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Biomedical subjects

C Blanchard

Publications and source records attributed to C Blanchard.

At least 19 recordsLinked to original sources
PubMed1999

Strategic physician communication and oncology clinical trials.

PURPOSE: Clinical trials are the primary means for determining new, effective treatments for cancer patients, yet the number of patients that accrue is relatively limited. The purpose of this study was to explore the relationship between physician behavior and patient accrual to a clinical trial by videotaping the interaction. PATIENTS AND METHODS: Forty-eight patient-physician interactions involving 12 different oncologists were videotaped in several clinics at the H. Lee Moffitt Cancer Center and Research Institute (Tampa, FL). The purpose of each interaction was to present the possibility of a clinical trial to the patient. A coding system, the Moffitt Accrual Analysis System, was developed by the authors to code behaviors that represented both the legal-informational and social influence models of communication behavior. Thirty-two patients agreed to participate in the clinical trial. RESULTS: Videotaping was found to be a viable, valid, and reliable method for studying the interaction. Physicians who were observed to use both models of influence were found to enroll more patients. Thus, patients were more likely to accrue to the trial when their physician verbally presented items normally included in an informed consent document and when they behaved in a reflective, patient-centered, supportive, and responsive manner. Discussion of benefits, side effects, patient concerns and resources to manage the concerns were all associated with accrual. CONCLUSION: This research has implications for modifying physician behavior and, thus, increasing the numbers of patients accruing to oncology clinical trials.

Adult↗
PubMed1999

Oral combination chemotherapy in the management of AIDS-related lymphoproliferative malignancies.

An oral combination chemotherapy regimen initially developed for AIDS-related non-Hodgkin's lymphoma includes lomustine (CCNU), etoposide, cyclophosphamide, and procarbazine. This regimen takes advantage of oral administration, the in vitro synergy of these drugs and their first-line efficacy in lymphoma, and the ability of lomustine and procarbazine to cross the blood-brain barrier. This regimen was used to treat 38 patients with AIDS-related non-Hodgkin's lymphoma. The overall objective response rate was 66% (34% complete response rate) with a 5% CNS relapse rate, and a median survival duration of 7.0 months. One-third of the patients survived for 1 year, 11% for 2 years, and half of the patients survived free from progression of their lymphoma. On the basis of these results, this oral regimen was modified and administered to 5 patients with AIDS-related primary CNS lymphoma as part of a sequential combined-modality chemotherapy and radiation regimen. Rapid progression of CNS disease was observed in this group of patients, with a median survival duration of 1.0 month. The identical regimen was administered to 7 patients with AIDS-related Hodgkin's disease: we observed a 71% partial remission rate and a median survival duration of 7.0 months. Myelosuppression remains the most significant clinical toxicity. Our results with this oral regimen appear comparable to those of standard intravenous combination chemotherapy regimens in patients with AIDS-related non-Hodgkin's lymphoma.

Administration, Oral↗
PubMed1998

Neuronal and behavioral differences between Mus musculus domesticus (C57BL/6JBy) and Mus musculus castaneus (CAST/Ei).

Previous studies have demonstrated that classical inbred strains of laboratory mice do not exhibit large genetic distances when simple sequence repeats (SSRs) are used to test for their polymorphisms whereas mice from wild origin exhibit high polymorphisms (more than 90%) for these sequence when compared with classical inbred strains of laboratory mice. The difference between Mus musculus castaneus and C57BL/6J reaches 98% and F1s male and female are fertile. These two properties pave the way for gene mapping derivating segregating generations between these strains. The phenotypical characteristics of Mus musculus castaneus have not been investigated, unfortunately. The first screening of Mus musculus castaneus and C57BL/6By was carried out for sensorial and motor development, spontaneous behavior in new environment, paw preference, maternal behavior, aggression in two different situations and time to learn escape in a water maze. Morphometry of hippocampus and weight of the male reproductive organs for measures that have been reported to be correlated with several of the examined behavior are also reported. The authors tested also reactivity to one drug (beta-CCM) revealing seizure proneness. The two strains differ for 69% of the reported measures. Comparison to other strains for the same measures obtained in the laboratory for identical tests with mice reared in identical situations provided the mean to compare Mus musculus castaneus with a large set of more or less traditional mice. This strain has the most extreme position for 80% of the comparisons.

Aggression↗
PubMed1997

Glutamate toxicity enhances tau gene expression in neuronal cultures.

Tau protein is a microtubule-associated protein normally expressed in neurons. In Alzheimer's disease (AD) brains, phosphorylated tau accumulates in paired helical filaments which form neurofibrillary tangles in affected neurons; moreover, tau mRNA expression is increased in affected regions of AD brains. Glutamate, an excitatory neurotransmitter but also a potent neurotoxin under pathologic conditions, is known to produce neuronal degeneration and death accompanied by an increase in tau immunoreactivity in primary neuronal cultures. The goal of the present study is to evaluate the effects of glutamate on tau gene expression in neuronal cultures. We report a delayed and long-lasting enhancement of tau mRNA expression after a 15 min exposure to toxic concentrations of glutamate: neuronal tau mRNA levels reach a peak after 3 hr and remain increased 6 and 12 hr after the end of glutamate exposure. Both NMDA and AMPA/ kainate receptors are involved in this tau gene overexpression. Actinomycin D prevents this tau mRNA induction indicating that transduction signals elicited by glutamate act at the transcriptional level. The role of this delayed tau overexpression is not elucided but could be linked to either a reactive survival process or to a programmed cellular degeneration.

Animals↗
PubMed1997

Cultured neurons expressing phosphorylated tau are more resistant to apoptosis induced by NMDA or serum deprivation.

Apoptosis is a programmed cell death that occurs during the development of the nervous system and in neurodegenerative disorders. Tau protein is a cytoskeletal component that promotes microtubule polymerization and stabilization. Apoptosis was induced in primary neuronal cultures by a prolonged exposure (16 h) to the NMDA (N-methyl-D-aspartate 20 microM) or by serum deprivation. The percentages of apoptotic neurons expressing phosphorylated tau (AT8) immunoreactivity are comparable in control and NMDA-exposed cultures (7.5 +/- 1.9 and 6.9 +/- 1.9%, respectively). At the opposite, the percentage of apoptotic neurons expressing de-phosphorylated tau (tau 1) immunolabelings is dramatically increased in NMDA-treated cultures (X 2.3 of controls). Similar results were also observed 48 h after serum deprivation. These results demonstrate in vitro that under these conditions, resistant and sensitive cortical neurons to apoptosis can be partly differentiated according to their phosphorylated tau immunoreactivities.

Animals↗
PubMed1997

Efficacy of venlafaxine in depressive illness in general practice.

A double-blind, placebo-controlled study of 229 patients with a Research Diagnostic Criteria diagnosis of major, minor or intermittent depression was used to compare the clinical profiles of venlafaxine and imipramine in general practice. Venlafaxine produced a significant improvement compared to placebo in symptoms of depression and anxiety as rated by the total MADRS and percentage of responders, the CGI improvement, the CGI severity of illness, the BSA psychic anxiety item and the HSCL. On a number of these measures, venlafaxine was also significantly more effective than imipramine. Venlafaxine was significantly superior to both imipramine and placebo for the SARS total score and the items 'social/leisure' and 'extended family.' A similar proportion of patients discontinued treatment in each group, but fewer patients on venlafaxine discontinued treatment because of an unsatisfactory response.

Adult↗
PubMed1996

Communication, accrual to clinical trials, and the physician-patient relationship: implications for training programs.

BACKGROUND: Previous studies have demonstrated that less than 20% of fully eligible patients participate in cancer clinical trials. One of the major factors determining whether patients will be successfully accrued to trials is the quality of the communication occurring between the physician and patient (and family members if present). The accrual process is embedded within the longer-term relationship between the physician and the patient. It is argued that the interaction occurring during the consent process is part of an "alliance building" that the physician and patient use to confront the uncertainty inherent in both the disease itself and the outcome of therapy. METHODS AND RESULTS: The authors describe the framework of a study currently under way in which they are tracking the variation in ways that this interaction is managed by a sample of oncologists and their patients. Physicians and patients are simultaneously filmed and viewed in a split-screen format. A coding system is being developed to analyze the congruence between physicians and patients as they encode and decode sequences of verbal and nonverbal messages. The goal is to understand how physicians and patients manage uncertainty related to the disease and its outcomes. CONCLUSIONS: The authors suggest implications of these observed patterns for the broader range of communicative competencies that medical students must learn.

Classification↗
PubMed1995

A phase I study of chemically synthesized verotoxin (Shiga-like toxin) Pk-trisaccharide receptors attached to chromosorb for preventing hemolytic-uremic syndrome.

A double-blind, placebo-controlled study was conducted to document possible side effects associated with oral consumption of synthetic verotoxin (VT, shiga-like toxin) Pk-trisaccharide receptor sequences attached to Chromosorb (Synsorb-Pk) by healthy adult volunteers. Synsorb-Pk reclaimed from volunteer stool samples was also analyzed to determine if its VT-binding activity was affected by exposure to the pH extremes and digestive processes of the human gastrointestinal tract. No participant reported any Synsorb-Pk-related adverse reactions, and no clinically important trends in laboratory data were evident. Synsorb-Pk recovered from stools retained its ability to absorb VT in polymyxin extracts of VT-producing Escherichia coli and also neutralized VT when mixed in vitro with VT-positive stools from children with hemorrhagic colitis or hemolytic-uremic syndrome (HUS). These results suggest a potential use for Synsorb-Pk in preventing HUS in patients infected with VT-producing E. coli.

Absorption↗
PubMed1993

[Cerebral intraventricular and/or intraparenchymal hemorrhages in full-term newborn infants. Long-term outcome].

BACKGROUND: Intraventricular and parenchymal hemorrhages are rare in full-term neonates. Their prognosis is still under discussion. POPULATION AND METHODS: 6 full-term newborns admitted between January 1985 and December 1988 developed intracranial hemorrhage: 3 had intraventricular hemorrhage and 3 parenchymal without intraventricular hemorrhage. The study includes the results of a questionnaire on the pregnancy and delivery, clinical, ultrasonographic and CT scan data. The long-term neuro-developmental outcome was assessed when the children were 4 to 7 year-old. RESULTS: All the patients were given phenobarbitone for 1 month to 1 year (one patient was given phenobarbitone plus phenytoin). One patient, aged 1 month, required insertion of a valve, because hydrocephalus developed. One patient had difficulties at school with developmental retardation; another patient developed minor difficulties. The 4 other patients had normal motor and mental development with good scholastic performances. CONCLUSIONS: The prognosis for intraventricular and parenchymal hemorrhage seems better in full-term than in pre-term infants.

Cerebral Hemorrhage↗
PubMed1992

The effects of carbocisplatin and radiation on skin flap survival.

Carbocisplatin is used as an inductive chemotherapeutic agent prior to irradiation in the treatment of head and neck cancers. Controversy exists whether carbocisplatin sensitizes normal epithelial tissues, including skin, to radiation. The combined effect of radiation and carbocisplatin on the survival of skin flaps was studied in an experimental model using dorsal flaps in Sprague-Dawley rats. Skin flaps were created 6 weeks after exposure to irradiation and carbocisplatin. Flap survival was assessed 7, 14, and 21 days after the flaps were initially created. Exposure of the flaps to irradiation alone, carbocisplatin alone, combined irradiation and carbocisplatin, or combined irradiation and fractionated carbocisplatin did not result in any significant decrease in flap survival when compared with untreated animals.

Animals↗
PubMed1990

Chief complaint of fatigue: a prospective study.

The Dartmouth COOP Project, a primary care research network, conducted a prospective study of patients presenting to 28 primary care practices with a chief complaint of fatigue. Data were gathered on fatigue status, associated systems, health status, and origin of fatigue. Fatigue patients were demographically similar to nonfatigue patients but had significantly worse physical and mental health at study intake. Sixty-three percent of physicians and 52% of patients rated fatigue origin as primarily physical (gamma = 0.48, P less than .05), but in 41% of cases, physicians indicated there was substantial interaction between physical and psychological factors. Only two factors--depression and anxiety--separated fatigue of physical origin from fatigue of psychological origin. Clinicians must thoughtfully evaluate fatigue's often multiple causes and communicate their understanding of those causes to the patient to gain support for a reasonable treatment regimen.

Adult↗
PubMed1986

Dothiepin hydrochloride: treatment efficacy and safety.

Dothiepin, a thio analogue of amitriptyline, has been used extensively in Europe during the past 15 years. It is a safe and effective agent for the treatment of major depressive disorder. Although the onset of action is comparable to that of other tricyclic antidepressants, dothiepin may cause fewer intolerable side effects and have less cardiotoxicity than these other compounds. In addition, dothiepin reduces the anxiety associated with some major depressive episodes. These features suggest that dothiepin may be particularly helpful for treating anxious depressed patients and patients who have underlying cardiac disease or who are elderly.

Adult↗
PubMed1984

[Computer program for the processing of data collected during therapeutic trials in psychiatry].

A computer program is described which has been developed over several years and allows for the easy processing of psychiatric data gathered in clinical trials. It provides user-defined parametrization of a computer-aided data entry system, the use of the program created to input data to the computer and the data processing of the data collected either through modifications of the file created or by statistical analysis, the procedures of which have been simplified to enable its performance even by lay people.

Clinical Trials as Topic↗