Brain tumor support group: content themes and mechanisms of support.

PURPOSE: To describe the experiences and needs of patients with brain tumors as evidenced in analysis of themes from support group discussions and to increase knowledge of supportive mechanisms operant in support groups for medically vulnerable populations. DESIGN: Descriptive, exploratory. SETTING: An urban medical center on the U.S. West Coast. SAMPLE: Participants in a brain tumor support group, including patients, families, friends, and facilitators. METHODS: Researchers analyzed observational field notes and videotapes of a brain tumor support group's meetings over a six-month period using grounded theory methods to develop inclusive conceptual categories of themes and to document mechanisms of support. FINDINGS: Five thematic categories emerged: telling the story, managing medical advice, seeking and exchanging information, the long haul, and family life changes. Two major categories of supportive mechanisms emerged: finding a safe haven and maintaining morale, each of which contained several contributing dimensions. MAIN RESEARCH VARIABLES: Discussion topics, dialogue, and interaction among participants during the support group meetings. CONCLUSIONS: The support group provided a specific therapeutic forum for patients with brain tumors and their families, especially regarding the difficulties of survival and maintaining quality of life after initial treatment. IMPLICATIONS FOR NURSING PRACTICE: Findings generated knowledge that can guide patient care, particularly follow-up care after initial treatment. Support group facilitation by expert nurse clinicians can provide health-care guidance and emotional support to medically vulnerable patients and their families through symptom assessment and management, timely referral, therapeutic group process, promotion of self-care, and adaptive coping.

Family recovery after vascular surgery.

Twenty-one families were observed in a 3-month study to assess family coping with major vascular surgery and recovery. Analysis of family measures data (the Family APGAR, the Family Inventory of Resource for Management, and the Family Crisis Oriented Personal Evaluation Scales) was combined with grounded theory method to assess family responses over time and recovery outcomes. Containment emerged as the major conceptual category of the grounded theory. Containment refers to a constellation of constructed meanings for events and behavioral responses used by families to regulate the impact of the surgical crisis and reduce family disruption. This "contained" coping pattern was manifested in families' avoidant behaviors and narrow definitions of the problem: that is, they defined their situation in terms of the surgical repair as cure rather than palliative intervention for a chronic, progressive disease. Situational factors such as the insidious development of the illness and the primary focus of care providers in the hospital on surgical care (allowing families' narrow definitions of their situation to remain unchallenged) also contributed to containment. Containment resulted in poor risk factor management as a major recovery outcome. Isolation and family conflict were evident throughout the recovery period. Concerns generated by continued evidence of morbidity during recovery contributed to a developing awareness of underlying disease, and diminishing containment when this growing awareness was openly shared within the family. Significant findings of the family measures analysis were compared with the grounded theory of the qualitative data. Each corroborated the other in key dimensions.

Quantitation of acute myocardial infarct size by nuclear magnetic resonance imaging.

Nuclear magnetic resonance (NMR) imaging has shown potential in the detection and characterization of acute myocardial infarction in humans. This study was performed to evaluate the capability of NMR imaging in the measurement of infarct size in patients with recent myocardial infarction. Electrocardiographic (ECG)-gated spin-echo NMR imaging was performed in 26 patients a mean of 9 +/- 3 days (range 5 to 20) after infarction. The imaging technique used provided single-slice, spin-echo (time to echo [TE] = 60 ms) images of the left ventricle in its true short axis, allowing direct correlation of NMR infarct location and size with the region of severe hypokinesia on left ventriculography. In all 20 patients with complete NMR studies, infarct location was correctly identified by using specific, objective criteria. The correlation between the mean infarct volume (29 +/- 11 ml) and the quantitated left ventricular hypokinetic segment (7.5 +/- 4.0 cm) was good (r = 0.84, p = 0.0002), suggesting that NMR imaging of the heart may have a role in the noninvasive assessment of myocardial infarct size in patients.

An image filing system for the implementation of image processing algorithms in a research environment.

An image filing system (IFS) has been written to facilitate the implementation and testing of image processing algorithms in a research environment. A programming substrate has been developed to provide applications with routines for acquiring, displaying, and manipulating images without regard for the underlying information format. Images of diverse modalities are cataloged and tracked through a series of image operations with descriptive pointers to all antecedents. This paper presents the design and implementation of the image filing system and describes one of the major image processing applications developed in the IFS environment.