The approach to pain (prize winning entry of the Peter Chambiras Memorial Essay Competition--1974).
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Humans↗
Biomedical subjects
B A Sullivan
Publications and source records attributed to B A Sullivan.
Quality of life in patients with metastatic colorectal cancer receiving chemotherapy: a randomized, double-blind trial comparing 5-FU versus 5-FU with leucovorin.
We compared health-related quality of life (HQL) measures in 210 patients with metastatic colorectal cancer who were receiving equitoxic regimens of weekly 5-fluorouracil (5-FU) plus leucovorin (LV) or 5-FU alone in a multicenter, placebo-controlled, double-blind, randomized trial. The HQL was assessed during the first 120 days of treatment by the patient-generated functional living index-cancer (FLIC) questionnaire. Also assessed were clinician-generated measures to evaluate physical functioning and suffering: Karnofsky performance status (KPS), body weight, disease symptoms, and hospitalization. No significant difference was detected between treatment groups in HQL or in any measurement of efficacy or toxicity. The number of patients hospitalized was similar in both groups, 35 patients receiving 5-FU-LV, 32 receiving 5-FU-placebo, but those receiving 5-FU-LV were hospitalized longer (450 vs 315 total days). The KPS improved or stabilized in 23% and 37% of patients, respectively. Overall, FLIC scores significantly improved in 27% or remained stable in 62% of all patients; disease symptoms improved in 19-49%; a weight increase of 2 kg or more occurred in 27%. A change in FLIC was not associated with tumor response or improvement in pain, but a decline in FLIC was associated with improved survival. An improvement in KPS or weight was associated with tumor response and strongly correlated with survival. Improvement of pain was associated with a stable or increase in weight, and worsening of pain correlated with lack of tumor response.
Adenocarcinoma↗
Gestational diabetes.
OBJECTIVE: To review the detection, diagnosis, and clinical management of gestational diabetes. DATA SOURCES: MEDLINE, Gestational Diabetes Guideline Review, 1968-1998. STUDY SELECTION: By the author. DATA EXTRACTION: By the author. DATA SYNTHESIS: Gestational diabetes is a common complication of pregnancy, occurring in 2% to 6% of pregnancies. Uncontrolled gestational diabetes is associated with increased infant morbidity and mortality, macrosomia, and cesarean deliveries, and is a strong marker for the future development of maternal diabetes mellitus. Women with risk factors for gestational diabetes should be screened for glucose intolerance at 24 to 28 weeks' gestation. If a screening plasma glucose concentration is 140 mg/dL or greater one hour after a 50 gram oral glucose load, then a diagnostic 100 gram, three-hour oral glucose tolerance test should be performed. Medical nutrition therapy is the cornerstone of management and must be designed to meet individual needs. Self-monitoring of blood glucose should be taught to and performed by all women with gestational diabetes. Insulin, which does not readily cross the placental barrier, is the drug therapy of choice in women failing medical nutrition therapy. CONCLUSION: Pharmacists can optimize overall care by educating, monitoring, and intervening or assisting the patient in the management of gestational diabetes.
Adult↗