Cytotoxic chemotherapy for incurable colorectal cancer: living with a PICC-line.

AIMS: (i) To determine which aspects of living with a peripherally inserted central catheter (PICC) line cause Modified de Gramont (MdG) patients most difficulty. (ii) To explore MdG patients' views of the PICC-line experience. (iii) To determine if patients view PICC-lines as a benefit or a burden when receiving ambulatory MdG chemotherapy. DESIGN: A two-stage, descriptive study. METHODS: Phase 1 comprised semi-structured interviews. Phase 2 surveyed the MdG population. Phase 1 interview data informed the Phase 2 questionnaire. The setting was a West of Scotland Cancer Care Centre and the sample was: Phase 1, a convenience sample of 10 MdG patients; Phase 2, 62 consecutive patients. RESULTS: A response rate of 93.9% for Phase 2. The majority of PICC-line patients held favourable views towards having a PICC-line and adapted well with minimal disruption to daily life. Concerns were evident regarding coping at home with a PICC-line, chemotherapy spillage, dealing with complex information and the responsibility of patients/carers regarding PICC-line management. Patients preferred ambulatory chemotherapy to in-patient treatment. CONCLUSIONS: PICC-lines should be considered for more chemotherapy patients but service development is necessary to ensure individual needs are addressed. RELEVANCE TO CLINICAL PRACTICE: Contributes to the PICC-line literature by providing a national patient perspective on a range of daily living activities (DLAs). PICC-line patients prefer out-patient ambulatory chemotherapy rather than in-patient treatment. The longer a patient has a PICC-line, the more able they are to manage activities such as dressing. Concerns remain over chemotherapy spillage, partner/carer responsibility for PICC-line maintenance and the proper balance between required information and what the patient wants to know.

Falls risk following discharge from a geriatric day hospital.

OBJECTIVE: To assess the predictive validity of the Elderly Mobility Scale (EMS), Functional Reach (FR) and the Barthel Index (BI) in identifying recurrent fallers following discharge from a geriatric day hospital (GDH). SUBJECTS: Seventy-six GDH patients with identified mobility problems. METHODS: Each patient was assessed by an independent physiotherapist before and after a programme of physiotherapy using the EMS, FR and BI and a 'falls follow-up' assessment was performed after four months. RESULTS: Fifty-four per cent (29 out of 54) of patients had reduced mobility at follow-up. Twenty-five per cent (18 out of 71) of patients had two or more falls post discharge. Using logistic regression analysis for EMS, FR and BI at discharge, each of these variables individually was significantly associated with the risk of having two or more falls (p = 0.008, 0.017 and 0.031 respectively). A prognostic tree was developed for GDH patients identifying high-risk and low-risk groups. CONCLUSION: EMS, FR and BI were all significantly associated with GDH patients with mobility problems having two or more falls. A prognostic tree identified high- and low-risk groups of GDH patients and should now be tested prospectively.

A homeopatia e uma resposta placebo? / Is the homeopathy a placebo response?

Num experimento duplo-cego randomizado, foi testada a hipotese de que as potencias homeopaticas sao placebo. O modelo escolhido para estudo comparou, os efeitos de uma preparacao de mistura de polens de capim com placebo, em 144 pacientes com Febre do Feno ativa. A resposta era mais significativa quando os resultados eram corrigidos para a dose de polen, e quando ela estava associada a uma diminuicao de 50% da necessidade de anti-histaminicos. Nos pacientes que receberam o tratamento homeopatico foi notada, inicialmente, uma agravacao mais frequente dos sintomas, seguida de melhora. Nao houve evidencia que sustentasse a ideia de que a acao do placebo explica, completamente, as respostas clinicas para as drogas homeopaticas

A homeopatia e uma resposta placebo? / Is the homeopathy a placebo response?

Num experimento duplo-cego randomizado, foi testada a hipotese de que as potencias homeopaticas sao placebo. O modelo escolhido para estudo comparou, os efeitos de uma preparacao de mistura de polens de capim com placebo, em 144 pacientes com Febre do Feno ativa. A resposta era mais significativa quando os resultados eram corrigidos para a dose de polen, e quando ela estava associada a uma diminuicao de 50 porcento da necessidade de anti-histaminicos. Nos pacientes que receberam o tratamento homeopatico foi notada, inicialmente, uma agravacao mais frequente dos sintomas, seguida de melhora. Nao houve evidencia que sustentasse a ideia de que a acao do placebo explica, completamente, as respostas clinicas para as drogas homeopaticas

L'homeopathie est-elle une reponse placebo? / Is homeopathy a placebo answer?

En partant de l'hypothese selon laquelle les dilutions homeopathiques sont des placebos on a realise un essai randomise en double-aveugle, avec controle placebo. Le modele d"etude comparait le effets d'une preparation homeopathique d'un melange de pollens de graminees a ceux d'un placebo chez 144patients atteints de rhume des foins. Chez les patients traites par l'homeopathie, on a observe une regression significative des symptomes reveles a la fois par le patient et par le medecin. Cette reponse s'est revelee plus significative encore a l'examen des chiffres de comptage du pollen et a correspondu a une diminution de moitie des besoins en anti-histaminiques. Une periode d'aggravation initiale des symptomes ete notee plus souvent chez les patients ayant recu la dilution et a ete suivie d'amelioration dans ce groupe. Aucune preuve n'a ete relevee en faveur de l'idee que l'action placebo explique totalement la reponse clinique aux remedes homeopathiques