Health records today: a "confidentiality-access" maze.
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Biomedical subjects
Publications and source records attributed to C Ferguson.
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Fifty-two patients with advanced breast or colorectal cancer have been treated with methotrexate (MTX) (50 mg/m2) followed 6 hours later by 5-FU (600 mg/m2). The mean serum MTX level immediately prior to 5-FU administration was 1.37 mumols/L (1.37 X 10(-6) M). Of 29 evaluable patients with breast cancer (six of whom had received prior chemotherapy), one achieved a complete response and five achieved a partial response (total response rate, 21%). Among 16 evaluable patients with colorectal cancer (three of whom had received prior chemotherapy), there were no objective responses. Although hematologic toxicity was generally mild, mucositis occurred in 20 patients (severe in three), and at least one early death was attributable to toxicity. These results indicate that at doses of MTX and 5-FU which are in general use in combination chemotherapy for breast cancer, sequential treatment does not have a therapeutic advantage. In colorectal cancer, the same combination is inactive.
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Certain continuous lymphoid and myeloid tumor cell lines of rodent origin are unable to grow in tissue culture in the absence of pre-formed L-cystine (CYS). In contrast, three NZB murine lymphoid cell lines obtained from NZB mice free of hematopoietic neoplasm can grow as well in cystine-deficient media containing L-cystathionine (CSN), the immediate precursor of CYS in the biosynthetic pathway, as in cystine sufficient medium. The former class of cells is, therefore, CYS auxotrophs (CYS-) and the latter CYS prototrophs (CYS+). Compared to CYS+ cells, the CYS- lines appear to be relatively deficient in the enzyme cystathionase, which catalyzes the cleavage of CSN to CYS and alpha-ketobutyrate. Using protein synthetic capacity as a criterion, normal thymocytes from mixed-bred Swiss mice behave like CYS prototrophs, while those from littermates bearing Moloney type C virus-induced thymic tumors behave like CYS auxotrophs. The former are also characterized by substantially higher levels of cystathionase than the latter. Extracts of thymocytes from tumor-free AKR mouse thymus are also characterized by higher levels of cystathionase activity than extracts of spontaneous AKR thymomas. Exogenous in vitro type C virus infection of a CYS+ cell results in vigorous virus production but no concomitant reduction in cystathionase activity. Thus viral replication alone in any random lymphoid cell is not sufficient to alter the enzyme level. The data therefore suggests that CYS auxotrophy may closely accompany neoplastic transformation of certain hematopoietic cells in vivo, including that induced by certain "thymic" type C viruses.
This paper presents results of a study to determine 1) the effects of Medicare on the patients of hospital use in specific disease groups, and 2) the sensitivity of length of stay and proportions of admission in specific disease groups to "short-run" changes in hospital occupancy rates. The analysis indicates that Medicare did increase utilization of hospital services by patients 65 and over through increases in both admissions and average length of stay. The largest increases occurred in the lower risk disease categories, although it is pointed out that this result does not necessarily imply a misallocation of hospital resources. The results also indicate significant differences among different socioeconomic groups and a much greater initial impact on the 75 and over age group than on the 65-74 age group.
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The cultural differences within and between countries influence everything from the philosophy of life, accepted behaviours and human relations to the way in which people perform their work. Below, nurses from Spain, Scotland and Canada argue that this cultural diversity also influences the profile of nursing and has implications for nursing practice, education and research.
The introduction of Project 2000 diploma-level courses in Scotland raised many questions about how a smooth preparation and transition could be effected. One of the main difficulties related to how the new students' supernumerary status would affect their learning experiences in clinical areas, and how practitioners could be helped to make the students' experiences valuable in educational terms. This article describes how one Scottish college decided to employ preceptorship as the framework for clinical supervision, and how it prepared practitioners for their new responsibilities.
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