ABSTRACT
Patients who undergo autologous peripheral blood stem cell (PBSC) transplantation experience multiple symptoms that adversely affect quality of life. We assessed symptoms during the acute phase of autologous PBSC transplantation to determine the severity of individual symptoms and to determine overall symptom profiles in 100 patients with multiple myeloma or non-Hodgkin's lymphoma. Study subjects completed the blood and marrow transplantation module of the M. D. Anderson Symptom Inventory before hospitalization, during conditioning, on day of transplantation, at nadir (the time of lowest white blood cell count) and on day 30 post-transplantation. Additional symptom, quality-of-life and medical status measures were collected. Symptom means were mild at baseline, intensified during conditioning, peaked at nadir and decreased by day 30. At nadir, the most severe symptoms for the entire patient sample were lack of appetite, fatigue, weakness, feeling sick, disturbed sleep, nausea and diarrhea. Cancer diagnosis was a significant predictor of changes in symptoms over time. The patterns of fatigue, pain, sleep disturbance and lack of appetite were significantly different for patients with multiple myeloma as compared with patients with non-Hodgkin's lymphoma.
Subject(s)
Lymphoma, Non-Hodgkin/therapy , Multiple Myeloma/therapy , Peripheral Blood Stem Cell Transplantation/adverse effects , Peripheral Blood Stem Cell Transplantation/psychology , Quality of Life , Adult , Affect , Aged , Female , Humans , Lymphoma, Non-Hodgkin/psychology , Male , Middle Aged , Multiple Myeloma/psychology , Severity of Illness Index , Sleep Wake Disorders , Transplantation Conditioning/adverse effects , Transplantation, AutologousABSTRACT
The focus of this article is the ethical dilemmas challenging oncology nurses and their patients. The cancer diagnosis itself may present ethical issues related to genetic testing, prevention and early detection, and information sharing. Cancer treatment options may involve considerations related to level of appropriate care, informed consent, patient education, and unproven, but promising, therapies. Finally, the ethical issues related to outcomes of the disease and treatment, such as pain control, advanced directives, do not resuscitate order, discontinuation of medically inappropriate care, euthanasia, and physician assisted suicide are discussed.
Subject(s)
Ethics, Nursing , Neoplasms/nursing , Algorithms , Decision Making , Humans , Jurisprudence , Medical Futility , Neoplasms/complications , Neoplasms/therapy , Pain/etiology , Pain Management , Truth DisclosureABSTRACT
Molecular recognition between complementary strands of DNA allows construction on a nanometre length scale. For example, DNA tags may be used to organize the assembly of colloidal particles, and DNA templates can direct the growth of semiconductor nanocrystals and metal wires. As a structural material in its own right, DNA can be used to make ordered static arrays of tiles, linked rings and polyhedra. The construction of active devices is also possible--for example, a nanomechanical switch, whose conformation is changed by inducing a transition in the chirality of the DNA double helix. Melting of chemically modified DNA has been induced by optical absorption, and conformational changes caused by the binding of oligonucleotides or other small groups have been shown to change the enzymatic activity of ribozymes. Here we report the construction of a DNA machine in which the DNA is used not only as a structural material, but also as 'fuel'. The machine, made from three strands of DNA, has the form of a pair of tweezers. It may be closed and opened by addition of auxiliary strands of 'fuel' DNA; each cycle produces a duplex DNA waste product.
Subject(s)
DNA , DNA/chemistry , DNA/ultrastructure , Electrophoresis, Polyacrylamide Gel , Equipment and Supplies , Nucleic Acid Conformation , Nucleic Acid HybridizationABSTRACT
Respiratory syncytial virus (RSV) infections in adult BMT recipients are frequently complicated by fatal pneumonias. Therapy of RSV pneumonia with aerosolized ribavirin alone has been reported to be associated with a 70% mortality rate. Because immune globulin therapy has been reported to be beneficial, we conducted a prospective trial of combination therapy with aerosolized ribavirin and intravenous immunoglobulin (IVIG). Aerosolized ribavirin was administered at 20 mg/ml for 18 h a day and IVIG was administered at 500 mg/kg every other day for the length of ribavirin therapy. Four lots of IVIG were chosen with RSV microneutralization Ab titers of 1:2048 to 1:8102. Between 8 January and 3 March 1993, during a community outbreak, 19 (45%) of 42 hospitalized adult BMT recipients with an acute respiratory illness were documented to have RSV disease. Two-thirds of these infections were hospital-acquired. All 19 patients presented with signs and symptoms of an upper respiratory tract illness. Sixteen patients developed pneumonia. The mortality was 22% in nine patients with pneumonia in whom therapy was initiated prior to the onset of profound respiratory failure. In contrast, the mortality was 100% in three patients with pneumonia in whom therapy was initiated within 24 h of respiratory failure requiring mechanical ventilation and in four untreated patients. We conclude that RSV may cause devastating outbreaks of severe pneumonia among hospitalized adult BMT recipients. Early diagnosis and combination therapy with ribavirin and IVIG was associated with a favorable outcome.
