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Background Patients (background + patient)
Selected AbstractsInterferon Alfa-2b or Not 2b?DERMATOLOGIC SURGERY, Issue 1 2007Significant Differences Exist in the Decision-Making Process between Melanoma Patients Who Accept or Decline High-Dose Adjuvant Interferon Alfa-2b Treatment BACKGROUND Patients with thick (Breslow >4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers ,10% improvement in relapse-free survival and overall survival with significant toxicity. OBJECTIVE The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy. METHODS Of 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a ,50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17,5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01,4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease. [source] Therapy of circadian rhythm disorders in chronic fatigue syndrome: no symptomatic improvement with melatonin or phototherapyEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 11 2002G. Williams Abstract Background Patients with chronic fatigue syndrome (CFS) show evidence of circadian rhythm disturbances. We aimed to determine whether CFS symptoms were alleviated by melatonin and bright-light phototherapy, which have been shown to improve circadian rhythm disorders and fatigue in jet-lag and shift workers. Design Thirty patients with unexplained fatigue for > 6 months were initially assessed using placebo and then received melatonin (5 mg in the evening) and phototherapy (2500 Lux for 1 h in the morning), each for 12 weeks in random order separated by a washout period. Principal symptoms of CFS were measured by visual analogue scales, the Shortform (SF-36) Health Survey, Mental Fatigue Inventory and Hospital Anxiety and Depression Scale. We also determined the circadian rhythm of body temperature, timing of the onset of melatonin secretion, and the relationship between these. Results Neither intervention showed any significant effect on any of the principal symptoms or on general measures of physical or mental health. Compared with placebo, neither body temperature rhythm nor onset of melatonin secretion was significantly altered by either treatment, except for a slight advance of temperature phase (0·8 h; P = 0·04) with phototherapy. Conclusion Melatonin and bright-light phototherapy appear ineffective in CFS. Both treatments are being prescribed for CFS sufferers by medical and alternative practitioners. Their unregulated use should be prohibited unless, or until, clear benefits are convincingly demonstrated. [source] A2. The carer's perception of dietitians' advice and its impact on the management of patients receiving haemodialysisJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2000M. A. Rezaie Background Patients with end stage renal disease and their carers suffer many changes in their daily life style as a result of haemodialysis (HD) treatment. Information and education concerning the management of dietary requirements and restrictions for renal patients should be aimed at both patients and their carers. Aim This study investigated the impact of dietitians' involvement and advice on the carers' ability to manage patients' dietary/fluid requirements. Method A total of 36 carers of renal patients receiving unit haemodialysis treatment were randomly recruited into this study from a hospital in Cardiff, Wales. All the carers completed the Haemodialysis carers questionnaire (HCQ), specifically designed for this study, delivered to them in the outpatient clinic by the dietitian. Results Of the 36 carers, 22 (61%) were female, six (16.7%) were male and eight (22%) did not report their gender. Thirteen (36%) of the carers were between the ages of 20,54 years and 23 (64%) were 55 years of age and older. Twenty-six (72%) of the carers involved in this study were spouses and 34 (94.4%) of the carers lived with the patient. The mean duration of haemodialysis treatment for the patient was found to be 20 months. The results indicated that although the majority of the carers were informed about patients' dietary and fluid restrictions, 45% had not received any dietary information. Dietitians' one-to,one interactions with the carer was the most effective way of providing information in enabling them to better manage the patient compared to other methods such as leaflet and information packs (P = 0.01). The majority of the carers knew how to contact the renal dietitian, however, many did not (P = 0.001). Almost all the carers considered receiving information about the purpose of HD, feed back on the patients' condition, fluid/dietary restriction and details of available community resources as very important. Those carers who had the benefit of a dietitian's involvement believed that their advice was very helpful and enabled them to cope better with the management and complications of patient fluid and dietary requirements (P < 0.02). Strong correlations were found (rs = 0.67; P < 0.01) between the amount of information received by the carers and the level of the carers satisfaction with this information. In contrast, there were no significant correlations between the amount of information received by the carers and different aspects of managing the patients' diet, because 45% of the carers received none or little information. Conclusions Dietitians should involve the carers in the management of HD patient's dietary/fluid requirements and restrictions in order to provide better quality of care and quality of life for both the patient and the carer. [source] An Alcohol Oxidase Dipstick Rapidly Detects Methanol in the Serum of MiceACADEMIC EMERGENCY MEDICINE, Issue 12 2007Jason B. Hack MD Background Patients presenting with ingestions of methanol and ethylene glycol pose a significant challenge to emergency physicians. The decision to initiate antidotal therapy must be made quickly and is currently based on the presence of indirect signs, symptoms, and laboratory tests, because no real-time diagnostic test exists to measure these substances. Objectives To determine whether a commercially available ethanol-in-saliva detecting dipstick (ALCO-Screen) would be a reliable and rapid indicator of toxic alcohol presence in the serum of an animal model. Methods Fifty mice randomly received intraperitoneal doses of methanol, ethylene glycol, or ethanol to induce serum concentrations of approximately 5,400 mg/dL. Thirty minutes after injection, serum was obtained. Serum was both applied to the dipstick and frozen for definitive concentration determination by gas chromatography. After 2 minutes, dipsticks were evaluated for color change by a blinded observer and photographed to be evaluated by other blinded observers at a later time. Results All concentrations of methanol ,5 mg/dL consistently caused a color change on the ALCO-Screen. Ethylene glycol reliably caused a color change at ,300 mg/dL. There was significant agreement among multiple observers whether or not color change had occurred using the ALCO-Screen. Conclusions A commercially available dipstick that uses an alcohol oxidase colorimetric reaction reliably and rapidly detects very low serum concentrations of methanol but not ethylene glycol in this animal model. This color change is easily detected by most observers. [source] Efficacy and safety of a recombinant anti-immunoglobulin E antibody (omalizumab) in severe allergic asthmaCLINICAL & EXPERIMENTAL ALLERGY, Issue 4 2004S. T. Holgate Summary Background Patients with severe asthma are often inadequately controlled on existing anti-asthma therapy, constituting an unmet clinical need. Objective This randomized, double-blind, placebo-controlled trial evaluated the ability of omalizumab, a humanized monoclonal anti-IgE antibody, to improve disease control sufficiently to enable inhaled corticosteroid reduction in patients with severe allergic asthma. Methods After a run-in period when an optimized fluticasone dose (1000 ,g/day) was received for 4 weeks, patients were randomized to receive subcutaneous omalizumab [minimum 0.016 mg/kg/IgE (IU/mL) per 4 weeks; n=126] or matching placebo (n=120) at intervals of 2 or 4 weeks. The study comprised a 16-week add-on phase of treatment followed by a 16-week fluticasone-reduction phase. Short-/long-acting ,2 -agonists were allowed as needed. Results Median reductions in fluticasone dose were significantly greater with omalizumab than placebo: 60% vs. 50% (P=0.003). Some 73.8% and 50.8% of patients, respectively, achieved a 50% dose reduction (P=0.001). Fluticasone dose reduction to 500 ,g/day occurred in 60.3% of omalizumab recipients vs. 45.8% of placebo-treated patients (P=0.026). Through both phases, omalizumab reduced rescue medication requirements, improved asthma symptoms and asthma-related quality of life compared to placebo. Conclusion Omalizumab treatment improves asthma control in severely allergic asthmatics, reducing inhaled corticosteroid requirements without worsening of symptom control or increase in rescue medication use. [source] | ||||||||||