Giant-block twist grain boundary smectic phases.

Study of a diverse set of chiral smectic materials, each of which has twist grain boundary (TGB) phases over a broad temperature range and exhibits grid patterns in the Grandjean textures of the TGB helix, shows that these features arise from a common structure: "giant" smectic blocks of planar layers of thickness l(b) > 200 nm terminated by GBs that are sharp, mediating large angular jumps in layer orientation between blocks (60 degrees < Delta < 90 degrees ), and lubricating the thermal contraction of the smectic layers within the blocks. This phenomenology is well described by basic theoretical models applicable in the limit that the ratio of molecular tilt penetration length-to-layer coherence length is large, and featuring GBs in which smectic ordering is weak, approaching thin, melted (nematic-like) walls. In this limit the energy cost of change of the block size is small, leading to a wide variation of block dimension, depending on preparation conditions. The models also account for the temperature dependence of the TGB helix pitch.

Polarization-modulated smectic liquid crystal phases.

Any polar-ordered material with a spatially uniform polarization field is internally frustrated: The symmetry-required local preference for polarization is to be nonuniform, i.e., to be locally bouquet-like or "splayed." However, it is impossible to achieve splay of a preferred sign everywhere in space unless appropriate defects are introduced into the field. Typically, in materials like ferroelectric crystals or liquid crystals, such defects are not thermally stable, so that the local preference is globally frustrated and the polarization field remains uniform. Here, we report a class of fluid polar smectic liquid crystals in which local splay prevails in the form of periodic supermolecular-scale polarization modulation stripes coupled to layer undulation waves. The polar domains are locally chiral, and organized into patterns of alternating handedness and polarity. The fluid-layer undulations enable an extraordinary menagerie of filament and planar structures that identify such phases.

Young widows' experience with an Internet self-help group.

1. Finding empathetic support is an important factor in coping for people with various needs. 2. Support group resources may be limited due to long travel distances, expense of child care, lack of transportation, or no available group for specific needs. 3. Nurses can guide their patients to Internet support groups for self-care when traditional groups are not accessible or applicable to their circumstances.

Demands of illness in people treated for colorectal cancer.

PURPOSE/OBJECTIVES: To describe the most common and most intense demands of illness in people with colorectal cancer. DESIGN: Descriptive, comparative. SETTING: People with colorectal cancer were accrued through weekly online computer postings. SAMPLE: 121 people (68 men and 53 women) from 35 states (n = 106) and six other countries (n = 15) who were treated for colon, rectal, or anal cancer. METHODS: Mailed questionnaires included a 125-item, self-report instrument with seven subscales (Demands of Illness Inventory (DOII) and a 14-item demographic form. MAIN RESEARCH VARIABLES: Demands of illness, time since treatment, perception of illness state, activity level, and age. FINDINGS: Demands of illness were greatest in the personal meaning domain, with more than 93% of subjects reporting that they thought about the value of life and how long they might live. More than 85% reported uncertainty in six similar areas. The 10 most intense demands were predominately psychosocial and existential concerns. Respondents in the youngest age group (< 45 years) reported significantly greater demands in six of seven domains of the DOII than the middle and older groups. Three variables (time since treatment, perception of illness, activity level) accounted for 45% of the variance in DOII scores. CONCLUSIONS: Colorectal cancer imposed significant psychosocial and existential concerns on respondents, especially the youngest age group. IMPLICATIONS FOR NURSING PRACTICE: Nurses should address these concerns with patients while continuing to identify and scientifically test creative strategies to minimize psychosocial morbidity.

Spiritual well-being and demands of illness in people with colorectal cancer.

The purpose of this descriptive correlational study was to identify the relationship between subjects' spiritual well-being and the demands of illness (DOI) imposed by colorectal cancer. Potential subjects were notified about the study through computer networks. Those who met the criteria and wished to participate in the study used e-mail to request a study packet, which included an explanation of the study, the Demands of Illness Inventory (DOII), the Spiritual Well-Being Scale (SWBS), a demographic form, and a stamped return-reply envelope. Of the 170 packets requested, 121 (71%) were returned complete. More than half of the respondents were men and were of a Christian faith. Most respondents reported physical symptoms, but were able to carry on normal activity. Demands of illness were greater among men, the youngest subjects, those who received treatment in the previous 2 months, and those who reported decreased activity, metastatic disease, and/or terminal status. Women reported significantly greater spiritual well-being than men. Subjects who reported higher levels of spiritual well-being indicated significantly lower DOI related to physical symptoms, monitoring symptoms, and treatment issues. Findings indicate that a greater degree of spiritual well-being may help to mitigate the DOI imposed by colorectal cancer.

Lymphomas: long-term sequelae and survivorship issues.

OBJECTIVES: To provide a review of long-term sequelae of lymphoma and its treatment, with emphasis on second malignancies, survivorship issues, rehabilitation, and quality of life. DATA SOURCES: Review articles, research studies, and book chapters pertaining to late effects of treatment of lymphomas and to rehabilitation and quality of life for survivors of Hodgkin's disease or non-Hodgkin's lymphoma. CONCLUSIONS: Overall, the outlook for survivors of the lymphomas is positive. The risk of developing second malignancies as long-term sequelae, although relatively low, and the need for physical and psychological health maintenance, warrant lifetime follow-up and support. IMPLICATIONS FOR NURSING PRACTICE: Nurses have a key role in preparing patients for survivorship. By fostering a philosophy and program of rehabilitation that begins at the time of diagnosis, nurses can assist survivors of lymphoma to achieve quality of life.

Self-transcendence in older men attending a prostate cancer support group.

Self-transcendence has been shown to be related to well-being in older adults, women with breast cancer, women with AIDS, gay men with AIDS, and a healthy population. The purpose of this descriptive pilot study was to examine self-transcendence in another high-priority population: older men with prostate cancer. A convenience sample of 23 men, age 60 and older (M = 69), from three prostate cancer support groups completed Reed's Self-Transcendence Scale (STS) and a demographic data form. The men were predominantly white (82.6%), of the Catholic faith (56.5%), married (78.3%), and not working (87.0%). Over half (65.2%) had a college degree or higher; most viewed their health as good (69.6%) or excellent (21.7%); and the majority (56.5%) viewed their prostate cancer as affecting some of their daily activities. These men scored high on the STS (M = 50.07), which was consistent with previous findings in other populations. Findings of this study contribute to Reed's middle-range theory of self-transcendence. The discovery that self-transcendence is relevant to this group of older men with prostate cancer provides a basis for nurses to investigate the phenomenon in this population and help their clients explore the benefits of the self-transcendence resource.

Evaluation of a computer-based cancer support network.

PURPOSE: Via a descriptive survey, the authors evaluate the use of a computer network by individuals coping with cancer. DESCRIPTION OF SURVEY: Users were notified about the survey primarily through the computer network message board and obtained copies of the survey from the network library, electronic mail, or U.S. mail. Fifty-four participants from 27 states completed a 22-item forced-choice and Likert-type response survey developed by the investigators. RESULTS: Respondents reported using the network primarily for contacting others in a similar situation, obtaining information and emotional support, and encouraging others. Treatment of cancer and its effects on the family were reported as the most helpful topics. Respondents found the computer support network to be an excellent resource for information and emotional support, although participation was limited by cost and time constraints. CLINICAL IMPLICATIONS: Verbatim comments by respondents validate the needs of patients and families for ongoing information and support in the process of coping with cancer. Computer support networks can provide this service throughout the cancer continuum.

Perceived quality of life before and after implantation of an internal cardioverter defibrillator.

BACKGROUND: Although use of the internal cardioverter defibrillator in selected high-risk patient groups has significantly improved survival, questions have arisen regarding its impact on psychological adjustment and quality of life. OBJECTIVES: To determine whether there was a difference in perceived quality of life of internal cardioverter defibrillator recipients before implantation, reported retrospectively, and after implantation. METHODS: Survey packets containing a demographic data form, a modified version of the Ferrans and Powers Quality of Life Index: Cardiac Version, and a consent form were mailed to internal cardioverter defibrillator recipients accrued from two hospitals; 70 patients comprised the convenience sample. RESULTS: No significant difference in perceived overall quality of life was revealed by before and after implantation scores of t tests or analyses of variance. Young, unemployed patients with multiple health problems were most at risk for quality of life deficits. Overall, recipients in this study appeared to adapt effectively to the stresses associated with the device. CONCLUSIONS: Our results suggest that the internal cardioverter defibrillator did not prolong life at a sacrifice to quality of life. These findings can help identify patients at increased risk for quality of life deficits.

A survey of recipients of American Cancer Society master's degree scholarships.

PURPOSE/OBJECTIVES: To determine the contributions that recipients of American Cancer Society (ACS) master's degree scholarships have made to oncology nursing and care. DESIGN: Evaluation survey. SETTING: National. SAMPLE: All scholarship recipients since the program's initiation who were at least three years postfunding and who could be located (N = 103). The final sample consisted of 84 respondents. METHODS: Investigators mailed subjects surveys and conducted follow-up phone calls to increase the return rate. The 15-item survey tool contained four open-ended, nine short-response, and two Likert-type scale items. MAIN RESEARCH VARIABLES: Employment experience, ACS involvement, thesis topics, presentations/publications, integration of oncology nursing into practice, perceived ability to influence cancer prevention and detection, and professional goals. FINDINGS: A high rate of master's program completion, direct clinical involvement, ACS involvement, and prevention and detection activities. CONCLUSIONS: Recipients demonstrated a high degree of socialization into oncology nursing. They demonstrated that they are making important contributions to oncology nursing and cancer control. IMPLICATIONS FOR NURSING PRACTICE: Scholarships are an excellent way for oncology nurses to further their education and professional development. After graduation, these nurses are very likely to make strong contributions to nursing.

Coping strategies of long-term cancer survivors.

Cancer survival is a stressful experience requiring coping for the maintenance of equilibrium. Lazarus' Theory of Stress and Coping was the framework for this descriptive study of the use and effectiveness of coping strategies as assessed by long-term survivors of cancer. The Jalowiec Coping Scale (JCS) and a subject information sheet (SIS) were mailed to 128 potential subjects, identified by the snowball technique, who survived cancer for > 5 years, were not currently receiving therapy, and were not in a terminal stage of disease. Fifty-nine subjects with a mean survival of 13.03 years correctly completed and returned the questionnaire and were included in data analysis. Respondents were predominantly white (88.1%), female (83.7%), married (72.8%), employed as professionals (57.8%), 41-65 years of age (59.3%), and diagnosed with breast cancer (50.8%). Subjects rated optimistic, supportive, and confrontive strategies as most often used and effective. Length of survival did not result in different choices of strategies. Statistically significant differences were found in coping styles between elderly and middle-aged survivors. Results of this study increase nurses' awareness of effective coping strategies and the importance of assessment of coping in long-term survivors of cancer. The importance of social support, spirituality, and helping others is emphasized.

The whys of patient education.

The rationale for patient education is that patients and families have the right to be informed; that professional standards describe appropriate patient education; that health care organizations and the law require patient education; and patients, health care organizations, and that society benefit from the process. Patients with cancer benefit in terms of knowledge acquisition, enhanced self-care, reduced anxiety, enhanced self-concept and self-esteem, increased satisfaction with care, improved pain control, improved oral status, and reduced disruption in daily functioning. Health care organizations benefit in terms of quality services, reduced costs, and reduction in malpractice suits. Society benefits as patients with knowledge and skills maintain or resume functional status and return to school, work, or service activities. Nurses are key professionals in the coordination and delivery of patient education programs. They too have the opportunity to benefit from patient education through therapeutic alliances with patients and families that foster both personal and professional satisfaction.

Employee counseling with respect to lifestyles, life events, and breast cancer risks.

1. All women should be considered at risk for breast cancer, because about 75% of the cases occur in women who are not considered high risk, or in whom no cause is identified. 2. Risk is a function of unalterable genetic and constitutional factors that are modified by lifestyle, life events, and environmental factors. 3. Knowledge about factors that influence employee behaviors regarding their risks is useful for planning strategies to encourage health-promoting behaviors. 4. The future goal of education and counseling will be primary prevention as well as early detection of breast cancer.

Quality of life of oncology hospice patients: a comparison of patient and primary caregiver reports.

Promoting quality of life is a major goal of hospice nursing. Because family primary caregivers (PCGs) are responsible for and interact closely with patients, they greatly influence patients' quality of life. Disparities between patient and primary caregiver views may reflect misunderstanding, leading to inadequate symptom control, dissatisfaction with the caregiver role, and diminished psychological and physical well-being for both. This descriptive study compared patient and PCG views of the quality of life of hospice patients with cancer. A convenience sample of 23 patient-PCG pairs, selected from a home-based hospice, completed the Quality of Life Index (QLI). Computation of two-tailed paired t tests revealed that, with the exception of pain, there was no statistically significant difference between patient and PCG responses. Patients acknowledged significantly less pain than their PCGs reported for them. This difference has important clinical implications because effective pain control, a critical component of quality of life, is best achieved when patients and primary caregivers share a common perception of the patients' pain experience.