Groin recurrence in carcinoma of the vulva: management and outcome

CORMIO G., LOIZZI V., CARRIERO C., CAZZOLLA A., PUTIGNANO G. & SELVAGGI L. (2010) European Journal of Cancer Care 19 , 302–307
Groin recurrence in carcinoma of the vulva: management and outcome The aim of the study was to investigate the management and outcome of inguinal recurrence in vulvar carcinoma patients. A retrospective chart review was conducted on 140 patients with squamous cell carcinoma of the vulva treated between 1994 and 2006. Twenty‐one patients were found to have groin recurrence. Median interval between primary treatment of vulvar cancer and groin recurrence was 7 months. Three patients refused any treatment, 3 received chemotherapy, 2 inguino‐pelvic radiotherapy and 13 had resection of the groin recurrence. After surgery seven patients received irradiation of the groin and pelvis, and three patients received chemotherapy. One patient died following surgery; 19 patients died of disease with the median survival after diagnosis of inguinal recurrence of 9 months. Only one patient is alive without evidence of disease at 60 months following surgery. In univariate analysis, stage and grade at diagnosis, age and performance status at the recurrent disease, and the extent of residual tumour after resection of groin recurrence were predictors for survival. Groin recurrences from vulvar carcinoma carry a poor prognosis. Multi‐modal treatment may result in a palliation of the disease, and a very limited number of patients have long‐term survival.     

Returning to a changed ordinary life – families' lived experience after completing a child's cancer treatment

BJÖRK M., NORDSTRÖM B., WIEBE T. & HALLSTRÖM I. (2010) European Journal of Cancer Care 20 , 163–169 Returning to a changed ordinary life – families' lived experience after completing a child's cancer treatment The aim of the study was to illuminate the families' lived experience after completing a child's cancer treatment. The study took place at a University Hospital in southern Sweden. Interviews were carried out with 10 mothers, eight fathers, four patients and two siblings from a total of 10 families. The interviews were analysed with a hermeneutical phenomenological approach. One essential theme emerged from their stories, ‘returning to a changed ordinary life – incorporating a trying and contradictory experience’. The families felt relieved that the treatment was over yet they experienced strains in their daily life. Family members felt changed and especially the parents needed to focus on themselves in order to recover. Closeness with other people, especially their own family, was important. The previously sick children felt a loss of concern from their parents when treatment had ended, in contrast to siblings who experienced increased attention from their parents. Parents experienced being in uncharted territory and sometimes missed the security of hospital. For professionals it is important to offer the family a structured follow‐up to help them in their daily life after the child's treatment is completed.     

Fetal plasma catecholamine concentrations and fetal heart-rate variability during first stage of labour

Summary. Fetal heart-rate (FHR) variability was studied in 50 term fetuses during the first stage of labour. The variability was computed as an arbitrary index during a 20-min period preceding a fetal scalp blood sample which was used for the measurement of pH, adrenaline and noradrenaline. None of the fetuses was found to have a scalp blood pH<7.2. The short-term variability index was significantly correlated with the noradrenaline concentration in fetal blood, but the adrenaline levels which were generally very low showed no correlation with the variability values. There was no correlation between variability index and cervical dilatation or blood pH. We have shown previously high plasma catecholamine concentrations in the asphyxiated fetus with a decreased pH. In this study where fetal pH was normal a correlation between FHR variability and fetal scalp plasma noradrenaline levels was found. Thus an increased FHR variability might be an early sign of fetal distress when fetal pH is still normal.     

The psychiatric clinical specialist''s impact on psychiatric emergency services

Psychiatric emergency services have evolved into more comprehensive programs during the past two decades. With this evolution other disciplines have gained access to the services and integrated their expertise and philosophy into the daily care of patients. Nursing has been an integral part of this process and contributed its perspective in nursing care. This paper outlines the development of psychiatric emergency services with a special emphasis on the contribution of nursing specialists who have developed their role within the psychiatric emergency service.

What has been unique about the nursing contribution is the attention to individualizing patient care and modifying treatment approaches to meet the patients' needs and interests in psychiatric treatment. Additionally, nursing has complemented the physician's role by developing expertise in assessment that is both psychologically and biologically oriented. Nursing's future contribution to psychiatric emergency services should address mechanisms for tracking patients who enter the psychiatric emergency service system with an emphasis on linkage with other programs or resolution of the crisis episode.     

Mary Opal Wolanin: A life worth living…A life of giving, part 2

In September 1996, the Board of Directors of the National Gerontological Nursing Association NGNA) was invited to dine with Mary Opal Wolanin at her home the in the Air Force Village II Retirement Center near San Antonio, Texas. The evening was filled with excitement and with lively exchanges. Our hostess challenged the Board members as only a true leader can. The events of the evening were taped and are being published in two parts. In part 1 published in the September/October 1997 issue), Mary Opal Wolanin told NGNA about how she started in nursing and some of her early experiences in the profession. This article, the second about the evening with Mary Opal Wolanin, contains further excerpts of our conversation and some of my thoughts about that experience. She discusses many of her observations about nursing and nurses, as well as her “Law of Long-Term Consequences.” She asks important questions of today's nurses and challenges today's nursing leaders.     

Dutch Physiotherapy Guidelines for Low Back Pain

Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and appropriate physiotherapy for low back pain. They aim to improve the efficiency and effectiveness of physiotherapeutic care for patients with low back pain.The guidelines were constructed on the basis of the phases of the physiotherapy process, using the Dutch method of developing physiotherapy guidelines. Scientific evidence of systematic reviews was used as the basis for the recommendations. A computerised literature search of Medline, Cinahl, the Cochrane Database of Systematic Reviews and the Database of the Dutch National Institute of Allied Health Professions was conducted to identify relevant systematic reviews. If no evidence was available, consensus between experts was obtained.The guidelines were pilot tested among one hundred physiotherapists and reviewed by an external multi-disciplinary panel.The guidelines recommend that the diagnostic process should focus on disability and participation problems resulting from back pain. The treatment should consist of an active approach, in which the patients learn to take control over their back pain. For patients with a normal course, where activities and participation gradually increase, reassurance, adequate information and advice to stay active are the most important recommendations. For patients with an abnormal course, where activities and participation do not increase, exercise therapy should also be provided, with a behavioural approach if necessary.These are the first national physiotherapy guidelines for low back pain. The recommendations are largely in line with other primary care guidelines for low back pain. Implementation will be a major challenge for the near future.     

Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment

The effectiveness of a structured psychosocial intervention for women with breast cancer was studied in relation to a control group. The study was conducted in a hospital setting in Spain, and the aim of the intervention programme was to foster a higher quality of life and a more positive mental adjustment to the cancer. Three measures were used: baseline, post-treatment and 6-month follow-up for both groups. The dependent variables examined were quality of life and mental adjustment. The independent variable was the psychosocial intervention programme. Subjects were 188 women who had been operated for breast cancer and who satisfied a series of medical criteria, had no history of psychological problems and were between 25 and 65 years old. The results have shown that the psychosocial intervention programme was highly effective in improving the patients' quality of life, as compared with baseline measures, as well as compared with the control group. Additionally, the intervention increased the patients' fighting spirit and hopefulness/optimism, and reduced their anxious preoccupation as coping styles. These changes persevered at the 6-month follow-up.