Why are doctors still prescribing neuroleptics?

There are two main pharmacological methods of suppressing undesired behaviour: sedation or neuroleptics. Traditionally, the invention of neuroleptics has been hailed as one of the major clinical breakthroughs of the twentieth century, since they calmed agitation without (necessarily) causing sedation. The specifically neuroleptic form of behavioural control is achieved by making patients psychologically Parkinsonian, which entails emotional blunting and consequent demotivation. Furthermore, chronic neuroleptic usage creates dependence, so that in the long term, neuroleptics are doing most patients more harm than good. The introduction of 'atypical' neuroleptics (neuroleptically-weak but strongly sedative neuroleptics) has made only a difference in degree, and at the cost of a wide range of potentially fatal metabolic and other side-effects. For half a century, the creation of millions of Parkinsonian patients may have been misinterpreted as a 'cure' for schizophrenia. Such a wholesale re-interpretation of neuroleptic therapy represents an unprecedented disaster for the self-image and public reputation of both psychiatry and the whole medical profession. Nonetheless, except as a last resort, neuroleptics should swiftly be replaced by gentler and safer sedatives.     

Why should we still care about oncogenes?

Although oncogenes and their transformation mechanisms have been known for 30 years, we are just now using our understanding of protein function to abrogate the activity of these genes to block cancer growth. The advent of specific small-molecule inhibitors has been a tremendous step in the fight against cancer and their main targets are the cellular counterparts of viral oncogenes. The best-known example of a molecular therapeutic is Gleevec (imatinib). In the early 1990s, IFN-alpha treatment produced a sustained cytologic response in approximately 33% of chronic myelogenous leukemia patients. Today, with Gleevec targeting the kinase activity of the proto-oncogene abl, the hematologic response rate in chronic myelogenous leukemia patients is 95% with 89% progression-free survival at 18 months. There are still drawbacks to the new therapies, such as drug resistance after a period of treatment, but the drawbacks are being studied experimentally. New drugs and combination therapies are being designed that will bypass the resistance mechanisms.     

Why can't we do better breast examinations?

The professional practice of clinical breast examination (CBE) is a crucial element in early detection of neoplasms, but it is often compromised by insufficient formal training and conflicting demands on professional time. From an extensive research base, a training technology has been developed which generates highly proficient CBE. This technology is being adopted by agencies concerned with improved screening for breast cancer. New strategies for enhancing the role of CBE in breast cancer detection might include training and licensing personnel whose primary function would be to perform highly proficient CBE under professional supervision.     

Adjuvant therapy for HER2 positive breast cancer: are anthracyclines still necessary?

Anthracyclines are integral components of most adjuvant chemotherapy regimens for surgically removed early breast cancer and are central to the accepted treatment standards. Recently the standard anthracycline regimen of doxorubicin plus cyclophosphamide was found to be inferior in preventing recurrence of breast cancer when compared to cyclophosphamide and docetaxel, questioning the necessity to expose patients to the potential cardiotoxicity of anthracycline in the adjuvant setting. Trastuzumab, a humanized monoclonal antibody against the extracellular domain of the human epidermal growth factor receptor 2 (HER2) has become the cornerstone of treatment of breast cancers that overexpress HER2 in the neo-adjuvant and metastatic setting. Unfortunately, the combination of anthracyclines and trastuzumab produces a high incidence of cardiotoxicity as seen in early trials of metastatic breast cancer. Five adjuvant trials combining trastuzumab with different anthracycline-based regimens have been reported, all of them revealing similar efficacy in reducing recurrence of breast cancer. The trastuzumab adjuvant trial 006 from the Breast Cancer International Research Group shows for the first time that a nonanthracycline-containing regimen with trastuzumab has equivalent efficacy in decreasing the recurrence of breast cancer, with less incidence of cardiotoxicity when compared to anthracycline-containing trastuzumab adjuvant regimens. Further trials are needed to determine the optimal length of adjuvant therapy with trastuzumab, as well as long-term side effects with special attention to cardiotoxicity.     

Healing is who we are ... and who are we?

Yavapai Regional Medical Center (YRMC) has created, developed, embraced, and shared its vision of a total healing environment. The management/leadership team identified the values of respect, integrity, accountability, commitment, and quality as norms of behavior to reach YRMC's vision. This article describes how senior management at YRMC supports and reinforces the healing process as part of their everyday work life, resulting in better patient care and an improved bottom line. Nursing executives know that healing is the mantra of caregiving and the foundation of nursing itself. It is an invitation to each employee to invite his/her soul to work, which allows all employees to partner with nursing to become caregivers for each other. Understanding the transformation at YRMC begins with reading and listening to the stories that follow of the experiences and talents of the employees. Others are encouraged to use our model by first recognizing the positive talents and experience of staff members and then telling and retelling the stories that come from these experiences. We believe this will enhance the current healing in your organization and improve your environment "one conversation at a time," as it happened at YRMC. Yavapai Regional Medical Center is proud of its accomplishments. We wish to share our story and journey so that each nurse executive can be inspired to develop and live his/her own vision to create this healing environment.     

Why are nurses leaving nursing?

The causes of nurses' exodus from acute health care delivery practice may lie more in intrinsic factors rather than the heretofore overtly expressed reasons. This article examines bureaucratic factors, issues related to the medical profession and medical/scientific discourse, and factors within the nursing profession itself that may contribute to a nurse's unhappiness and dissatisfaction that causes him or her to leave. Nursing as emotional work and the implications for the individual nurse, and nursing as moral and moral distress are discussed. Suggestions to facilitate retention are made for changing the work environment to feel valued for their skillfully applied humanness.