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Background Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that critical information is often omitted or poorly presented. Decision aids (DAs) may assist in improving consent. Aims This study piloted a DA booklet for a high priority breast cancer prevention trial, IBIS-II DCIS, which compares the efficacy of an aromatase inhibitor (anastrozole) with tamoxifen in women who have had surgery for ductal carcinoma in situ (DCIS). Method Thirty-one Australian women participating in the IBIS-I breast cancer prevention trial and who are currently in follow-up agreed to read the IBIS-II DCIS participant information sheet and the DCIS DA booklet, complete a set of standardized questionnaires, and provide feedback on the DA via a semi-structured phone interview. Results Women found the DA helpful in deciding about trial participation, reporting that it aided their understanding over and above the approved IBIS-II DCIS participant information sheet and was not anxiety provoking. Women's understanding of the rationale and methods of clinical trials and the IBIS-II DCIS trial was very good; with more than 80% of items answered correctly. The only areas that were not understood well were the concepts of randomization and blinding. Conclusions This study suggests that the DA will be acceptable to and valued by potential participants in the IBIS-II DCIS study. The revised DA is currently being evaluated prospectively in a randomized controlled trial. If successful, such DAs could transform the consent process to large clinical trials and may also reduce dropout rates. [ABSTRACT FROM AUTHOR]

Introduction: Clinical trials have come to be regarded as the gold standard for treatment evaluation. However, many doctors and their patients experience difficulties when discussing trial participation, leading to poor accrual to trials and questionable quality of informed consent. We have previously developed a communication skills training program based on a typology for ethical communication about Phase II and III clinical trials within four categories. The training program consisted of a 1 day experiential workshop that included didactic teaching, exemplary video and role play. The aim of this study was to evaluate the effectiveness of the communication skills training workshop. Method: Oncologists were recruited from three major teaching hospitals conducting oncology outpatient clinics in three Australian capital cities. Ten oncologists and 90 of their adult cancer patients who were eligible for a Phase II or III clinical trial participated. Ninety informed consent consultations were audiotaped before (n = 59) and after (n = 31) training, and fully transcribed. The presence or absence of each domain component was coded and these were summed within categories. A coding manual was produced which enabled standardization of the coding procedure. Patients completed questionnaires before and after the consultation, and doctors completed a short measure of satisfaction after the consultation. Results: Doctors increased their use of some aspects of shared decision-making behavior (t87 = -1.945, p = 0.05) and described some aspects of essential ethical/clinical information more commonly. In addition they used less coercive behaviors (z = -1.976, p = 0.048). However, they did not provide more clinical information or structure their consultations in the recommended fashion. Patients in the post-training cohort reported more positive attitudes to clinical trials, but other outcomes were not affected by the intervention. Conclusions: This short training programme demonstrated limited success in improving the oncologist's communication skills when gaining informed consent. A larger randomized controlled trial of extended training is now underway. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Rural Systemic Adjuvant Therapy Project was initiated to encourage best practice in the treatment of women from rural areas who have breast cancer. METHOD: We developed an educational program, piloted it and conducted it in 5 regions. In a preevaluation/postevaluation, we assessed participants' perceived knowledge about systemic adjuvant therapy. RESULTS: A statistically significant increase occurred in participants' reported knowledge about all program topics. Improved communication links with the local or visiting medical oncologist were planned. CONCLUSION: The workshop program was found to be a successful tool for delivering evidence- based information about the use of systemic adjuvant therapy. [ABSTRACT FROM AUTHOR]

The health status of people with intellectual disability (ID) is poor, yet very little research has been done on their health needs. There are several barriers to performing this research. The aim of our research was to examine the significant barriers encountered in recruiting adults with ID to participate in research.Our project was a randomized controlled trial aiming to improve health advocacy of people with ID. We approached many organizations to recruit participants and kept records of our results. Recruitment was very low for the first 4 months. Then we adopted two new recruitment strategies– in-service telephone recruitment and meetings with prospective participants. We then monitored the subsequent recruitment rates. We also questioned participants about the difficulties they encountered when considering recruitment.Initial recruitment of participants yielded less than one-third of the expected number. Additional strategies implemented were partially successful. Significant barriers to recruitment included several sectoral issues and the challenges arising from the research process.While this population is a difficult one to reach for research, attempts to do so should not be abandoned, because the potential health benefits for this underserved group far outweigh the recruitment barriers experienced. [ABSTRACT FROM AUTHOR]

A cohort of 159 mothers were recruited post-partum and followed for seven months to examine the relationship between mothers' health post-partum and their patterns of seeking vaccination for their infants. Vaccination records for infants were obtained from a state-wide database. Only 44% of the mothers had maintained all age-appropriate vaccinations for their infant up to six months of age. Mothers who had two or more older children were four times more likely to have an infant who was not age-appropriately vaccinated at six months. Women experiencing mental health problems including anxiety and depression, seven months following the birth, were between three to five times more likely to have started the vaccination schedule late or not at all. The findings have implications for midwives and for nurses practising in maternal and child health, paediatrics and public health environments. Strategies focusing on enhancing mothers' psychosocial well-being postnatally through improved service delivery should improve their patterns of seeking vaccination for their infants. [ABSTRACT FROM AUTHOR]

The article presents a study which compares volunteers in sexuality and national health survey in Australian population. Respondents are less likely to be immigrants, more likely to be employed, more education and had higher socioeconomic status. The study shows that the means, estimates, and variances of self reported physical and mental health measure were the same to population norms.

Objective: To examine, using a 30-month prospective study, patterns of anxiety, depression and alcohol use in couples following stillbirth, neonatal death or sudden infant death syndrome.Methodology: One hundred and thirty-eight bereaved and 156 non-bereaved couples completed standardized interviews at 2, 8, 15 and 30 months post-loss.Results: At all interviews, bereaved couples were significantly more likely than non-bereaved couples to have at least one distressed partner. Rarely were both partners distressed in either group. For bereaved couples, 'mother only' distress declined from 21% to 10% during the study. 'Father only' distress ranged from 7% to 15%, peaking at 30 months. Bereaved mothers who were distressed at 2 months reported significantly lower marital satisfaction at 30 months.Conclusions: At the couple level, the experience of a baby's death is multifaceted. Gender differences are common and partners' needs may change over time. Early recognition of these differences may facilitate longer-term adjustment for both partners. [ABSTRACT FROM AUTHOR]

The University of Liverpool Library like other large academic libraries is constantly looking at the resource implications of supporting and maintaining a growing portfolio of electronic resources within the hybrid library. The streamlining of the maintenance of electronic journals within the Innovative Interface Inc. Innopac environment is described, as are local cataloguing procedures. The practical solution of one point of record maintenance whilst maintaining two routes to resource-linking is outlined. [ABSTRACT FROM AUTHOR]

Purpose: Peripheral neuropathy caused by the anticancer agents cisplatin and paclitaxel is a significant dose-limiting toxicity of these drugs. The growth factor leukaemia inhibitory factor (LIF) has neuroprotectant activity in preclinical models of nerve injury and degeneration and is now in a phase II trial in chemotherapy-induced peripheral neuropathy (CIPN). It is therefore important to ensure that LIF neither inhibits the antitumour activity of these drugs, nor stimulates tumour growth.Methods: Mature female Dark Agouti rats were implanted subcutaneously with a mammary carcinoma, DAMA. It was confirmed that the tumour expressed LIF receptors by reverse transcriptase polymerase chain reaction. Paclitaxel was administered at a dose of 5 mg/kg daily for 6 days, cisplatin at a dose of 3 mg/kg twice weekly and carboplatin at a dose of 10 mg/kg twice weekly. The effect of LIF on tumour growth and response to chemotherapy was assessed at two doses (2 and 10 microg/kg per day). Peripheral neuropathy was assessed in terms of gait disturbance and tail-flick threshold.Results: Neither dose of LIF stimulated growth of control tumours. Mean tumour volumes were lower on day 14 in all paclitaxel-, cisplatin- and carboplatin-treated groups, compared to controls (ANOVA P<0.001). LIF did not interfere with this antitumour effect. Cisplatin- and paclitaxel-treated groups had developed increasing tail-flick thresholds by day 14. These manifestations of sensory neuropathy were prevented by LIF administration.Conclusions: These results suggest that LIF may be safely used in human trials as a neuroprotectant for patients receiving cisplatin, paclitaxel and carboplatin without concern for impairment of antitumour effect. [ABSTRACT FROM AUTHOR]

Discusses a study which examined when American state courts may reform irrevocable trusts and when the United States Internal Revenue Service will accept the reformation, or when federal courts have forced acceptance. Ways to amend irrevocable trusts; Response of the service to reformations and revocations; Reformation guidelines that federal courts should adopt to provide relief for marital deduction problems similar to relief granted charitable gifts.

Data on chemotherapy-induced alopecia (CIA) as a side effect of cancer treatment are scarce. CIA is given minimal attention in clinical trials and in the literature. However, when asking the patients with cancer for their opinion, CIA appears to have a major impact, particularly on body image and quality of life. Currently, there is no commonly used measure to evaluate CIA; It is time to improve the management and measurement of CIA. [ABSTRACT FROM AUTHOR]

The access versus holdings debate has been one of the 'hot topics' within the information world for some time, and the performance of document delivery services is an integral part of the discussion. This article focuses on work currently being undertaken at the University of Liverpool to investigate and evaluate existing and future document supply services. Reference is made to related literature, the background to the pilot projects is explained, and the criteria utilised for the inclusion of services are propounded. A detailed evaluation of the following services is included: BL's inside, BODOS, Ei Text from Elsevier Engineering Information Inc., LAMDA and UnCover Preliminary results are reported. The conclusion to date is that, in their current form, document delivery services cannot be seen as a panacea for resolving the holdings versus access debate. [ABSTRACT FROM AUTHOR]

In light and in darkness, exposure of leaf segments to CO-free atmospheres caused a marked reduction in extractable RuBP carboxylase activity. By contrast, darkness caused a relatively small decrease in carboxylase activity in extracts from leaf segments kept in air containing CO. Recovery of carboxylase activity in leaves during illumination in air after exposure to CO-free conditions paralleled recovery of capacity for photosynthesis; in darkness recovery of carboxylase activity in leaves was slower than in the light. Extracts from leaves exposed to CO-free conditions recovered activity when provided with CO and Mg; there were clearly, however, substances in the extracts that modified the activity achieved and caused anomalous decreases and increases with time after extraction. Studies of the effect of orthophosphate on the activity of purified wheat carboxylase in vitro were consistent with the view that many of the effects observed on the activity of crude leaf extracts were due to orthophosphate content. [ABSTRACT FROM AUTHOR]

Background: Stress responses of bereaved parents (mothers 194, fathers 143) who experienced infant loss were compared with parents (mothers 203, fathers 157) with a live born child.Method: Psychological distress using scales of anxiety, depression and alcohol use was compared at 2, 8, 15 and 30 months post-loss.Results: Bereaved mothers showed significantly more anxiety/depression than controls at all four interviews. For bereaved fathers, anxiety/depression differed significantly from controls only at two months. Heavy alcohol use was significantly more prevalent at 2 and 30 months. Relative risks showed significant gender differences between bereaved parents at all four interviews for anxiety/depression. When this outcome was extended to include heavy drinking in addition to anxiety/depression, these differences diminished and were significant only at 2 and 8 months. CONCLUSION. Female responses are longer lasting and reflected by elevated levels of anxiety/depression. Male responses equally involve anxiety, depression and heavy alcohol consumption. [ABSTRACT FROM AUTHOR]