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This research considers the treatment of malignant melanoma. Data were collected from patient records for 78 individuals treated within the Yale Cancer Center Melanoma Unit. The patients were diagnosed with malignant melanoma prior to 1994 and progressed to stage I11 or N disease before their deaths.Due to the rapid progression of malignant melanoma, treatments are initiated at the time of diagnosis. Results of experimental Extreme Drug Resistance (EDR) tests subsequently become available. Physicians are warned the test results are not intended to guide therapy; however, assay directed therapies arguably result in better outcomes with other cancers. Thus, the question arises of whether the use of these tests might benefit patients in this context.This study evaluates the treatment decisions made using a multi-disciplinary approach within the Yale Cancer Center Melanoma Unit regarding patients with malignant melanoma relative to information contained in EDR tests conducted by Oncotech Inc. Within this comparison, three specific outcomes consistent with hypotheses of the study were assessed: the utilization of test results, drug toxicity and cost effectiveness and survival.Results were found to suggest that the initial treatment decisions of the Yale Cancer Center Melanoma Unit were in accord with tests results that were received henceforth for 74 of 78 patients. Two of those patients were in terminal stages of the disease thus treatments were unchanged; however two patients received a change in therapy.It is suggested that physicians made use of the tests as they became available. However, only two patients with therapies altered by the test results were shown to face reduced costs, drug toxicity, or have the benefit of improved survival. From the patient data collected, four patients receiving drugs to which their tumors exhibited EDR were found to exhibit shorter survival times. Literature review studies conducted to evaluate physician treatment approach and patient preference rate favorably the consideration of quality of life issues. The principle finding of this observational study which focuses upon the development of the Yale Cancer Center Melanoma Unit, suggest that a multidisciplinary approach to the treatment of malignant melanoma may offer quality of life benefits to the patient.

Type I and II osteoporosis will become an increasingly common problem in years to come, since the population structure is changing with the graying of America. This study identifies anthropometric and reproductive variables known to affect bone mineral in a mixed cross-sectional and longitudinal retrospective study. Data were collected from 3120 women and 1222 men throughout Arizona by single photon absorptiometry of the distal third of the radius by Lunar software for bone width, bone mineral content and bone mineral density and anthropometric, reproductive, nutritional and fracture histories. With age-stratified and age-adjusted statistical analyses, important relationships are found to exist between these variables. In females, the anthropometric variables--age, height and weight--are highly correlated with distal third radial width, bone mineral content and density. In males, weight is correlated with distal third radial width; age and weight with bone mineral content; and age, height and weight with bone mineral density. Reproductive variables--age, age at menarche and menopause and total reproductive span--are predictors for women who undergo surgical oophorectomy and hysterectomy, but not those who undergo natural menopause or either surgery. Variables related to pregnancy--age, height, weight, pregnancy duration and span--are predictors of distal third radial width. Only age, height and weight are predictors of bone mineral content. Age, height, weight, age at last pregnancy and one derived ratio are predictors of bone mineral density. When variables related to breastfeeding are incorporated, pregnancy duration and derived ratios are identified for predictors of distal third radial width. Only one ratio is related to bone mineral content, whereas pregnancy number, pregnancy and breastfeeding duration and derived ratios are useful predictors of bone mineral density. These findings suggest that pregnancy and breastfeeding leave lasting effects on bone mineral. While techniques exist to measure bone mineral in various locations, the distal third of the radius is more trabecular than some sites (e.g., the femoral head and vertebral centra). With such changes documented in the radius, more extreme effects are expected at more trabecular locations. Thus, a life's reproductive history is etched in bone.

This study explored near-death experience (NDE) survivors' perceptions and communication in the disclosure of NDEs to health care professionals and significant others, interventions encountered, and effects of those actions. Eight adult NDErs, selected through network sampling, were interviewed. Content analysis was used to describe the interactions from the experients' perspective. A dynamic communication process emerged as central to disclosure about NDEs. Study subjects identified several barriers to disclosure. Actions that were most helpful included listening, showing interest, offering opportunities for disclosure, and providing information and confirmation. Negative actions and their impacts included ignoring or refusal to listen, minimizing the experience, discounting, and medicating the person. Health care professionals were perceived to lack knowledge of the phenomenon and to appear afraid, disinterested, or too busy to talk. All experients conveyed a need to talk about the NDE. Implications for nursing practice include widespread dissemination of information about NDEs and maximizing communication skills to meet NDE patients' needs.

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<p> Rural West Virginia has a very high percentage of older adults. The age-related disease of Alzheimer&rsquo;s threatens the health of older Appalachians, yet research on Alzheimer&rsquo;s disease (AD) in this population is scarce. In order to improve screening rates for cognitive impairment, Appalachians need to understand their vulnerability. The first step would be to assess their knowledge about AD but a suitable AD knowledge test has not been developed. The purpose of this study was to test the reliability and validity of a new measure of knowledge about AD that is culturally congruent, and to examine factors that may predict AD knowledge in this rural population. A correlational descriptive study was conducted with 240 participants from four samples of older adults in south central rural Appalachian West Virginia using surveys and face-to-face interviews. Results from tests for stability, reliability including Rasch modeling, discrimination and point biserial indices, and concurrent, divergent, and construct validity were favorable. Findings were that although more diversity in test item difficulty is needed, the test discriminated well between persons with higher and lower levels of education [<i>F</i>(2, 226) = 170.51, <i>p</i> = .001]. Using multiple regression, the predictors of AD knowledge included caregiver status, miles from a healthcare provider, gender, and education; (<i>R</i>²=.05, F(4,187) = 2.65, <i>p</i> =. 04). Only years of education accounted for a significant proportion of unique variance in predicting the total BKAD score (<i>t</i> = 2.14, <i>p</i> =. 03). Implications include the need for further tool refinement, testing for health literacy, coordination with recent statewide efforts to educate the public regarding AD, and community based participatory research in designing culturally effective education programs that will ultimately increase screening and detection of Alzheimer&rsquo;s disease in rural populations.</p>

<p> The hospitalization of one's infant is a stressful situation that can lead to decreased bonding and poor health outcomes. This longitudinal comparative design study examined the effects of neonatal palliative care (PC) consultation on stress levels and satisfaction scores of parents of neonatal intensive care unit (NICU) infants. Clinical data was abstracted from the medical record. Demographic data, stress scores, and satisfaction reports were obtained via self-report.</p><p> Mean stress scores indicated most parents experienced moderate stress due to NICU hospitalization. Some parents met diagnostic criteria for acute stress disorder. While all parents expressed satisfaction with care received; PC parents were extremely satisfied with care. No statistically significant differences in stress or satisfaction scores were noted between parents who received PC consultation and those who did not. Study conclusions validate previous research regarding NICU parent stress and show that additional quantitative and qualitative research regarding NICU palliative care is warranted. </p>

<p> The purpose of this study was to investigate factors that influence consumer choice in menu items at fast food chain restaurants. The study utilized social media, specifically Facebook, to collect data from various areas of the United States.</p><p> Previous literature on the effectiveness of nutrition menu labeling on decreasing calories ordered reported mixed results. Some studies point to groups that may be least affected by menu labeling: men, individuals of certain races, obese individuals, individuals of lower socioeconomic status, unemployed individuals, and individuals who dine outside of the home frequently.</p><p> The results of this study indicated that men and individuals who dine outside of the home more than three times per week are less influenced by nutrition information than their counterparts. Additionally, about half the participants in this study reported that they do not notice or look for nutrition information. Further research and outreach programs are needed in this area.</p>

<p> <b>Background:</b> Whole genome sequencing (WGS) is increasingly used for research and clinical purposes. This study explored attitudes of parents of children with a suspected autism spectrum disorder (ASD) toward WGS. <b>Methods:</b> A topic guide informed by the Theory of Planned Behavior was developed covering perceived benefits, concerns, barriers, and facilitators regarding WGS. Participants also summarized likely major factors in their decision. Interviews were audio-recorded, transcribed and analyzed for themes using framework analysis. <i><b>Results:</b></i> Participants (n=10) were generally in favor of WGS. The most recurring themes were: helping their affected child; concerns that secondary findings could be emotionally overwhelming; facilitators relating to access, e.g. living near a major medical center. When summarizing, money/insurance issues were most raised; this was also the most recurring barrier. <b>Conclusion: </b> Parents of children with ASD were enthusiastic but also expressed concerns about WGS. These findings will be useful to future research with this and other populations.</p>

<p> Obesity has recently become a worldwide epidemic, with 75% of American adults overweight and 33% classified as obese (World Health Organization, 2005). The rise in obesity has brought a similarly marked focus on weight loss. While weight loss is often achievable, prior medical research has shown maintaining weight loss to be the largest hurdle, with roughly 95% of individuals regaining back the weight loss within a 5 year period (Berry &amp; Canetti, 2009). Despite this, relatively little research has been conducted investigating the psychological and relational characteristics of individuals that successfully maintain major weight loss, and the impact drastic weight loss has on relationships, family systems and romantic relationships. Consequently, systems therapists wishing to support an individual and their families throughout the weight loss process are left without empirical or theoretical guidance. The purpose of this study was to contribute to the development of a theory of drastic weight loss maintenance that explains identity and relationships changes that unfold before, during and after weight loss within successful weight loss maintainers. Unstructured, open-ended qualitative interviews were conducted with five former contestants of NBC's television program <i>The Biggest Loser.</i> Overall, weight loss experiences fell into two broad categories of personal narrative/identity and systemic/relationship themes. Narrative therapy's concept of personal narratives was used to classify narrative/identity themes as the dominant themes and beliefs within a personal narrative. Systemic/relationship themes included themes in intergenerational backgrounds, family systems and relationships. Themes amongst those participants who were successful at weight maintenance were also compared to participants who were struggling to maintain their weight loss results. A sequential model outlining how narrative/identity themes and systemic/relationship themes combine in order to create successful long-term weight maintenance after drastic weight loss is proposed. Clinical and research implications for couple, family and individual psychotherapy are also discussed.</p>