ABSTRACT
Informational need assessment has become an important part of health care in order to provide information effectively in clinical settings. Literature on information needs in the West suggests that breast cancer (BC) patients needed more information than doctors had provided, and information that fully met their needs was associated with patients' long-term well-being. Since few studies on this issue have been conducted in Japan, where the general consultation style is less open and more indirect, compared with that in the West, the application of the findings in the West is questionable. The purpose of this qualitative study was to explore perceived information needs among female BC patients in Japan. Twelve Japanese women with BC participated in semi-structured face-to-face interviews. Grounded theory using verbatim transcripts extracted two main themes: information needed to minimize physical and psychological impacts of treatment and information needed for the resumption of normal life. These were closely related at two time points. Physical support after discharge was perceived as relatively insufficient, especially by women experiencing post-operative arm complications. More open and direct communication was preferred between patients and doctors/family members in the recovery phase. Unmet needs for information may lead to patients' distress.
Subject(s)
Adaptation, Psychological , Breast Neoplasms/psychology , Communication , Needs Assessment/standards , Patient Education as Topic/standards , Professional-Patient Relations , Adult , Female , Humans , Japan , Middle Aged , Qualitative ResearchABSTRACT
Over-expression of the proto-oncogene HER2/neu in breast cancer and certain other tumors appears to be a central mechanism that may be partly responsible for cellular progression of the neoplastic phenotype. Transfection of mammalian cells and over-expression of HER2/neu appears to result in reduced sensitivity to the cytotoxic effects of tumor necrosis factor (TNF) and reduced sensitivity to immune effector killing. The single-chain recombinant antibody sFv23 recognizes the cell-surface domain of HER2/neu. The cDNA for this antibody was fused to the cDNA encoding human TNF, and this sFv23/TNF fusion construct was cloned into a plasmid for expression in Escherichia coli. The fusion protein was expressed and purified by ion-exchange chromatography. SDS-PAGE demonstrated a single band at the expected m.w. (43 kDa). Western analysis confirmed the presence of both the antibody component and the TNF component in the final fusion product. The fusion construct was tested for TNF activity against L-929 cells and found to have biological activity similar to that of authentic TNF (SA 420 nM). The scFv23/TNF construct bound to SKBR-3 (HER2-positive) but not to A-375 human melanoma (HER2-negative) cells. Cytotoxicity studies against log-phase human breast carcinoma cells (SKBR-3-HP) over-expressing HER2/neu demonstrate that the sFv23/TNF fusion construct was 1, 000-fold more active than free TNF. Tumor cells expressing higher levels of HER2/neu (SKBR-3-LP) were relatively resistant to both the fusion construct and native TNF. These studies suggest that fusion constructs targeting the HER2/neu surface domain and containing TNF are more effective cytotoxic agents in vitro than native TNF and may be effective against tumor cells expressing intermediate, but not high, levels of HER2/neu.
Subject(s)
Cell Survival/drug effects , Genes, erbB-2 , Immunotoxins/toxicity , Receptor, ErbB-2/genetics , Tumor Necrosis Factor-alpha/toxicity , Animals , Breast Neoplasms , Cloning, Molecular , Escherichia coli , Female , Humans , Immunotoxins/genetics , Immunotoxins/pharmacokinetics , Kinetics , L Cells , Melanoma , Mice , Proto-Oncogene Mas , Receptor, ErbB-2/analysis , Recombinant Fusion Proteins/pharmacokinetics , Recombinant Fusion Proteins/toxicity , Tumor Cells, Cultured , Tumor Necrosis Factor-alpha/genetics , Tumor Necrosis Factor-alpha/pharmacokineticsABSTRACT
According to a population-based estimate, chronic pelvic pain (CPP) affects approximately 15% of women aged 18-50. The psychosocial impact of CPP is reflected in mood disturbance, disruption of normal activity and relationships as well as pain. Identification of psychosocial factors as cause or effect remains problematic. Results of a study of 105 women with CPP using the British version of the SF-36 Health Survey Questionnaire are presented, together with analyses of face validity and reliability. While generally reflecting health status, specific problems with the questionnaire are identified related to the episodic nature of pelvic pain, and avoidance as a means of preventing pain exacerbations. Health economic analyses relating to CPP are reviewed and the implications for future directions in treatment strategy are discussed in the context of limited options of proven efficacy.
Subject(s)
Pelvic Pain/economics , Pelvic Pain/psychology , Adolescent , Adult , Child , Child Abuse, Sexual/psychology , Child, Preschool , Chronic Disease , Female , Health Care Costs , Health Status Indicators , Humans , Middle Aged , Mood Disorders/complications , Psychophysiologic Disorders/complications , Quality of Life , Surveys and Questionnaires , United KingdomABSTRACT
OBJECTIVE: To develop a behavioural assessment based on observations of patients recovering after severe head injury whereby data could be collected by observation and by testing everyday tasks. DESIGN: A prospective observational study of a cohort of 88 consecutive hospital admissions with severe head injury. SETTING: Two district general hospitals in the UK. PATIENTS: Eighty-eight consecutive admissions with severe traumatic head injury. Ages ranged from 14 to 67 years, mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. RESULTS: Fifty-eight items of behaviour were identified. Paired preference analysis was used to identify a sequence of recovery of these behaviours. The sequence began with arousal and led on to behaviours signalling recovery of social interaction and communication. Subsequent behaviours indicated increasing cognitive organization and return of orientation and memory. The behaviours on the scale are hierarchical and range from coma to emergence from PTA. CONCLUSIONS: A scale to assess patients and monitor cognitive recovery after severe head injury has been developed. While individual patients will show some departures from the sequence identified, the scale helps to make explicit the earliest stages of natural recovery patterns after head injury.
Subject(s)
Craniocerebral Trauma/diagnosis , Trauma Severity Indices , Adolescent , Adult , Aged , Amnesia/diagnosis , Coma/diagnosis , Craniocerebral Trauma/physiopathology , Craniocerebral Trauma/psychology , Humans , Middle Aged , Neurobehavioral Manifestations , Observation , Prognosis , Prospective Studies , Recovery of Function , Reproducibility of ResultsABSTRACT
A total of 136 specimens were tested for the presence of herpes simplex virus by routine tissue culture and a commercial enzyme-linked immunosorbent assay (Ortho Diagnostic Systems, Inc.). Forty-six (33.8%) of the specimens were positive by tissue culture. The sensitivity and specificity of the commercial system were 69.6 and 93.3%, respectively. The commercial system was rapid and moderately specific but lacked the sensitivity necessary for direct specimen testing.
Subject(s)
Enzyme-Linked Immunosorbent Assay , Immunoenzyme Techniques , Simplexvirus/classification , Antigens, Viral/analysis , HumansABSTRACT
Two 48-h Vero cell systems were compared with viral culture in human fibroblastic cells for isolation and identification of herpes simplex virus from clinical specimens. Both 48-h systems had 79% sensitivity and greater than 99% specificity as compared with the conventional tissue culture method.
