(14): 931-8). Attempts were made to give examples of how these key issues could be applied to nursing practice. This second article involves the examination of the ethical issues of truth-telling and autonomy that emerged in the role play and again attempts to integrate the theoretical underpinnings with nursing practice in the knowledge that the arguments advanced are neither right nor wrong. This deduction is based on the fact that each human being is unique; therefore, each interaction that occurs between two people is also unique. Nursing can strive to provide better, more effective and more sensitive communication because ethical communication is, it is argued, the realm in which nurses toll.

The labyrinth of health as perceived by two groups of community nurses.

The purpose of this research was to examine a group of 16 health visitors and a group of 16 community mental health nurses perceptions of health and health awareness. The study was mainly qualitative and exploratory in nature with some quantitative data being collected to condense the data. All 32 respondents were interviewed using a semistructured, tape recorded format. The content of the data was scrutinized and emerging patterns, themes, and concepts were noted and coded using a tried and tested theoretical process. The findings were related to the questions asked and comparisons were drawn between the information received from each group. An examination of the data revealed that the group of health visitors defined health terms of 'functional' states, described health in physical terms, and practiced physical exercises as their health valuing behaviours in order to keep themselves healthy. This key theme also emerged with reference to their value of health at family and global levels. Taking their health for granted and being grateful for it when they saw someone in the community less well off than themselves was also highlighted as a major theme. The group of community mental health nurses defined their health in 'being' states and described health in a holistic manner. They perceived the value and concept of 'freedom' to be related to and embraced within the concept, definition and value of health at individual, family and global levels. They practiced aesthetic health valuing behaviours to enhance their appreciation of health and self. Mental health, the ability to make choices, being self actualizing and the capacity to love and be loved were the key themes emerging throughout this group's responses. It would be interesting to develop this research from a community health perspective.

Nursing: a spiritual perspective.

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the article argues, and the reverse is also true. Spirituality in health is inextricable in each person's search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness. Abstract themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse.

HIV risk behavior, street outreach, and condom use in eight high-risk populations.

In this paper we examine risk behavior, exposure to street outreach, and condom use in samples of injecting drug users (IDUs) and high-risk youth. We used systematic sampling methods to produce representative samples of injecting drug users IDUs (five sites) and high-risk youth (three sites). The populations surveyed engaged in high levels of sexual risk behavior: 20% to 46% reported two or more sex partners in the last month. The majority (62% to 97%) knew someone infected with HIV. Condom use rates approached national health promotion goals for nonsteady partners but not for steady or main partners. Having a condom at time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents have been in contact with street outreach programs and many acknowledged some personal risk for HIV infection. However, most of the injecting drug users and high-risk youth interviewed (and their sex partners) were still at risk through unprotected sex.

PIP: Samples of IV drug users (IVDUs) and high-risk youth were surveyed to gain insight into their HIV risk behavior, exposure to street outreach, and condom use. The IVDUs were sampled from Atlanta, Philadelphia, Chicago, New York, and Los Angeles; 69-77% are male; they are predominantly Hispanic and Black; and more than 50% were older than age 40 years. The high-risk youth were sampled from Los Angeles, San Diego, New York, and San Francisco. They were aged 12-23 years and had been recurrently without shelter during the past year, or had been without permanent shelter for the past two months, or had derived their livelihood from dealing drugs on the street, prostitution, panhandling, and crime. 65-81% are male, approximately 50% in New York are White and 78% in San Francisco, 39-54% were age 20 or older, and 52-73% were currently living on the street, although only 10-32% had stayed in a shelter during the past year. At least 75% were supported at least in part by the street economy and 15-33% identified themselves as gay or bisexual. Many of the youth covered in the survey in San Francisco were on tour with the Grateful Dead folk rock music group. 20-46% reported having two or more sex partners in the last month, up to one-third reported having no sex partner in the past month, 62-97% knew someone infected with HIV, and 18-26% of the IVDUs and 11-41% of youth reported sometimes exchanging sex for money, food, shelter, or other things. Among respondents who had sex during the past month, 17-44% reported using a condom during vaginal sex with main partners, and 55-75% with other partners. The highest rates of condom use were for anal sex, followed by vaginal and oral sex. In most categories, however, the majority of respondents were not using condoms to protect themselves from HIV or other sexually transmitted diseases. Having a condom at the time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents had been in contact with street outreach programs and many acknowledged some personal risk for HIV infection.

An exploration of women's perceptions of the major factors that contributed to their alcohol abuse.

The purpose of this research was to explore the interviewees' perceptions of the major factors that contributed to their alcohol abuse. The research was carried out by interviewing seven women who were identified by community mental health professionals. The research was qualitative and exploratory. The semi-structured tape-recorded interview technique was used as an enquiry tool. The tapes were then transcribed and coded, and the findings were scrutinized and scanned for emerging themes and concepts using an interactive and cyclical process of data-reduction techniques, data display and verification of findings. The findings suggest that the majority of the interviewees could identify and isolate specific life events and past-life crises that contributed to an increase in their alcohol intake. Results also indicate that there is a need to consider the efficacy of the current models of primary, secondary and tertiary care as well as relapse-prevention programmes of care in order to facilitate women to have every opportunity to make informed and rational health choices about their drinking behaviours, and to maintain abstinence, for the promotion of positive mental health and for enhancing the quality of their lives.

Biotransformation of benzaldehyde by Saccharomyces cerevisiae: characterization of the fermentation and toxicity effects of substrates and products.

Although higher initial rates of phenylacetyl carbinol formation were observed in fermentations containing a high starting benzaldehyde level, a massive reduction in yeast viability was observed resulting in early cessation of production formation. Pulse feeding to maintain lower benzaldehyde concentrations resulted in a lower initial reaction rate, but prolonged yeast viability and the biotransformation. This resulted in higher overall product tilers. As benzaldehyde concentration was increased, yeast growth rate was reduced (0.5 g/L), inhibited (1-2 g/L), or cell viability reduced (3 g/L). Benzaldehyde appeared to alter the cell permeability barrier to substrates and products. Reductions in yeast biomass levels and especially protein and lipid content were observed during the biotransformation. The effects of benzaldehyde and reaction products on yeast pyruvate decarboxylase and alcohol dehydrogenase stability were determined. Homogenized yeast cells produced similar phenylacetyl carbinol levels to whole yeast only if supplemented with thiamine pyrophosphate and magnesium.

Long-term effects of training in relaxation and stress-coping in patients with migraine: a 3-year follow-up.

Research on the short-term effects of psychological interventions in migraine indicates improvement rates of 50 percent. Yet long-term follow-ups are scarce: the studies extending to three years provide evidence for the maintenance of effects, but these studies evaluate the benefits of rather complex psychological treatments and the samples include other types of headache. We compared the effects of single-method psychological interventions upon migraine. The study reports results obtained from 24 patients three years after completion of relaxation training, which is a psychophysiological regimen, and stress-coping training, which is a cognitive-behavioral regimen. Results for the complete sample, excluding data biased by confounding factors, provide clear evidence of the preservation of effects in migraine. Relaxation training (RT) and stress-coping training (SCT) were equally effective and both groups exhibited little medication consumption since completion of training. Among the secondary effects, SCT was found to improve assertiveness and active problem solving, and to decrease depressive reaction. The study yielded two predictor variables--little external stress for relaxation training, and high self motivation for stress-coping training--that accounted for more than 50 percent of the effect variance in the respective groups. Although more research is needed to substantiate our findings, the results suggest that, thus far, there is little reason to favor multimodal training or more complex psychological treatments over single-method psychological interventions in migraine. Also, our results do not support the assumed superiority of cognitive-behavioral treatment over psychophysiological treatment. Research on factors predicting long-term effects of psychological interventions in migraine may profit from considering separate variables on skill rehearsal and skill employment (instead of employing a global measure of home practice), and from a measure for post-training external stress.