Perceived control and involvement in self care in patients with colorectal cancer

Aim. This paper reports the qualitative findings from a mixed methods study which explored patients’ understandings of perceived control in relation to their self care during chemotherapy for colorectal cancer. Background. A greater degree of patient involvement in self care is increasingly being encouraged; however, little is known about how factors such as perceived control influence patients’ active involvement in self care. Design. Qualitative, longitudinal study. Methods. Semi structured interviews were conducted with 11 patients before and after six months of chemotherapy treatment for colorectal cancer in a Scottish cancer centre between March 2005–June 2006. The interviews, conducted as part of a larger study, explored patients’ understandings of their perceived control over managing treatment‐related side effects and how this influenced their attitudes toward, and role preferences in, self care. Results. Patients fell into one of two groups: ‘high’ or ‘low’ perceived controllers. High‐perceived controllers were more likely to view their active involvement in self care positively, as being necessary in managing treatment‐related effects and were less likely to rely on nurses to take overall responsibility for the management of treatment‐related side effects. Low‐perceived controllers were less likely to believe in the importance or necessity of their active involvement in self care and more likely to perceive nurses as being the ones responsible for the management of treatment‐related side effects. Conclusions. Perceived control during treatment for cancer influences patients’ perceptions toward, and role preferences in, self care. Relevance to clinical practice. Clinical interventions designed to enhance involvement in self care would benefit from focussing on enhancing patients’ perceived control and understanding their role preferences in self care. Patients with different understandings of perceived control may require different help and support to encourage their involvement in self care.     

Glucose tolerance in granuloma annulare

Granuloma annulare (GA) may be associated with glucose intolerance. Twenty-one patients with GA were evaluated. Four patients were found to have frank diabetes mellitus and 2 were excluded from the data analysis because of obesity. The remaining patients and 14 age- and weight-matched controls had oral and intravenous glucose tolerance tests (GTT). During the oral GTT the fasting plasma glucose, the 2-h plasma glucose, the area of the glucose curve, the 1-h serum insulin, and the area of the insulin curve were all significantly greater in the GA patients than in the controls. During the intravenous GTT the immediately releasable insulin pool was intact, while the fasting plasma glucose and the area of the glucose curve were greater in the GA patients than in the controls. The data taken together suggest that glucose tolerance may be reduced in GA and that insulin resistance may exist.     

Historical perspectives on the treatment of gastroesophageal reflux disease

The current vogue in the historical evolution of the management of the problem of reflux is represented by augmentation procedures for the lower esophageal sphincter. Rather than employ a transperitoneal approach, these are directed at the sphincter by the transesophageal route and include stitching, collagen injection and radio-frequency-induced fibrosis. It is however probable that these techniques will suffer all the drawbacks of any mechanical intervention but somewhat decrease the morbidity of open, albeit minimally invasive surgery. Similarly, a specific pharmacotherapeutic probe targeting the lower esophageal sphincter, while long fantasized, remains to be identified.     

Handgrip strength after the Blalock-Taussig shunt: 14 to 34 year follow-up

To determine the long-term functional impact of the Blalock-Taussig (BT) shunt, we studied handgrip strength in 56 patients (10-28 years) following total repair of tetralogy of Fallot. Of the 56, 16 (29%) had a previous right BT shunt, 5 of 56 (9%) had a previous left BT shunt, and the remaining 35 patients either had a Potts shunt or primary total repair. The mean age at the time of right BT was 2.8 +/- 1.6 (SD) years, left BT 1.7 +/- 1.2 years, and total repair for all patients was 7.1 +/- 2.2 years. Mean age at the time of study was 26 +/- 9 years. Right-and left-handgrip strength were measured with a Jamar dynamometer, averaging the results of grip position 2, 3, and 4 to accommodate variation in hand size. Since absolute values of hand strength were strongly associated with sex (p = 0.006) and body surface area (p = 0.016), we calculated the ratio of right-hand to left-handgrip strength (RL ratio). The RL ratios were: 0.98 +/- 0.13 (right BT), 1.21 +/- 0.11 (left BT), and 1.13 +/- 0.16 (no BT): (p = 0.004 right BT vs. no BT, p = 0.07 left BT vs. no BT, Wilcoxon rank sum test). Thus, although frequently clinically inapparent, handgrip strength tested many years post-BT shunt is reduced on the side of the shunt.     

Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care

The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally different from acute care, relying on several features: opportunistic case finding for assessment of risk factors, detection of early disease, and identification of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-effectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment.