Summary One hundred cancer patients undergoing active treatment were interviewed to determine how they perceived their illness and how their perceptions compared with those of their attending physicians.Ninety-eight patients recognized that they had cancer and 87 correctly identified the tumour type. Sixtyfour of 67 patients with local or regional disease were aware of this, but 11 of 33 patients with metastatic disease incorrectly believed that the cancer was localized. Five of 52 patients being treated for cure thought they were being treated palliatively, and 16 of 48 patients receiving palliative treatment believed that the doctor's aim was to cure them. Forty of these 48 patients significantly overestimated the probability that the treatment would prolong their lives. (Parsons, 1951). Others have since stressed that "mutual participation" must replace paternalism as the basis of the modern doctor-patient relationship, if physicians are to succeed in combating the public's growing distrust of the profession (Haug & Sussman, 1969;Brody, 1980;Jensen, 1981). It is now generally agreed by doctors and lay people in North America that patients should participate actively in decisions about their care. This participation can only be meaningful if the patient understands his situation well enough to perform the kind of cost-benefit analysis that has traditionally been left to the doctor. Thus it is now more important than ever for patients to be well-informed about their illness and its treatment.Patients must already give their 'informed consent' for any form of medical intervention, but 'informed consent' has proved difficult to define and even more difficult to realize in practice. Information is not always effectively transmitted to the patient, and it has been suggested that complex medical information may be of little value to those who do not have the educational background necessary to interpret it (Robinson and Merav, 1976;Cassileth et al., 1980a; Mackillop & Johnson, 1986 Over a three-month period we attempted to interview every available patient, but, if a member of the healthcare team preferred that the patient not be interviewed, these wishes were respected. One hundred and sixteen patients were approached. They were told that the aims of the study were to find out how well patients understand their illness and to learn if communication between doctors and patients is effective. Written consent was obtained from each participating patient. The consent form outlined the study's objectives and explained that the interview would be videotaped. Sixteen of the 116 patients who were approached chose not to participate. Eleven felt that the interview process would be too stressful and five felt that it would be too inconvenient. The interviewer (WES) is not medically trained and was unaware of the patient's diagnosis. Interviews were videotaped to avoid notetaking during the course of the conversation, but a checklist was used to ensure that all patients were asked the same questions. The content and format o...

Summary. Studies have been performed on six members of one family with May‐Hegglin anomaly (MH) five of whom manifested a mild bleeding tendency. All were thrombocytopenic (25000–1420007/μl). Platelet kinetic studies (51Cr) showed normal survival (two autologous, one MH to normal, one normal to MH). Mean platelet volume was increased; content (per platelet) of cholesterol, phospholipid, and tyrosine was elevated 3‐ to 6‐fold. Total body platelet mass calculated from these parameters was normal. Tests of platelet function demonstrated normal adhesiveness to collagen, normal prothrombin consumption, and enhanced platelet factor 3 activity. Bleeding time was prolonged (5/5), platelet retention by glass beads was diminished (3/3), clot retraction was poor (5/5), and aggregation by ADP, adrenaline and collagen was similar to that of normal platelets at the same low concentration. It is considered that the bleeding tendency probably reflects thrombocytopenia per se as do those tests of platelet function that are impaired. Review of the published cases supports this contention. Normal platelet survival, normal total circulating platelet mass, and intrinsically normal platelet function suggest that the giant platelets and the thrombocytopenia result from impaired and disorderly megakaryocyte fragmentation.

Understanding the costs of cancer care offers opportunities to formulate a strategic plan to control cancer costs and maintain quality care. Comprehensive cancer solutions to address the full spectrum of care will facilitate improved quality and patient outcomes.

Reasons for an increase in maximal O2 consumption (VO2max) following blood reinfusion remain unclear; thus the present investigation was undertaken to examine the arterial and femoral venous blood gases during submaximal and maximal exercise. Four untrained males (22-25 yr) performed modified Balke work capacity tests under control conditions (Hct = 42.4 +/- 0.8%; Hb = 14.7 +/- 0.5 g X 100 ml-1) and following autologous blood reinfusion (Hct = 46.2 +/- 1.3%; Hb = 16.4 +/- 0.9 g X 100 ml-1). VO2 was determined by open-circuit spirometry and cardiac output by the N2O method; radial arterial and deep femoral venous blood were sampled at each work load throughout the incremental work tests. Following blood reinfusion, subjects' VO2max increased (P less than 0.05) from 4.0 (in control) to 4.5 1 X min-1. Throughout submaximal exercise arterial PO2 remained relatively constant (between 80.1 +/- 4.4 and 89.1 +/- 5.0 Torr) and cardiac output unchanged, comparing the two experimental conditions. Femoral venous PO2 values were almost identical throughout the work capacity tests, declining at exhaustion to 15.7 +/- 1.5 Torr in control and to 13.8 +/- 3.3 Torr postreinfusion. It appeared that the subjects' increase in VO2max postreinfusion was due to an increased O2 supplied to the tissue [i.e., cardiac output (Q) X arterial O2 content (CaO2)] by the central circulation. This resulted from a small (10%) increase in Q and a constant elevation in CaO2 of 1.7-2.2 ml X 100 ml-1, since virtually no changes were observed in the femoral venous blood postreinfusion and the acid-base status and temperature, important determinant of O2 dissociation, were (almost) identical, comparing the two experimental conditions.

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SummaryCohorts of “young” and “old” platelets were prepared and compared with each other, and with total platelet populations. It was found that approximately 22% of the platelet mass, including phospholipid, cholesterol and protein was lost as the platelets aged in the circulation. No one phospholipid fraction was specifically altered. With aging there was significant reduction in the ability of platelets to respond to aggregating stimuli and to release Pf3. Pf4 activity seemed to be fully preserved and there was no detectable change in specific gravity. Ultrastructural changes seemed to be limited to a decrease in the number of glycogen granules.It is recognised that the observed changes may be a passive consequence of platelet aging. However, it is speculated that loss of platelet substance may in someway be related to a functional role of platelets - perhaps the maintenance of endothelial integrity.It is also postulated, on the basis of the reported findings, that radioisotopic labels such as DFP which give an exponential platelet survival curve bind to a platelet constituent which is lost during the aging process.

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