Revealing a cancer diagnosis to patients: attitudes of patients, families, friends, nurses, and physicians in Lebanon-results of a cross-sectional study.

BACKGROUND: Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis. METHODS: Study participants included 343 physicians, nurses, cancer patients, families, and friends from clinics in two major hospitals in Lebanon. All completed a 29-item questionnaire that assessed, by demographic group, the information provided about cancer, opinions about the disclosure of the diagnosis to cancer patients, perceived consequences to patients, and the roles of family, friends, and religion. RESULTS: Overall, 7.8% of the patients were convinced that cancer is incurable. Nearly 82% preferred to be informed about their diagnosis. Similarly, 83% of physicians were in favour of disclosing a cancer diagnosis to their patients. However, only 14% of the physicians said that they revealed the truth to the patients themselves, with only 9% doing so immediately after confirmation of the diagnosis. Disclosure of a cancer diagnosis was preferred before the start of the treatment by 59% of the patients and immediately after confirmation of the diagnosis by 72% of the physicians. Overall, 86% of physicians, 51% of nurses, and 69% of patients and their families believed that religion helped with the acceptance of a cancer diagnosis. A role for family in accepting the diagnosis was reported by 74% of the patients, 56% of the nurses, and 88% of the physicians. All participants considered that fear was the most difficult feeling (63%) experienced by cancer patients, followed by pain (29%), pity (8%), and death (1%), with no statistically significant difference between the answers given by the participant groups. CONCLUSIONS: The social background in Lebanese society is the main obstacle to revealing the truth to cancer patients. Lebanese patients seem to prefer direct communication of the truth, but families take the opposite approach. Physicians also prefer to communicate the reality of the disease at the time of diagnosis, but in actuality, they instead disclose it progressively during treatment. Faith is helpful for acceptance of the diagnosis, and families play a key role in the support of the patients. An open discussion involving all members of society is necessary to attain a better understanding of this issue and to promote timely disclosure of a cancer diagnosis.

How the origin of fresh household waste affects its ability to be biodegraded: an assessment using basic tools and its application to the city of Kara in Togo.

Waste biodegradation has been largely investigated in the literature by using conventional tests like the BMP test and the respirometric test, whereas only few studies deal with the use of leaching tests in combination with biological activity measurements. Consequently, this study used an improved leaching test to evaluate the biodegradability of two deposits of fresh household waste from the city of Kara in Togo. The first deposit came from households in neighborhoods located in the outskirts of the city and the second consisted of fresh waste, mainly composed of business waste and household waste, collected in the urban center and aimed at being deposited in the landfill. A physicochemical characterization of the two deposits completed the leaching test. The biological activity was monitored by measuring O(2) consumption and CO(2) production. pH, DOC/OM, VFA/DOC ratios and the SUVA index was measured in the leaching juice to assess both the state of degradation of the waste in the deposits and the ability of the organic matter to be mobilized quickly and to be easily assimilated by microorganisms. The biodegradability of waste from the city of Kara correlated with their origin even though the physical characteristics of the two deposits studied differed greatly.

Susceptibility of chicken embryos to highly virulent infectious bursal disease virus.

The susceptibility of chicken embryos to highly virulent infectious bursal disease virus (hvIBDV), strains F539 and DV86, was examined with respect to three inoculation routes and compared with the classical type of IBDV, strain G691. Death patterns of embryos infected with strains F539 and DV86 of hvIBDV were observed constantly and most of the infected embryos died; however, the death pattern associated with the strain G691 of classical IBDV was erratic and not related to the virus titer inoculated. The chorioallantoic membrane (CAM) route was the most sensitive route of infection, while the allantoic sac (AS) route was the least, regardless of the strain. The difference in titer of hvIBDV between the CAM and yolk sac (YS) route was less than that of classical IBDV. Constant lethality to embryos seems to be distinctive characteristic of hvIBDV.

Changes in surgical treatment of peptic ulcer disease within a veterans hospital in the 1970s and the 1980s.

To determine if the surgical treatment of peptic ulcer disease within a Veterans Administration hospital has changed over the past decade, we compared two groups of patients. Group 1 (n = 104) had surgery between 1974 and 1977 and group 2 (n = 61) had surgery between 1984 and 1987. In group 1, 49 (47%) ulcer operations were performed for chronic symptoms, while in group 2, 11 (18%) were performed for nonemergent reasons. The remaining 55 (53%) patients in group 1 and 50 (82%) in group 2 had operations for complications of peptic ulcer. When expressed per 1000 admissions, the rates of operations for complications were similar (1.08 vs 1.1). The relative proportions of perforation, bleeding, or obstruction were similar for patients in the two groups, as was the American Society of Anesthesiologist's Physical Status rating (3.1 vs 3.2). The fitness score, a scale for assessing preoperative risk with 10 representing the greatest risk, was also similar (6.7 vs 6.8). An American Society of Anesthesiologist's Physical Status value of greater than 3 and a fitness score of greater than 6 indicate that these patients were at high risk with an expected operative mortality of greater than 25%. In fact, the mortalities in groups 1 and 2 for patients having emergency operations for complications were 29% and 30%, respectively. The marked reduction in elective ulcer operations observed in our institution may be due to several factors, including better nonoperative therapy (eg, histamine receptor antagonists), physician preference for nonoperative treatment of chronic ulcers, or a reduced incidence of chronic ulcer within our population. However, the number of emergency operations for complications of ulcer has remained constant. These complications occur in poor-risk patients with concomitant illness, and the operative mortality for these patients is high.