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Early Discontinuation (early + discontinuation)
Selected AbstractsPostoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric casesPEDIATRIC ANESTHESIA, Issue 3 2001Corinne Lejus MD Background: The objective of this prospective study was the evaluation of the analgesia provided by an epidural infusion of bupivacaine and fentanyl after different types of surgery in children. Methods: Data were collected from 348 epidural analgesia in 87 children below 2 years of age, in 80 children between 2 and 6 years and 181 above 6 years of age, for a median duration of 43 postoperative hours. Bupivacaine (mean concentration 0.185%) and fentanyl (5 ,g·kg,1·day,1) were administered on the surgical ward. Results: Pain control was considered excellent in 86% of the 11 072 pain hourly assessments. Analgesia was found to be better for children older than 2 years, and the overall quality of their night's sleep was better than that of older children. Higher pain scores were noted for Nissen fundoplication surgery and club foot repairs. Early discontinuation rarely occurred, and only because of technical problems with the epidural catheter (4%) or insufficient analgesia (6%). Complications were minor (nausea/vomiting 14%, pruritus 0.6%, urinary retention 17%) and easily reversed. Conclusions: This combination of bupivacaine,fentanyl provides safe analgesia after major surgery in children with frequent clinical monitoring. Regular pain assessments of intensity and duration are useful to improve the quality of postoperative analgesia. [source] The influence of medication beliefs and other psychosocial factors on early discontinuation of disease-modifying anti-rheumatic drugsMUSCULOSKELETAL CARE, Issue 3 2007DClinPsy, M. Wong MSc Abstract Objective:,Although drug survival time might be a better measure of clinical effectiveness than drug adherence, there is little research literature in this area, in particular about the influence of medication beliefs and psychosocial factors. This study aimed to investigate the above relationships using patients who were newly diagnosed with rheumatoid arthritis (RA). Methods:,Sixty-eight RA patients starting their first disease-modifying anti-rheumatic drug (DMARD) were interviewed shortly after initiating therapy, and then one year later. Before each meeting, patients were asked to complete a set of questionnaires, including Beliefs about Medication, Spielberger State-Trait Anxiety Inventory , Short Form, the modified Stanford Health Assessment Questionnaire, Beck Depression Inventory-1 and the Significant Others Scale. Relevant sociodemographic background, disease activity and drug history were obtained. Clinical measures such as grip strength and joint count were assessed. Results:,A stepwise logistic regression analysis was applied to two patient groups: those who continued taking their DMARD one year later, and those who did not. No significant difference between the groups for levels of disability and disease activity were found. Only age and anxiety emerged as significant predictors of drug discontinuation at 52 weeks. Conclusions:,Contrary to expectation, this study demonstrated that older and less anxious patients were more likely to discontinue taking their initial DMARD within the first year. The study may have implications for counselling older and less anxious patients prior to DMARD therapy. However, there are limitations in generalizing the results because of the small population sample. It also did not take into account drug intolerance as a pertinent factor for early drug discontinuation. Copyright © 2007 John Wiley & Sons, Ltd. [source] Acute interstitial nephritis due to mesalazineNEPHROLOGY, Issue 2 2005Case Report SUMMARY: A case of mesalazine-induced acute interstitial nephritis (AIN) in a 41-year-old patient with ulcerative colitis (UC) is reported here. Clinical symptoms such as fever and arthralgia, and laboratory findings such as eosinophilia and renal failure suggested AIN, which was confirmed by biopsy. With withdrawal of mesalazine and intravenous methylprednisolone the patient's renal function was recovered. It is observed that early discontinuation of mesalazine is associated with amelioration of interstitial nephritis in most patients, so the recommendation is that patients receiving mesalazine should undergo routine monitoring of renal function. Delayed diagnosis may lead to permanent renal function impairment. [source] Rapid steroid discontinuation for pediatric renal transplantation: A single center experiencePEDIATRIC TRANSPLANTATION, Issue 5 2007Keith K. Lau Abstract:, To determine the outcomes of pediatric renal transplant recipients who received immunosuppression consisting of early withdrawal of corticosteroids at a single Northern California center. Protocols using minimal steroid exposure have been recently reported in adult transplant recipients with successful results. We examined the outcomes of pediatric renal transplant recipients who were managed at our center using a protocol with very early discontinuation of steroids after renal transplantation. We retrospectively studied the medical records of all renal transplant recipients followed at the Children's Hospital at the University of California, Davis Medical Center from 01/2004 to 12/2005. All patients were less than 18 yr of age at the time of transplantation. The immunosuppressive protocol included three tapering daily doses of methylprednisolone, together with five doses of thymoglobulin followed by maintenance therapy with tacrolimus and MMF. Eight patients with equal numbers of males and females were transplanted during this time period. There were equal numbers of Caucasians, African-Americans, Hispanics, and Asians. A total of 37.5% (3/8) of the subjects received preemptive transplantation, 25% (2/8) received peritoneal, and 37.5% (3/8) received hemodialysis before transplantation. The median (range) age at transplantation was 12.3 (3.1,16.0) year with a follow-up of 1.7 (0.9,2.8) year. At one yr post-transplantation, 57% (4/7) of patients still required anti-hypertensives. Three children required erythropoietin supplementation after transplantation. The mean delta height standard deviation score at 12 months was 0.20 ± 0.56. There were no episodes of clinical acute rejection. One patient switched from tacrolimus to sirolimus due to biopsy-proven CAN. No patient became diabetic or required hypoglycemic agents. Surveillance biopsies showed no subclinical acute rejection in any patient. Steroid-free immunosuppression is safe in children after renal transplantation. Larger number of patients and longer follow-up are required to further confirm the effectiveness and safety of immunosuppression with rapid steroid discontinuation. [source] Caregiver depression predicts early discontinuation of care for disabled elderly at homePSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2001Yumiko Arai MD Abstract This longitudinal study investigates the caregiving experiences among Japanese caregivers who provided informal care at home for disabled elderly between 1998 and 1999. Forty-seven caregivers of the impaired elderly continued caregiving at home in Matsuyama Town, a rural area of northern Japan, while 18 caregivers discontinued it. The mean score of the Center for Epidemiologic Studies Depression Scale in 1998 among those who gave up caregiving was significantly higher than that of those who continued caregiving, indicating that depression predicts early discontinuation of care in the home. This is one of the few studies in Japan to suggest that initial caregiver depression is a factor in the decision to terminate care for the disabled elderly at home. [source] PSA surge/flare-up in patients with castration-refractory prostate cancer during the initial phase of chemotherapyTHE PROSTATE, Issue 16 2009T. Nelius Abstract BACKGROUND Docetaxel-based chemotherapy has shown great promise for the treatment of CRPC and is considered the current standard of care. PSA is mainly used as marker to monitor the treatment response. Several articles were published reporting an initial PSA surge/flare-up after starting chemotherapy. The cause and the impact of this phenomenon are discussed controversially. The intention of this review is to define the significance of initial PSA surge/flare-up and to increase awareness to this phenomenon in the urological community. MATERIALS AND METHODS A comprehensive literature search was performed in different data bases using various key words. Relevant articles and references between 1999 and 2009 were reviewed and analyzed for data on the association between chemotherapy and initial PSA surge/flare. RESULTS The incidence of a PSA surge/flare-up ranges according to the reported studies between 7.6% and 13.6%. A PSA surge/flare-up was reported up to 404% from baseline PSA level followed by PSA response. The median duration of a PSA surge/flare-up is 2,3 weeks and can last up to 6,8 weeks. However, the occurrence of a PSA surge/flare-up did not impact outcome and survival negatively compared to patients with an immediate PSA response. CONCLUSIONS A considerable portion of CRPC patients experience an initial PSA surge/flare-up under systemic chemotherapy. The definitions used for PSA surge/flare-up differ slightly in the literature. This issue needs to be solved since it might impact defining treatment response. As a PSA surge/flare-up did not impact outcome and survival negatively, chemotherapy should be continued according to the literature addressing specifically the phenomenon of a PSA surge/flare-up for a minimum of 8 weeks or 3 rounds of a 3-weekly cycle chemotherapy regimen before further decisions are made about efficacy. However, Scher et al. recommended a 12-week period drug exposure based on their results on PSA progression-free survival and overall survival. This dilemma needs to be addressed in further data analysis in order to establish a general rule regarding when to stop chemotherapy. Physicians should be aware of this effect to avoid inadequate early discontinuation of chemotherapy. The underlying mechanisms of a PSA surge/flare-up are still elusive and need further clarification. Prostate 69: 1802,1807, 2009. © 2009 Wiley-Liss, Inc. [source] Reply to early discontinuation of tamoxifenCANCER, Issue 11 2007A lesson for oncologists No abstract is available for this article. [source] A phase II study of cisplatin, doxorubicin, and ifosfamide with peripheral blood stem cell support in patients with skeletal osteosarcoma and variant bone tumors with a poor prognosis,CANCER, Issue 1 2004Shreyaskumar R. Patel M.D. Abstract BACKGROUND The authors evaluated the efficacy and toxicity of cisplatin, ifosfamide, and doxorubicin with peripheral blood stem cell (PBSC) support in adult patients with osteosarcomas and variants with a poor prognosis. METHODS Between December 1994 and January 2001, 37 patients (20 males and 17 females) with a median age of 38 years (range, 18,63 years) entered the study. Ten patients had pelvic osteosarcomas (OS), 6 had malignant fibrous histiocytomas, 5 had metastatic OS, and 16 had miscellaneous histologies. The authors used doxorubicin (60,75 mg/m2) and ifosfamide (10 g/m2) followed by granulocyte,colony-stimulating factor (G-CSF) (5 ,g/kg twice per day) for mobilization of PBSC, collected at a median of 12 days (range, 10,14 days). Three cycles with cisplatin (120 mg/m2), ifosfamide (10 g/m2), and doxorubicin (75 mg/m2), given 28 days apart, were planned followed by PBSC (2,4 × 106 CD34-positive cells/kg) infusion plus G-CSF. RESULTS Patients received a median of three cycles (range, one to three cycles) in addition to the mobilizing cycle. The median PBSC collection was 17.5 × 106/kg (range, 13.2,90.8 × 106/kg) with a median of 1 apheresis (range, 1,2 aphereses). Twenty-eight patients underwent surgery, 10 achieved 95,100% necrosis, and 4 achieved 90,94% necrosis. Six patients required early discontinuation of therapy due to toxicities, two patients developed progressive disease, and one patient was deemed unresectable. The median time to progression (TTP) and overall survival by Kaplan,Meier estimates for all 37 patients was 19 months and 49 months, respectively. CONCLUSIONS The authors accomplished the objective of improving the rate of necrosis with intensification of preoperative therapy. However, TTP and survival rates remained poor. The toxicity profile of this regimen is prohibitive and alternative strategies need to be investigated. Cancer 2004. © 2004 American Cancer Society. [source] Steroid avoidance in renal transplantation using basiliximab induction, cyclosporine-based immunosuppression and protocol biopsiesCLINICAL TRANSPLANTATION, Issue 1 2005Mysore S Anil Kumar Abstract:, Background:, Reducing chronic steroid exposure is important to minimize steroid-related morbidity, particularly for susceptible renal transplant recipients. Steroid-free and steroid-sparing protocols have shown benefits, but safety has not been established for all populations. We investigated the safety of steroid avoidance (SA) in a population including African-Americans, using modern immunosuppression with protocol biopsy monitoring. Methods:, A randomized-controlled SA trial (early discontinuation, days 2,7) was conducted in a population (n = 77) including African-Americans and cadaveric kidney recipients. Patients received basiliximab, cyclosporine (CsA), and mycophenolate mofetil (MMF). In controls, steroids were tapered to 5 mg prednisone/d by day 30. Protocol biopsies were performed (1, 6, 12 and 24 months) to evaluate subclinical acute rejection (SCAR) and chronic allograft nephropathy (CAN). Results:, The SA did not result in significantly higher incidences of graft loss, AR, SCAR, CAN, or renal fibrosis. SA patients experienced similar renal function, comparable serum lipid levels, and a trend toward fewer cases of new-onset diabetes. Clinical outcomes of African-American and non-African-American patients did not significantly differ. Conclusions:, The SA is safe in the context of basiliximab induction and CsA-based immunosuppression. This protocol could minimize steroid-related side effects in susceptible groups, including African-Americans, without increasing the risk of AR or graft failure. [source] | ||||||||||