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Treatment Variables (treatment + variable)
Selected AbstractsDoes hormonal manipulation in conjunction with permanent interstitial brachytherapy, with or without supplemental external beam irradiation, improve the biochemical outcome for men with intermediate or high-risk prostate cancer?BJU INTERNATIONAL, Issue 1 2003G.S. Merrick OBJECTIVE To determine whether hormonal manipulation improves the biochemical outcome for men with intermediate or high-risk prostate cancer and undergoing permanent brachytherapy with or without supplemental external beam radiation therapy. PATIENTS AND METHODS From April 1995 to August 2000, 350 patients with intermediate-risk (225 men; a Gleason score of , 7 or a prostate specific antigen, PSA, level of , 10 ng/mL or clinical stage , T2b) or high-risk features (125 men; two or three of a Gleason score of , 7 or PSA , 10 ng/mL or clinical stage , T2b) underwent transperineal ultrasonography-guided permanent brachytherapy. No patient underwent pathological lymph node staging. Of these patients, 293 received supplemental external beam radiation therapy (EBRT), 141 received hormonal manipulation, with 82 having hormonal therapy for , 4 months (median 4) for cytoreduction, while 59 had neoadjuvant and adjuvant hormonal manipulation (median 8 and 12 months for intermediate- and high-risk, respectively). The median patient age was 68.5 years. No patient was lost to follow-up. The mean (sd) and median follow-up was 50 (18) and 49 months (calculated from the day of implantation). Biochemical disease-free (BDF) survival was defined using a consensus definition. The clinical variables evaluated for BDF survival included risk group, Gleason score, patient age, clinical T-stage and pretreatment PSA. Treatment variables included use of hormonal manipulation stratified into cytoreductive (, 4 months) vs adjuvant (> 4 months) regimens, supplemental EBRT, isotope and dosimetric variables. RESULTS For intermediate-risk patients, the 6-year actuarial BDF survival rates were 98%, 96% and 100% for hormone naïve, cytoreductive and adjuvant treatment, respectively (P = 0.693); for high-risk patients the respective values were 79%, 94% and 92% (P = 0.046). When stratified by pretreatment PSA, hormonal manipulation improved the outcome for patients with a PSA of , 10 ng/mL (P = 0.019), but not for those with < 10 ng/mL (P = 0.661). Hormonal status was not statistically significant in predicting biochemical outcome when stratified by Gleason score. The follow-up in hormone-naïve patients was significantly longer than that in hormonally manipulated patients, at 55 (20) vs 43 (15) months (P < 0.001). In a multivariate analysis only the Gleason score predicted failure in intermediate-risk patients, while pretreatment PSA, the use of hormonal manipulation and Gleason score predicted the outcome in high-risk patients (P = 0.035). For both hormone-naïve and hormonally manipulated BDF patients, the median PSA level after implantation was < 0.1 ng/mL. CONCLUSION In patients treated by permanent prostate brachytherapy, hormonal manipulation improved the biochemical outcome for those at high-risk and those with an initial PSA of , 10 ng/mL, but not for those with intermediate-risk features. The use of hormonal therapy for> 4 months conferred no additional biochemical advantage over short-course regimens. Because the follow-up in hormone-naïve patients was longer than that for those receiving hormonal manipulation, additional follow-up will be mandatory to confirm the durability of these findings. [source] The psychosocial impact of parental cancer on children and adolescents: a systematic reviewPSYCHO-ONCOLOGY, Issue 2 2007Tessa Osborn Abstract This review aimed to identify (i) whether early stage parental cancer is associated with an increased risk of psychosocial difficulties amongst children and adolescents; (ii) which factors are associated with variations in psychosocial functioning amongst these children and adolescents. Searches of four electronic databases and the reference lists of relevant articles revealed 10 studies which satisfied the inclusion criteria for the first review question and thirteen studies for the second. Limitations in methodological quality and modest numbers of studies examining the same variables, restricted the conclusions which could be drawn. Overall, the evidence suggests that children and adolescents do not generally experience elevated levels of serious psychosocial difficulties compared to reference groups, but they are at a slightly increased risk for internalising type problems. Adolescent daughters appear to be the most negatively affected group. The prevalent use of measures of child psychopathology may be masking more context-specific problems and lower levels of distress. Family variables, especially family communication/expressiveness, are consistently associated with child/adolescent psychosocial functioning and there is suggestive evidence for the role of maternal depression/adjustment and parenting variables. There is little evidence that medical/treatment variables are important predictors of child outcomes. These findings have implications for identifying families with children most in need of support and indicating variables to target in interventions. Copyright © 2007 John Wiley & Sons, Ltd. [source] Behavioral Facilitation of Medical Treatment of Headache: Implications of Noncompliance and Strategies for Improving AdherenceHEADACHE, Issue 2006Jeanetta C. Rains PhD Clinical recommendations were gleaned from a review of treatment adherence published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Nonadherence is prevalent among headache patients, undermines treatment efficacy, and should be considered as a treatment variable; (2) Calling patients to remind them of appointments and recalling those who miss a scheduled appointment are fundamentally the most cost-effective adherence-enhancing strategies, insofar as failed appointment-keeping acts as a ceiling on all future treatment and adherence efforts; (3) Simplified and tailored medication regimens improve adherence (eg, minimized number of medications and dosings, fixed-dose combinations, cue-dose training, stimulus control); (4) Screening and management of psychiatric comorbidities, especially depression and anxiety, is encouraged; (5) The concept of self-efficacy as a modifiable psychological process often can be employed to predict and improve adherence. [source] Consumer response to tobacco smoke in service settingsJOURNAL OF CONSUMER BEHAVIOUR, Issue 4 2010Frederic B. Kraft Establishing smoking policies which accommodate customers' smoking preferences is a major problem for restaurants, bars, hotels, and other firms in the service industry. This study is based on the premise that tobacco smoke can be considered a component of both the physical and ambient retail service environment. Because of legal and ethical concerns, the presence or absence of environmental tobacco smoke (ETS) in two types of eating facilities (bar and fine dining restaurant) was operationalized by the presentation to respondents of photographs which pictured customers in a setting where smoking was either present or absent. The success of this method of manipulation of the treatment variable was assessed with a thought listing procedure. Thought listing responses indicate that both treatments (type of facility and smoking policy) were adequately conveyed by the photographs. Results indicate that cognitive, emotional, and behavioral responses were all negatively affected by the presence of tobacco smoke. The conclusion is that managers who permit smoking in their facilities risk losing non-smoking patrons while smokers are little affected by either the presence or absence of smoke. The major contributions of this study include both the exploration of tobacco smoke as part of the retail service environment for eating establishments and the use of thought listings as a manipulation check for variables which were manipulated through use of photographs depicting the treatment conditions. Copyright © 2010 John Wiley & Sons, Ltd. [source] Intense Pulsed Light Treatment of Photoaged Facial SkinDERMATOLOGIC SURGERY, Issue 8 2004Douglas E. Kligman MD Background. It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines. Objective. The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system. Methods. Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases. Results. There was a shift in clinical grading from more to less severe on all three measures of photoaging. Conclusion. Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects. [source] Clinical findings and outcomes of ulcerative keratomycosis in 30 horses in the mid-Atlantic United States (2006,2007)EQUINE VETERINARY EDUCATION, Issue 1 2010M. E. Utter Summary The purpose of this study was to determine the clinical course and outcome associated with keratomycosis in horses in the mid-Atlantic USA. Records of horses diagnosed with keratomycosis at New Bolton Center from November 2006 to November 2007 with positive fungal culture were retrospectively studied. Neither horses with ulcerative keratitis and a negative fungal culture nor those with stromal abscesses were included. Subject details, history, clinical findings, therapy and outcome were recorded. Thirty horses fitted both inclusion criteria (diagnosis of keratomycosis and positive corneal fungal culture). Fourteen of 30 cases occurred during summer. Aspergillus was the most commonly cultured fungal genus (17/30, or 57%) followed by Alternaria (4/30). Seventeen horses had positive bacterial and fungal cultures. Fifteen of 30 horses were treated surgically by a keratectomy and amnion (8) or conjunctival (7) graft. Itraconazole was the most common topical anti-fungal therapy and was utilised in 25/30 horses. Globe survival was 97% (29/30). All surviving globes had a positive menace response and were visual at the last examination. It was concluded that in the mid-Atlantic USA, fungal keratitis is common, has the highest incidence in summer, and is usually associated with a positive outcome. Aspergillus may be a relatively more common corneal pathogen in this region than elsewhere in the USA. Surgical cases were more likely to have fungal hyphae identified on cytology and tended to be hospitalised longer than medical cases. There was no apparent association between surgical disease and all other patient, organism and treatment variables. [source] A multivariate analysis of the outcome of endodontic treatmentEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 3 2004Dag Ørstavik In the present study, multivariate analyses were performed on clinical and treatment variables that may influence the outcome of endodontic treatment. Data collected in a previous clinical-radiographic follow-up study were used. Of 810 treated, 675 roots in 498 teeth were followed for 6 months to 4 yr. Of these, 192 (the CAP group) had pre-existing, chronic apical periodontitis and 483 (the NAP group) had not. Root canal treatment followed a standard procedure with one of three sealers chosen at random. Demographic, clinical and radiographic variables were recorded at the start of, and during treatment. The periapical index (PAI) score was used to record the outcome of treatment, and applied in two different endpoint modes (END1 and END2) as the dependent variable for multivariate statistical analyses using logistic regression and the general model. The modes reflected increasing PAI scores (END1) and conventional success/failure assessment (END2). Dropouts were largely similar to the cases followed up. A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups. Several of these were not significant in univariate analyses (e.g. the effect of sealer). Conventional success/failure analyses (END2) identified fewer of the influential variables and had low explanatory power, whereas PAI scores on an ordinal scale (END1) were most sensitive in identifying variables of influence on the treatment outcome. [source] The effects of Daphnia on nutrient stoichiometry and filamentous cyanobacteria: a mesocosm experiment in a eutrophic lakeFRESHWATER BIOLOGY, Issue 7 2002M. J. PATERSON 1.,Stoichiometric theory predicts that the nitrogen : phosphorus (N : P) ratio of recycled nutrients should increase when P-rich zooplankton such as Daphnia become dominant. We used an enclosure study to test the hypothesis that an increased biomass of Daphnia will increase the relative availability of N versus P sufficiently to decrease the abundance of filamentous cyanobacteria. The experiment was conducted in artificially enriched Lake 227 (L227) in the Experimental Lakes Area (ELA), north-western Ontario, Canada. Previous studies in L227 have shown that the dominance of filamentous, N-fixing cyanobacteria is strongly affected by changes in the relative loading rates of N and P. 2.,We used a 2 × 2 factorial design with the addition or absence of D. pulicaria and high or low relative loading rates of N and P (+NH4, ,NH4) in small enclosures as treatment variables. If Daphnia can strongly affect filamentous cyanobacteria by altering N and P availability, these impacts should be greatest with low external N : P loading rates. The phytoplankton community of L227 was predominantly composed of filamentous Aphanizomenon spp. at the start of the experiment. 3.,Daphnia strongly reduced filamentous cyanobacterial density in all enclosures to which they were added. The addition of NH4 had only a small impact on algal community composition. Hence, we conclude that Daphnia did not cause reductions in cyanobacteria by altering the N : P ratio of available nutrients. 4.,Despite the lack of evidence that Daphnia affected filamentous cyanobacteria by altering the relative availability of N and P, we found changes in nutrient cycling consistent with other aspects of stoichiometric theory. In the presence of Daphnia, total P in the water column decreased because of an increase in P sedimentation. In contrast to P, a decrease in suspended particulate N was offset by an increase in dissolved N (especially NH4). Hence, dissolved and total N : P ratios in the water column increased with Daphnia as a result of differences in the fate of suspended particulate N versus P. There was minimal accumulation and storage of P in Daphnia biomass in the enclosures. 5.,Our experiment demonstrated that Daphnia can strongly limit filamentous cyanobacterial abundance and affect the biogeochemical cycling of nutrients. In our study, changes in nutrient cycling were apparently insufficient to cause the changes in phytoplankton community composition that we observed. Daphnia therefore limited filamentous cyanobacteria by other mechanisms. [source] Acute oral toxicity of colchicine in rats: effects of gender, vehicle matrix and pre-exposure to lipopolysaccharideJOURNAL OF APPLIED TOXICOLOGY, Issue 5 2007Paddy L. Wiesenfeld Abstract The oral toxicity of a single administration by gavage (10, 20 or 30 mg kg,1 body weight) of colchicine (COL) was determined in young, mature male and female Sprague-Dawley rats. The effect of COL was evaluated in the presence or absence of additional treatment variables that included vehicle and lipopolysaccharide (LPS) pre-exposure. The vehicle for COL was either Half and Half cream (H & H) or saline, and each group included pretreatment with either saline or a low, minimally toxic dose (83 µg kg,1 body weight) of LPS. Colchicine toxicity in both male and female age-matched rats was characterized by progressively more severe dose-related clinical signs of toxicity. These included mortality, decreased body weight and feed intake during the first several days after dosing, with recovery thereafter in surviving animals. There were differences in the severity of the toxic response to COL between male and female rats. The most notable sex-related difference was in COL lethality. Female rats were two times more susceptible to the lethal effects of COL than male rats. Saline or H & H delivery vehicles did not result in any apparent qualitative or quantitative differences in COL toxicity. LPS pretreatment significantly potentiated COL lethality in both males and females, although the potentiation in males was greater than in females. LPS pretreatment modestly increased the COL induced anorexic effect in surviving males, but not in surviving female animals. LPS did not appear to modulate either the body weights or clinical signs of COL induced toxicity in surviving males or females. Copyright © 2007 John Wiley & Sons, Ltd. [source] Antifungal Activity Stability of Flaxseed Protein Extract Using Response Surface MethodologyJOURNAL OF FOOD SCIENCE, Issue 1 2008Y. Xu ABSTRACT:, The stability of the antifungal activity of flaxseed (Linum usitatissimum) protein extract was evaluated in this study. Response surface methodology (RSM) using Box,Behnken factorial design was used to evaluate the effects of treatment variables, that is, temperature (50 to 90 °C), time (1 to 29 min), and pH (2 to 8), on the residual antifungal activity (RAA) against Penicillium chrysogenum, Fusarium graminearum, Aspergillus flavus, and a Penicillium sp. isolated from moldy noodles. Regression analyses suggested that the linear terms of the temperature and time had significant (P < 0.05) negative effects on the RAA against all test fungi, whereas that of pH had a significant (P < 0.1) positive role on the RAA of all 3 fungi. In addition, the RAA was significantly (P < 0.05) affected by the quadratic terms of time for all fungi, and the quadratic term of temperature played a significant (P < 0.1) role on RAA against F. graminearum. One interaction term (temperature-pH) was found to significantly (P < 0.1) affect the RAA against both Penicillium strains tested. The results indicated that , 90% antifungal activity was lost after the protein extracts were heated at 90 °C for 8 min except for F. graminearum. At pasteurization condition, , 50% activity was retained except for P. chrysogenum. The results also suggested that neutral and alkaline pH favored the antifungal activity stability of the protein extracts. Thus, flaxseed protein might be promising if used as a preservative in foods with neutral or alkaline pH requiring mild heat treatments. [source] Family, demographic and illness-related determinants of HRQL in children with brain tumours in the first year after diagnosis,PEDIATRIC BLOOD & CANCER, Issue 6 2009Anthony Penn MBBCh, MRCPCH Abstract Aims To evaluate the relationship between parent- and child-report Health-Related Quality of Life (HRQL) and demographic, tumour and family variables in children with a brain tumour in the first year after diagnosis and to identify determinants of HRQL at 12 months. Procedure Longitudinal prospective study: Semi-structured interviews took place approximately 1, 6 and 12 months after diagnosis. HRQL was measured using the self- and parent-report PedsQL 4.0 Total Scale Score. Tumour and treatment variables considered included tumour site and grade, hydrocephalus at diagnosis, chemotherapy and radiotherapy. Family variables included measures of family function, family support and family stress, the primary carer's coping strategies and symptoms of depression and anxiety. Univariate analyses were used at all three time points, and to identify potential early predictors of HRQL at 1 year. Regression analysis was then used to identify the most important determinants of HRQL at 1 year. Results Thirty-five patients completed the 12-month interviews. There were consistent significant negative correlations between concurrent family impact of illness and parent and self-report HRQL, and positive correlations between concurrent family support and parent-report HRQL. Treatment with radio- or chemotherapy correlated with child-report HRQL only at some time points. Multivariate analysis showed infratentorial tumour site, and poor HRQL at 1 month best predicted poor self- and parent-report HRQL at 12 months. Conclusion Children with infratentorial tumours and poor HRQL early after diagnosis tend to have poor HRQL at 1 year. While family factors are important modulators of concurrent HRQL, they do not appear important in predicting HRQL. Pediatr Blood Cancer 2009;53:1092,1099. © 2009 Wiley-Liss, Inc. [source] Posttrauamatic stress disorder (PTSD) in young adult survivors of childhood cancerPEDIATRIC BLOOD & CANCER, Issue 2 2007Mary T. Rourke PhD Abstract Background Posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) were assessed in young adult survivors of childhood cancer, including the role of four sets of variables in understanding PTSD in this population: demographic characteristics, disease and treatment factors, psychosocial and functional outcomes, and cancer-related beliefs. Procedure One hundred eighty-two survivors of pediatric malignancies, ages 18,37 years old completed a psychiatric interview and self-report measures. Survivors were ,5 years from diagnosis and ,2 years from the completion of cancer treatment for a variety of cancers. Results Nearly 16% of the sample had PTSD. Most survivors reported re-experiencing symptoms. There were no significant differences between survivors with and without PTSD on demographic or disease and treatment variables. Survivors with PTSD reported more psychological problems and negative beliefs about their illness and health status than those without PTSD. A logistic regression model predicted 50% of the variance in PTSD. Conclusions PTSD affects a subset of young adult cancer survivors. These survivors experience more psychological problems in general. Beliefs about the cancer experience are more potent predictors of PTSD than demographic or disease and treatment factors. Screening for PTSS and PTSD in cancer survivors is recommended. Pediatr Blood Cancer 2007;49:177,182. © 2006 Wiley-Liss, Inc. [source] Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood DiabetesPEDIATRIC DIABETES, Issue 4 2009J Åman Background:, The Hvidoere Study Group on Childhood Diabetes has demonstrated persistent differences in metabolic outcomes between pediatric diabetes centers. These differences cannot be accounted for by differences in demographic, medical, or treatment variables. Therefore, we sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers. Methods:, An observational cross-sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants. Hemoglobin A1c (HbA1c) levels were assayed in one central laboratory. All individuals with diabetes aged 11,18 yr (49.4% female), with duration of diabetes of at least 1 yr, were invited to participate. Individuals completed a self-reported measure of quality of life (Diabetes Quality of Life - Short Form [DQOL-SF]), with well-being and leisure time activity assessed using measures developed by Health Behaviour in School Children WHO Project. Results:, Older participants (p < 0.001) and females (p < 0.001) reported less physical activity. Physical activity was associated with positive health perception (p < 0.001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis. The more time spent on the computer (r = 0.06; p < 0.05) and less time spent doing school homework (r = ,0.09; p < 0.001) were associated with higher HbA1c. Between centers, there were significant differences in reported physical activity (p < 0.001) and sedentary behavior (p < 0.001), but these differences did not account for center differences in metabolic control. Conclusions:, Physical activity is strongly associated with psychological well-being but has weak associations with metabolic control. Leisure time activity is associated with individual differences in HbA1c but not with intercenter differences. [source] Medicine-taking behaviour in schizophrenia , part 1PROGRESS IN NEUROLOGY AND PSYCHIATRY, Issue 4 2010Celia L Feetam MSc. In this, the first of two articles, Celia Feetam and Hannah Roberts focus on factors contributing to poor medicine-taking behaviour in schizophrenia and the consequences of this. The second article will consider treatment variables that may influence such behaviour and the interventions that have been proposed to improve medicine-taking behaviour in those diagnosed with schizophrenia. These articles follow on from two articles published in Progress in 2009 on Medicine-taking behaviour in depression.1,2. Copyright © 2010 Wiley Interface Ltd [source] Medicine taking behaviour in depression , part 1PROGRESS IN NEUROLOGY AND PSYCHIATRY, Issue 1 2009Celia Feetam MSc, MCMHP, MRPharmS In this,the first of two articles,poor adherence with antidepressant treatment and the effect on outcome are explored. The factors important in the selection of an antidepressant are also considered. In the second article, treatment variables that may affect adherence will be examined alongside various interventions that have been proposed to improve medicine taking behaviour in patients with depression. Copyright © 2009 Wiley Interface Ltd [source] T1N0 Triple Negative Breast Cancer: Risk of Recurrence and Adjuvant ChemotherapyTHE BREAST JOURNAL, Issue 5 2009Henry G. Kaplan MD Abstract:, Adjuvant treatment of T1N0 breast cancer (BC) has evolved in recent years with chemotherapy options dependent on tumor size and cellular characteristics. Our goal is to describe the difference in outcome between T1N0 triple negative (TriNeg) and estrogen/progesterone receptor positive/her2/neu-negative BC. From our institute's registry, we identified primary BC patients diagnosed from 1998 to 2005, estrogen/progesterone receptor negative (ER,/PR,)/her-2/neu negative (her2,) (TriNeg = 110) and ER+/PR+/her2, (HR+/her2, = 919). Clinical diagnosis and treatment variables were chart abstracted. Vital and disease status were updated annually. Pearson chi-squared tests were used for bivariate analysis. Hazard ratios were calculated using the Cox proportional hazards model. Average patient age was 59 years, range 23,93 years and average length of follow-up was 4.22 years. T-stage distribution for HR+/her2, patients was 9% T1a (>0.1, ,0.5 cm), 34% T1b (>0.5 cm, ,1 cm), 57% T1c (>1 cm, ,2 cm) and for TriNeg, 6% T1a, 21% T1b, and 73% T1c. Sixty-five per cent of T1b and 73% T1c TriNeg patients received chemotherapy versus 7% of T1b and 32% of T1c HR+/her2, patients with TriNeg patients more likely to receive doxorubicin/cyclophosphamide/paclitaxel combined therapy. Recurrence rates were the following, T1b: 8.7%, TriNeg (2/23) versus 0%, HR+/her2, (0/315) and T1c: 8.8%, TriNeg (7/80) versus 2.1%, HR+/her2, (11/523). Five year relapse-free survival was 98% in the HR+/her2, group and 89% in the TriNeg group (log rank test = 27.77, p < 0.001). The hazard ratio for recurrence in the TriNeg group was 6.57 (95% CI = 2.34, 18.49) adjusted for age, tumor size, and adjuvant chemotherapy. Triple negative T1N0 patients have greater recurrence risk in spite of more aggressive therapy by both number treated and adjuvant chemotherapy type even in a low-risk category. New treatment modalities specific for triple negative disease are urgently needed. [source] Antimalarial treatment may have a time-dependent effect on lupus survival: Data from a multinational Latin American inception cohortARTHRITIS & RHEUMATISM, Issue 3 2010Samuel K. Shinjo Objective To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort. Methods Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser). Results Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6,98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6,11 months, 146 (12.8%) for 1,2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41,8.37), 2.7 (95% CI 1.41,4.76), and 0.54 (95% CI 0.37,0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18,4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39,0.99). Conclusion Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. [source] Psycho-social issues in long-term survivors of testicular cancer: Directions for future researchASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2008Tim LUCKETT Abstract Testicular cancer is the most common non-skin cancer in young men and among the most curable of all neoplasms, making patients' long-term physical, psychological and social well-being of major concern. To date, research on outcomes has been restricted almost entirely to survivors in Europe and the USA. The current article reviews the international literature with a view to developing directions for future research in the Asia,Pacific region. We conclude that planning interventions to improve outcomes awaits further, prospective, controlled studies aimed at establishing the predictive value not only of socio-demographic, disease and treatment variables but also of psycho-social variables underlying adjustment and recovery. Ideally, research of this kind would: (i) highlight aspects of the experience of testicular cancer and its treatment that might be targeted by changes to patterns of care, and (ii) identify groups at risk of poor outcomes who could be identified for early intervention through screening. Planning of prospective research would itself benefit from further, large-scale, cross-sectional research aimed at identifying those variables that would prove most informative when tracked over time. Exploratory research of this kind should be aimed at providing a snapshot of men's well-being in the context of a comprehensive range of variables that include patterns of care, unmet needs, satisfaction with treatment and social support as well as disease and treatment variables. Outcome variables should include disease-specific concerns such as psycho-sexual problems as well as general physical, psychological and social well-being. [source] Adjunctive antidepressant use and its clinical correlates in patients with schizophrenia: an East Asia multicenter comparative prescribing auditASIA-PACIFIC PSYCHIATRY, Issue 1 2010FAMS, Kang Sim MBBS, MMed (Psychiatry) Abstract Aims: Previous pharmacoepidemiological studies have highlighted considerable rates of adjunctive psychotropic medication prescriptions in patients with schizophrenia, including the use of adjunctive antidepressants, but this has not previously been studied in East Asia. This study examined the frequency of adjunctive antidepressant prescriptions in patients with schizophrenia and their clinical correlates in six East Asian countries and territories. Methods: Co-prescription of antidepressants for a sample of 2,136 patients with schizophrenia from six countries and territories (China, Hong Kong, Korea, Japan, Taiwan, Singapore) were evaluated in 2004 using a standardized protocol. Results: Adjunctive antidepressant prescriptions were found in 6.5% (n=139) of the patients with some intercountry differences. Co-prescription of antidepressants was significantly associated with younger age, shorter duration of index admission, electroconvulsive therapy in the past month, less likelihood of manifesting disorganized speech, and prescription of first generation antipsychotic drugs. Concomitant antidepressant prescription was associated with greater weight and increased number of adverse events including constipation, sedation and sexual dysfunction. On multivariate analysis, it was found that country, younger age and history of electroconvulsive therapy for the past month were significantly associated with adjunctive antidepressant use. Discussion: Adjunctive antidepressant use for schizophrenia in East Asia was associated with a number of demographic, clinical, and treatment variables. The association with greater weight and more adverse events reinforces the notion that prescription of adjunctive psychotropic medication is not without its costs. The challenge for the clinician is to constantly reevaluate the risk benefit ratio in the process of understanding the patient in a holistic context and to optimize the treatment regimes for patients with schizophrenia. [source] Hepatic artery chemoembolization for 110 gastrointestinal stromal tumorsCANCER, Issue 12 2006Response, prognostic factors, survival Abstract BACKGROUND. The efficacy of hepatic artery chemoembolization (HACE) was evaluated for gastrointestinal stromal tumors (GISTs) metastatic to the liver. METHODS. Records for patients with metastatic GIST who underwent HACE between January 1993 and March 2005 were reviewed and cross-sectional images were used to determine objective tumor response. Progression-free survival in the liver (PFS-liver) and overall survival (OS) were calculated with the Kaplan,Meier method. Patient, tumor, and treatment variables were analyzed to identify factors influencing survival. RESULTS. Of the 110 patients identified, the radiologic response to HACE could be evaluated in 85 patients, 12 of whom (14%) demonstrated partial responses, 63 of whom (74%) demonstrated stable disease, and 10 of whom (12%) demonstrated progressive disease. PFS-liver rates were 31.2%, 8.2%, and 5.4% at 1, 2, and 3 years, respectively; the median PFS time was 8.2 months. OS rates were 62% at 1 year, 32% at 2 years, and 20% at 3 years; the median OS time was 17.2 months. Patients who had >5 liver metastases and received only 1 HACE treatment were found to have a shorter PFS compared with patients with fewer metastases or those who received ,2 HACE sessions. Extensive liver involvement, the presence of extrahepatic metastases, and progression of liver disease after HACE were associated with poor OS. Use of imatinib prolonged OS time. CONCLUSIONS. HACE produced a durable tumor response or disease stabilization in the majority of patients with GISTs metastatic to liver. Extent of liver disease, presence of extrahepatic disease, number of embolization treatments, and use of imatinib were found to have prognostic influence on PFS, OS, or both. Cancer 2006. © 2006 American Cancer Society. [source] Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures?CLINICAL OTOLARYNGOLOGY, Issue 6 2006An e-tool-based analysis Objectives:, The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. Study design:, Cross-sectional study. Setting:,, Head and Neck Oncology Unit, Tertiary Referral Centre. Patients:, Forty-two patients following total laryngectomy. Intervention:, Videofluoroscopy using an e-tool (JRuler). Main outcome measures:, Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. Results:, Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. Conclusions:, Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality. [source] Improved final height in Turner's syndrome following growth-promoting treatment at a single centreACTA PAEDIATRICA, Issue 9 2003EJ Gault Aims: To examine the final height (FH) outcome of girls with Turner's syndrome (TS) treated at a single Scottish centre (Glasgow group), to compare it with an earlier national analysis (Scottish group) and to suggest reasons for any change. Methods: Retrospective growth and treatment data for 29 Glasgow patients were compared with those of 26 Scottish patients. Results: Age at GH start (mean ± SD) was 10.1 ± 2.6 vs 12.1 ± 1.7 y (p < 0.01) in the Glasgow versus Scottish groups, with overall duration of treatment 6.2 ± 2.4 vs 3.7 ± 1.1 y (p < 0.001) and years of GH treatment before pubertal induction 2.7 ± 2.8 vs 0.3 ± 0.8 y (p < 0.001), respectively. Pubertal induction was at a similar age: 12.7 ± 1.8 vs 12.8 ± 1.8 y (ns). FH was 151.1 ± 4.6 cm in the Glasgow group compared with 142.6 ± 5.6 cm in the Scottish group (p < 0.001), with FH -projected adult height (PAH) 5.7 ± 4.6 cm vs 0.6 ± 3.6 cm (p < 0.001), respectively. Univariate analysis of the Glasgow group's FH , PAH with a number of growth and treatment variables identified no statistically significant relationships. Conclusion: This group's improved FH and FH , PAH, relative to an earlier sample, are attributed to the introduction of GH treatment from a younger age and for longer, overall and before pubertal induction. In addition, the authors believe that compliance with treatment has been enhanced by this single centre's dedicated Turner clinic and the efforts of its established "growth team". These data demonstrate that a favourable FH can be achieved using a safe and financially viable dose of GH, while inducing puberty at a "normal" age. [source] Posterior pelvic exenteration for primary rectal cancerCOLORECTAL DISEASE, Issue 4 2006G. C. Bannura Abstract Background, Indications for and the prognosis of posterior pelvic exenteration (PPE) in rectal cancer patients are not clearly defined. The aim of this study was to analyse the indications, complications and long-term results of PPE in patients with primary rectal cancer. Methods, A retrospective review included patient demographics, tumour and treatment variables, and morbidity, recurrence, and survival statistics. These results were compared with a group of female patients who underwent standard resection for primary rectal cancer in the same period (non PPE group). Results, The series included 30 women with an average age of 56.7 years (range 22,78). Tumour location was recorded in three cases in the upper rectum, 13 cases in the medium rectum and 14 cases in the lower rectum. A sphincter-preserving procedure was performed in 70% of the patients. Mean operative time was 4.2 h (range 2,7.5 h). Overall major morbidity rate in this series was 50% and mean hospital stay was 19.7 days (range 9,60 days). There was no hospital mortality. Pathological reports showed direct invasion of uterus, vagina or rectovaginal septum in 19 cases, involvement of perirectal tissue in 25 cases and positive lymph nodes in 18 cases. Comparison between PPE and non PPE groups showed no differences in mean tumour diameter, histological grade and tumour stage, but patients in the first group were younger. Although low tumours were seen more frequently in the PPE group (P = 0.003), the rate of sphincter-preserving procedure was comparable in both groups. Operative time was longer (P = 0.04) and morbidity was higher (P = 0.0058) in the PPE group. Local recurrence with or without distant metastases for the whole series was 30%. Five-year survival rate for patients who underwent curative resections (TNM I,III) was 48% in the PPE group vs 62% in the non PPE group (P = 0.09). Conclusions, In the present series, PPE prolonged operative time, increased postoperative complications and showed a trend toward poor prognosis in recurrence and survival. However, PPE offers the only hope for cure to patients with a primary rectal cancer that is adherent or invades reproductive organs. [source] | |||||||||||||||||||||||||||||||