A PIL for every ill? Patient information leaflets (PILs): a review of past, present and future use

This article reviews the usefulness and importance of written information, specifically leaflets, being given to patients. Evidence suggesting how both patient and doctor may benefit from the giving of written information is reviewed. Identification of good practice relating to the content and readability of leaflets is discussed. An argument is put forward that the giving of written information is an under-utilized resource in contributing to improving patient outcomes but that this may be changing with the increasing use of patient leaflet databases. The advantages and disadvantages of computer- generated patient leaflets are discussed and desirable further areas of research on computer-generated leaflets are proposed.      

Numerical simulation of local pharmacokinetics of a drug after intravascular delivery with an eluting stent

We use mathematical modelling to delineate the influence of two important factors on local pharmacokinetics of a drug delivered via an eluting stent, namely: (1) diffusional resistance of a stent coating, and (2) reversible binding of a drug to the vascular tissue. A system of differential equations that describes diffusion of the drug out of the polymeric coating of the stent into the vascular tissue and into the bloodstream, as well as reversible binding of the drug within the vascular tissue, was solved numerically and the spatial profiles of the concentration of the drug at various points of time were produced and analysed. Also, kinetic curves of the spatial average concentration of the drug within the wall were constructed, and the areas under those curves (AUC) were calculated. The simulations showed that AUC might be enhanced, if the stent is coated with a continuous layer of a drug-releasing medium with a high diffusional resistance. Both the residence time and the average concentration of the drug within the vascular wall increase in this case mainly because the coating imposes a diffusional barrier between the vascular tissue and the bloodstream, thereby reducing the wash-out. If the drug reversibly binds to the tissue, the residence time increases greatly, but the AUC for the free (unbound) drug remains unchanged, implying that the presence of the drug in the vessel is prolonged at the expense of a proportional reduction in concentration of a free drug within the tissue. These findings justify the design of eluting stents with continuous coatings with enhanced diffusional resistance and the engineering of drugs with enhanced affinity to the vascular matrix. Reversible binding to tissue may be beneficial for prolonging the presence of the drug in the target tissue, and for avoiding potential toxic peak effects of high concentrations of the free (unbound) drug.     

Neurohormonal changes during formation of latent inhibition in rats predisposed to catalepsy

The response of two monoaminergic systems to induction of latent inhibition has been studied in two rat strains. The noradrenergic system of the Wistar rat brain responded uniformly and systemically in the hippocampus, hypothalamus, amygdala, and frontal cortex. It has been shown that footshock induced a decrease in the norepinephrine level and the return of the mediator level to the control level in the “adaptation + footshock” groups for the four brain regions studied. Significant differences in norepinephrine levels were found in the “footshock” group in the hippocampus and hypothalamus of Wistar rats but not GC rats. The lowest serotonin level in the hippocampus was found in the “adaptation + footshock” group of the cataleptic strain. Opposite changes in corticosterone levels in the blood plasma of GC and Wistar rats were significant according to the F test (F[2, 70] = 3.908, p < 0.05). Differences in the testosterone levels between the two strains during induction of the latent inhibition were absent.     

Learning in Rats Predisposed to Catatonic States in a Morris Water Maze

Studies in a Morris water maze showed that GC rats, which are predisposed to catalepsy, did not differ from Wistar rats in terms of the proportion of correct attempts or the time taken to find a platform hidden beneath the water. However, in contrast to Wistar rats, rats of the cataleptic strain tended to show passive drifting and demonstrated longer-lasting episodes of immobility in the water. PLM+ rats, which are predisposed to hyperkinesia in the form of pendulum-like horizontal movements of the head and shoulder girdle, took longer to find the platform and showed a reduced proportion of correct platform-finding attempts than Wistar rats and PLM– rats, bred for the absence of pendulum-like movements.     

Colorectal Cancer in the Family: Psychosocial Distress and Social Issues in the Years Following Genetic Counselling

Background

This study examined: (1) levels of cancer-specific distress more than one year after genetic counselling for hereditary nonpolyposis colorectal cancer (HNPCC); (2) associations between sociodemographic, clinical and psychosocial factors and levels of distress; (3) the impact of genetic counselling on family relationships, and (4) social consequences of genetic counselling.

Methods

In this cross-sectional study, individuals who had received genetic counselling for HNPCC during 1986–1998 completed a self-report questionnaire by mail.

Results

116 individuals (81% response rate) completed the questionnaire, on average 4 years after the last counselling session. Of all respondents, 6% had clinically significant levels of cancer-specific distress (Impact of Event Scale, IES). Having had contact with a professional psychosocial worker for cancer risk in the past 10 years was significantly associated with higher levels of current cancer specific distress. Only a minority of the counselees reported any adverse effects of genetic counselling on: communication about genetic counselling with their children (9%), family relationships (5%), obtaining life insurance (8%), choice or change of jobs (2%), and obtaining a mortgage (2%).

Conclusion

On average, four years after genetic counselling for HNPCC, only a small minority of counselled individuals reports clinically significant levels of distress, or significant family or social problems.