Prevention of HPV-related oral cancer: assessing dentists' readiness.

OBJECTIVES: Epidemiological research indicates an association between the Human Papillomavirus (HPV) with a subset of oral cancers (OC). Dentists may play a role in primary prevention of HPV-related OC by discussing the HPV vaccine with patients. This study assessed dentists' readiness to discuss the HPV vaccine with female patients. STUDY DESIGN: Cross-sectional web-based survey. METHODS: A web-based survey based on the Transtheoretical Model was administered among Florida dentists (n = 210). RESULTS: The majority of participants (97%) fell into the precontemplation and contemplation stages of readiness to discuss the HPV vaccine with patients. Perceived role and liability were determined to be predictive of dentists in contemplation stage as opposed to those in precontemplation (P < 0.05). CONCLUSIONS: Findings suggest liability and perceived role as processes of change necessary to guide dentists to primary prevention of HPV-related OC despite high levels of knowledge. As public awareness of HPV-related OC increases, dentists may become more involved in primary prevention. Results of the current study may assist in developing intervention strategies for engaging dentists in discussing the HPV vaccine with patients.

Nefazodone in patients with treatment-refractory posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a highly prevalent and often chronic disorder among combat veterans, persisting in as many as 15% of Vietnam veterans for at least 20 years. Treatment response in veterans with combat-related PTSD has been disappointing. Although anxiolytics, anticonvulsants, antipsychotics, and antidepressants have been tried, none has been consistently associated with improvement in all primary symptom domains (i.e., intrusive recollections, avoidance/numbing, and hyperarousal). This open-label study evaluated the use of nefazodone in a group of Vietnam veterans with chronic, treatment-refractory symptoms of PTSD. METHOD: Male outpatients with DSM-IV PTSD who had failed a minimum of 3 previous medication trials were eligible for the study. Nineteen Vietnam combat veterans entered the study and were treated with nefazodone, 100-600 mg/day, for 12 weeks. PTSD symptoms, anxiety, depression, sleep, sexual functioning, and adverse events were assessed weekly. RESULTS: Severity of depression lessened, as did PTSD symptoms of intrusive recollections, avoidance, and hyperarousal. Depressive symptom severity as measured by the Beck Depression Inventory decreased by a mean of 30%. Similarly, there was an overall drop in the intensity of PTSD symptoms as measured by the Clinician Administered PTSD Scale of 32% with a 26% improvement for symptoms of intrusion, 33% for avoidance, and 28% for arousal. In addition, improvements in sleep and sexual functioning were reported. The mean daily dose of nefazodone after 12 weeks was 430 mg (range, 200-600 mg/day). The most frequently reported side effects were headaches (53%), dry mouth (42%), and diarrhea (42%), but side effects tended to be mild and transient. CONCLUSION: In this group of Vietnam veterans with chronic treatment-refractory PTSD and multiple comorbid Axis I psychiatric disorders, nefazodone was well tolerated and effective. Larger, controlled studies are warranted.

Comparing patient, parent, and staff descriptions of fatigue in pediatric oncology patients.

Fatigue in children and adolescents with cancer is a disruptive symptom meriting clinical intervention by nurses, but has eluded definition, measurement, and intervention. Fatigue in these patients exists within a greater context of illness, treatment, and child and family development. Any effort to define, measure, and intervene with fatigue needs to take into consideration the major components of these children and adolescents' treatment context. The purpose of this descriptive study was to learn from three perspectives (patient, parent, and staff) how fatigue is identified and defined in 7- to 12-year-old children and in 13- to 18-year-old adolescents with cancer, and what factors contribute to or alleviate this fatigue. To elicit this information, separate focus groups were conducted with patients, parents, and staff at two pediatric oncology centers. Resulting interview data were analyzed using pragmatic and semantic content analysis techniques and the Wilson concept analysis process. Findings clearly indicated that children, adolescents, parents, and staff define patient fatigue differently. The conceptual definition from the child data emphasizes the physical sensation of the fatigue; alternating and at times merging physical and mental tiredness are emphasized in the adolescent's definition. Parents and staff view themselves as responsible for alleviating patient fatigue; patients viewed rest and distraction as their primary sources of improving fatigue. The conceptual definitions of fatigue as rendered by our three groups of participants can assist pediatric oncology patients, their parents, and staff in identifying fatigue. Factors identified by these participants as contributing or alleviating fatigue could be the basis for future interventions designed to reduce fatigue in pediatric oncology patients.

Antidepressant treatment of posttraumatic stress disorder and major depression in veterans.

Many patients with chronic posttraumatic stress disorder (PTSD) suffer from comorbid major depression. The present study examines the responsiveness of such dual-diagnosis patients to antidepressant medication. Subjects were enrolled in the PTSD medication clinic at the San Diego Veterans Affairs Medical Center. Inclusion criteria were current diagnoses of PTSD and major depression, at least 6 months of regular participation in the clinic, and treatment with antidepressant medication at therapeutic levels and durations. Exclusion criteria were current drug or alcohol abuse, primary psychotic illness, and poor compliance or frequent missed appointments. Among 72 patients meeting inclusion and exclusion criteria, 50% were estimated to be substantially improved, on the basis of Clinical Global Evaluation (CGE) scores of 2 or 1, after remaining on the same antidepressant treatment regimen at therapeutic doses for at least 1 month. Antidepressant medications affecting predominantly serotonin reuptake (sertraline, fluoxetine) were associated with better outcomes than antidepressants affecting predominantly norepinephrine reuptake (nortriptyline, desipramine).

Critical care in a thinking environment: a personal perspective.

This paper is a transcript of a presentation made at the BACCN Conference. It highlights from the personal experience of the author a number of behaviours important in creating a thinking environment. Four areas are specifically focused on: giving colleagues attention; appreciating each other; management of meetings; and challenging limited assumptions.

Eating behaviors of nursing home residents who display agitation.

To determine if cognitive level and agitation affect eating behavior, 33 females and four males in a 210-bed nursing home were studied. The researcher inconspicuously observed the evening meal for subjects on three occasions. Nearly 80% of the subjects showed a high frequency of agitation and 84% exhibited cognitive impairment. More than one-half were independent in feeding, with caregivers neither touching nor encouraging subjects during more than half of the 110 meals observed. No significant relationships were demonstrated between level of agitation and eating behavior or between cognitive level and eating behavior.

A practical approach to the child with anemia.

Anemia can be defined as a reduction in the hemoglobin concentration and red blood cell mass compared with age-matched normal values. Anemia is caused by poor production of red blood cells, destruction of red blood cells, or loss of red blood cells. Pediatric nurse practitioners will encounter patients in their practice who have anemia resulting from each of these causes. Common clinical presentations include the child who is feeling well but is found to have a low hemoglobin concentration on a routine screening test, the child who is "tired" and does not eat well, the infant or child who is being evaluated for other chronic problems and is found to have a low hemoglobin concentration, and last, the child who is obviously pale, lethargic, and requires immediate assessment and evaluation.