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1.  A Labor of Love 
Cancer nursing  2013;36(6):474-483.
Evidence suggests that emotional distress and objective demands of cancer caregiving are comparable to those of dementia caregiving, yet little research has focused on the physical health of cancer caregivers. Whether the stress leads directly to changes in health or whether the stress leads to changes in health behaviors, which in turn affect health, has not been systematically examined.
The objective of this study was to review the research literature regarding changes in health behaviors associated with caring for an individual with cancer.
Literature was reviewed from multiple databases including CINAHL (Cumulative Index to Nursing and Allied Health Literature), CINAHL Plus, PsycNET, PubMed, SCOPUS, EMBASE, and Web of Science. Key words included “health behavior,” “health promotion,” ”caregivers/caregiving,” “cancer/oncology,” “diet/nutrition,” “exercise/physical activity,” “stress management,” “smoking” and “alcohol.” Studies were included if they involved informal adult caregivers and at least 1 behavior associated with a healthy lifestyle. Of the 866 studies identified, 8 met the criteria.
Studies revealed conflicting information, with some suggesting deleterious changes in behaviors, whereas others found the changes protective.
The lack of uniformity of terminology and conflicting findings make it difficult to conclude the impact of the caregiving experience on the health behaviors of cancer caregivers. Something is placing caregivers at risk for illness and early death, but the mechanisms behind the risk and the role of unhealthy behaviors are not clear.
Implications for Practice
At a minimum, cancer caregivers should be screened for behavior changes and disease risk. Developing standardized measures for future research including controlled, longitudinal studies is needed.
PMCID: PMC4196265  PMID: 23132126
Burden; Cancer; Caregivers; Health behaviors; Screening; Stress
2.  “I Am a Nice Person When I Do Yoga!!!” 
To develop a better understanding of how yoga practice affects one’s interpersonal relationships.
Content analysis was used to qualitatively analyze written comments (n = 171) made regarding yoga improving interpersonal relationships in a large cross-sectional survey of yoga practitioners (N = 1,067).
Four themes were identified: Yoga practice leads to personal transformation, increases social interaction, provides coping mechanisms to weather relationship losses and difficulties, and leads to spiritual transcendence. Practitioners believed that their interpersonal relationships improved because their attitude and perspective had changed, making them more patient, kind, mindful, and self-aware. They expressed an aspect of community that was both practical (they met new friends) and spiritual (they felt they belonged). They thought they could better weather difficulties such as divorce and death. A number discussed feeling a sense of purpose and that their practice contributed to a greater good.
There appears to be an aspect of community associated with yoga practice that may be beneficial to one’s social and spiritual health. Yoga could be beneficial for populations at risk for social isolation, such as those who are elderly, bereaved, and depressed, as well as individuals undergoing interpersonal crises.
PMCID: PMC4196270  PMID: 24166108
yoga; healing modalities; psychosocial; clinical/focus area; interpersonal; conceptual/theoretical descriptors/identifiers
3.  National Survey of Yoga Practitioners: Mental and Physical Health Benefits 
to describe yoga practice and health characteristics of individuals who practice yoga, and to explore their beliefs regarding the effects of their yoga practice on their health.
a cross-sectional design with anonymous online surveys
4307 randomly selected individuals from 15 US Iyengar yoga studios (n = 18,160), representing 41 states; 1087 individuals responded, with 1045 (24.3%) surveys completed.
Outcome Measures
Freiberg Mindfulness Inventory, Mental Health Continuum (subjective well-being), Multi-factor Screener (diet), PROMIS sleep disturbance, fatigue, and social support, International Physical Activity Questionnaire.
Age: 19 to 87 years (M = 51.7 ± 11.7), 84.2% female, 89.2% white, 87.4% well educated (≥ bachelor’s degree). Mean years of yoga practice = 11.4 (± 7.5). BMI = 12.1–49.4 (M = 23.1 ± 3.9). Levels of obesity (4.9%), smoking (2%), and fruit and vegetable consumption (M = 6.1 ± 1.1) were favorable compared to national norms. 60% reported at least one chronic/serious health condition, yet most reported very good (46.3%) or excellent (38.8%) general health. Despite high levels of depression (24.8 %), nearly all were moderately mentally healthy (55.2%) or flourishing (43.8%). Participants agreed yoga improved: energy (84.5%), happiness (86.5%), social relationships (67%), sleep (68.5%), and weight (57.3%), and beliefs did not differ substantially according to race or gender. The more they practiced yoga, whether in years or in amount of class or home practice, the higher their odds of believing yoga improved their health.
Individuals who practice yoga are not free of health concerns, but most believe their health improved because of yoga. Yoga might be beneficial for a number of populations including elderly women and those with chronic health conditions.
PMCID: PMC3721070  PMID: 23876562
4.  A problem-solving education intervention in caregivers and patients during allogeneic hematopoietic stem cell transplantation 
Journal of health psychology  2013;19(5):602-617.
The aim of this study was to determine the effect of problem-solving education on self-efficacy and distress in informal caregivers of allogeneic hematopoietic stem cell transplantation patients. Patient/caregiver teams attended three 1-hour problem-solving education sessions to help cope with problems during hematopoietic stem cell transplantation. Primary measures included the Cancer Self-Efficacy Scale–transplant and Brief Symptom Inventory–18. Active caregivers reported improvements in self-efficacy (p < 0.05) and distress (p < 0.01) post-problem-solving education; caregiver responders also reported better health outcomes such as fatigue. The effect of problem-solving education on self-efficacy and distress in hematopoietic stem cell transplantation caregivers supports its inclusion in future interventions to meet the multifaceted needs of this population.
PMCID: PMC3890378  PMID: 23471761
anxiety; behavioral medicine; cancer; coping; distress; family; health behavior; intervention
5.  Health-Related Quality of Life Following Allogeneic Hematopoietic Stem Cell Transplantation 
It is common knowledge that an allogeneic hematopoietic stem cell transplantation (HSCT) will have an enormous impact on the lives of transplant recipients and their families. Once an appropriate donor is identified, the curative potential of this treatment often drives the decision to proceed knowing that there will be intense physiologic toxicities and adverse effects on health-related quality of life (HRQL). Twenty-five years ago, HRQL was identified as an efficacy parameter in the evaluation of new anticancer drug therapy. Overall, the evidence suggests that an allogeneic HSCT has a significant impact on the overall HRQL of recipients, which is a result of decrements across all dimensions, including a significant symptom profile. The degree of impact on overall HRQL and the multiple dimensions varies across the transplant trajectory. Specific HRQL dimensions, such as physical function and symptoms, are easily incorporated into a clinician’s assessment whereas other dimensions (eg, psychosocial) are less commonly integrated. The translation of HRQL results to improve clinical practice is not well established. Clinicians are often uncertain when to assess the scope of HRQL and how to interpret the information in a clinically meaningful way. The purpose of this review is to highlight the quality-of-life effects of allogeneic HSCT and discuss application into clinical practice.
PMCID: PMC3460526  PMID: 21239801
6.  Hematopoietic Stem Cell Transplantation Nursing: A Practice Variation Study 
Oncology nursing forum  2009;36(6):E317-E325.
To examine practice variation in hematopoietic stem cell transplantation (HSCT) nursing and to identify the gap between recommended standards of practice and actual practice across settings. Additional practices relevant to HSCT nursing also were explored.
Research Approach
Cross-sectional, descriptive survey.
National and international cancer centers.
A convenience sample was obtained from the 2006 Oncology Nursing Society Blood and Marrow Stem Cell Transplant Special Interest Group membership list (N = 205). Most participants were women (94%) with a median age of 45 years. The primary role was bedside nurse (46%), with an adult-only population (78%) in an academic (84%), inpatient (68%-88%) center. 39 (94%) U.S. states and 7 (6%) non-U.S. countries were represented.
Methodologic Approach
Survey development was guided by Dillman Mail and Internet survey design. Electronic questionnaires were conducted with Zoomerang™ Market Tools.
Main Research Variables
Infection control practices across bone marrow transplantation settings.
Descriptive statistics revealed minimal practice variation regarding infection control across transplantation types or conditioning regimens. Practices regarding implementation of restrictions on patients’ hygiene, diet, and social interactions varied by phase of transplantation, with the greatest variations occurring during the post-transplantation phase. Sixty-two percent of respondents reported using published guidelines; 72% reported using organization-specific policies.
Although published standards are under consideration, practice variation exists across transplantation centers. Whether the variation is caused by a lack of compliance with published guidelines or by the poor delineation of details for providers to translate the guidelines into practice is not known.
Identifying gaps in the literature and inconsistencies in HSCT practices is an important first step in designing evidence-based projects that can be used to standardize practice and link best practices to improved patient outcomes.
PMCID: PMC3459318  PMID: 19887345
7.  Frequency of Yoga Practice Predicts Health: Results of a National Survey of Yoga Practitioners 
Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity). Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results. Mean age 51.7 (± 11.7) years; 84.2% female. Frequency of home practice favorably predicted (P < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study) predicted at least 1 health outcome (P < .05). Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits.
PMCID: PMC3425136  PMID: 22927885
8.  Distress Screening in Allogeneic Hematopoietic Stem Cell (HSCT) Caregivers and Patients 
Psycho-oncology  2011;20(6):615-622.
Family caregivers of allogeneic hematopoietic stem cell transplant (HSCT) patients are at risk for experiencing significant psychological distress yet screening caregivers has not been well studied.
This analysis explored the psychometric characteristics of the Distress Thermometer (DT) by examining its relationship, sensitivity and specificity relative to the Brief Symptom Inventory 18 (BSI-18) and the Multidimensional Fatigue Symptom Inventory (MFSI) in a sample of allogeneic HSCT caregivers and patients.
Longitudinal data were drawn from an ongoing intervention study for HSCT caregivers and patients. Data from one hundred and fifty-six English-speaking adults where patients (n=65) were receiving their first allogeneic HSCT with at least one adult caregiver (n=91) were eligible for this analysis. Study questionnaires were administered at baseline, initial discharge and 6 weeks following discharge.
Construct validity was supported by significant relationships (p<0.001) between the DT and the BSI-18 GSI and the MFSI-Emotional subscales for caregivers and patients. The diagnostic utility of the DT for patients was good (AUC=.85±.05, p=.001), while for caregivers it was poor (AUC=.61±.08, p=.28). A DT cut point of 5 was supported for patients (sensitivity=1.0, specificity=.68), while for caregivers there was less confidence (sensitivity=.70, specificity=.52). Caregivers and patients reporting a higher number of problems had a greater level of distress (p<0.001).
These findings support the validity of the DT in screening for distress in HSCT caregivers and patients. Although the diagnostic utility of the DT for HSCT caregivers may be limited, understanding factors associated with distress can guide practice for this understudied population.
PMCID: PMC3105246  PMID: 21626610
Cancer; Oncology; Distress Thermometer; Distress screening; Validity; Accuracy
9.  Variation in Supportive Care Practices in Hematopoietic Cell Transplantation 
Hematopoietic cell transplantation is an elective procedure that results in prolonged immune suppression and high treatment-related morbidity and mortality. Transplant centers and physicians use a variety of prophylaxis and monitoring strategies to prevent or minimize complications. Little is known about the variability in these practices. We conducted an international Internet-based survey of 526 physicians to describe the spectrum of supportive care practices employed. Consistency in pretransplant cardiac (96%) and pulmonary (95%) screening, informed consent documentation (93%), and use of antifungal prophylaxis (92%) was observed. Greater heterogeneity was seen in use of myelogenous growth factors, empiric antibiotic therapy, protective isolation procedures, posttransplant monitoring, and environmental and social restrictions. Although some practice differences were associated with physician characteristics and transplant type, most practice variation remained unexplained. These results suggest a need for well-designed observational and interventional studies to provide data about which supportive care practices improve outcomes. For practices proved to be beneficial, publication of guidelines and incorporation of monitoring into quality improvement initiatives may help standardize practices.
PMCID: PMC3304538  PMID: 18940677
Practice variation; Supportive care; Autologous stem cell transplantation; Allogeneic stem cell transplantation
10.  Caregiving Burden, Stress, and Health Effects Among Family Caregivers of Adult Cancer Patients 
Jama  2012;307(4):398-403.
Unlike professional caregivers such as physicians and nurses, informal caregivers, typically family members or friends, provide care to individuals with a variety of conditions including advanced age, dementia, and cancer. This experience is commonly perceived as a chronic stressor, and caregivers often experience negative psychological, behavioral, and physiological effects on their daily lives and health. In this report, we describe the experience of a 53-yearold woman who is the sole caregiver for her husband, who has acute myelogenous leukemia and was undergoing allogeneic hematopoietic stem cell transplantation. During his intense and unpredictable course, the caregiver's burden is complex and complicated by multiple competing priorities. Because caregivers are often faced with multiple concurrent stressful events and extended, unrelenting stress, they may experience negative health effects, mediated in part by immune and autonomic dysregulation. Physicians and their interdisciplinary teams are presented daily with individuals providing such care and have opportunity to intervene. This report describes a case that exemplifies caregiving burden and discusses the importance of identifying caregivers at risk of negative health outcomes and intervening to attenuate the stress associated with the caregiving experience.
PMCID: PMC3304539  PMID: 22274687
11.  Defining Clinical Research Nursing Practice: Results of a Role Delineation Study 
Clinical research nursing is a specialty nursing practice focused on the care of research subjects and implementation of clinical research. A five-dimensional model (Clinical Practice [CP], Study Management, Care Coordination and Continuity, Contributing to the Science [CS], Human Subjects Protection) has been validated nationally to represent the domain of clinical research nursing practice. The purpose of this study was to describe the frequency and importance of activities within each dimension as performed by nurses in clinical research and to describe differences between roles. One thousand and four nurses from the NIH Intramural Campus in Bethesda, Maryland, were invited to participate in an anonymous web-based survey. Participants (N = 412) were predominantly female (90%) with ≥11 years research experience (70%). Two hundred eighty-eight respondents (70%) identified themselves as clinical research nurses (CRNs) and 74 (18%) as research nurse coordinators (RNCs). CP activities were reported most frequent and important whereas CS activities were least frequent and important. CRN and RNC activity frequency differed across all dimensions (p < 0.001) with CRNs reporting significantly higher levels of CP activities and significantly lower levels in other dimensions. Delineating specialty activities and practice across roles enhances the understanding of nurses’ role in clinical research and provides groundwork for role-based training.
PMCID: PMC3304543  PMID: 22212223
clinical trial; clinical research; nursing staff organization; research personnel; role delineation study; research professional; clinical research nurse/ing
12.  Validating the Clinical Research Nursing Domain of Practice 
Oncology Nursing Forum  2011;38(2):E72-E80.
To develop and validate a taxonomy for the domain of clinical research nursing.
Clinical research settings in the United States.
A purposefully selected expert panel of 22 nurses who were actively practicing or supervising in a clinical research environment.
A study team consisting of nurses with experience in clinical research synthesized peer-reviewed articles, academic curricula, professional guidelines, position descriptions, and expert opinion. Using the Delphi technique, three rounds of surveys were conducted to validate the taxonomy. The three sequential questionnaires were completed over five months.
Main Research Variables
Activities performed by nurses in a clinical research setting.
A taxonomy for clinical research nursing was validated with five dimensions and 52 activities: Clinical Practice (4 activities), Study Management (23 activities), Care Coordination and Continuity (10 activities), Human Subjects Protection (6 activities), and Contributing to the Science (9 activities).
This study validated activities for direct care providers and nurses with the primary focus of research coordination. The findings identify a variety of activities that are unique to nurses in a clinical research setting.
Implications for Nursing
Nurses play an integral role in the clinical research enterprise. Validating a taxonomy for the specialty of clinical research nursing allows for roles to be compared across settings, competency requirements to be defined, and nursing organizations to be guided in the development of specialty certification.
PMCID: PMC3304545  PMID: 21356644
13.  Favorable Outcomes in Patients Surviving 5 or More Years after Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies 
Allogeneic hematopoietic stem cell transplantation (SCT) is a curative treatment for some hematological malignancies. As the overall number of survivors continues to increase, studies systematically examining outcomes in long-term survivors are needed. We studied the clinical and quality of life outcomes in SCT recipients surviving five or more years from SCT. Since 1993, 262 patients with hematological malignancies received a T cell depleted myeloablative SCT from an HLA-identical sibling at a single center. Ninety-two survived beyond 5 years from SCT (median follow-up 9.4 years, range 5.1-15.3). Median age at transplantation was 35 years (range 10 - 56). Twenty-two (24%) received a bone marrow transplant, and 70 (76%) received a peripheral blood SCT. Of the 92 survivors, 60 completed quality of life measures. The main outcomes examined were chronic graft-versus-host-disease (cGVHD), disease relapse, survival, health-related quality of life (HRQL) (Functional Assessment of Cancer Therapy-General), physical and mental health (SF-36) and symptom experience (Rotterdam Symptom Checklist). Seventy-five (82%) of 92 survivors no longer required systemic immunosuppressive treatment (IST). Four (4.3%) relapsed with leukemia at a median of 8.5 years (range 6.2 -14.0) after SCT. Four (4.3%) died between 7.4 and 13.4 years post SCT (1 relapse, 1 lung cancer, 1 pneumonia, 1 brain hemorrhage). Most survivors beyond 5 years had an excellent performance status with no difference in physical and mental health and higher HRQL scores (p =0.02) compared with population norms. Although physical and psychological symptom distress was low, those with higher symptom distress experienced inferior HRQL. These results show that five or more years after T cell depleted SCT for hematological malignancy most individuals survive disease free with an excellent performance status, preserved physical and psychological health, and excellent HRQL.
PMCID: PMC2897903  PMID: 20302959
leukemia; hematopoietic stem cell transplantation; long-term outcome
14.  Function, Adjustment, Quality of Life and Symptoms (FAQS) in Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Survivors: A Study Protocol 
The population of survivors following allogeneic HSCT continues to increase, and yet their experiences of recovery and long-term survivorship have not been fully characterized. This paper presents a study protocol examining over time the functional status, psychosocial adjustment, health-related quality of life, and symptom experience of survivors who have undergone allogeneic transplantation. The aims of the study are to: 1) explore the patterns of change in these health outcomes during the survivorship phase; 2) characterize subgroups of survivors experiencing adverse outcomes; and 3) examine relationships among outcomes and demographic and clinical factors (such as age, graft-versus-host disease (GVHD), and disease relapse).
In this longitudinal observational study, adults who survive a minimum of 3 years from date of allogeneic transplantation complete a series of questionnaires annually. Demographic and clinical data are collected along with a series of patient-reported outcome measures, specifically: 1) Medical Outcomes Study SF- 36; 2) Functional Assessment of Chronic Illness Therapy (FACIT) - General, 3) FACIT-Fatigue; 4) FACIT- Spiritual; 5) Psychosocial Adjustment to Illness Scale; 6) Rotterdam Symptom Checklist-Revised; and 7) Pittsburgh Sleep Quality Index.
This study will provide multidimensional patient-reported outcomes data to expand the understanding of the survivorship experience across the trajectory of allogeneic transplantation recovery. There are a number of inherent challenges in recruiting and retaining a diverse and representative sample of long-term transplant survivors. Study results will contribute to an understanding of outcomes experienced by transplant survivors, including those with chronic GVHD, malignant disease relapse, and other late effects following allogeneic transplantation.
Trial Registration NCT00128960
PMCID: PMC3101119  PMID: 21496339
15.  An Individualized Dyadic Problem-Solving Education Intervention for Patients and Family Caregivers During Allogeneic HSCT: A Feasibility Study 
Cancer nursing  2010;33(2):E24-E32.
Allogeneic hematopoietic stem cell transplantation (HSCT) generates multiple problems that vary in complexity and create significant distress for both patients and their caregivers. Interventions that address patient and caregiver distress during allogeneic HSCT have not been tested.
To evaluate the feasibility of conducting an individualized dyadic problem-solving education (PSE) intervention during HSCT and estimate a preliminary effect size on problem-solving skills and distress. Intervention/Methods: The PSE intervention consisted of four sessions of the Prepared Family Caregiver PSE model. Data were collected with an interventionist log, subject interviews and standardized questionnaires.
Of the thirty-four adult dyads screened, twenty-four were ineligible primarily due to non-English speaking (n=11) and inconsistent caregivers (n=10). Ten dyads (n=20) were enrolled and eight dyads (n=16) completed the intervention. Of the thirty-one sessions, 29 were completed (94%). Worsening patient condition was the primary reason for sessions to be incomplete. Patients attended 90% of the sessions; caregivers attended 74%. Reasons for missed sessions included patient symptom distress and limited caregiver availability. Dyads reported being very satisfied (4.8±0.61; range 1–5) stating “an opportunity to talk” and “creative thinking” were most beneficial.
Results suggest that dyads can participate in PSE during HSCT and view it as beneficial. Participants identified the active process of solving problems as helpful.
Implications for Practice
Targeted interventions that promote effective, meaningful behaviors are needed to guide patients and caregivers through HSCT. Future research recommendations include: testing a version of PSE with fewer sessions, including spousal and non-spousal caregivers and those who are non-English speaking.
PMCID: PMC2851241  PMID: 20142739
17.  The Symptom Experience in the First 100 Days Following Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) 
Goals of Work
Despite advances in allogeneic hematopoietic stem cell transplantation (HSCT), post-transplant complications are common and patients’ symptom experience has not been well documented.
To characterize the symptom experience of adult patients pre-transplantation and days 0, 30 and 100 after allogeneic HSCT.
Data from 76 participants enrolled in a prospective Health-Related Quality of Life (HRQL) study were used. Symptom occurrence, distress, and clusters were determined based on the 11 symptoms of the Symptom Distress Scale (SDS).
Participants were on average 40 years old (SD ± 13.5). The majority (54%) received reduced intensity conditioning. Prevalent symptoms included fatigue (68%) and worry (68%) at baseline; appetite change (88%) at day 0; and fatigue at days 30 (90%) and 100 (81%). Participants reported the following symptoms as severely distressing: worry (16%) [baseline], insomnia (32%) [Day 0], appetite change (22%) [Day 30] and fatigue (11%) [Day 100]. The total SDS score was highest at day 0 (M = 26.6 ± 7.6) when the highest number of symptoms were reported [Mdn = 8 (1 - 11)]. Symptoms formed clusters comprised of fatigue, appearance change, and worry at baseline, and fatigue, insomnia and bowel changes at days 0 and 30. Compared to those with low symptom distress, participants with moderate/severe symptom distress reported poorer HRQL.
Allogeneic HSCT patients present for transplantation with low symptom distress yet experience multiple symptoms and high symptom distress after HSCT conditioning. Understanding the symptom experience of allogeneic HSCT patients can guide management strategies and improve HRQL.
PMCID: PMC2885854  PMID: 18322708
Complications; Cancer; Recovery; Clinical Assessment; Symptom Burden
18.  Non-Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation 
Seminars in oncology nursing  2009;25(2):120-128.
To review the literature related to nonmyeloablative stem cell transplantation, and the unique characteristics and patient population to which it applies.
Data Sources
Research studies, research and clinical reviews, clinical experience
Nonmyeloablative stem cell transplantation has demonstrated effective and safe application in a heterogeneous population not otherwise eligible for an allogeneic transplantation. Although many principles are based on those of conventional myeloablative transplantation, the engraftment kinetics, patient selection and regimen related complications are distinct.
Implications for Nursing Practice
Nurses must be knowledgeable about nonmyeloablative stem cell transplantation including the provision of individualized care for a heterogeneous population. This can include non-traditional transplant indications, elderly cancer patients and those with comorbidities.
PMCID: PMC2728008  PMID: 19411015
Regimen Intensity; Transplant Engraftment; Chimerism; Comorbidities; Elderly
The intravenous injection of rabbit antidog-placenta or antidog-kidney serum produced immediate evidence of glomerulonephritis in dogs. The lesions produced by the two agents were indistinguishable. The glomerulonephritis so induced may terminate in death within 8 days, may progress to a chronic form or may heal. The acute phase of the nephritis was usually associated with severe exudative and necrotizing renal lesions, while the pathologic sequences in surviving dogs were essentially reparative. However, 1 dog of 8 in the chronic phase developed a progressive chronic nephritis and died in uremia.
PMCID: PMC2136548  PMID: 13271691
Cirrhosis of the liver was produced in rats by feeding a diet low in protein (4 per cent casein) and deficient in lipotropic factors. The degree of liver cirrhosis was determined from specimens obtained at biopsy. Comparable groups of animals then were treated with diets containing 4 per cent casein and 30 per cent casein. The 4 per cent casein diets were supplemented with choline and methionine; the 30 per cent casein diets were fed with and without added choline. On supplementing the low protein diet with choline and methionine the animals remained feeble, their growth remained stunted, and their livers showed signs of progressive cirrhosis. In contrast, animals fed the higher protein diet (with or without added choline) grew normally, and their livers showed signs indicating arrest and regression of the disease process. These studies suggest that the feeding of high protein (30 per cent casein) diets to rats with nutritional cirrhosis produces reparative effects greater than those attributable to the supplements choline and methionine.
PMCID: PMC2136141  PMID: 14955576

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