Becoming a nurse faculty leader: doing your homework to minimize risk taking.

Risk taking is an important aspect of academic leadership; yet, how does taking risks shape leadership development, and what are the practices of risk taking in nurse faculty leaders? This interpretative phenomenological study examines the meaning and experience of risk taking among formal and informal nurse faculty leaders. The theme of doing your homework is generated through in-depth hermeneutic analysis of 14 interview texts and 2 focus group narratives. The practice of doing one's homework is captured in weighing costs and benefits, learning the context, and cultivating relationships.

Can a virtual patient trainer teach student nurses how to save lives--teaching nursing students about pediatric respiratory diseases.

Introduction: Virtual environments offer a variety of benefits and may be a powerful medium with which to provide nursing education. The objective of this study was to compare the achievement of learning outcomes of undergraduate nursing students when a virtual patient trainer or a traditional lecture was used to teach pediatric respiratory content.

Methods: This was a randomized, controlled, posttest design.

Becoming a nurse faculty leader: facing challenges through reflecting, persevering and relating in new ways.

Aim: The aim of the present study was to explore the experience of becoming a nurse faculty leader.

Background: In a recent interpretation of 23 interviews conducted with nurse faculty leaders from across the United States about their experiences of becoming a leader three themes were identified: being thrust into leadership, taking risks and facing challenges.

Evaluation: This interpretive phenomenological study further explicates three aspects of how nurse educators faced challenges in becoming and serving as a leader.

A comparative study of 2 sustained-release morphine preparations for pain in advanced cancer.

Purpose: Several sustained-release morphine (SRM) formulations are available internationally. This study compared 2 such products available in the United States, SR1 and SR2.

Patients And Methods: In an open-label study, patients with advanced cancer pain were randomized to receive SR1 or SR2 every 12 hours around-the-clock (ATC) for 5 days, with immediate release (IR) liquid morphine for rescue dosing (RD).

Symptom evaluation in palliative medicine: patient report vs systematic assessment.

Purpose: This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey.

Materials And Methods: Consecutive patients referred to the palliative medicine program at the Cleveland Clinic Foundation were screened. Open-ended questions were asked initially followed by a 48-item investigator-developed symptom checklist.

The business of palliative medicine--Part 3: The development of a palliative medicine program in an academic medical center.

Palliative medicine is the total continuing care of patients with cancer. Most resources for cancer care focus on curative attempts while often ignoring the symptoms created by the disease and its treatment. Attempts at curative treatment of the malignancy must be coupled with pain and symptom relief psychosocial and spiritual care, and support for the patient and family extending from the time of diagnosis through the bereavement period.

A syllabus for fellowship education in palliative medicine.

Recent years have seen significant growth in palliative medicine training programs and positions. There are plans to pursue palliative medicine specialty status with the American Board of Medical Specialties and accreditation of fellowship programs with the American College of Graduate Medical Education. A work group of program directors, supported initially by the Cleveland Clinic and then by the American Board of Hospice and Palliative Medicine, has recently published standards for fellowship training.

Complicated bereavement: a national survey of potential risk factors.

We developed a Bereavement Risk Questionnaire to rate 19 possible factors for assessing complicated bereavement. A four-point scale was used (0 = no risk, 3 = significant risk). The questionnaire was mailed nationwide in the United States to 508 hospice bereavement coordinators, and 262 responded.

Established and potential therapeutic applications of cannabinoids in oncology.

Cannabis occurs naturally in the dried flowering or fruiting tops of the Cannabis sativa plant. Cannabis is most often consumed by smoking marihuana. Cannabinoids are the active compounds extracted from cannabis.

Communication of a cancer diagnosis: patients' perceptions of when they were first told they had cancer.

Fifty consecutive cancer patients cared for by a palliative medicine program were interviewed concerning the initial communication of their diagnosis. The majority of patients were satisfied with the manner and the circumstances in which the information was imparted. A minority of women were significantly more unhappy than men about the manner in which they were told.

The cancer anorexia-cachexia syndrome: a survey of the Prognostic Inflammatory and Nutritional Index (PINI) in advanced disease.

Other than weight loss, most traditional methods of nutritional assessment are not acceptable in advanced cancer patients because they are inaccurate, too expensive for routine use, or too difficult for a debilitated person to complete. The prognostic inflammatory and nutritional index (PINI) is a formula devised to evaluate nutritional status and prognosis in critically ill patients. It has been suggested that the PINI score can be used to follow most pathological conditions.

Autonomic nervous system dysfunction in advanced cancer.

The autonomic nervous system (ANS) innervates every organ in the body and is largely involuntary. There have been reports of autonomic dysfunction in cancer patients, but most are case reports. There are suggestions that this abnormality may be common in advanced cancer.

Gastrointestinal symptoms among inpatients with advanced cancer.

Nearly one-half of the most frequently reported and most distressing symptoms in patients with advanced cancer are gastrointestinal in nature. This prospective study was designed to assess the frequency of gastrointestinal symptoms among inpatients admitted to a palliative medicine program with advanced cancer. Twenty-nine men and 2l women, with a median age of 64 years (range, 35-84), were interviewed about 17 gastrointestinal symptoms.

The efficacy and side effects of continuous infusion intravenous morphine (CIVM) for pain and symptoms due to advanced cancer.

Morphine is the strong opioid of choice in the management of moderate-to-severe chronic cancer pain. The preferred route of administration is oral, in individually titrated doses, regularly scheduled around the clock We conducted a retrospective study of continuous intravenous morphine (CIVM) in a palliative medicine program in 107 consecutive patients. The results suggest CIVM is an effective, safe, and versatile method of morphine administration when used with a defined protocol.

A phase II study of hydrocodone for cough in advanced cancer.

Purpose: Cough is a common symptom in advanced cancer. The use of hydrocodone as an antitussive has not been studied previously in this setting. This study evaluates hydrocodone for cough in advanced cancer

Methods: The results presented are from a phase II study with dose titration.

Symptoms and prognosis in advanced cancer.

As death from cancer approaches, the associated symptoms become more important. Not only do these symptoms impair quality of life and guide palliative management of the patient, but some also appear to have prognostic value in determining clinical course and survival. A comprehensive prospective analysis of symptoms in 1,000 patients on initial referral to the Palliative Medicine Program of the Cleveland Clinic was conducted.

The impact of a palliative medicine consultation service in medical oncology.

This prospective study of consecutive patients describes the palliative medicine consult service in a tertiary level cancer center and its impact on patient care. All inpatients/outpatients referred to the Palliative Medicine Program in a 4-month period were enrolled. Data were collected at the initial consultation using standardized forms with spaces for: reason for the consultation, referring service, demographics and history, ECOG performance status, symptoms, prognosis and diagnostic tests, treatment, and care plan.

A phase II study of low-dose megestrol acetate using twice-daily dosing for anorexia in nonhormonally dependent cancer.

Anorexia is a common problem in advanced cancer. Low-dose megestrol acetate, a semi-synthetic progesterone, given twice daily, is an effective appetite stimulant in advanced cancer patients. There was an excellent correlation between patient satisfaction and the primary response criteria (appetite improvement).

The business of palliative medicine--Part 2: The economics of acute inpatient palliative medicine.

Economic feasibility is a major factor in the viability of established acute inpatient palliative medicine. Several clinical, administrative, and financial parameters determine the financial health of inpatient care. Financial management metrics include case mix index (CMI) (as determined by the Federal Register as an assigned relative weight to the diagnosis-related group (DRG) reflecting resource consumption), direct costs, indirect costs, contribution margin, and in the future of all patient revised-DRG (APR-DRG).

Can a soft diet prevent bowel obstruction in advanced pancreatic cancer?

Although many patients are advised to follow a high-fiber diet to avoid constipation, it seems that a soft diet such as that recommended after bowel surgery may well be more helpful in avoidance of intestinal obstruction.