Computer-based patient record systems.

OBJECTIVES: To provide oncology nurses with an overview of computer-based patient record (CPR) systems, a key infrastructure requirement in information management that is essential to maintaining a scientific basis for health care. DATA SOURCES: Published articles, research studies, and review articles pertaining to CPR systems. CONCLUSIONS: Progress in hardware development, software applications, and interfaces combine to bring us multimedia patient record systems. Many obstacles have been overcome as standards have emerged and technologies conform to those standards. However, there has been limited success in implementation of such systems. Early acceptance of structured data and problem-oriented documentation set the framework for charting in the electronic record. IMPLICATIONS FOR NURSING PRACTICE: Oncology clinicians and cancer patients alike will realize greater efficiencies and increased quality in health care when the CPR is fully implemented.

Clinical and histologic effects of facial skin rejuvenation with pulsed- and continuous-wave flash-scanned CO(2) lasers.

LEARNING OBJECTIVES: The reader is presumed to have some understanding of the use of lasers in skin resurfacing. After studying the article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 409. BACKGROUND: The selection of the ideal laser for facial resurfacing is debatable. OBJECTIVE: The purpose of the study was to determine whether any clinical and histologic differences existed in short- and long-term results after treatment with the Coherent UltraPulse 5000G laser (a pulsed laser; PL) and the Sharplan Silk Touch laser (a continuous-wave laser [CWL] with a flash scanner). METHODS: Eight patients underwent facial resurfacing treatment on different areas. In each case, one side was treated with the PL and the other with the CWL. The condition of the patients and the treated tissue were monitored periodically after treatment. Histologic assessment of punch biopsies was performed 3 months and 1 year after treatment with hematoxylin-eosin, Masson trichromic, and Verhoeff's stains. RESULTS: The areas treated with the PL achieved earlier epithelialization with a good appearance. Longer-lasting erythema was observed on the side treated with the CWL. On a histologic level, although the PL-treated tissue epithelialized more quickly, at 3 months and 1 year the collagen was better compacted and better aligned in the CWL-treated tissue, and the macroscopic appearance of the CWL-treated areas was more enhanced. CONCLUSIONS: The more active vascularization seen in the CWL-treated tissue, associated with the longer-lasting erythema and possibly greater collateral thermal injury, is possibly the reason for the better collagenization and remodeling of collagen and elastin fibers as compared with the results with the PL-treated tissue. This may explain the longer effect associated with CWL treatment. The clinician would do well to bear in mind the histologic findings as well as the macroscopic clinical results when assessing the long-term effects of laser skin resurfacing. (Aesthetic Surg J 2001;21:399-411.).

Concurrent interstitial radiotherapy and infusional chemotherapy for recurrent gynecologic malignancies.

Patients with unresectable locally recurrent gynecologic malignancies pose a difficult therapeutic challenge. Conventional therapies are frequently unsuccessful and offer only marginal palliation. In this study, interstitial 192iridium-needle implants and concomitant infusional 5-fluorouracil (5FU) and cisplatin (CDDP) or carboplatin (CBDCA) chemotherapy were used to treat 14 women with recurrent pelvic tumors. Malignancies of the cervix, endometrium ovary, tube and vulva are represented; all patients were heavily pretreated. Twenty interstitial implants were performed in these 14 patients. Needle distributions and doses were individualized to accommodate the recurrent tumor volumes. Tumor responses were seen in 12 patients (six complete and six partial responses). Four women remain clinically free of disease and four are alive with disease at 18-34 months of follow-up. There were no severe acute toxicities, however, four patients have subsequently developed fistulae associated with tumor progression. Although longer follow-up is required, the high response rate, wide applicability and acceptable toxicity observed in this heavily pretreated patient population warrant further study of combined interstitial radiation and chemotherapy.

Strategies for risk management in cancer nursing.

In the current social and legal climate, nurses are increasingly subject to litigation charging professional negligence. A higher professional standing for nursing and a larger role in the decision-making aspects of health care have helped to effect this revolution. There are inherent risks in providing health care that are intensified by the rapid growth in medical technology and complex treatment. Claims brought against nurses have been categorized in studies, and primary causes of patient injury in the healthcare facility are also identified. Using these and other data, areas within cancer nursing that predispose to the risk of increased liability can be anticipated. Issues that are unique to the acute care, ambulatory, or homecare setting in oncology are described. Risk management is a mechanism that addresses the prevention and control of financial loss resulting from claims of negligence. Using risk management concepts, strategies are developed to help the cancer nurse recognize intrinsic dangers and reduce the potential for liability.

Cancer of the vulva and vagina.

Vulvar and vaginal cancer are rare malignancies and require aggressive treatment for survival. The prospect for cure in early stage disease is excellent. The major treatment modalities for these diseases, surgery and radiation, will affect structural alteration of the genitalia, requiring physical and psychological rehabilitation over an extended period of time. Quality of life is an important focus in cancer nursing. Efforts to control symptoms or adverse effects and to enhance the psychological adjustment are important aspects of patient care. Vulvar and vaginal cancer leave obvious residual effects, and disfigurement and dysfunction will be a part of these women's lives. Husbands and partners are also affected, and adjustments of both the patient and her partner are expected to continue for years. An active position assumed by the nurse will aid the patients' adaptive responses to these devastating diseases.

The role of a nurse-clinician in joint practice with gynecologic oncologists.

Increasing interest in nurse-physician collaborative practice resulted in a study proposing to profile a nurse-clinician in joint practice with gynecologic oncologists. The functions performed in the work setting and the undertaking of other activities in professional life are seen as the instrumental features of the nursing role. Nurses and physicians responded to a questionnaire related to nursing functions involving teaching, research, professional development and the independent and medically overlapping activities of patient care. Physicians indicated a perception of the nurse in a liaison role. Nurses perceived a strong obligation to perform functions relating to professional development. Psychosocially oriented care components ranked prominently in the perception of both groups. Data from the study suggests that the specialized nurse occupies an integrating role with physicians in meeting health care needs of patients. Implications from the findings are translated to the practical setting through a description of duties of the gynecologic oncology nurse.