Implementing national standards for cancer pain management: Program model and evaluation

The purpose of this quasi-experimental (pre- and posttest) study was to test a model pain management program (PMP) to implement the American Pain Society (APS) quality assurance standards for the management of acute and chronic cancer pain using a continuous quality improvement (CQJ) approach to improve professionals' knowledge and skills, patient satisfaction, and to identify areas needing improvement. The sample consisted of 1210 nurse responses and 698 interviews of patients with pain during hospitalization at a major urban cancer center. The PMP provided a structure (standards), educational opportunities, and training in CQI methods. Outcome measures included a patient evaluation questionnaire and concerns checklist: nurse knowledge, attitude and barriers questionnaire; and focus groups to identify areas needing improvement. Significant improvements were found in patients' satisfaction, nurses' knowledge and attitude scores, and reductions in nurses' perceptions of barriers. Focus groups revealed the need for improved communication among disciplines about pain and better assessment of patients unable to self-report. The program met its goal of implementing the APS standards, educating nurses, and identifying “system” problems, and improving overall patient satisfaction.     

Reproductive health of adolescents in Bangladesh

The health and social effects of pregnancy in married women 13-23 years of age were studied among a population of 175,000 in rural Bangladesh. Data collected by a structured questionnaire identified pregnant women who were followed twice during pregnancy and twice postpartum. Maternal mortality for the 13-17 age group was 5.8/1000 compared to 1.8/1000 for the 18-23 year olds. Major causes of death in the younger group were obstructed labor and toxemia. The neonatal death rate was 80/1000 for the younger group and 43/1000 for the older group. The major cause of death of infants born to the younger mothers was birth injury. In infants born to older mothers, it was tetanus. Perinatal death rate was 66.4/1000. All deliveries occurred at home, and 89% of births were attended by relatives, neighbors or an untrained birth attendant. Only 13% of the women had ever used contraceptives. Use varied from 2.9% at 16 years to 24.7% at 23 years. Suggestions are made for improving maternal and child health care in rural Bangladesh.     

Instructional improvement: how to overcome the barriers?

This is no easy way to improve teaching. Not one or even two activities are right or best for all instructions. The improvement of instruction requires a multi directional approach. When faculty members, departmental heads or interested administrator come across an idea they find appealing, they often tend to be converted and start proselytizing. The way to better teaching lies in review of videotaped teaching samples or diagnostic student evaluation with consultation, or seminars on course design, or monitoring with master teachers, peer assessment or whatever the favored strategy happens to be. All of these are possible ways to better teaching, made right or best only after they have been carefully matched with their instructional needs of the teacher, course content & instructional setting.     

Suppression of angiogenesis and tumor growth by selective inhibition of angiopoietin-2

Angiopoietin-2 (Ang2) exhibits broad expression in the remodeling vasculature of human tumors but very limited expression in normal tissues, making it an attractive candidate target for antiangiogenic cancer therapy. To investigate the functional consequences of blocking Ang2 activity, we generated antibodies and peptide-Fc fusion proteins that potently and selectively neutralize the interaction between Ang2 and its receptor, Tie2. Systemic treatment of tumor-bearing mice with these Ang2-blocking agents resulted in tumor stasis, followed by elimination of all measurable tumor in a subset of animals. These effects were accompanied by reduced endothelial cell proliferation, consistent with an antiangiogenic therapeutic mechanism. Anti-Ang2 therapy also prevented VEGF-stimulated neovascularization in a rat corneal model of angiogenesis. These results imply that specific Ang2 inhibition may represent an effective antiangiogenic strategy for treating patients with solid tumors.     

An overview of palliative nursing care

Studies tell us that most people fear a protracted, painful death; unfortunately, this is what many experience. Palliative nursing care seeks to change this. This new series challenges nurses to think differently about caring for people when cure isn't possible.     

Supportive care program,Pain Service,Memorial Sloan-Kettering Cancer Center

Advanced cancer patients being cared for at home, with severe pain and multiple symptoms, strain the resources of individual community practitioners and family members. Supportive care programs, such as that developed by the Pain Service at Memorial Sloan-Kettering Cancer Center (New York), with good communication and liaison work between hospital and community, add a much needed dimension to pain and symptom control for these patients and their families, as well as ongoing support to community physicians and nurses.     

Pain management in the home

There is a major shift in responsibility for day-to-day pain management when a patient is to be cared for at home. What was primarily the responsibility of the nurse/physician team in the inpatient setting now becomes the responsibility of the patient and family. Poorly controlled pain affects not only the patient, but the family system as a whole. Successful pain management at home depends on a patient and family who feel reasonably confident in understanding the cause of the pain and in their ability to use the analgesics as prescribed (eg, around-the-clock doses and “rescue” doses), how to recognize and report changes in the pain site, character and severity, how to recognize and report adverse side effects from the analgesic prescribed, how to use non-drug measures to help relieve the pain, and how to access help and support on a 24-hour basis. Therefore, family education is key.