By Theresa A. Veach, Donald R. Nicholas, and Marci A. Barton Published by Brunner-Routledge, New York, 2002 255 pages, $34.95 (Hardcover) Cancer and the Family Life Cycle is a nicely organized work that integrates six phases of the family life cycle with six defined stages of cancer treatment. The authors have created narratives for the single young adult, newly forming couple, the family with adolescents, the family launching children and the family in later life as they move through diagnosis, treatment, rehabilitation, survival, recurrence/advanced disease and end of life care. This guide is written for practitioners who work with cancer patients and their families in settings such as hospitals, nursing homes and hospice, as well as private practice settings. The book reinforces the importance of early psychosocial assessment and interventions along the continuum of illness and provides a framework for conceptualizing the impact of cancer on the family system and individual family members. Chapter 1, “Introduction and Purpose,” provides interesting history on the perception of cancer since the 1800's. The evolution of the illness is explored as it changed from a shameful, hopeless diagnosis to a treatable disease impacting multidimensional aspects of patient and family life. This ongoing evolution is reflected in some of the complex constructs and language presented in this guide. For example, phrases such as “cancer as a new family member” (p. 23), “married couples who have had cancer” (p. 159), “cancer to be kept in its place” (p.135) are woven through the text and seem to represent the ongoing struggles to establish a language and conceptual framework that set boundaries around the illness and its influences. This same evolving language impacts the perception of family who are alternately described as “part of the team” and as the “unit of treatment.” How we see the role of family influences the therapeutic formulation and interventions. This book does a fine job of discussing the implications of boundaries and rules of communication within families; it misses an opportunity to do the same in the area of our language as clinicians. Each chapter of this guide is similarly organized. There is an overview of medical, treatment, existential and psychosocial aspects and case examples for each life cycle phase. The case examples integrate genograms, diagnostic interview, assessment and interventions. Tables help coordinate life cycle stage with the following factors: life cycle tasks, cancer's potential disruption to the system, psychosocial interventions and specific topics of communication. Figures describe the emotional process of transitions as families are asked to adjust and adapt boundaries, rules, roles and communication patterns consequent to diagnosis and treatment realities. The case examples are rich with suggested interventions ranging from speaker/listener communication techniques; rituals; and structural, problem solving, group, behavioral and mind-body interventions. Cultural and diversity aspects of the patient/family experiences are not discussed; instead, clinicians will need to integrate this aspect of assessment into the valuable constructs that are provided. This practitioner guide is a useful clinical tool. It represents an ideal wherein patients and families are afforded an initial biopsychosocial assessment, ongoing interventions, options for home care and end-of-life care. The guide can empower clinicians to intervene with patients and families, and encourage specific advocacy efforts to enhance the quality and availability of these important services.
The British Journal of Dermatology publishes original articles on all aspects of the biology and pathology of the skin. Originally the Journal, founded in 1888, was devoted almost exclusively to the interests of the dermatologist in clinical practice. However, the rapid development, since the 1950s, of research on the physiology and experimental pathology of the skin has been reflected in the contents of the Journal, which now provides a vehicle for the publication of both experimental and clinical ethical research and serves equally the laboratory worker and the clinician. To bridge the gap between laboratory and clinic the Journal publishes reviews of recent advances in such aspects of dermatology as laboratory research, contact dermatitis, therapeutics and drug reactions. Other regular features include concise communications, case reports, book reviews, correspondence, news and notices, and selected society proceedings.
Quality of life in epilepsy: beyond seizure counts in assessment and treatment . Edited by gus a baker and ann jacoby. (Pp 316, £38.00). Published by Harwood Academic Publishers, Amsterdam, 2000. ISBN 90 5823 121 6. The issue of quality of life in epilepsy has developed enormously over the past 10 years. Although this is still rather belated in relation to other conditions where the issue has been around for much longer, there is a healthy debate ongoing about what indeed is quality of life and it is likely that no answer to this question will ever be forthcoming. Nevertheless, in terms of health outcome research, there is a place for quality of life measurement. Epilepsy, perhaps more …
the circulatory blood volume (oligaemia) is the most important factor in the production of wound shock, and that circulatory collapse occurs if a patient's effective blood volume is reduced below 70 per cent of normal. Grant and Reeve conclude that the most valuable signs in determining the degree of reduction in blood volume are the amount of tissue damage, and the systolic blood pressure. They regard the patient's own hand as the unit of measurement, and observed that circulatory blood loss was approximately 10 per cent for each " hand " of tissue damage. Large wounds equivalent to a tissue damage of three to five hands
Although Bright had noted the " full hard pulse " of his patients, he had no means of measuring their blood-pressure. The first unequivocal demonstration of a renal extract with a pressor action was given in 1898 by Tigerstedt and von Bergmann, the active substance being named renin. Little more was learnt until 1934, when Goldblatt's experiments stimulated Widespread investigation. These experiments are now so well known that a
increase in the numbers of deaths from pulmonary embolism was noticed, and was decided to look further into the matter to find out whether the increase was in fact real, and whether it could be attributed to any particular cause. Only those cases of pulmonary embolus actually proved by autopsy have been considered, and the inquiry was limited to the Royal Infirmary Branch and therefore includes only medical, surgical, orthopaedic and skin cases. A study of the annual incidence of fatal pulmonary embolism from 1940 to 1950 showed a gradual slight increase from 1940 to 1949, and then in i95?> a
Figures we are told can prove anything. Cannot we deduce from those quoted by Professor Lennon in his stimulating contribution to the January Journal that Bristol has been relatively successful in reducing maternal deaths to the occasional unavoidable ones from haemorrhage or toxaemia? I think also that there will be very mixed views concerning the Professor's ideas on domiciliary midwifery. If conditions are satisfactory there is much to be said in favour of confinement at home. If this is any less safe for the normal case it-has only become so in quite recent years. In this area however not only afe home conditions in a great many cases unsatisfactory with regard to accommodation and help, but for a long time there has been a conditioning towards hospitals or nursing homes
The criteria for selection of cases for leucotomy have been those commonly adopted in Great Britain: mental disorder which has not responded to other methods of therapy, with negligible chances of spontaneous improvement and usually with preservation of emotional tension or of interest in social intercourse. In all but two of the 178 cases, the standard prefrontal leucotomy was performed. Tables I and II indicate the material classified by diagnosis and age-groups. Of the thirty-two cases classed as affective, twenty-nine were in chronic depression ; the remaining three had shown both manic and depressive symptoms. Of the thirteen cases grouped as Other Disorders, ten were neurotic, two postencephalitic, and one a defective psychopath.
most are not serious. Reactions are more likely to happen when the daily dosage is high or when administration is prolonged. Most of the untoward effects occur in the gastro-intestinal tract and this system seems more susceptible in women than in men. Other systems of the body are affected far less frequently. With oral therapy about forty per cent of patients develop some symptoms of signs in the mouth. They complain of dryness, cracks at the corners of the
Herniation of the cardiac end of the stomach through the oesophageal hiatus ?f the diaphragm, and the resulting disorganization of the normal sphincter Mechanism at the cardia, is a common disease that can cause distress at any period ?f the patient's life from early infancy onwards. Most cases fall into two groups: children under the age of seven, and adults in their fifth to seventh decades. The '?west incidence is amongst adolescents and young adults but patients who first c?niplain to their doctors in the later decades will often volunteer the information lhat they " have had trouble all their lives, but worse recently The sexes are affected about equally up to the age of fifty, when the incidence amongst females rises steeply above that amongst males. Some patients date their symptoms from a Pregnancy; others remain free from distress till late in life, a fact difficult to correlate with the growing belief that the majority of these hernias are congenital ln origin, and suggesting rather that factors other than the mere presence of part ?f the stomach in the chest may be responsible for the symptoms, or for the complications usually causing the symptoms. The reason why the pathological significance of hiatus hernia and the misery Jt can cause the patient have occasioned so little clinical interest in the past, has keen the frequent coexistence of other lesions, abdominal, cardiac, or medi-astinal, which have tended to mask the hernia as the culprit. The patient's distress was attributed to the small cluster of gallstones , the hypotonic stomach, 0r to some occult cardiac condition vaguely suspected. Even when improvements in radiological technique began to bring these hernias to light, there was stlU no move to assign to them any responsibility for the patient's symptoms and traditional textbook myth of their innocence continued to bewitch the ^inician. As recently as 1947 Radloff and King in reporting on fifty cases of latus hernia stated: " In sixty-eight per cent concomitant disease was found and was often responsible for the symptoms. Only thirty per cent had symptoms ^at could be attributed to the hernia. Surgery was necessary in only three cases." They concluded: " Diaphragmatic hernia is usually an insignificant nding, and is unusually asymptomatic." This opinion is at variance with the experience of most clinics in this country, XvWe at least fifty per cent of cases, and in children up to eighty …
