ABSTRACT
Health professionals are routinely exposed to evidence of pain in others. It is important that the processes by which they evaluate pain be understood. The purposes of this article are to review and synthesize recent research on how health professionals judge the pain of others and to present a conceptual model of this process. Methodological and conceptual issues in the conduct of pain judgement studies are addressed. Research in this field over the last 40 years has indicated that, when compared with the pain judgements of patients themselves, health professionals tend to underestimate pain. The authors review the relation of this underestimation bias to such variables as the nature of the patient's pain and the clinical experience of the judge. They also review experiential and cognitive-perceptual variables found to influence the degree of underestimation bias, such as the amount of exposure to evidence of pain and suspicion about the motivations of the patient. A model of the pain decoding process is presented. The issue of whether underestimation has implications for treatment outcome is addressed and priorities for future research are identified.
Subject(s)
Attitude of Health Personnel , Models, Nursing , Nursing Assessment/standards , Pain Measurement , Pain/diagnosis , Severity of Illness Index , Attitude to Health , Bias , Clinical Competence/standards , Cognition , Empathy , Health Knowledge, Attitudes, Practice , Humans , Judgment , Nurse-Patient Relations , Nursing Assessment/methods , Nursing Evaluation Research , Pain/nursing , Pain/psychology , Pain Measurement/methods , Pain Measurement/nursing , Pain Measurement/standards , Perception , Prejudice , Reproducibility of Results , Research Design , Sensitivity and SpecificityABSTRACT
Superoxide anions react with nitric oxide to form peroxynitrite and hence reduce the bioavailability of nitric oxide in the arteries. Extracellular superoxide dismutase (EC-SOD) is a major superoxide scavenger in human plasma and vascular tissues. The objective of this study is to assess whether essential hypertension is associated with an alteration in EC-SOD activity. In this report, blood samples were obtained from hypertensive (n=39) and normotensive (n=37) African-Americans. Plasma EC-SOD activity was measured using in-gel activity staining and spectrophotometric assays, EC-SOD protein level was measured using Western blotting, nitrotyrosine was measured using slot blotting, 8-isoprostane was measured with an enzyme immunoassay, and plasma copper and zinc concentrations were measured using an atomic absorption assay. Our data demonstrate that the copper, zinc, and plasma EC-SOD protein concentrations in the hypertensive and normotensive subjects are indistinguishable. Compared to normotensive controls, hypertensive patients have significantly reduced plasma EC-SOD activity. Plasma nitrotyrosine and 8-isoprostane levels are significantly higher in the hypertensive patients than in normotensive controls. Results from this study suggest that a reduction in EC-SOD activity in hypertensive patients is not due to a down-regulation of the SOD3 gene (encoding EC-SOD) or deficiency in mineral cofactors. Furthermore, the reduced EC-SOD activity might be at least partially responsible for the increased oxidative stress, as reflected by increased plasma nitrotyrosine and 8-isoprostane, in hypertensive subjects.
Subject(s)
Hypertension/enzymology , Superoxide Dismutase/metabolism , Adult , Black or African American , Blood Glucose , Cholesterol/blood , Copper/analysis , Dinoprost/analogs & derivatives , Dinoprost/metabolism , Female , Humans , Hypertension/blood , Hypertension/ethnology , Male , Middle Aged , Superoxide Dismutase/blood , Triglycerides/blood , Zinc/analysisABSTRACT
BACKGROUND: Phyllodes tumors (cystosarcoma phyllodes) are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but has never been associated with lymph node metastases. CASE PRESENTATION: A 26-year-old woman presented with a firm, mobile, non-tender mass in the left breast and palpable lymph nodes in the left axilla. The excised lesion appeared well circumscribed and lobulated, with variable fleshy and firm areas. Microscopic examination showed a circumscribed fibroepithelial lesion with a well developed leaf-like architecture, in keeping with a benign phyllodes tumor. The epithelial component showed extensive high grade ductal carcinoma in-situ (DCIS) and invasive carcinoma of no special type, located entirely within the phyllodes tumor. Subsequent axillary lymph node dissection revealed metastatic carcinoma in four lymph nodes. CONCLUSIONS: Although rare, phyllodes tumors may harbor DCIS and invasive carcinoma, with potential for lymph node metastasis.
