Treatment with zoledronic acid ameliorates negative geometric changes in the proximal femur following acute spinal cord injury.

Acute spinal cord injury is associated with rapid bone loss and an increased risk of fracture. In this double-blind, randomized, placebo-controlled trial, 17 patients were followed for 1 year after administration of either 4 or 5 mg of zoledronic acid or placebo. Bone mineral density (BMD) and structural analyses of the proximal femur were performed using the hip structural analysis program at entry, 6 months, and 12 months. The 17 subjects completed 12 months of observation, nine receiving placebo and eight zoledronic acid. The placebo group showed a decrease in BMD, cross-sectional area, and section modulus and an increase in buckling ratio at each proximal femur site at 6 and 12 months. Six months after zoledronic acid, BMD, cross-sectional area, and section modulus increased at the femoral neck and intertrochanteric regions and buckling ratio decreased consistent with improved bone stability. However, at 12 months, the femoral narrow-neck values declined to baseline. In contrast to placebo, the intertrochanteric region and femur shaft were maintained at or near baseline through 12 months in the zoledronic acid-treated group. Urine N-telopeptide excretion was increased at baseline and declined in both the placebo and treatment groups during the 12 months of observation. We conclude that a single administration of zoledronic acid will ameliorate bone loss and maintain parameters of bone strength at the three proximal femur sites for 6 months and at the femur intertrochanteric and shaft sites for 12 months.

A new psychosocial screening instrument for use with cancer patients.

The authors performed a principal components factor analysis on the 18-item Brief Symptom Inventory (BSI-18), a new brief screening inventory. The factor analysis, in which four factors were specified, is consistent with findings in a previous community sample. The study sample consisted of 1,543 cancer patients who completed the full BSI as part of their entry into care at a regional cancer center. The reliability of the BSI-18 was determined based on the calculation of the internal consistency, mean item scores, and correlations with the total score of the BSI. In addition, sensitivity and specificity was calculated to determine the ability of the BSI-18 to discriminate positive and negative cases. The BSI-18 is a shortened version of the BSI that can serve as a brief psychological screening instrument. The BSI-18 can be incorporated into outpatient clinics to prospectively and rapidly identify cancer patients with elevated levels of distress who are in need of clinical interventions. Early identification of distress with appropriate interventions can reduce distress, enhance quality of life, and decrease health care costs.

The prevalence of psychological distress by cancer site.

PURPOSE: The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined. PATIENTS AND METHODS: The sample was extracted from a database that consists of 9000 patients who completed the Brief Symptom Inventory as a component of comprehensive cancer care. Relevant data points for each case included age, diagnosis, gender, insurance status, marital status, race and zip code. Simple frequencies, percentages, measures of central tendency and variability were calculated. In addition, a univariate and multiple regression analysis was used to examine the relationships of these relevant variables to psychological distress. RESULTS: The overall prevalence rate of distress for this sample was 35.1%. The rate varied form 43.4% for lung cancer to 29.6% for gynecological cancers. While some rates were significantly different, diagnoses with a poorer prognosis and greater patient burden produced similar rates of distress. Pancreatic cancer patients produced the highest mean scores for symptoms such as anxiety and depression, while Hodgkin's patients exhibited the highest mean scores for hostility. CONCLUSIONS: These results offer vital support for the need to identify high-risk patients through psychosocial screening in order to provide early intervention. To simply perceive cancer patients as a homogeneous group is an erroneous assumption. Failure to detect and treat elevated levels of distress jeopardizes the outcomes of cancer therapies, decreases patients' quality of life, and increases health care costs.

Problem-solving cancer care education for patients and caregivers.

PURPOSE: A program evaluation was conducted to explore the potential effects of a 90-minute problem-solving education session for persons with advanced cancer and their families. DESCRIPTION OF PROGRAM: Patients with advanced cancer and their families, who were visiting a tertiary-care outpatient setting, were invited to attend a 90-minute individualized educational session that taught basic problem-solving principles using a cognitive-behavioral framework. Pre-education and posteducation data were collected about the confidence of participants in providing care, their feelings about being informed about resources, and their perceptions of their problem-solving ability. RESULTS: At baseline, most participants reported low confidence about their ability to provide cancer care and felt uninformed about community resources, but they viewed themselves as moderate-to-good problem solvers. Forty-two educational sessions were delivered to 49 caregivers and 40 patients. Two months later, participants reported feeling more informed about community resources and achieved higher posteducation scores for problem-solving ability. More caregivers than patients reported that reading The Home Care Guide for Cancer made a great deal of difference in their approach to home care. CLINICAL IMPLICATIONS: Most educational sessions for families affected by cancer focus on delivering information, not on building skills. These findings suggest that a one-on-one educational session that teaches problem-solving skills can be successfully delivered in a busy clinic setting. Family caregivers are especially likely to benefit from this program.

Screening to predict complicated grief in spouses of cancer patients.

OBJECTIVES: Grief is the expected reaction to the death of a family member or close friend and is accompanied by substantial distress for almost everyone who experiences it. For some the grief response becomes complicated. This pilot study sought to identify individuals at high risk for complicated grief, by 1) examining the relationships that exist between family functioning before the death, psychological distress, and the grief reaction of a family after the death, and 2) presenting the use of screening with standardized measures to identify those at risk. MATERIALS AND METHODS: This pilot study examined the relationships between family functioning, psychological distress, and grief reaction. A cross-sectional design was used and the instrument included the Family Adaptability and Cohesion Evaluation Scale (FACES III), the Brief Symptom Inventory (BSI), and the Texas Revised Inventory of Grief (TRIG). Significant relationships were identified between the level of family functioning, psychological distress and grief reaction. Depression, anxiety, and general distress were significantly correlated with the two subscales of the TRIG. CONCLUSIONS: The findings clearly illustrate the merit of psychosocial screening of spouses and suggest the possible benefits of screening before the patient's death, using FACES III and the BSI to identify which spouses are at risk for complicated grief reactions.

Clinical social work practice in the U.S. Army: an update.

This article presents the results of a mail survey sent to active-duty and civilian social workers in the U.S. Army to investigate contemporary clinical social work practiced in the Army today. Of the 173 active-duty social workers listed in the 1994 Directory of Army Social Work Officers, 94 returned completed surveys. The civilian respondents, of which there were 77, obtained the survey at the request of the investigators from active-duty social workers. The demographics of the social workers and the client populations served are presented. A factor analysis revealed 10 distinct theoretical and methodological categories reportedly utilized by the respondents. Pearson's correlation revealed a moderate negative relationship between practitioner's years of experience and all client diagnostic categories. The results of stepwise multiple regression analysis between theories, methods, and client groups are presented and discussed. The anticipated future concentration of social work assets according to practice setting and practitioner status is also discussed.