Parallel information transfer in a multinode quantum information processor.

We describe a method for coupling disjoint quantum bits (qubits) in different local processing nodes of a distributed node quantum information processor. An effective channel for information transfer between nodes is obtained by moving the system into an interaction frame where all pairs of cross-node qubits are effectively coupled via an exchange interaction between actuator elements of each node. All control is achieved via actuator-only modulation, leading to fast implementations of a universal set of internode quantum gates. The method is expected to be nearly independent of actuator decoherence and may be made insensitive to experimental variations of system parameters by appropriate design of control sequences. We show, in particular, how the induced cross-node coupling channel may be used to swap the complete quantum states of the local processors in parallel.

Analysis of content regarding death and bereavement in nursing texts.

Information contained in textbooks provides the foundation for undergraduate education and entry into clinical practice. Inadequate knowledge of health care professionals in end of life (EOL) has been documented and efforts are in progress to improve this care. This paper reports on a project to strengthen nursing education in EOL care. One of the three project goals was the evaluation of EOL content in 50 nursing textbooks. This paper reports findings in two of the nine areas of the analysis framework which are Death and Bereavement. Findings indicate significant deficiencies in the content within these texts. Improvement in text content will require collaboration of palliative care professionals and textbook publishers and can result in increased ability of nurses to improve EOL care.

Use of routine and breakthrough analgesia in home care.

PURPOSE/OBJECTIVES: To describe current use of routine analgesics in home care and the treatment of breakthrough pain. DESIGN: Descriptive, companion study. SETTING: Homecare agencies in southern California. SAMPLE: Convenience sample of 369 patients with cancer participating in a pain-education study. METHODS: Data regarding breakthrough pain were derived from the homecare medical records and patient interviews. MAIN RESEARCH VARIABLES: Analgesic medications prescribed and used for treatment of routine and breakthrough cancer pain. FINDINGS: Results demonstrate discrepancy between recommended pain management in clinical practice guidelines and the actual practice of pain management at home. Deficiencies were found in medications prescribed as well as in actual use by patients. CONCLUSIONS: Optimum relief of cancer pain is contingent on adequate treatment of routine and breakthrough pain, including greater use of recommended analgesics in adequate doses and clinical care consistent with clinical practice guidelines. IMPLICATIONS FOR NURSING PRACTICE: Breakthrough pain is a common problem affecting the quality of life of patients with cancer. Improved management of breakthrough pain is contingent on accurate pain assessment, optimum use of analgesics, and patient education. Nurses should address the important topic of breakthrough pain as new analgesic drugs and methods of delivery become available.

Cultural considerations in education for cancer pain management.

BACKGROUND: Ethnicity is an important factor not only in the incidence of cancer but also in relation to symptom management. Inadequate pain management at home has been demonstrated to result in associated physical symptoms as well as great distress to patients and family. METHODS: The study purpose was to evaluate a structure program to educate patients about cancer pain management. The City of Hope quality-of-life (QOL) tool was used to measure patient outcomes in the QOL domains of physical, psychological, social, and spiritual well-being. The Patient Pain Questionnaire was used to assess knowledge and beliefs about pain. RESULTS: A total of 369 patients were enrolled in the study. The three largest groups, Caucasians, Hispanics, and African Americans, were compared. There were several significant differences between groups; overall; Hispanics had the worst pain and QOL outcomes. CONCLUSIONS: The findings demonstrate significant differences among the three ethnic groups, which indicates a continued need for cultural considerations in patient education.

Family caregiving in cancer pain management.

The experience of cancer pain is known to greatly affect family caregivers as well as patients. There are many demands placed on caregivers of cancer patients with pain at home as a result of the shifting of care from the acute setting to the home. These complex demands significantly affect caregiver quality of life. The purpose of this study was to describe the experience of pain management from the perspective of family caregivers of patients with cancer amidst the current healthcare environment. This quasi-experimental study involved 231 family caregivers of patients with cancer pain receiving home care. Family caregivers were assessed in conjunction with a pain education program that provided patient and. family education regarding pain assessment, drug and nondrug interventions. Assessment measures used were the Quality of Life (QOL)-Family Caregiver Tool, Knowledge and Attitudes about Pain (K&A) Tool, and Caregiver Finances Tool. Study findings reveal disruption to family caregiver quality of life in the areas of physical, psychological, social, and spiritual well-being. There is also a continued need for education regarding cancer pain management. Comparison between patients and family caregivers demonstrates that pain impacts both the patient experiencing it and their caregivers.

Perceptions of quality of life in Hispanic patients with cancer.

PURPOSE: The purpose of this study was to describe perceptions of quality of life (QOL) of Hispanic patients with cancer pain. DESCRIPTION OF STUDY: This qualitative pilot study is guided by the conceptual framework of pain and QOL. From interviews with 17 Hispanic patients with cancer pain, data on perceptions of QOL were analyzed and are reported here. RESULTS: The study demonstrated the influence of culture on perceptions of QOL and the impact of pain on QOL. Several themes were identified for each domain of QOL, including physical, psychological, social, and spiritual well-being. The role of the family and faith in God were important components of QOL for all patients. CLINICAL IMPLICATIONS: It is important for clinicians to devote greater attention to cultural assessment and to include cultural beliefs in cancer care to improve QOL for Hispanic patients. The role of the family and religious beliefs should be included in the planning and evaluation of each patient's care.

Influence of culture on cancer pain management in Hispanic patients.

PURPOSE: The purpose of this pilot study was to describe the influence of culture on cancer pain management in Hispanic (Mexican and Central American) patients. DESCRIPTION OF STUDY: This qualitative study is guided by the conceptual framework of the Pain and Quality of Life model and the Biocultural Model of Pain. It was developed as a companion study to a National Cancer Institute (NCI)-funded project to disseminate a pain education program for adult patients with cancer and their family care givers in community home-care agencies. After completing the NCI study, Hispanic subjects were invited to participate in the qualitative companion study. A total of 17 subjects, the majority of whom were women, were interviewed. The Hispanic Pain Experience Questionnaire (HPEQ) was used to elicit answers to open-ended questions regarding the perception and management of cancer pain. RESULTS: Themes that emerged from the questionnaire were Influence of Culture, Expressions of Pain, Managing Pain/Medications, and Use of Nondrug Interventions. Responses suggest that culture, family beliefs, and religion contribute significantly to management and expression of pain by the patient and care giver. In addition, this group showed that pain may be approached with stoicism; therefore, lack of verbal or behavioral expression of pain does not indicate a lack of pain itself. These patients also demonstrated a reliance on folk beliefs and nondrug interventions. The most common reason cited for noncompliance with pharmacologic treatment was an inability to understand instructions. CLINICAL IMPLICATIONS: When providing care to Hispanic patients, it is imperative to be nonjudgmental, sensitive, and respectful. To improve compliance, the multidisciplinary cancer team should 1) incorporate the patients' folk healthcare practices and beliefs into the plan of care when possible; 2) involve family members and friends in the patient's care, identifying one key family contact; and 3) ensure that instructions for medications are available in Spanish and understood by the patient and care giver. When patients' overall beliefs and values are respected, compliance with pharmacological and other interventions may increase accordingly.

Ethical issues in pain management.

The elderly are a vulnerable group and many will face several chronic illnesses, with cancer being likely among them. Each year approximately one million elderly are abused, with the most vulnerable being those who rely on family members for their care. Humphrey stated that old age "is sufficient cause to give up" even when the individual is not suffering. Humphrey's statement exemplifies how much our society has come to devalue the elderly. Opponents of euthanasia and assisted suicide as alternatives to effective palliative care contend that we are degrading not only the sanctity of life for the elderly, but we are also undermining the goals of medicine.