The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

The detection of psychiatric illness by questionnaire

Qualitative Interviewing: The Art of Hearing Data

With digital equipment becoming increasingly networked, either on wired or wireless networks, for personal and professional use alike, distributed software systems have become a crucial element in information and communications technologies. The study of these systems forms the core of the ARLES' work, which is specifically concerned with defining new system software architectures, based on the use of emerging networking technologies. In this context, we concentrate on the study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence.

반도체 공정 overview

BACKGROUND

The aim of this study was to determine the prevalence and predictors of the perceived unmet needs of cancer patients undergoing treatment for their disease at public treatment centers.



METHODS

A total of 1492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 major public cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1370 eligible patients, 1354 (99%) consented to participate and 888 (65%) returned completed surveys. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days.



RESULTS

Patients' perceived needs were assessed across the following five areas: psychologic, health system and information, physical and daily living, patient care and support, and sexuality. Patients' perceived needs were highest in the psychologic, health system and information, and physical and daily living domains. Logistic regression modeling revealed subgroups of patients with different types of needs. The significant predictors of reporting some unmet need for help varied according to the domain examined.



CONCLUSIONS

This statewide study shows that cancer patients experience high levels of unmet needs across the range of domains examined. The study provides information that may be valuable in identifying areas where interventions could be tested and evaluated in an attempt to address the unmet needs of people living with cancer. [See related article on pages 217–25, this issue.] Cancer 2000;88:225–36. © 2000 American Cancer Society.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/%28SICI%291097-0142%2820000101%2988%3A1%3C226%3A%3AAID-CNCR30%3E3.0.CO%3B2-P

The unmet supportive care needs of patients with cancer

BACKGROUND
This study aimed to assess the face, content, and construct validity and the internal reliability of a tool for assessing the generic needs of patients with cancer (the Supportive Care Needs Survey).

METHODS
A total of 1492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1370 eligible patients, 1354 (99%) consented to participate and 888 (65%) completed the survey. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days.

RESULTS
In the assessment of construct validity, the principal components method of factor analysis identified 5 factors with eigenvalues greater than 1, which together accounted for 64% of the total variance (patients' needs in the domains of psychologic, health system and information, physical and daily living, patient care and support, and sexuality). Face and content validity were found to be high following pilot tests and tests of reading ease. Internal reliability coefficients (Cronbach alpha) of all 5 factor-based scales were found to be substantial, ranging from 0.87 to 0.97.

CONCLUSIONS
These findings suggest that the Supportive Care Needs Survey provides a reliable and valid index of the global needs of oncology patients. The standardized and widespread application of this instrument is recommended following further refinement and evaluation. [See related article on pages 226−37, this issue.] Cancer 2000;88:217–25. © 2000 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/%28SICI%291097-0142%2820000101%2988%3A1%3C217%3A%3AAID-CNCR29%3E3.0.CO%3B2-Y

Evaluation of an instrument to assess the needs of patients with cancer

PURPOSE AND DESIGN: One of the more difficult tasks that clinicians must perform as part of their care of patients is that of conveying bad news, such as a severe diagnosis or death. However, there is a paucity of empirically founded information that relates to the specific steps for breaking bad news. We report on a set of guidelines for breaking bad news that was developed using a consensus process and incorporates the views of medical oncologists, general practitioners, surgeons, nurse consultants, social workers, clergy, human rights representatives, cancer patients, hospital interns, and clinical directors of medical schools in Australia. RESULTS AND CONCLUSION: It is recommended that further research be undertaken in a number of areas. First, there is a need to assess patients' versus providers' perceptions of the importance of each of the steps in breaking bad news, in order to define criteria for minimal levels of competence in this area. Second, controlled trials are needed to assess the effectiv...

Breaking bad news: consensus guidelines for medical practitioners.

Background The aim of this study was to determine the prevalence and predictors of the perceived unmet needs of cancer patients undergoing treatment for their disease at public treatment centers. Methods A total of 1,492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 major public cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1,370 eligible patients, 1,354 (99%) consented to participate and 888 (65%) returned completed surveys. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days. Results Patients' perceived needs were assessed across the following five areas: psychologic, health system and information, physical and daily living, patient care and support, and sexuality. Patients' perceived needs were highest in the psychologic, health system and information, and physical and daily living domains. Logistic regression modeling revealed subgroups of patients with different types of needs. The significant predictors of reporting some unmet need for help varied according to the domain examined. Conclusions This statewide study shows that cancer patients experience high levels of unmet needs across the range of domains examined. The study provides information that may be valuable in identifying areas where interventions could be tested and evaluated in an attempt to address the unmet needs of people living with cancer.

The unmet supportive care needs of patients with cancer. Supportive Care Review Group.

Objective This study aimed to develop and validate a short version of the Supportive Care Needs Survey (SCNS) that would reduce respondent burden and could be used in routine cancer care, without compromising the psychometric properties of the original instrument. Methods Secondary analyses of the data from two studies (n = 888 and 250) were undertaken. All 59 items of the original SCNS were assessed using psychometric analyses and evaluated for clinical utility. The 34 items retained were examined for internal consistency, ceiling and floor effects, known groups validity, convergent validity, sensitivity and readability. Results The 34-item instrument has five factors (psychological, health system and information, physical and daily living, patient care and support, and sexuality needs) identical to the original instrument, explaining 73% of the variance. Internal consistency was high with Cronbach’s alpha coefficients for the five factors ranging from 0.86 to 0.96. Correlations of the 34-item short-form SCNS (SCNS-SF34) with three other measures of psychosocial well-being demonstrated convergent validity (r = 0.48‐0.56). Kappa coefficients of at least 0.83 for each domain indicated almost perfect agreement between the 34-item and 59-item surveys to identify patients needing help. The 34-item SCNS maintained the psychometric properties of the original instrument and could be readily comprehended by people with seventh to eighth grade education. Conclusions The SCNS-SF34 is a valid instrument for measuring cancer patients’ perceived needs across a range of domains, and could be utilized as part of routine cancer care.

Afaf Girgis

Papers

The unmet supportive care needs of patients with cancer

Evaluation of an instrument to assess the needs of patients with cancer

Breaking bad news: consensus guidelines for medical practitioners.

The unmet supportive care needs of patients with cancer. Supportive Care Review Group.

Brief assessment of adult cancer patients' perceived needs: development and validation of the 34‐item Supportive Care Needs Survey (SCNS‐SF34)