Obstacles to prostate cancer screening in African-American men.

The purpose of this correlational study was to measure structural obstacles to a free prostate cancer screening. The sample consisted of 549 men, 69% who were African-American. The men attended a prostate cancer educational program and were offered free prostate cancer screening at their physician of choice. Structural obstacles that were predictors in screening participation were "making an appointment" (p = 0.02), "planning for an appointment" (p = 0.05), and "reminders of prostate cancer screening" (p = 0.02). The demographic variables of race and marital status were also predictors of screening participation. Implications for health education are given.

Perceived benefits: a predictor of participation in prostate cancer screening.

Prostate cancer is the most frequently diagnosed major cancer and the second cause of cancer-related deaths among men. With early detection through screening and timely treatment, 9 out of 10 men will survive a minimum of 5 years. However, with late diagnoses, only 3 out of 10 men will have a 5-year minimum survival rate. Guided by a conceptual map, this correlational research examined perceived benefits as a predictor of participation in free prostate cancer screening. Perceived benefits are the personal belief and valuing of screening for early detection of prostate cancer. All subjects received one of four educational interventions: traditional, peer educator, client navigator, or combination. Participation in prostate cancer screening was measured by compliance with the American Cancer Society's Guidelines, which included a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test. The purposive sample (n = 1,522) of men, ages 40 to 70 years, was recruited from randomly selected churches, barbershops, industries, housing projects, and car dealerships in a southeastern state. Seventy-two percent of the sample was African American. Predictors of participation in free prostate cancer screening were these: perceived benefits, being white, having at least a high school education, being married, and receiving the client navigator or combination educational intervention. The Benefits Scale was significant (p = 0.013, odds ratio (OR) = 1.059) as a predictor for participation in screening when all demographic variables and educational interventions were controlled. Practice implications for nursing are discussed and recommendations for future research are presented.

The impact of prostate cancer knowledge on cancer screening.

PURPOSE/OBJECTIVES: To test the effect of knowledge on participation in prostate cancer screening. DESIGN: Quasi-experimental design; PRECEDE framework. SAMPLE: 319 men, 82% African American. METHODS: Prostate cancer knowledge was measured with a Prostate Cancer Knowledge Questionnaire prior to a community-based educational program. Men were referred to their personal physicians for a free prostate cancer screening. Results were sent to the Prostate Cancer Project. MAIN RESEARCH VARIABLES: Prostate cancer knowledge and participation in free prostate screening with a digital rectal examination and prostate specific antigen. FINDINGS: Prostate cancer knowledge was a predictor in participation in screening (p = 0.05). IMPLICATIONS FOR NURSING PRACTICE: Nurses need to target educational interventions for African American men, who have the highest incidence of and mortality rates for prostate cancer, to significantly reduce mortality rates. This study documented the importance of providing educational programs to increase participation in prostate cancer screening.

Recruitment of African Americans into prostate cancer screening.

PURPOSE: Both incidence and mortality rates for prostate cancer are significantly higher in African American men than in white men. This report identifies community sites for the optimal recruitment of African American men into prostate cancer screening. DESCRIPTION OF STUDY: A descriptive study was conducted, providing an educational program to 1369 African American men, 1264 of whom completed a survey on demographic data, prostate cancer knowledge, and prostate cancer screening history. The programs were offered at six different types of community sites, including various work sites, churches, housing projects, National Association for Advancement of Colored Persons (NAACP) sites, barber shops, and a state fairground. Free prostate cancer screening was offered to all participants. RESULTS: The advertised mass screening site (state fairground), the most common method used nationally to recruit African American men for cancer screening, was the least effective site, with only 16 men completing the survey. Of the 1264 men completing the survey at all community sites, 597 men (47%) did so at work sites and 438 (35%) did so at churches. Per site, the largest percentage of men who had never been screened was at work sites (n = 276, 46%) and NAACP sites (n = 22, 33.8%). The highest percentage of men who obtained free screening were at the state fairground (14 of 16), churches (256 of 438), and work sites (336 of 597). The most prostate cancers were detected at the housing projects, where 3 of 38 (7.9%) men who were screened received diagnoses of prostate cancer. CLINICAL IMPLICATIONS: To reduce prostate mortality rates in African American men, healthcare providers need to make a concerted effort to increase prostate cancer education and screening in this population. To be effective, recruitment of African American men must move from a provider/health site orientation to a consumer/community orientation. These findings indicate that recruitment strategies are more successful if efforts are based in the community or where a large number of African American men live and/or work. Because a history of screening has been shown to be a predictor for current participation, programs need to target men who have not had previous screening ever or within the last year. In addition, the large percentage of men recruited at work sites who had not been screened previously indicates an opportunity for collaboration with healthcare professionals in employee health programs. Efforts to increase participation in prostate cancer screening will be enhanced significantly by eliciting the active involvement of community leaders.

Increasing prostate cancer screening in African American men with peer-educator and client-navigator interventions.

BACKGROUND: Few African American men participate in prostate cancer screening, although they have higher prostate cancer incidence and mortality rates. METHODS: This study documents the benefits of two educational methods; the peer-educator method and the client-navigator method, in increasing their participation. RESULTS: Sixty-one percent of the 1,211 African American men who received an educational program on prostate cancer participated in the free prostate cancer screening. Men who received the peer-educator method intervention, which included a testimony in support of prostate cancer screening given by an African American man, were more likely to participate, p = 0.04, than were men who received a standard educational program. Also, men who received the client-navigator method intervention, which included 1) a phone call aimed at overcoming screening barriers and 2) reminders for screening, were more likely to participate, p = 0.0001. CONCLUSIONS: More African American men will participate in prostate cancer screening following the peer-education and client-navigator interventions.

Teaching older adults by adapting for aging changes.

Few teaching programs are geared to meet the special learning needs of the elderly. This pilot study used a quasi-experimental pretest-posttest design to measure the effect of the Adaptation for Aging Changes (AAC) Method on fecal occult blood screening (FOBS) at meal sites for the elderly in the South. The AAC Method uses techniques that adjust the presentation to accommodate for normal aging changes and includes a demonstration of the procedure for collection of the stool blood test, memory reminders of the date to return the stool blood test, and written materials adapted to the 5th grade reading level. In addition, actual practice of the FOBS with the use of peanut butter was added to the AAC Method, making it the AAC with Practice Method (AACP) in two sites. The American Cancer Society's colorectal cancer educational slide-tape show served as the basis for all of the methods. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data from 135 Council on Aging meal sites' participants. The average age of the participants was 72 years; the average educational level was 8th grade; over half the sample was African-American; and half of the participants had incomes below the poverty level. Results support a significant increase in participation in FOBS in participants taught by the AACP Method [chi 2 (1, n = 56) = 5.34, p = 0.02; odds ratio = 6.2]. This research provides support for teaching that makes adaptations for aging changes, especially adaptations that include actual practice of the procedure.

Using elderly educators to increase colorectal cancer screening.

This article reports on the elderly educator method, a practical and economical intervention that was used for increasing the rate of return of fecal occult blood sampling in colorectal screening among 171 socioeconomically disadvantaged older persons. Two methods that used elderly educators had an overall response rate of more than 60%. Logistic regression shows a statistically significant difference between two methods that used elderly educators and two methods that did not.

Knowledge of colorectal cancer among older persons.

Cancer screening is a national health priority, especially for colorectal cancer, the second leading cause of death due to cancer in the United States. The researchers measured colorectal cancer knowledge among 211 older Americans. A quasiexperimental pretest-posttest two-by-two factorial design was used to test the effect of knowledge on participation in fecal occult blood screening. The American Cancer Society's colorectal cancer educational slide-tape presentation served as the basis for all of the educational programs. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data. One-half of the participants had incomes below the poverty level. Almost one-half the subjects in the study sample stated that they had not received any information about colorectal cancer within the past year. Caucasians had more knowledge of colorectal cancer than African Americans [F(1, 78) = 7.92, p < 0.01] and persons with higher income had more knowledge than persons with less income [F(2, 76) = 3.01, p = 0.05]. Subjects showed significant increases in colorectal cancer knowledge 6 days after the colorectal cancer education program [t(79) = 2.59, p = 0.01] and this increased knowledge was a predictor of participation in free fecal occult blood screening [chi 2(1, n = 164) = 5.34, p = 0.02].

Plasma drug efflux--a new approach to optimization of drug infusion for constant blood concentration of thiopental and methohexital.

Plasma Drug Efflux is a time-varying measure of the rate of loss of drug from the plasma during conditions of constant plasma concentration. Its practical use is to define the parameters required for a programmed infusion to maintain a desired plasma concentration. The method of deriving the Efflux function, which does not depend on conventional pharmacokinetic models, was developed and tested using thiopental and methohexital in a total of 51 unselected surgical patients free of hepatic or renal disease. Throughout a predetermined, known, but arbitrary computer-controlled drug infusion, the rate of which was modified according to patient lean body mass (LBM) and the desired concentration, blood samples were taken and the plasma assayed for either drug by an HPLC method. By dividing the known variable infusion rate at the time of each sampling by the arterial plasma concentration at each time, an estimate of the rate of loss of drug from the plasma at each point, the Plasma Drug Efflux, was obtained. An error correcting iterative process was used with successive groups of patients until the optimum infusion profile was achieved. Only three iteration steps were required to optimize the infusion profile for each drug. The optimized infusion profile for thiopental was 25.35e-.145t + 4.85e-.0148t + 8.8 ml X min-1 X kgLBM-1, and, for methohexital, 22.21e-.092t + 5.09e-.0121t + 15 ml X min-1 X kgLBM-1. It was concluded that the process of optimization under clinical conditions resulted in infusion profiles suitable for establishing and maintaining a designated arterial plasma concentration in adult surgical patients for periods up to 3 h.

Thiopentone levels during cardiopulmonary bypass. Changes in plasma protein binding during continuous infusion.

Plasma total and unbound concentrations of thiopentone were investigated during exponentially decreasing infusions in seven patients undergoing cardiopulmonary bypass. Total plasma thiopentone concentrations reached a plateau (10.2, SD 2.1 micrograms/ml) soon after the initial bolus dose and commencement of the infusion. Concentrations were maintained until the onset of cardiopulmonary bypass, whereupon total plasma thiopentone concentration fell abruptly to 50.0 (SD 5.8) percent of the prebypass level. The unbound fraction of thiopentone increased from 16.6 (SD 1.9) percent before bypass to a maximum of 29.3 (SD 5.6) percent during bypass (p less than 0.01), decreased to 22.9 (SD 3.3) percent at the end of bypass (p less than 0.01), but was still elevated 5-7 hours later (20.5, SD 2.5 percent). The result of the changes in binding was a smaller decline in unbound thiopentone concentration at the onset of bypass to 76.4 (SD 15.7) percent of the prebypass level. Also, unbound levels returned to the prebypass level by the end of bypass, whereas total levels remained low.

Pentobarbitone formation during thiopentone infusion.

The plasma concentrations and elimination half-life of pentobarbitone were determined in 14 surgical patients receiving a continuous, exponentially decreasing, infusion of thiopentone (mean total dose, 1.05 g; SD 0.34; mean duration of infusion 2.4 hours, SD 0.7) as the primary anaesthetic agent. The plasma pentobarbitone concentration increased gradually, to reach a maximum of 1.49 micrograms/ml (SD 0.61) at the end of the thiopentone infusion, which was 15.5 per cent (SD 6.04) of the plasma thiopentone concentration. The elimination half-life of pentobarbitone measured over the following 70 hours in nine of the patients was 34.3 hours (SD 8.2), which is within the range of values reported previously in several studies in which pentobarbitone was administered directly to volunteers. It was concluded that the formation of this active metabolite during 2-3 hour thiopentone infusions was unlikely to be of clinical relevance, but that significant concentrations may occur with longer thiopentone infusions.

Meeting the terminal functions of a baccalaureate curriculum: the students' perception.

Nursing faculty have established terminal functions which graduates are expected to be able to accomplish after successfully completing the nursing program. Students have asked themselves and faculty if they are ready to perform as professional nurses after graduation. This study utilized the terminal functions established by one medium-size state university to obtain data regarding the students' perceptions of their competencies based on the terminal functions. The assessment was conducted at the time of graduation and again one year post-graduation. The data may provide other faculty with a method to further evaluate nursing curricula and illustrate the changes in graduates' perceptions of their abilities over time.

Evaluation of infusion regimens for thiopentone as a primary anaesthetic agent.

Several multi-stage infusion regimens and a computer controlled exponentially decreasing infusion regimen were evaluated in twelve patients undergoing head and neck surgery or neurosurgery. Thiopentone dosage was based on the mean of pharmacokinetic parameter values from the literature and adjusted for each patient's lean body mass in order to rapidly achieve a predetermined plasma thiopentone concentration of 15 or 20 micrograms/ml in the period following the initial bolus dose to induce anaesthesia. Anaesthesia was satisfactory in all cases. Plasma thiopentone concentrations were maintained between 10-20 micrograms/ml during infusion in the five patients who received either a four or five stage infusion and in the six patients who received the exponential infusion, but not in the single patient who received a two-stage infusion. The mean recovery time was 111 min. The plasma concentrations of total and unbound thiopentone at awakening showed little intersubject variability, despite considerable differences in total dose and duration of infusion, suggesting the absence of acute tolerance to the drug. Plasma clearance of total thiopentone correlated strongly with calculated lean body mass and to a lesser extent with total body weight suggesting that lean body mass, in particular, should be an accurate predictor of thiopentone maintenance dose requirements. This study shows that it is feasible to use thiopentone as a primary anaesthetic agent during surgery by administering the drug either as an exponentially decreasing infusion or as an infusion comprising 4 or 5 stepwise decreasing rates.