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Prior Treatment (prior + treatment)
Selected AbstractsRheological Examination of White Pepper Slurries to Determine Prior Treatment of Pepper with Gamma-IrradiationJOURNAL OF FOOD SCIENCE, Issue 2 2001S.D. Yi ABSTRACT: A study was carried out to examine rheological properties for the detection of irradiated white pepper by viscosity and maximum viscosity methods. Samples in polyethylene bags were irradiated and measured for apparent viscosity and maximum viscosity. The viscosity of all samples decreased with increasing stirring speeds and irradiation dose. This trend was similar for maximum viscosity. The results suggest that the detection of irradiated white pepper is possible by both the viscometric and maximum viscosity methods. Therefore, maximum viscosity method can be used as a new method to detect the irradiated white pepper. [source] Alpha-melanocyte-stimulating hormone attenuates behavioral effects of corticotropin-releasing factor in isolated guinea pig pupsDEVELOPMENTAL PSYCHOBIOLOGY, Issue 5 2009Patricia A. Schiml-Webb Abstract During a 3-hr period of social isolation in a novel environment, guinea pig pups exhibit an initial active phase of behavioral responsiveness, characterized primarily by vocalizing, which is then followed by a stage of passive responsiveness in which pups display a distinctive crouch, eye-closing, and extensive piloerection. Prior treatment of pups with alpha-melanocyte-stimulating hormone (,-MSH) reduces each of the passive behaviors. The onset of passive responding during separation can be accelerated with peripheral injection of corticotropin-releasing factor (CRF). To examine whether CRF produces its effects through a mechanism similar to that of prolonged separation, we examined the effect of administering ,-MSH to pups injected with CRF. As expected, CRF markedly enhanced passive responding during a 60-min period of separation. ,-MSH delivered by either intracerebroventricular infusion or intraperitoneal injection significantly reduced each of the passive behavioral responses without significantly affecting active behavior. These findings, together with previous results indicating that it is the anti-inflammatory property of ,-MSH that is responsible for its behavioral effects during prolonged separation, suggest that peripheral CRF speeds the induction of passive responding through a mechanism involving enhanced proinflammatory activity. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 399,407, 2009. [source] (,)Epigallocatechingallate protects the mitochondria against the deleterious effects of lipids, calcium and adenosine triphosphate in isoproterenol induced myocardial infarcted male Wistar ratsJOURNAL OF APPLIED TOXICOLOGY, Issue 8 2008P. T. Devika Abstract The present study was undertaken to evaluate the protective effect of (,)epigallocatechin gallate (EGCG) on mitochondrial lipids, lipid peroxides, Na+/K+ ATPase, calcium and adenosine triphosphate in isoproterenol (ISO) induced myocardial infarction in male Wistar rats. Rats were pretreated with EGCG (30 mg kg,1 body weight) orally using an intragastric tube daily for a period of 21 days. After that, ISO (100 mg kg,1 body weight) was subcutaneously injected to rats at intervals of 24 h for two days. ISO induced rats showed significant increase in the levels of cholesterol, triglycerides and free fatty acids with subsequent decrease in the levels of phospholipids in mitochondrial fraction of the heart. ISO induction also caused significant increase in lipid peroxidation products (thiobarbituric acid reactive substances and lipid hydroperoxides) and significant decrease in the activity of Na+/K+ ATPase in mitochondrial fraction of the heart. A significant increase in the levels of calcium and significant decrease in the levels of adenosine triphosphate were observed in ISO-induced mitochondrial heart. Prior treatment with EGCG (30 mg kg,1) significantly protected these alterations and maintained normal mitochondrial function. Thus, this study confirmed the protective effect of EGCG on mitochondria in experimentally induced cardiotoxicity in Wistar rats. Copyright © 2008 John Wiley & Sons, Ltd. [source] Latest news and product developmentsPRESCRIBER, Issue 22 2007Article first published online: 28 DEC 200 Glitazones: benefits outweigh the risks Following a review of the safety of rosiglitazone and pioglitazone, the European Medicines Agency (EMEA) has concluded that their benefits outweigh their risks in the approved indications. The review was prompted by reports of an increased risk of fractures in women and, in patients taking rosiglitazone, ischaemic heart disease. The EMEA concluded that prescribing information for rosiglitazone should now include a warning that, in patients with ischaemic heart disease, it should only be used after careful evaluation of each patient's individual risk, and the combination of rosiglitazone and insulin should only be used in exceptional cases and under close supervision. No change was considered necessary to the prescribing information for pioglitazone. Modern dressings no better? A systematic review has found only weak evidence that modern dressings are better than saline gauze or paraffin gauze for healing acute and chronic wounds (Arch Dermatol 2007;143: 1297-304). The analysis, which included 99 studies, found that only hydrocolloids were demonstrably better than older dressings for healing chronic wounds, and alginates were superior to other modern dressings for debriding necrotic wounds. There was no evidence that modern dressings offered superior overall performance to the older alternatives. Hospital inflation twice primary care level The cost of drugs prescribed in secondary care but dispensed in the community increased by 6.4 per cent in 2006 - twice the rate of inflation in primary care - according to the latest statistics on hospital prescribing in England. The increase follows a reduction in costs in 2005 after the introduction of the new PPRS scheme. Data from The Information Centre (www.ic.nhs.uk) show that hospital medicines make up about 24 per cent of the NHS drugs budget. Secondary care has a consistently better record than primary care in prescribing lower-cost alternatives within therapeutic categories, eg simvastatin and pravastatin among the statins, omeprazole and lansoprazole among PPIs, and ACE inhibitors among drugs acting on the renin angiotensin system. The most expensive drug prescribed by hospital specialists and dispensed in the community is interferon beta. MHRA limits the use of fibrates The Medicines and Healthcare products Regulatory Agency (MHRA) has advised that fibrates should now be reserved for the treatment of isolated severe hypertriglyceridaemia. They should be considered for hypercholesterolaemia only when a statin or other treatment is contraindicated or not tolerated. In the latest Drug Safety Update, the MHRA says there is insufficient evidence of long-term benefits from fibrates, and first-line use is no longer justified because the evidence for the benefits of statins is robust. The MHRA also warns that some breastfeeding infants have increased susceptibility to the adverse effects of codeine taken by their mother, and that St John's wort may affect the hepatic metabolism of any anticonvulsant. Annual zoledronic acid infusion cuts mortality after hip fracture Once-yearly infusion of zoledronic acid (Aclasta) after hip fracture reduces deaths over a two-year period by 28 per cent compared with placebo, US investigators say (N Engl J Med 2007;357:1799-809). The HORIZON Recurrent Fracture Trial randomised 2127 men and women (mean age 75) within 90 days of surgery for hip fracture to zoledronic acid 5mg yearly or placebo. Mortality over 1.9 years of follow-up was 9.6 per cent with zoledronic acid and 13.3 per cent with placebo. Zoledronic acid also significantly reduced the rate of any new clinical fractures (by 35 per cent) and new clinical vertebral fractures(by 45 per cent),but the lower rate of hip fracture (2.0 vs 3.5 per cent with placebo) was not statistically significant. Rivastigmine patch for mild to moderate AD Rivastigmine (Exelon) is now available as a transdermal patch for the treatment of mild to moderate Alzheimer's disease. Applied once daily, the patch delivers 9.5mg per 24 hours and, says manufacturer Novartis, is associated with a lower incidence of nausea and vomiting than a comparable oral dose. The patch is available in two strengths: 4.6mg per 24hr is equivalent to oral doses of 3 or 6mg per day, and the 9.5mg per 24hr patch is equivalent to 9 or 12mg per day orally. The recommended dose of the patch is 9.5mg per day; both strengths cost £83.84 for 30 patches. Women more aspirin resistant than men? The cardioprotective effect of low-dose aspirin may be lower in women than men, say Canadian investigators (BMC Medicine 2007;5:29 doi: 10.1186/1741-70155-29). Their meta-analysis of 23 randomised trials involving a total of 113 494 participants found that aspirin significantly reduced the risk of nonfatal but not fatal myocardial infarction (MI). About one-quarter of the variation in its effects on nonfatal MI was accounted for by the sex mix of the trial population. Separating the results by sex showed the reduction in risk with aspirin use was statistically significant in men (relative risk, RR, 0.62) but not in women (RR 0.87). Look after physical health of mentally ill GPs and other primary care workers should take more responsibility for the physical health of their mentally ill patients, say advocacy groups. Mind and Body: Preventing and Improving Physical Health Problems in Patients With Schizophrenia points out that the mental health needs of patients with schizophrenia are met in secondary care, but their physical health needs should be met in primary care. In particular, the metabolic effects of antipsychotics may lead to obesity, diabetes and cardiovascular disease, and weight gain in particular is a frequent reason for nonadherence to treatment. The Mind and Body Manifesto was developed by SANE, The Mental Health Nurses Association, The National Obesity Forum and The Disability Rights Commission and sponsored by Bristol-Myers Squibb Pharmaceuticals Limited and Otsuka Pharmaceuticals (UK) Ltd. Copies are available from elizabeth.green@ ogilvyhealthworld.com. Health eCard costs Some costs quoted in our article on the Health eCard (The Health eCard: the way ahead for medical records?,5 October issue, pages 28-9) have been revised: the card and initial download will cost patients £39.50, and GPs will be entitled to charge patients £10 per annum for subsequent downloads. NICE appraisals of cytokine inhibitors in RA NICE has endorsed the use of the anti-TNF agents adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade), normally in conjunction with methotrexate, for the treatment of active RA when methotrexate and another DMARD have failed (also see New from NICE below). NICE has provisionally concluded, subject to consultation, that abatacept (Orencia) should not be recommended for the treatment of RA. Boots and BMJ launch health advice site www.askbootshealth.com is a new website providing information about health and medicines for the public produced by Boots using information provided by the BMJ Publishing Group. The website covers many of the topics already available from NHSDirect, with perhaps more information about available treatments. Diabetes care shows small improvement The third National Diabetes Audit in England and Wales has found that more people with diabetes were achieving the targets set by NICE for cholesterol levels, glycaemic control and blood pressure in 2005/06 - but younger patients were doing less well. Overall, the HbA1C target of ,7.5 per cent was achieved in 60 per cent of people with diabetes compared with 58 per cent in 2004/05. However, HbA1C was >9.5 per cent in 30 per cent of children and young people, of whom 9 per cent experienced at least one episode of ketoacidosis. More topics for NICE New topics referred to NICE include clinical guidelines on ovarian cancer, coeliac disease and stable angina, public health guidance on preventing cardiovascular disease, and technology appraisals on insulin detemir (Levemir) for type 1 diabetes, several treatments for cancer and hepatic and haematological disorders, and biological therapies for juvenile arthritis. New from NICE NICE appraisal on anti-TNFs for RA Since NICE published its first appraisal of agents acting against tumour necrosis factor-alpha (anti-TNFs) for the treatment of RA in 2002, the product licences for etanercept (Enbrel) and infliximab (Remicade) have changed and a new agent, adalimumab (Humira), has been introduced. The anti-TNFs act in different ways. Infliximab is a chimeric monoclonal antibody that binds to TNF-alpha, neutralising its activity. Etanercept, a recombinant human TNF-alpha receptor fusion protein, and adalimumab, a human-sequence antibody, both bind to TNF-alpha and block its interaction with cell surface receptors. Adalimumab also modulates some biological responses induced or regulated by TNF-alpha. These agents are recommended for adults with severe active RA (defined as a disease activity score - DAS28 - greater than 5.1) who have already tried two disease-modifying drugs, including methotrexate (if not contraindicated). Prior treatment should have been of at least six months' duration, including two months at the standard dose (unless limited by toxicity). Anti-TNFs should normally be prescribed with methotrexate; when this is not appropriate, etanercept and adalimumab may be prescribed as monotherapy. Treatment with an anti-TNF should be continued beyond six months only if there is an adequate response (defined as an improvement in DAS28 of at least 1.2). Data from the British Rheumatology Society Biologics register show that, after six months, 67 per cent of patients met NICE criteria for an adequate response; this declined to 55 per cent at 18 months. The basic annual cost of treatment is £9295 for adalimumab 40mg on alternate weeks or etanercept 25mg twice weekly; infliximab costs £3777 for a loading dose, then £7553-£8812 depending on dose. Assuming no progression of disability, the incremental costs per QALY (compared with sequential DMARDs) were £30 200 for adalimumab, £24 600 for etanercept and £39 400 for infliximab. There are no direct comparative trials of the anti-TNFs, and their clinical trial findings are not directly comparable. Unless other factors determine treatment choice, NICE therefore recommends the least expensive. If the first anti-TNF is withdrawn within six months due to an adverse event, a second may be tried. [source] Preconditioning of skeletal muscle against contraction-induced damage: the role of adaptations to oxidants in miceTHE JOURNAL OF PHYSIOLOGY, Issue 1 2004F. McArdle Adaptations of skeletal muscle following exercise are accompanied by changes in gene expression, which can result in protection against subsequent potentially damaging exercise. One cellular signal activating these adaptations may be an increased production of reactive oxygen and nitrogen species (ROS). The aim of this study was to examine the effect of a short period of non-damaging contractions on the subsequent susceptibility of muscle to contraction-induced damage and to examine the changes in gene expression that occur following the initial contraction protocol. Comparisons with changes in gene expression in cultured myotubes following treatment with a non-damaging concentration of hydrogen peroxide (H2O2) were used to identify redox-sensitive genes whose expression may be modified by the increased ROS production during contractions. Hindlimb muscles of mice were subjected to a preconditioning, non-damaging isometric contraction protocol in vivo. After 4 or 12 h, extensor digitorum longus (EDL) and soleus muscles were removed and subjected to a (normally) damaging contraction protocol in vitro. Muscles were also analysed for changes in gene expression induced by the preconditioning protocol using cDNA expression techniques. In a parallel study, C2C12 myotubes were treated with a non-damaging concentration (100 ,m) of H2O2 and, at 4 and 12 h following treatment, myotubes were treated with a damaging concentration of H2O2 (2 mm). Myotubes were analysed for changes in gene expression at 4 h following treatment with 100 ,m H2O2 alone. Data demonstrate that a prior period of non-damaging contractile activity resulted in significant protection of EDL and soleus muscles against a normally damaging contraction protocol 4 h later. This protection was associated with significant changes in gene expression. Prior treatment of myotubes with a non-damaging concentration of H2O2 also resulted in significant protection against a damaging treatment, 4 and 12 h later. Comparison of changes in gene expression in both studies identified haem oxygenase-1 as the sole gene showing increased expression during adaptation in both instances suggesting that activation of this gene results from the increased ROS production during contractile activity and that it may play a role in protection of muscle cells against subsequent exposure to damaging activity. [source] Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: implications for public healthDRUG AND ALCOHOL REVIEW, Issue 2 2008ANDREAS PLÜDDEMANN Abstract Introduction and Aims. In the past decade, methamphetamine has become increasingly a drug of concern globally. The purpose of this study is to describe the changing trends in treatment admissions for methamphetamine abuse in Cape Town, South Africa and to highlight the implications of these changes for policy, practice and research. Design and Methods. Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance and information on prior treatment. Results. The results indicate that between 2004 and 2006 a dramatic increase in treatment admissions for methamphetamine abuse occurred, a large proportion of the methamphetamine patients are adolescents and that the drug is almost exclusively smoked. Discussion and Conclusions. The rapid increase in admissions for methamphetamine abuse is of great concern, particularly as the drug has a number of serious, often chronic, side effects and that a large proportion of the patients are adolescents. The implications for public health are discussed. [source] Chitosan Incorporating Cetyltrimethylammonium Bromide Modified Glassy Carbon Electrode for Simultaneous Determination of Ascorbic Acid and DopamineELECTROANALYSIS, Issue 17 2007Xuelian Zou Abstract Simultaneous determination of a neurotransmitter, dopamine (DA), and ascorbic acid (AA) is achieved at neutral pH on a chitosan incorporating cetyltrimethylammonium bromide (CTAB) modified glassy carbon (GC) electrode. Differential pulse voltammetry (DPV) technique was used to investigate the electrochemical response of DA and AA at a glassy carbon electrode modified with chitosan incorporating CTAB. An optimum 6.0,mmol L,1 of CTAB together with 0.5 wt% of chitosan was used to improve the resolution and the determination sensitivity. In 0.1,mol L,1 aqueous phosphate buffer solution of pH,6.8, the chitosan-CTAB modified electrode showed a good electrocatalytic response towards DA and AA. The anodic peak potential of DA shifted positively, while that of AA shifted negatively. Thus, the difference of the anodic peaks of DA and AA reached 0.23,V, which was enough to separate the two anodic peaks very well. The presented method herein could be applied to the direct simultaneous determination of DA and AA without prior treatment. The anodic peak currents (Ipa) of DPV are proportional to DA in the concentration range of 8,,M to 1000,,M, to that of AA 10,,M to 2000,,M, with correlation coefficients of 0.9930 and 0.9945, respectively. The linear range is much wider than previously reported. [source] Efficient and sensitive method of DNA silver staining in polyacrylamide gelsELECTROPHORESIS, Issue 1 2005Lujiang Qu Abstract DNA silver staining is widely used to detect DNA fragment in polyacrylamide gel with high sensitivity. Conventional procedures of the silver staining involve several steps, which take about 40 min to 2 h in total. To improve the efficiency of DNA silver staining, a more efficient protocol is developed in this study. The procedure comprises only four steps including impregnating, rinsing, developing, and stopping, and could be completed within 20 min. Nitric acid and ethanol in the silver-impregnation step of the new procedure eliminates the need for prior treatment of gels with a fixing solution and following rinse prior to impregnation with silver. The procedure has high sensitivity and long storage lifetime. The minimum detectable mass of DNA is 0.44 and 3.5 ng in denaturing and nondenaturing polyacrylamide gel, respectively. [source] A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 6 2009M. I. Berman Abstract The aim of the present study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN. Three participants enrolled; all completed the study. All participants had a history of 1,20 years of intensive eating disorder treatment prior to enrollment. Participants were seen for 17,19 twice-weekly sessions of manualized ACT. Symptoms were assessed at baseline, post-treatment and 1-year follow-up. All participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up. Simulation modelling analysis (SMA) revealed for some participants an increase in weight gain and a decrease in eating disorder symptoms during the treatment phase as compared to a baseline assessment phase. These data, although preliminary, suggest that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Definitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body, and glomus vagaleHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2001Russell W. Hinerman MD Abstract Purpose To evaluate the results of treatment for 71 patients with 80 chemodectomas of the temporal bone, carotid body, or glomus vagale who were treated with radiation therapy (RT) alone (72 tumors in 71 patients) or subtotal resection and RT (8 tumors) at the University of Florida between 1968 and 1998. Methods and Materials Sixty-six lesions were previously untreated, whereas 14 had undergone prior treatment (surgery, 11 lesions; RT, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All three patients who received prior RT had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 66 patients (93%); 5 years, 53 patients (75%); 10 years, 37 patients (52%); 15 years, 29 patients (41%); 20 years, 18 patients (25%); 25 years, 12 patients (17%); and 30 years, 4 patients (6%). Results There were five local recurrences at 2.6 years, 4.6 years, 5.3 years, 8.3 years, and 18.8 years, respectively. Four were in glomus jugulare tumors and one was a carotid body tumor. Two of the four patients with glomus jugulare failures were salvaged, one with stereotactic radiosurgery and one with surgery and postoperative RT at another institution. Two of the five recurrences had been treated previously at other institutions with RT and/or surgery. Treatment for a third recurrence was discontinued, against medical advice, before receiving the prescribed dose. There were, therefore, only 2 failures in 65 previously untreated lesions receiving the prescribed course of RT. The overall crude local control rate for all 80 lesions was 94%, with an ultimate local control rate of 96% after salvage treatment. The incidence of treatment-related complications was low. Conclusions Irradiation offers a high probability of tumor control with relatively minimal risks for patients with chemodectomas of the temporal bone and neck. There were no severe treatment complications. © 2001 John Wiley & Sons, Inc. Head Neck 23: 363,371, 2001. [source] Effect of extended MMX mesalamine therapy for acute, mild-to-moderate Ulcerative ColitisINFLAMMATORY BOWEL DISEASES, Issue 1 2009Michael A. Kamm MD Abstract Background: Many patients with ulcerative colitis (UC) respond to mesalamine therapy within 8 weeks. Those not achieving remission after 8 weeks are often treated with steroids or other immunosuppressive therapies. This study aimed to determine the effect of 8 weeks' high-dose MMX mesalamine extension therapy in patients with active, mild-to-moderate UC who had previously failed to achieve complete remission in 2 phase III, double-blind, placebo-controlled studies of MMX mesalamine (SPD476-301 and -302). Methods: Patients with active, mild-to-moderate UC who did not achieve clinical and endoscopic remission after ,8 weeks' treatment with MMX mesalamine (2.4 or 4.8 g/day), ASACOL® (mesalamine) delayed-release tablets 2.4 g/day, or placebo in the phase III studies received MMX mesalamine 4.8 g/day for 8 weeks. The aim was to assess remission at week 8, defined as a total modified UC Disease Activity Index score of ,1, calculated as: scores of 0 for rectal bleeding and stool frequency, a combined Physician's Global Assessment score and sigmoidoscopy score of ,1, no mucosal friability, and a ,1 point reduction from baseline in sigmoidoscopy score. Results: Overall, 304 patients who entered this acute extension study were evaluated; 59.5% achieved remission at week 8. Remission rates were similar irrespective of prior treatment in the initial acute phase III studies. Conclusions: Most patients with mild-to-moderate UC who fail to achieve remission with up to 8 weeks' initial mesalamine therapy can achieve clinical and endoscopic remission following a further 8 weeks' treatment with high-dose MMX mesalamine therapy, thereby avoiding step-up therapy. (Inflamm Bowel Dis 2008) [source] Hepatocellular carcinoma in Sydney South West: late symptomatic presentation and poor outcome for mostINTERNAL MEDICINE JOURNAL, Issue 8 2007L. Gellert Abstract Background: Hepatocellular cancer (HCC) is a serious complication of cirrhosis and chronic hepatitis B infection. The aim of the study was to determine the characteristics of patients with HCC presenting within the South West Sydney area, including an analysis of the rates and benefits of hepatocellular surveillance. Methods: Data from patients with HCC presenting to Liverpool and Bankstown Hospitals from July 1993 to June 2003 were analysed retrospectively, predominantly from hospital records. Results: Of the 151 HCC patients, 41% were Asian born. Most of the patients required an interpreter. Chronic viral hepatitis infection was present in 91 patients, of whom only 7% had previously received antiviral therapy. Alcohol alone was considered responsible in 31 patients. Cirrhosis could be documented in 58% of patients. Most of the patients (75%) presented symptomatically. The median survival was 5.1 months. When HCC was detected by surveillance, the tumours were slightly but not significantly more likely to be operable and the patients tended to be offered some form of active treatment more frequently. Multivariate analysis identified detection by surveillance, lower Child,Pugh score, smaller tumour size and eligibility for some form of treatment to be associated with a more favourable outcome. Conclusion: We observed low rates of surveillance for HCC, low recognition of cirrhosis before development of HCC and low rates of prior treatment of viral hepatitis. The poor outcome of HCC in the small group who had some sort of community surveillance is also a concern requiring further investigation. [source] Contemporary referral of patients from community care to cardiology lack diagnostic and clinical detailINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2006S. Bodek Summary The quantity of referrals to secondary care is increasing. That the quality of medical referrals is decreasing is a common allegation yet has rarely been assessed. We report a time-limited, cross-sectional survey evaluating cardiological referral information quality. Referral letters (n = 218, excluding direct access pro formas) from GPs to the Cardiology Department at City Hospital, Birmingham, were collated and analysed over 2 months. A subset (n = 49) of these patients completed questionnaires assessing their knowledge and patient communication of the referral. Information quality was poor (length, diagnosis, expectation, prior treatment and investigation) with almost half of all letters containing only outline symptomatic complaints without diagnosis. The majority of patients referred had not been investigated or treated in any way before referral. Despite lack of understanding of the reason for referral, typically the majority of patients expressed themselves as satisfied with the process. Given most referrals are seen as appropriate, information exchange between secondary and primary care is crucial. By contrast, the standard of even basic clinical assessment communicated between primary care and secondary care was severely limited. The reason(s) why medical assessment is lacking are unclear but must be explored to give more support to primary care to complete basic medical task particularly if investment is to flow into this source. [source] Why do primary care doctors diagnose depression when diagnostic criteria are not met?INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2000Michael Höfler Abstract This study examines predictors of false positive depression diagnoses by primary care doctors in a sample of primary care attendees, taking the patients' diagnostic status from a self-report measure (Depression Screening Questionnaire, DSQ) as a yardstick against which to measure doctors' correct and false positive recognition rates. In a nationwide study, primary care patients aged 15,99 in 633 doctors' offices completed a self-report packet that included the DSQ, a questionnaire that assesses depression symptoms on a three-point scale to provide diagnoses of depression according to the criteria of DSM-IV and ICD-10. Doctors completed an evaluation form for each patient seen, reporting the patient's depression status, clinical severity, and treatment choices. Predictor analyses are based on 16,909 patient-doctor records. Covariates examined included depression symptoms, the total DSQ score, number and persistence of depression items endorsed, patient's prior treatment, history of depression, age and gender. According to the DSQ, 11.3% of patients received a diagnosis of ICD-10 depression, 58.9% of which were correctly identified by the doctor as definite threshold, and 26.2% as definite subthreshold cases. However, an additional 11.7% of patients not meeting the minimum DSQ threshold were rated by their doctors as definitely having depression (the false positive rate). Specific DSQ depression items endorsed, a higher DSQ total score, more two-week depression symptoms endorsed, female gender, higher age, and patient's prior treatment were all associated with an elevated rate of false positive diagnoses. The probability of false positive diagnoses was shown to be affected more by doctors ignoring the ,duration of symptoms' criterion than by doctors not following the ,number of symptoms' criterion for an ICD or DSM diagnosis of depression. A model selection procedure revealed that it is sufficient to regress the ,false positive diagnoses' on the DSQ-total score, symptoms of depressed mood, loss of interest, and suicidal ideation; higher age; and patient's prior treatment. Further, the total DSQ score was less important in prediction if there was a prior treatment. The predictive value of this model was quite good, with area under the ROC-curve = 0.86. When primary care doctors use depression screening instruments they are oversensitive to the diagnosis of depression. This is due to not strictly obeying the two weeks duration required by the diagnostic criteria of ICD-10 and DSM-IV. False positive rates are further increased in particular by the doctor's knowledge of a patient's prior treatment history as well as the presence of a few specific depression symptoms. Copyright © 2000 Whurr Publishers Ltd. [source] Retrospective study of fever in dogs: laboratory testing, diagnoses and influence of prior treatmentJOURNAL OF SMALL ANIMAL PRACTICE, Issue 7 2006I. A. Battersby Objectives: To analyse the demographic information of dogs referred for investigation of fever, to determine the usefulness of various diagnostic investigations and to assess the effect of treatment before referral on the presence of fever at referral, the duration of the investigation and the ability to reach a final diagnosis. Methods: The clinical records of 66 dogs, in which fever was part of the clinical signs documented by the referring veterinary surgeon, were reviewed. The effects of treatment 24 hours before referral on temperature at initial consultation and on time to diagnosis were evaluated. The effect of body temperature at initial consultation on cost and on time to diagnosis was also determined. The effect of insurance on costs incurred was assessed. The utility of different diagnostic investigations was recorded, and cases were classified according to the final diagnosis. Results: Only 34·8 per cent of dogs were diagnosed with immune-mediated disease, with most frequent diagnoses being steroid-responsive meningitis and polyarthritis. Treatment 24 hours before referral significantly increased the time to diagnosis (P=0·004) and affected the presence of fever at referral (P=0·006). Insurance status did not significantly affect cost incurred by the owner. Clinical Significance: This study documents a high incidence of immune-mediated disease in dogs referred for investigation of fever. It also documents a higher incidence of inflammatory central nervous system disease in febrile dogs than that reported previously. Of the diagnostic modalities employed in the majority of cases, radiography, cytology and bacteriological and fungal cultures (fluids/tissues) were the most useful. It is suggested that treatment is withdrawn or withheld before commencing diagnostic investigation of fever. [source] Antecedent Ethanol Attenuates Cerebral Ischemia/Reperfusion-Induced Leukocyte-Endothelial Adhesive Interactions and Delayed Neuronal Death: Role of Large Conductance, Ca2+ -activated K+ ChannelsMICROCIRCULATION, Issue 6 2010QUN WANG Please cite this paper as: Wang, Kalogeris, Wang, Jones and Korthuis (2010). Antecedent Ethanol Attenuates Cerebral Ischemia/Reperfusion-Induced Leukocyte-Endothelial Adhesive Interactions and Delayed Neuronal Death: Role of Large Conductance, Ca2+ -activated K+ Channels. Microcirculation17(6), 427,438. Abstract EtOH-PC reduces postischemic neuronal injury in response to cerebral (I/R). We examined the mechanism underlying this protective effect by determining (i) whether it was associated with a decrease in I/R-induced leukocyte-endothelial adhesive interactions in postcapillary venules, and (ii) whether the protective effects were mediated by activation of large conductance, calcium-activated potassium (BKCa) channels. Mice were administered ethanol by gavage or treated with the BKCa channel opener, NS1619, 24 hours prior to I/R with or without prior treatment with the BKCa channel blocker, PX. Both CCA were occluded for 20 minutes followed by two and three hours of reperfusion, and rolling (LR) and adherent (LA) leukocytes were quantified in pial venules using intravital microscopy. The extent of DND, apoptosis and glial activation in hippocampus were assessed four days after I/R. Compared with sham, I/R elicited increases in LR and LA in pial venules and DND and apoptosis as well as glial activation in the hippocampus. These effects were attenuated by EtOH-PC or antecedent NS1619 administration, and this protection was reversed by prior treatment with PX. Our results support a role for BKCa channel activation in the neuroprotective effects of EtOH-PC in cerebral I/R. [source] Treating Pain Patients at Risk: Evaluation of a Screening Tool in Opioid-Treated Pain Patients With and Without AddictionPAIN MEDICINE, Issue 2 2003FACP, Robert Friedman MD ABSTRACT Patients receiving opioid treatment for chronic pain, many of whom were hospitalized with medical complications of substance abuse, were asked to complete a screening questionnaire to help validate a simple self-administered survey. Questions relating to tobacco abuse and prior treatment for drug and alcohol abuse distinguished patients with addiction and pain from opioid-treated chronic pain patients. [source] (216) Pain and Addiction: Screening Patients at RiskPAIN MEDICINE, Issue 3 2001Victor Li Introduction: Addictive disease is a common co-morbidity in chronic pain patients [1]. 26% of patients on methadone treatment believed that prescribed opioids led to their addiction [2]. We report initial validation of a Screening Tool for Addiction Risk (STAR). Methods: Questions based on prior studies of pain and addiction, addiction-screening tools [3,4], discussions with clinicians experienced in pain medicine and addiction, and our clinical experience were used to develop the STAR. After obtaining IRB approval, chronic pain patients completed the 14-item STAR questionnaire. 14 patients with chronic pain and history of drug addiction (DSM-IV Criteria) and 34 additional chronic pain patients completed the survey as part of their initial clinical evaluation. Patient responses were compared to determine which were questions accounted for statistically significant differences. Results: Questions related to respondent classification of addict based on chi-square analysis and Fisher's exact test were: prior treatment in a drug rehabilitation facility (p < 0.00001), nicotine use (p < 0.0032), feeling of excessive nicotine use (p < 0.0007), and treatment in another pain clinic (p < 0.018). A factor analysis linked addiction to first three questions mentioned above. Question: "Have you ever been treated in a drug or alcohol rehabilitation facility?" had a positive predictive value of 93% for addiction. Responses to recreational substance use, alcohol abuse, recent anxiety or depression, unemployment, emergency room visits, family history of drug or alcohol abuse, multiple physicians prescribing pain medication, or a prior history of physical or emotional abuse were not different between either patient group. Discussion: Screening for addiction is an important part of management of chronic pain patients. A history of treatment in drug or alcohol rehabilitation facility and questions related to cigarette smoking may be useful to screen for potential risk of addiction. Further investigations needed to validate results of this study. [source] Epitaxial strain energy measurements of GaN on sapphire by Raman spectroscopyPHYSICA STATUS SOLIDI (C) - CURRENT TOPICS IN SOLID STATE PHYSICS, Issue 7 2005H. J. Park Abstract This study reports a non-destructive method of measuring the residual strain in the GaN epilayer grown on sapphire substrate by micro-Raman spectroscopy. Operating in confocal mode this method allows a depth-dependent measurement of residual strain in the epitaxial layer without prior treatment of the sample. This approach to measurement of residual strain is demonstrated on GaN epitaxial films grown by both MOCVD and H-MOVPE. In the case of MOCVD grown films, the biaxial strain energy was found to vary from 0 (GaN surface) to 5.0 kJ/mole (GaN/sapphire interface), but in the case of H-MOVPE grown samples the strain energy varied from 6.5 kJ/mole , hydrostatic strain (GaN surface) to 25.0 kJ/mole , biaxial strain (GaN/sapphire interface), indicating that the surface layer of the N-terminated H-MOVPE material is not free from strain. Estimates are given for the curvature of substrate, lattice parameter of epitaxial layer, and the interface shear modulus. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Safety of Modified Radical Neck Dissection for Differentiated Thyroid Carcinoma,THE LARYNGOSCOPE, Issue 3 2004Michael E. Kupferman MD Abstract Objectives/Hypothesis The management of cervical metastases from differentiated thyroid carcinoma (DTC) remains controversial. Most surgeons perform a neck dissection (ND) for clinically apparent disease. The extent of nodal dissection varies from regional to comprehensive. Morbidity from ND in the setting of DTC remains high, particularly when performed in the setting of a thyroidectomy (TT). To determine complications from ND for DTC, we retrospectively reviewed our surgical experience of modified radical neck dissection for nodal metastases. Study Design Retrospective chart review. Methods Between 1997 and 2002, 39 consecutive patients (31 females and 8 males) underwent 44 comprehensive NDs of levels II,V for DTC. Central compartment dissection (CCD) (levels VI and VII) was also performed during 23 of these procedures. Twenty (45.5%) patients had prior treatment elsewhere. Preoperative pathology revealed papillary carcinoma in 22 patients (56.4%), tall cell variant in 11 (28.2%), and follicular variant in 6 (15.4%). Results Ten patients (20%) underwent ND alone, whereas 6 (14%) underwent simultaneous ND and TT. Fifteen patients underwent simultaneous ND, TT, and CCD (30%). Temporary hypocalcemia occurred after 21% of NDs that were performed in the setting of either TT or CCD or both. There were no cases of permanent hypoparathyroidism. Transient regional lymph node (RLN) paresis occurred in two patients and was associated with a concomitant central compartment nodal dissection; there were no permanent RLN palsies. Transient spinal accessory nerve paresis developed after 27% of NDs performed. Two patients developed chyle leaks. Conclusions When ND is necessary for the treatment of thyroid malignancies, the procedure can be performed safely with acceptable morbidity. [source] Endoscopic Staple Diverticulostomy for Recurrent Zenker's Diverticulum,THE LARYNGOSCOPE, Issue 1 2003Richard L. Scher MD Abstract Objectives The purpose of this study was to evaluate the technical feasibility, effectiveness, and morbidity of using endoscopic staple diverticulostomy (ESD) as treatment for Zenker's diverticulum (ZD) recurring after either prior endoscopic treatment or external diverticulectomy or diverticulopexy. Study Design A retrospective review of a case series of 18 patients with recurrent ZD. Methods All patients cared for with ZD were evaluated to identify those patients with recurrent ZD. The clinical records of patients with recurrent ZD were reviewed for: demographics, prior treatment, time to recurrence, factors associated with recurrence, technical feasibility of treatment, complications, effectiveness and duration of symptom relief. Results Between March 1995 and July 2001, a total of 127 consecutive patients with ZD received care. Eighteen of these patients were treated for recurrent ZD: nine treated originally by ESD, and nine by external approach (seven by diverticulectomy and two by diverticulopexy), with three of these patients treated twice. Seventeen patients had partial or complete relief of symptoms after their initial treatment, with recurrence of symptoms noted 0 to 60 months later. Specific factors associated with recurrence of symptoms were identified in only one patient. Treatment of recurrent ZD by ESD was technically feasible in 16 of the patients. Complete or improved symptom relief has been reported by 16 of the patients after revision ESD, with follow-up from 9 to 69 months. No significant treatment complications occurred. Fifteen patients resumed clear liquid diet on the day of surgery, and one on the day after surgery. All patients were discharged from the hospital by the second postoperative day (mean = 0.6 d). Conclusions ESD is an effective, technically feasible, and safe treatment for patients with ZD recurring after prior endoscopic or external treatment, and it should be the initial treatment of choice for these patients. [source] A novel, spontaneously immortalized, human prostate cancer cell line, Bob, offers a unique model for pre-clinical prostate cancer studies,THE PROSTATE, Issue 14 2009Gerhardt Attard Abstract INTRODUCTION New in vitro models of castration-resistant prostate cancer (CRPC) are urgently required. METHODS Trans-rectal needle biopsies (TRBP) of the prostate were performed for research purposes on progressing CRPC patients who had not received prior treatment to the prostate. Biopsies were immediately digested with collagenase and plated onto collagen-coated flasks with a feeder layer of 3T6 cells and cultured in cytokine-supplemented keratinocyte serum-free medium. RESULTS Biopsies from 25 patients were collected and one of these, following an initial period of crisis, spontaneously immortalized. A series of cell lines called Bob were then established from a clone that survived CD133-selection followed by 4 weeks under adhesion-independent conditions in methylcellulose. Gains and losses previously described in clinical prostate tumors, most notably loss of 8(p) and gain of 8(q), were identified on comparative genomic hybridization and long-term growth in culture, survival in methylcellulose and invasion through matrigel confirmed the malignant phenotype of Bob. Furthermore, Bob expressed high levels of p53 and markers of early differentiation, including K8, prostatic acid phosphatase and prostate stem cell antigen. There was, however, no in vivo growth and ERG and ETV1 were not rearranged. Growth in serum permitted some differentiation. CONCLUSION This is the first spontaneously immortalized prostate cancer cell line to be established from a TRBP of a patient with CRPC. Bob is a novel pre-clinical model for functional studies in CRPC and especially for studying the CRPC "basal" phenotype. Prostate 69: 1507,1520, 2009. © 2009 Wiley-Liss, Inc. [source] Retrospective review of mitomycin C use as third-line chemotherapy in metastatic colorectal cancerASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2008Wei CHUA Abstract The aim of this review was to determine the therapeutic value of the combination of mitomycin C with either infusional 5-fluorouracil or oral capecitabine in metastatic colorectal cancer when used as third-line treatment or beyond in the setting of routine clinical practice. We retrospectively reviewed 18 patients with advanced colorectal cancer who received this combination at our institution after the failure of two lines of prior treatment. All the patients were assessable for toxicity and survival and 14 for tumor response. The median age of the patients was 61 (range 39,78). Of these, 72% were male and 78% had Eastern Cooperative Oncology Group performance status 0 or 1. Eighty nine percent of the patients had metastatic involvement of the liver and five patients had at least three sites of metastatic involvement. All patients had received at least two lines of chemotherapy and had progressed on an oxaliplatin-containing regimen. Most of the patients had previously received an irinotecan-containing regimen, and a third had received prior biological agents. Overall, none of the patients achieved either complete or partial responses. Two patients (11%) achieved stable disease and 12 patients (67%) had progressive disease. The median progression-free survival was 2.7 months (range 0.5,8.8) and the median overall survival was 5.4 months (range 1.3,31.2). This chemotherapy regimen was well tolerated with an acceptable toxicity profile. The results of our review confirm the low efficacy of combination mitomycin C in heavily pretreated Australian patients with advanced colorectal cancer. This review confirms that it has no role after two lines of modern combination chemotherapy regimens and recommends that focus should be placed on investigating newer agents for good performance status patients progressing after these treatments. [source] Electrophysiological effects of 5-hydroxytryptamine on isolated human atrial myocytes, and the influence of chronic , -adrenoceptor blockadeBRITISH JOURNAL OF PHARMACOLOGY, Issue 8 2003Davide Pau 5-Hydroxytryptamine (5-HT) has been postulated to play a proarrhythmic role in the human atria via stimulation of 5-HT4 receptors. The aims of this study were to examine the effects of 5-HT on the L-type Ca2+ current (ICaL) action potential duration (APD), the effective refractory period (ERP) and arrhythmic activity in human atrial cells, and to assess the effects of prior treatment with , -adrenoceptor antagonists. Isolated myocytes, from the right atrial appendage of 27 consenting patients undergoing cardiac surgery who were in sinus rhythm, were studied using the whole-cell perforated patch-clamp technique at 37°C. 5-HT (1 nM,10 ,M) caused a concentration-dependent increase in ICaL, which was potentiated in cells from , -blocked (maximum response to 5-HT, Emax=299±12% increase above control) compared to non- , -blocked patients (Emax=220±6%, P<0.05), but with no change in either the potency (log EC50: ,7.09±0.07 vs ,7.26±0.06) or Hill coefficient (nH: 1.5±0.6 vs 1.5±0.3) of the 5-HT concentration,response curve. 5-HT (10 ,M) produced a greater increase in the APD at 50% repolarisation (APD50) in cells from , -blocked patients (of 37±10 ms, i.e. 589±197%) vs non- , -blocked patients (of 10±4 ms, i.e. 157±54%; P<0.05). Both the APD90 and the ERP were unaffected by 5-HT. Arrhythmic activity was observed in response to 5-HT in five of 17 cells (29%) studied from , -blocked, compared to zero of 16 cells from the non- , -blocked patients (P<0.05). In summary, the 5-HT-induced increase in calcium current was associated with a prolonged early plateau phase of repolarisation, but not late repolarisation or refractoriness, and the enhancement of these effects by chronic , -adrenoceptor blockade was associated with arrhythmic potential. British Journal of Pharmacology (2003) 140, 1434,1441. doi:10.1038/sj.bjp.0705553 [source] Five-year lung cancer survivalCANCER, Issue 6 2010Which advanced stage nonsmall cell lung cancer patients attain long-term survival? Abstract BACKGROUND: The core strategy of American College of Chest Physicians lung cancer guidelines is identification of the earliest symptoms of lung cancer and the immediate initiation of diagnosis and treatment. In the absence of screening, most symptomatic lung cancer is discovered at advanced stages, with the goal of long-term survival entirely dependent on effective treatment of stage III and IV lung cancer. METHODS: In a retrospective review, all patients diagnosed with stage IIIA, IIIB, and IV nonsmall cell lung cancer (NSCLC) between the years 1986 and 2001 at City of Hope National Medical Center who survived 5 years or longer were analyzed to identify parameters that might predict long-term survival. RESULTS: Of 846 patients presenting with stage III or IV disease, 56 (6.6%) survived 5 years or longer. Sixteen patients died of primary tumor progression beyond 5 years. Two 5-year survivors died of second tobacco-caused neoplasms, and 16 died from medical conditions potentially related to prior treatment. A substantial majority of survivors were from specific pathologic subsets including: 1) resectable N2 disease (n = 17, 30.4%), 2) multiple lung tumors (n = 7, 12.5%), 3) T3N0 (n = 5, 8.1%), and 4) single site distant metastasis (n = 8, 14.2%). CONCLUSIONS: Despite aggressive multimodality therapy, 5-year survival in patients with advanced stage NSCLC was very poor and limited to small pathological subsets. Patients with advanced stage NSCLC who did not belong to 1 of these subsets had a small chance of long-term survival. Cancer 2010. © 2010 American Cancer Society. [source] Health status of the oldest adult survivors of cancer during childhood,,CANCER, Issue 2 2010Lisa B Kenney MD Abstract BACKGROUND: Young adult survivors of childhood cancer have an increased risk for treatment-related morbidity and mortality. In this study, the authors assessed how treatment for childhood cancer affects older-adult health and health practices. METHODS: One hundred seven adults treated for childhood cancer between 1947 and 1968, known to have survived past age 50 years, were identified from a single-institution cohort established in 1975. Updated vital status on eligible cases was obtained from public records. Survivors and a control group of their age-matched siblings and cousins completed a mailed survey to assess physical and social function, healthcare practices, and the prevalence of common adult illnesses. RESULTS: Of the 107 survivors known to be alive at age 50 years, 16 were deceased at follow-up; 7 deaths could be associated with prior treatment (second malignancy in radiation field [3], small bowel obstruction after abdominal radiation [2], and cardiac disease after chest irradiation [2]). The 55 survivors (median age, 56 years; range, 51-71 years), and 32 family controls (median age, 58 years; range, 48-70 years), reported similar health practices, health-related quality of life, and social function. However, survivors reported more frequent visits to healthcare providers (P < .05), more physical impairments (P < .05), fatigue (P = .02), hypertension (P = .001), and coronary artery disease (P = .01). An increased risk of hypertension was associated with nephrectomy during childhood (odds ratio, 18.9; 95% confidence interval, 3.0-118.8). CONCLUSIONS: The oldest adult survivors of childhood cancer continue to be at risk for treatment-related complications that potentially decrease their life expectancy and compromise their quality of life. Cancer 2010. © 2010 American Cancer Society. [source] Vincristine sulfate liposomes injection (Marqibo) in heavily pretreated patients with refractory aggressive non-Hodgkin lymphoma,CANCER, Issue 15 2009Report of the Pivotal Phase 2 Study Abstract BACKGROUND: Marqibo, a sphingosomal/cholesterol encapsulation of vincristine sulfate has targeted, increased, and sustained delivery of vincristine to tumor tissues. A phase 2, open-label, single-arm, and multinational study evaluated the efficacy and tolerability of Marqibo as a single agent in patients with multiply relapsed or refractory aggressive non-Hodgkin lymphoma (NHL). METHODS: Eligible patients had relapsed or refractory de novo or transformed aggressive NHL and prior treatment with at least 2 multiagent chemotherapy regimens. Marqibo was administered at 2 mg/m2, every 2 weeks, for a maximum of 12 cycles or until toxicity or disease progression. RESULTS: One hundred and nineteen patients were enrolled and treated on trial. Ninety-six had histological confirmed de novo (N = 89) or transformed (N = 7) aggressive NHL. Median number of cycles was 4 (median dose/cycle 4 mg). Overall response (CR and complete response unconfirmed and PR) was 25% (95% confidence interval [CI], 17, 35), CR and complete response unconfirmed confirmed by external reviewers was 5%. Median overall survival was 6.6 months (Kaplan-Meier estimate, 95% CI, 4.7, 9.8). Grade 3 of 4 neurotoxicity occurred in 32% of patients. All patients had prior neurotoxic agents, and 85% had baseline residual neuropathy symptoms (grades 1-2) from prior treatment. CONCLUSIONS: Marqibo is an active agent in patients with heavily pretreated aggressive NHL, and tolerated at approximately twice the dose intensity of standard vincristine. Its activity supports further investigation as a substitution for vincristine in combination treatment of lymphoid disorders. Cancer 2009. © 2009 American Cancer Society. [source] Effect of intravitreal bevacizumab (Avastin®) in neovascular age-related macular degeneration using a treatment regimen based on optical coherence tomography: 6- and 12-month resultsACTA OPHTHALMOLOGICA, Issue 5 2010Christina Leydolt Abstract. Purpose:, To study the effect of intravitreal bevacizumab therapy on visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) within a follow-up period of 6 and 12 months. Methods:, A retrospective analysis of 102 eyes of 102 consecutive patients with neovascular AMD evaluated repeated intravitreal bevacizumab (1 or 2.5 mg) injections. Retreatment was performed following an optical coherence tomography (OCT)-based regimen. Ophthalmic examination included best-corrected visual acuity (BCVA), dilated fundus examination and OCT imaging. Data were analysed at baseline, 6 months (24 weeks) and 12 months (48 weeks) after treatment initiation. Results:, BCVA remained stable at 6 months (mean: 0.00 ± 0.41 logMAR; p = 0.95) and 12 months (mean: +0.02 ± 0.43 logMAR; loss of , 1 letter; p = 0.70) after the first treatment. OCT retinal thickness decreased by a mean of ,37.8 ± 101.6 ,m (p < 0.05) compared to baseline at month 6 and ,38.6 ± 93.3 ,m (p < 0.05) at month 12. A mean of 2.6 ± 1.2 injections were needed to obtain absence of fluid by OCT, and the time to recurrence was 23 ± 11 weeks thereafter. There was no difference in BCVA and OCT outcomes between treatment-naive eyes and eyes that had undergone prior treatment. Conclusion:, The 6- and 12-month follow-up of repeated intravitreal bevacizumab therapy in eyes with neovascular AMD demonstrated stabilization of vision and no safety concerns. An OCT-based retreatment strategy appears appropriate in the management of patients treated with intravitreal bevacizumab. [source] Mohs' micrographic surgery for basal cell carcinomas on the eyelids and medial canthal area.ACTA OPHTHALMOLOGICA, Issue 4 2000ABSTRACT. Purpose: To report our experience of reconstruction and follow-up of eyelid basal cell carcinomas treated with Mohs' micrographic technique. Methods: Sixty-four periocular basal cell carcinomas, with a high risk of recurrence in one or more aspects with regard to location, size, morphology or prior treatment, were excised using Mohs' micrographic technique. All ensuing defects were repaired. The cases were followed prospectively for up to ten years. All complications and interventions were documented during the follow-up period. Results: The average size of the defect before repair was 21 mm (range 5,45 mm). The mean follow-up time was 49 months (range 3,120). The recurrence rate was 5% (3 of 64 cases). The three recurrences occurred after one, four and six years, respectively. Conclusions: The recurrence rate of high risk tumours reported in this study was less than reported with other modes of treatment and comparable with that in other studies using Mohs' micrographic technique. [source] Inference for two-stage adaptive treatment strategies using mixture distributionsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES C (APPLIED STATISTICS), Issue 1 2010Abdus S. Wahed Summary., Treatment of complex diseases such as cancer, leukaemia, acquired immune deficiency syndrome and depression usually follows complex treatment regimes consisting of time varying multiple courses of the same or different treatments. The goal is to achieve the largest overall benefit defined by a common end point such as survival. Adaptive treatment strategy refers to a sequence of treatments that are applied at different stages of therapy based on the individual's history of covariates and intermediate responses to the earlier treatments. However, in many cases treatment assignment depends only on intermediate response and prior treatments. Clinical trials are often designed to compare two or more adaptive treatment strategies. A common approach that is used in these trials is sequential randomization. Patients are randomized on entry into available first-stage treatments and then on the basis of the response to the initial treatments are randomized to second-stage treatments, and so on. The analysis often ignores this feature of randomization and frequently conducts separate analysis for each stage. Recent literature suggested several semiparametric and Bayesian methods for inference related to adaptive treatment strategies from sequentially randomized trials. We develop a parametric approach using mixture distributions to model the survival times under different adaptive treatment strategies. We show that the estimators proposed are asymptotically unbiased and can be easily implemented by using existing routines in statistical software packages. [source] | ||||||||||||||||||||||||||||||||||