Talk that talk: storytelling and analysis rooted in African American oral tradition

Stories are the foundation of qualitative research. However, the development of qualitative methods rooted in oral traditions remains largely unexplored by researchers. The contextual and historical influences on storytelling and storytaking are critical features of the African American oral tradition that are often ignored or minimized in qualitative research. Despite the complex and often contentious history of African Americans, their oral traditions have not been explored to reveal the depth of their lived experiences and the way those experiences inform their health concerns. The purpose of this article is twofold. First, dialogues about storytelling and storytaking are revisited and critiqued. Second, a comprehensive analytic process for gathering and interpreting stories rooted in African American oral tradition is outlined.     

Tardive dyskinesia associated with metoclopramide in persons with developmental disabilities

Metoclopramide is an anti-emetic medication that has been associated with movement disorders such as extra-pyramidal reactions and tardive dyskinesia (TD). Reports of these reactions have been documented in the general population, but investigations of side effects in persons with mental retardation are scant. Given the high incidence of gastrointestinal disturbance in persons with mental retardation, and the popularity of this medication to treat such problems, these individuals could be at risk for developing movement disorders resulting from metoclopramide use. We compared incidence rates of TD over a 1-year period in developmentally disabled individuals taking either metoclopramide, typical antipsychotics, or no psychotropic medications (Table 1). Assessment was completed using the Dyskinesia Identification System--Condensed User Scale (DISCUS), a standardized measure of TD found to be reliable and valid for persons with mental retardation. No significant differences in DISCUS scores between the metoclopramide and antipsychotic treated groups were noted across four measurements taken during the course of 1 year. Additionally, no difference was found between these two groups for a number of participants who met criteria for probable TD on at least one of the DISCUS administrations. Comparisons between all three groups on one testing occasion revealed a significant difference between groups. The no psychotropic control group showed significantly less TD symptomology than the antipsychotic or metoclopramide groups.     

Intravenous Cereport (RMP-7) Enhances Delivery of Hydrophilic Chemotherapeutics and Increases Survival in Rats with Metastatic Tumors in the Brain

Purpose. The following experiments determined whether intravenous infusions of Cereport enhance delivery of chemotherapeutics and prolong survival in rats with metastatic tumors in the brain. Methods. Autoradiography and scintillation were used to examine uptake of the lipophilic (paclitaxel and carmustine) and the hydrophilic (carboplatin) chemotherapeutic agents, as well as the large hydrophilic marker, 70 kDa dextran. Cereport was also tested in combination with the chemotherapeutic drugs carboplatin, vinorelbine, gemcitabine and carmustine to determine if Cereport could enhance the survival benefit beyond that provided by chemotherapy alone. Results. Cereport enhanced the uptake of carboplatin and dextran, but not paclitaxel or carmustine. The pattern of Cereport's uptake effect with carboplatin revealed that Cereport selectively increased the proportion of highly permeable regions. Survival was significantly enhanced when Cereport was combined with either carboplatin, vinorelbine, or gemcitabine, but not carmustine, compared to each chemotherapeutic agent alone. Conclusions. These data provide the first evidence that Cereport, or any receptor-mediated approach intended to enhance the permeability of the blood-brain tumor barrier, can increase the delivery hydrophilic drugs to metastatic tumors in the brain, increasing survival in tumor-bearing rats.     

A national framework for cancer surveillance in the United States

Enhancements to cancer surveillance systems are needed for meeting increased demands for data and for developing effective program planning, evaluation, and research on cancer prevention and control. Representatives from the American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, National Cancer Registrars Association, and North American Association of Central Cancer Registries have worked together on the National Coordinating Council for Cancer Surveillance to develop a national framework for cancer surveillance in the United States. The framework addresses a continuum of disease progression from a healthy state to the end of life and includes primary prevention (factors that increase or decrease cancer occurrence in healthy populations), secondary prevention (screening and diagnosis), and tertiary prevention (factors that affect treatment, survival, quality of life, and palliative care). The framework also addresses cross-cutting information needs, including better data to monitor disparities by measures of socioeconomic status, to assess economic costs and benefits of specific interventions for individuals and for society, and to study the relationship between disease and individual biologic factors, social policies, and the environment. Implementation of the framework will require long-term, extensive coordination and cooperation among these major cancer surveillance organizations. We acknowledge the contributions of Ronda Starr, who assisted in the preparation of the tables, the web addresses for the data sources, and the references.     

Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project

BACKGROUND: Recent reports have suggested that anemia is associated with adverse outcomes in patients with heart failure (HF), but were unable to adjust for a broad range of comorbid conditions. As a result, whether anemia is a truly independent predictor of risk or a marker of comorbid illness in these patients is unknown. METHODS: We analyzed medical records from the Centers for Medicare & Medicaid Services' National Heart Care Project, a national sample of 50,405 patients 65 years and older admitted to acute care hospitals with a principal discharge diagnosis of HF between April 1, 1998, and March 31, 1999, or between July 1, 2000, and June 30, 2001. Multivariable logistic regression analyses were conducted to test whether hematocrit level was an independent predictor of all-cause mortality and HF-related readmission at 1 year. RESULTS: In unadjusted analysis, lower hematocrit levels were associated with increased 1-year mortality and readmission for HF. Compared with patients with a hematocrit greater than 40% to 44%, those with a hematocrit of 24% or less had a 51% higher risk of death (relative risk [RR], 1.51; 95% confidence interval [CI], 1.35-1.68; P<.001) and a 17% higher risk of HF-related readmission (RR, 1.17; 95% CI, 1.01-1.34; P = .04). However, after adjustment for multiple comorbidities and other clinical factors, the association between lower hematocrit levels and increased 1-year mortality was markedly attenuated, even in those patients with the most severe anemia (hematocrit, < or = 24% vs > 40%-44%: RR, 1.02; 95% CI, 0.86-1.19; P = .85). The association between lower hematocrit values and HF-related readmission persisted after multivariable adjustment (hematocrit, < or = 24% vs > 40%-44%: RR, 1.21; 95% CI, 1.04-1.38; P = .01). CONCLUSIONS: Although anemia is an independent predictor of hospital readmission, its relationship with increased mortality in HF patients is largely explained by the severity of comorbid illness. These findings suggest that anemia may be predominantly a marker rather than a mediator of increased mortality risk in older patients with HF.