The increasing hospital disease burden of haemochromatosis in England.

BACKGROUND: Hereditary haemochromatosis is a preventable cause of liver disease with an increasing disease burden. AIMS: To investigate time trends for hospital admission ascribed to haemochromatosis in England during the period from 1989/1990 to 2002/2003 and mortality from 1979 to 2005. METHODS: Hospital admission data, relating to both in-patients and day-cases, were obtained from the Hospital Episodes Statistics service. Mortality rates for England and Wales were provided by the Office for National Statistics. RESULTS: Haemochromatosis is an uncommon cause for hospital admission. Age-standardized in-patient admission rates increased over the study period by 269% in men and by 290% in women: (from 0.64 to 2.36 and from 0.21 to 0.81 per year per 100 000). The increase in age-standardized day-case admission rates was even higher (men: from 2.78 to 34.9 per year per 100 000, 1155%; women: from 0.58 to 11.67 per year per 100 000, 1924%). Haemochromatosis was recorded as an uncommon cause of death. CONCLUSIONS: Hospital in-patient and day case admissions for haemochromatosis increased markedly over the study period while mortality remained low. Both admission rates and mortality were higher in men than in women. The increase in admission rate may reflect improved recognition and diagnosis of iron overload disorders following identification of the HFE gene.

The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies.

PURPOSE/OBJECTIVES: To determine how educational and psychosocial care provided to adults with cancer affects seven outcomes--anxiety, depression, mood, nausea, vomiting, pain, and knowledge. DESIGN: Meta-analysis. SAMPLE: 116 intervention studies. A standardized mean difference between a treatment and control group (i.e., an effect-size value) was calculated for 98 studies; for 18 additional studies, it was only possible to code the direction of treatment effect (i.e., whether the treatment or control group had a higher score). Most analyses were limited to the 98 studies from which an effect-size value was obtainable. These studies were published between 1976 and 1993 and were based on data obtained from 5,326 patients with cancer. METHODS: A comprehensive literature search yielded more than 20,000 potentially relevant citations that were reviewed. Study, subject, treatment, and outcome characteristics of the studies meeting selection criteria were coded. MAIN RESEARCH VARIABLES: Manner of subject assignment to treatment condition; type of control group; publication form; type of psychoeducational care; and the outcomes of anxiety, depression, mood, nausea, vomiting, pain, and knowledge. FINDINGS: Statistically significant, beneficial effects were found in relation to all seven of the outcomes. Three threats to validity were examined and were not found to be a problem related to the outcomes examined. CONCLUSIONS: Psychoeducational care was found to benefit adults with cancer in relation to anxiety, depression, mood, nausea, vomiting, pain, and knowledge. Differentiating among the effectiveness of various types of psychoeducational care was problematic. To maximize the utility of this knowledge for clinicians, more research is needed to evaluate the relative effectiveness of different types of psychoeducational care. IMPLICATIONS FOR NURSING PRACTICE: A strong research base has established the beneficial effects of psychoeducational care. Clinicians should examine their practice to determine if research-based psychoeducational care is being used sufficiently.

Testicular self-examination: an argument against routine teaching.

Primary care physicians are constantly urged to include new procedures, tests and patient education issues in their office practices. Recently some authorities have encouraged the routine teaching of testicular self-examination to young adult male patients. The following article reviews the current status of testicular tumours, highlighting the low incidence and rising cure rate. An approach is presented to the critical evaluation of self-examination as a screening device. Testicular self-examination is assessed in terms of its potential efficacy, effectiveness, availability and efficiency. In the authors' opinion, health care funds and physician time with young men could be better spent elsewhere.

Time-series designs in clinical nursing research: human issues.

Prospective time-series research methods require substantially greater commitment and effort from both subjects and investigators compared to designs that involve one-time data collection. Human issues such as retention, confidentiality, burnout, and clinician-researcher role conflict have not been adequately addressed in existing literature on time-series methodology. To maintain the scientific integrity of a time-series design and minimize unnecessary costs associated with subject and staff attrition, these issues should not be overlooked.

Hypothalamic-pituitary-adrenal function after subarachnoid haemorrhage.

In 18 patients with a ruptured aneurysm of the anterior communicating artery on the circle of Willis hypothalamuc-pituitary-adrenal function has been assessed by the diurnal variation in plasma cortisol levels and by the response to metyrapone, dexamethasone, and pyrogen. Eleven patients had an abnormal diurnal variation, seven had an abnormal response to metyrapone, and eight had an abnormal response to dexamethasone. All who were given pyrogen reacted normally to this stress. Two patients who died had lesions in the anterior hypothalamus, and it is suggested that this localization of lesions was responsible for the pattern of pituitary-adrenal dysfunction which was observed. An improvement in function was seen in many patients after an interval of a month.