Treatment of gastroparesis: a multidisciplinary clinical review.

This clinical review on the treatment of patients with gastroparesis is a consensus document developed by the American Motility Society Task Force on Gastroparesis. It is a multidisciplinary effort with input from gastroenterologists and other specialists who are involved in the care of patients with gastroparesis. To provide practical guidelines for treatment, this document covers results of published research studies in the literature and areas developed by consensus agreement where clinical research trials remain lacking in the field of gastroparesis.

Treatment of vinorelbine-associated tumor pain.

Vinorelbine is a synthetic vinca alkaloid used for the treatment of Hodgkin's disease and metastatic breast, non-small-cell lung, and ovarian cancers. Vinorelbine-associated tumor pain can be so severe that patients are unable to complete therapy. We present a series of three patients who were premedicated with ketorolac in an attempt to control infusion-related pain. Two of our patients responded well and were able to complete their courses of vinorelbine therapy. The third had persistently severe pain, and therapy was terminated because of pain and lack of response to vinorelbine treatment. These three cases support the hypothesis that surgery or radiation therapy before the use of vinorelbine may increase the likelihood of experiencing associated tumor pain. Premedication with ketorolac and morphine before vinorelbine infusion is proposed as a reasonable prophylactic treatment for associated tumor pain.

Morphine-Infused silver sulfadiazine (MISS) cream for burn analgesia: a pilot study.

Pain is considered the most distressing symptom of a burn wound, with analgesia usually provided via oral or parenteral medications. Use of systemic opioids can be complicated by fluctuations in bioavailability, absorption, and clearance of drugs caused by the burn. There has been little research done in the area of topical medications for burn analgesia. The following is a double-blind, placebo-controlled pilot study assessing the safety (side effects) and efficacy (pain ratings and medications administered) of morphine-infused silver sulfadiazine cream for burn pain. Four patients are reported on (2 in each group). Only participants taking placebo reported side effects related to morphine and necessitated anxiolytic medications. Pain ratings in the treatment group ranged from 0 to 7 with a mean of 2.1, whereas the placebo group's ratings ranged from 2 to 8 with a mean of 5.6. The placebo group averaged 55.3 mg oral morphine per half day, whereas the treatment group averaged 42.9 mg.

Emotionally expressive coping predicts psychological and physical adjustment to breast cancer.

This study tested the hypothesis that coping through emotional approach, which involves actively processing and expressing emotions, enhances adjustment and health status for breast cancer patients. Patients (n = 92) completed measures within 20 weeks following medical treatment and 3 months later. Women who, at study entry, coped through expressing emotions surrounding cancer had fewer medical appointments for cancer-related morbidities, enhanced physical health and vigor, and decreased distress during the next 3 months compared with those low in emotional expression, with age, other coping strategy scores, and initial levels on dependent variables (except medical visits) controlled statistically. Expressive coping also was related to improved quality of life for those who perceived their social contexts as highly receptive. Coping through emotional processing was related to one index of greater distress over time. Analyses including dispositional hope suggested that expressive coping may serve as a successful vehicle for goal pursuit.

Treatment of painful skin ulcers with topical opioids.

Recent research suggests that opioid receptors on peripheral nerve terminals may play an important role in the modulation of pain. Clinical applications of this knowledge have been rather slow to evolve. We describe a consecutive series of nine patients with painful skin ulcers due to a variety of medical conditions. All patients were treated with a topical morphine-infused gel dressing. Seven of the nine patients experienced substantial and another experienced a lesser (but still significant) degree of analgesia. The ninth reported no relief, but his wound was not an open ulcer. Discussion centers on the practical application of this development in the large number of patients with painful skin lesions.

Concurrent psychotherapy and pharmacotherapy in the treatment of depression and anxiety in cancer patients.

Over the past 30 years, numerous studies have compared the relative effectiveness of psychotherapy, pharmacotherapy, and concurrent therapeutic approaches in treatment of common psychiatric disorders, such as depression and anxiety. Generally, these studies have demonstrated that the combined approach is somewhat more effective in treating the disorder in question, as well as in preventing relapse. A number of theories regarding the reasons for this finding have been proposed. The application of this therapeutic approach to the specific population of cancer patients has not been studied in systematic research. This paper briefly reviews the studies comparing the efficacies of various treatment approaches for depression, discusses reasons for the efficacy of such an approach, and outlines a series of reasons why this may be the preferred model for intervening with cancer patients.

The effects of bereavement on adult sibling bone marrow donors' psychological well-being and reactions to donation.

As living organ, tissue, and bone marrow donation become increasingly prevalent treatments for a variety of diseases, better understanding of living donors' experiences, especially when the recipient does not survive after the transplant, also becomes more critical. Although some psychological outcome data exist concerning living donation, there have been no systematic prospective investigations, to date, of the psychological impact of bereavement among sibling bone marrow donors. Studies of bereavement effects in other donation settings such as unrelated bone marrow donation and related kidney donation, suggest that bereavement may have a significant impact on donors' reactions. The present investigation studied a panel of sibling bone marrow donors at three key points in the donation process in order to (1) examine donor psychological well-being across time, and (2) investigate the effect of the sibling recipient's death on donor well-being. We surveyed sibling donors by mail 1-2 weeks prior to donation, 1-2 weeks following donation, and again 1 year after their donation. In general, all donors reported high levels of predonation self-esteem, mastery, happiness and life satisfaction. As might be expected, bereaved donors felt less as if their donation had really helped their sibling as time passed. However, despite such donation-specific perceptions, bereaved donors experienced global psychological gains following bereavement including enhanced self-esteem, happiness, and life satisfaction compared to donors whose siblings were still living. These findings suggest that physicians and mental health practitioners should monitor donors' psychological well-being for extended periods post-donation, and should consider clinical interventions for bereaved and nonbereaved sibling donors.

The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates.

Psychosocial criteria play an important role in evaluating organ transplant candidates. The Transplant Evaluation Rating Scale (TERS) classifies patients' level of adjustment in 10 aspects of psychosocial functioning that are thought to be important in adjusting to transplantation. On the basis of pretransplant psychiatric consultations, 35 liver transplant recipients received retrospective TERS ratings. Results showed significant correlations between TERS scores and visual analogue scale ratings of five outcome variables at 1-3 years posttransplant. Significant interrater reliability was also found. The TERS represents a promising instrument for transplant candidate selection as well as a valuable tool for further research.