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Systematic Collection (systematic + collection)
Selected AbstractsAdult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivorsCLINICAL ENDOCRINOLOGY, Issue 6 2005Andreas Jostel Summary Objective, Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data. Design, In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12,18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study. Patients, All brain tumour survivors who received AGHRT (60 patients) were included in the analysis. Measurements, Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan. Results, All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration ± SD of GHRT was 6·7 ± 3·6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17·4 ± 8·3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7·7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0·02). All SNs occurred on average 22·8 (range 17,37) years after radiotherapy. Conclusions, Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future. [source] Correcting sinners, correcting texts: a context for the Paenitentiale pseudo-TheodoriEARLY MEDIEVAL EUROPE, Issue 1 2006Carine Van Rhijn This article presents the preliminary results of an investigation into the history of the Penitential of Pseudo-Theodore. It outlines the text's manu-script history, the scope of its contents, and its sources, arguing that it was a comprehensive, systematic collection. It also reconsiders the evidence for when and where it was composed, suggesting it was probably written in north-eastern France or the eastern Rhineland in the 820s or 830s. [source] Heroin-assisted treatment in Switzerland: a case study in policy changeADDICTION, Issue 1 2010Ambros Uchtenhagen ABSTRACT Background Switzerland introduced a pragmatic national drug policy when the former conservative abstinence-orientated politics proved unable to cope with an escalating number of users and related negative consequences for public health and public order. The high visibility of ,needle parks' and the size of the acquired immune deficiency disorder (AIDS) epidemic called for a new approach and for national leadership. Aims To describe the intentions, the process and the results of setting up the new treatment approach of prescribing heroin to treatment resistant heroin addicts, as an example of drug policy change. Materials and Methods A systematic collection of relevant documents is analysed and used as evidence for describing the process of policy change. Results Measures to reduce the negative consequences of continued use and to prevent the spread of AIDS were started mainly by private initiatives and soon taken up officially in the ,four-pillar' drug policy (including harm reduction, prevention, treatment and law enforcement). Medical prescription of heroin to chronic, treatment-resistant heroin addicts was one of the innovations, based on extensive scientific and political preparation. Detailed documentation and evaluation, ample communication of results, adaptations made on the basis of results and extensive public debate helped to consolidate the new policy and heroin-assisted treatment, in spite of its limitations as an observational cohort study. All necessary steps were taken to proceed from a scientific experiment to a routine procedure. Discussion Comparable policy changes have been observed in a few other countries, such as The Netherlands and Germany, based on the Swiss experience, with equally positive results of heroin-assisted treatment. These experiments were designed as randomised controlled trials, comparing intravenous heroin against oral methadone, thereby demonstrating the specific value of pharmaceutical diamorphine for maintenance treatment in opiate dependence. The positive impact of policy change and the positive outcomes of heroin-assisted treatment were acknowledged increasingly nationally and internationally, but made it difficult to continue the process of adapting policy to new challenges, due to the low visibility of present drug problems and to changing political priorities. Conclusion A major change in drug policy was effectively realised under typical conditions of a federalist country with a longstanding tradition of democratic consensus building. Facilitating factors were the size and visibility of the heroin problem, the rise of the Aids epidemic, and a pragmatic attitude of tolerating private initiatives opening the way to official policy change. [source] Treatment of osteoporosis: facing the challenges in the Asia-PacificINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 4 2008Syed Atiqul HAQ Abstract The prevalence of osteoporosis and fractures is projected to increase rapidly in the Asia-Pacific region in coming decades. At the societal level, healthcare providers will face the challenges of paucity of information, lack of awareness among physicians, resource constraints, lack of organization, absence of policies of cost reimbursement, insufficient representation of the problem in curricula and lack of effective, inexpensive and convenient therapy. Poverty, illiteracy, lack of awareness and interest in future quality of life, and co-morbidities with seemingly greater importance, will all act as challenges at the level of individual patients. Lack of compliance is a function of lack of awareness and motivation, cost, complexity of administration, side-effects and absence of immediately perceivable benefit. The challenges may be overcome through systematic collection of data, formation or activation of national osteoporosis planning and coordinating groups, development of national guidelines, programs of education of healthcare providers, patients and the general public, adoption of a population-based prevention strategy, cost-effective opportunistic screening using clinical decision rules like the osteoporosis self-assessment tool for Asians, use of the fracture risk assessment tool for therapeutic decision-making, giving due emphasis to the problem in curricula and development of mechanisms for cost reimbursement. The Asia-Pacific League of Associations for Rheumatology may take a lead in stimulating, organizing and coordinating these activities. [source] Harnessing experience: exploring the gap between evidence-based medicine and clinical practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2008M. Cameron Hay PhD Abstract Rationale, aims and objectives, There is mounting evidence of a gap between Evidence-based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and ,real world' patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice. Methods, We report on the findings of a pilot study of 29 individual and three focus group (n = 10) interviews exploring physicians' evaluations how they use multiple sources of information in clinical decision making and their thoughts on EF. Results, Physicians recognize a gap in translating EBM to practice. Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and EBM summarizing electronic clinical resources rather than refer directly to EBM literature. Confidence in making decisions based on clinical experience increases over time, yet few physicians reported having systems for tracking their clinical experience in designing treatment plans and patient outcomes. Most physicians saw EF as a promising way to track experience, thereby making scientific evidence more relevant to their own clinical practices. Conclusion, Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM. [source] Knowing What Works: Program EvaluationNEW DIRECTIONS FOR STUDENT SERVICES, Issue 90 2000Margaret A. Healy Program evaluation is a critical step in effective program planning. The programmer needs to know whether and how students change as a result of educational experiences. Through a systematic collection of data, the programmer gathers evidence of how programs help students meet their learning objectives and fulfill institutional goals. Further, the results of program evaluation can inform the next program planning cycle. [source] Clinical presentation, pathological features and natural course of metastatic uveal melanoma (MUM) as an orphan and commonly fatal diseaseACTA OPHTHALMOLOGICA, Issue 2009R VAN GINDERDEUREN Purpose Uveal melanoma (UM) is a rare disease characterized by an unpredictable course and variable outcome ranging from cure by local treatment to the occurrence of untreatable metastasis. The current project is focused on the characteristics of the metastatic phenotype of the disease Methods We performed data collection from 76 pts with MUM treated in Leuven between 1957-2008. Statistical analysis involved nonparametric technics, Kaplan Meyer and log rank test Results The median age at diagnosis of UM was 58 yrs (range 30-94). Common initial treatments were surgery (71%), brachytherapy (20%) and external beam RT (7%). Synchronous metastasis was found in only 9% of cases, all others had metachronous disease after a median interval of 40 mo (range, 7-420). Metastasis in >1 organ, was seen in 47% of cases. The most frequent metastatic site was the liver (96%), followed by lung, subcutaneous, bone and brain lesions. The median OS from diagnosis of UM was 46 months (range, 2-182), and only 4,5 months in pts with MUM (range, 1-128). 65% of MUM pts qualified for further treatment, The most common drugs given were DTIC, cisplatin, tamoxifen or phase I agents. Patient benefit (PR+SD) was seen in 16/45 pts (36%), including 2 PR Conclusion In this orphan disease with female predominance metastasis occurs late, is mainly found to the liver, and is associated with high morbidity, as >1/3 of pts do not qualify for further therapy. Advances in MUM can only be achieved by networking of sites interested in this tumour type with systematic collection of data and tissue to improve our understanding of the molecular biology of the disease [source] Reviewing child deaths,learning from the American experience,CHILD ABUSE REVIEW, Issue 2 2005Lisa Bunting Abstract Current systems for investigating child deaths in England, Wales and Northern Ireland have come under intense scrutiny in recent years and questions have been raised about the accuracy of child death investigations and resulting statistics. Research has highlighted the ways in which multidisciplinary input can contribute to investigative and review processes, a perspective which is further supported by recent UK policy developments. The experience of creating multidisciplinary child death review teams (CDRTs) in America highlights the potential benefits the introduction of a similar system might have. These benefits include improved multi-agency working and communication, more effective identification of suspicious cases, a decrease in inadequate death certification and a broader and more in-depth understanding of the causes of child deaths through the systematic collection and analysis of data. While a lack of funding, regional coordination and evaluation limit the impact of American CDRTs, the positive aspects of this process make it worthwhile, and timely, to consider how such a model might fit within our own context. Current policy developments such as the Home Office review of coroner services, the Children Bill and related Department for Education and Skills (DfES) work on developing screening groups demonstrate that strides have been made in respect of introducing a multidisciplinary process. Similarly, the development of local protocols for the investigation and[sol ]or review of child deaths in England, Wales and Northern Ireland highlights an increased focus on multidisciplinary processes. However, key issues from the American experience, such as the remit of CDRTs[sol ]screening panels, the need for national coordination and the importance of rigorous evaluation, can inform the development of a similar process in the UK. Copyright © 2005 John Wiley & Sons, Ltd. [source] | |||||||||||||