ABSTRACT
There are few effective therapies for high-risk sarcomas. Initial chemosensitivity is often followed by relapse. In vitro, mammalian target of rapamycin (mTOR) inhibition potentiates the efficacy of chemotherapy on resistant sarcoma cells. Although sarcoma trials using mTOR inhibitors have been disappointing, these drugs were used as maintenance. We conducted a Phase I/II clinical trial to test the ability of temsirolimus to potentiate the cytotoxic effect of liposomal doxorubicin and present here the dose-finding portion of this study. Adult and pediatric patients with recurrent or refractory sarcomas were treated with increasing doses of liposomal doxorubicin and temsirolimus using a continual reassessment method for escalation, targeting a dose-limiting toxicity rate of 20%. Blood samples were drawn before and after the first dose of temsirolimus in Cycles 1 and 2 for pharmacokinetic analysis. The maximally tolerated dose combination was liposomal doxorubicin 30 mg/m(2) monthly with temsirolimus 20 mg/m(2) weekly. Hematologic toxicity was common but manageable. Dose-limiting toxicities were primarily renal. Concurrent administration of liposomal doxorubicin resulted in increased exposure to sirolimus, the active metabolite of temsirolimus. Thus, the combination of liposomal doxorubicin and temsirolimus is safe for heavily pretreated sarcoma patients. Co-administration with liposomal doxorubicin did not alter temsirolimus pharmacokinetics, but increased exposure to its active metabolite.
Subject(s)
Antineoplastic Agents/therapeutic use , Bone Neoplasms/drug therapy , Doxorubicin/therapeutic use , Sarcoma/drug therapy , Sirolimus/analogs & derivatives , Adolescent , Adult , Aged , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/pharmacokinetics , Child , Dose-Response Relationship, Drug , Doxorubicin/administration & dosage , Doxorubicin/pharmacokinetics , Female , Humans , Male , Middle Aged , Recurrence , Sirolimus/administration & dosage , Sirolimus/pharmacokinetics , Sirolimus/therapeutic use , Young AdultABSTRACT
1. Home visiting psychiatric public health nurses are integral to expanding community-based mental health services for Japanese citizens living with schizophrenia and other mental illnesses. 2. Interviews with experienced psychiatric public health nurses revealed empowerment as the basic social process that guides their practice. Five empowering practice domains foster client autonomy. 3. Psychiatric public health nurses work with families, neighbors, educators, and employers to enable their clients' healthy living in the community.
Subject(s)
Community Mental Health Services , Psychiatric Nursing/methods , Public Health Nursing/methods , Schizophrenia/nursing , Community Health Nursing , Community Mental Health Services/legislation & jurisprudence , Community Mental Health Services/organization & administration , Humans , Japan , Licensure, Nursing , Nurse-Patient Relations , Patient ParticipationABSTRACT
Promoting mental health in an illness-oriented health care delivery system is challenging. Health promotion from a holistic perspective requires that mental health be viewed as important as physical health. The mental health needs of the elderly are numerous and often not addressed during routine visits for primary health care. Research consistently reports that elderly African Americans are not equal participants in the formal health care system. Consequently, promoting mental health in the African American elderly is a challenge made even more complicated because of this group's limited access to and use of mental health care services. Promoting the health of African Americans confronts many traditional values and practices of health care institutions and mental health practice. Therefore, health care providers must be innovative and creative to facilitate mental health promotion in this population of clients. The authors suggest that the Revised Health Promotion Model can serve as a framework for guiding the mental health care of elderly African Americans. Aspects of the model are particularly relevant for this population. The case of an elderly Black woman is presented as an illustration of ways in which the model may be applied with many cultural nuances.
Subject(s)
Aged/psychology , Black or African American/psychology , Health Promotion/methods , Mental Disorders/ethnology , Mental Disorders/nursing , Mental Health , Psychiatric Nursing/methods , Transcultural Nursing/methods , Aged, 80 and over , Attitude to Health/ethnology , Female , Health Knowledge, Attitudes, Practice , Humans , Models, Nursing , Patient Care Planning , Quality of Life , United States/epidemiologyABSTRACT
Cultural religious beliefs influence perceptions of mental illness, and any clinician interested in treating mentally ill people and their families must consider these beliefs so that he or she can develop culturally specific interventions. This article reports on the results of interviews with African American experts, mentally ill persons, and nurses caring for the mentally ill. A case study is used to illustrate the influence of southern religious beliefs on perceptions of mental illness and the behaviors of people who are mentally ill. Although many issues are considered in this analysis (i.e., ethnicity, geographic location, and religion), it is the influence of three religious traditions in the South--voodoo, slave religion, and evangelical Protestantism--that takes precedence in the analysis. Mental health professionals, especially psychiatric nurses, will find this information helpful when assisting hospitalized patients.
