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Biomedical subjects

C Lindley

Publications and source records attributed to C Lindley.

32 records · Page 2Linked to original sources
PubMed1995

Vinorelbine: a novel vinca alkaloid.

The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of vinorelbine are reviewed. Vinorelbine is a semisynthetic vinca alkaloid with a broader spectrum of antitumor activity in vitro than naturally occurring vinca alkaloids have. Vinorelbine shows selective activity against mitotic microtubules. Higher concentrations of vinorelbine relative to vinblastine and vincristine are required to affect axonal microtubules; presumably this accounts for the decreased neurotoxicity of vinorelbine. Vinorelbine is lipophilic and is rapidly distributed into peripheral tissues. It is highly bound to blood components. Vinorelbine is excreted slowly by the fecal route and rapidly by the urinary route. Disposition is characterized by a three-compartment model, high systemic clearance, and a long terminal-phase elimination half-life. In clinical studies, vinorelbine has shown antitumor activity both as a single agent and in combination with cisplatin in patients with non-small-cell lung cancer (NSCLC). Vinorelbine plus cisplatin produces a higher response rate and longer survival than vindesine plus cisplatin, a combination previously found to be superior to best supportive care. Encouraging results for vinorelbine in the treatment of advanced breast cancer, advanced ovarian epithelial cancer, and other tumors have also been observed. The dose-limiting adverse effect of vinorelbine is myelosuppression. Vinorelbine has FDA-approved labeling for use alone or in combination with cisplatin for the first-line treatment of unresectable, advanced NSCLC. The recommended dosage is 30 mg/sq m i.v. weekly administered by either slow i.v. push or i.v. infusion. Vinorelbine alone or in combination with other antineoplastics has shown activity against NSCLC, advanced breast cancer, and other malignancies. More study is needed to determine whether vinorelbine is superior to best supportive care in patients with NSCLC.

Antineoplastic Agents↗
PubMed1994

Overview of current development in patient-controlled analgesia.

Over the past two decades, numerous trials have assessed the safety and efficacy of patient-controlled analgesia (PCA). Advantages over conventional parenteral narcotics reported from these trials include equivalent to superior pain relief, superior patient satisfaction, decreased sedation and anxiety, faster return to normal functional status, and reduction in nursing time and hospitalization. The majority of these trials have been conducted in the postoperative patient population. In the mid to late 1980s, interest arose in applying PCA technology to the management of cancer pain. Factors that served as an impetus for the use of PCA in cancer pain included favorable reports from the postoperative setting and the often-cited statistics regarding the magnitude of the cancer pain problem. Advances in PCA technology coupled with advances in vascular access technology that allow the placement of long-term ports and catheters to facilitate intravenous, epidural, or intrathecal administration of opioid analgesics have made the applicability of PCA in ambulatory cancer patients an attractive option. The greatest breakthrough in PCA technology came with the introduction of devices making it possible to choose between intermittent (demand bolus) and continuous administration (continuous infusion) or both intermittent and continuous modes. A comparison of these types of PCA devices is described. The limitations of the literature involving PCA therapy in cancer patients make it difficult to identify optimal patient selection criteria, PCA administration schedules, drug selection and dosing, and optimal route of administration. The current status and pertinent issues related to these topics are addressed.

Analgesia, Patient-Controlled↗
PubMed1992

Treatment of gastrointestinal and renal adenocarcinomas with interferon-alpha.

Treatment of adenocarcinomas with interferon-alpha as a single agent has been disappointing. Recent efforts have focused on the combination of interferon with cytotoxic drugs such as 5-fluorouracil. A number of postulated mechanisms can explain synergistic interactions between 5-fluorouracil and interferon-alpha, including interaction with pyrimidine pathways, and alteration of drug metabolism. Previous studies in colorectal cancer, using 5-fluorouracil and interferon-alpha are reviewed, suggesting that the combination is more active than 5-fluorouracil alone. In renal cell carcinoma, the literature is reviewed, suggesting that daily interferon is the most efficacious schedule; preliminary data suggest that addition of 5-fluorouracil to interferon-alpha can double the expected response rate of 16% achieved by interferon-alpha alone.

Adenocarcinoma↗
PubMed1992

Quality of life measurements in oncology.

Quality of life (QOL) has transcended from an implicit concern to an explicit measurement in oncology. In contemporary clinical research, QOL can now often be identified and objectively measured in health as well as in illness. The major domains which comprise QOL in patients with cancer include symptoms and side effects, social function, physical function, and psychological status. One of the preferred methods for measuring QOL consists of self-administered questionnaires. A number of instruments have been developed which vary in features such as type of domains included, number of items, response options, specificity for disease type, and psychometric assessments. The role of QOL assessment is becoming increasingly important in clinical oncology.

Activities of Daily Living↗
PubMed1991

The lymphomas: Hodgkin's disease and non-Hodgkin's lymphomas.

This review presents an overview of a heterogeneous group of disorders that fall under the general heading of lymphomas. Many specific subtypes and presentations exist; their presentations, treatments, and prognoses vary greatly. Patients with lymphomas are generally treated with external beam radiation therapy, chemotherapy, or a combination of these two modalities. The community pharmacist may play an important role in management of patients by recognizing and alleviating the distressing side effects of treatment. Unfortunately, prevention and early detection play little role in the management of lymphomas. The improvement in survival rates of patients with all but indolent NHL is a direct result of advances in chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Outcome assessment: functional status measures and quality of life as therapeutic endpoints in oncology.

There is now agreement among most authorities regarding the need for a global measure of outcome in cancer clinical trials and guarded enthusiasm for incorporation of these. The next step--selection of existing instruments or development of new ones--appears to represent the current state of affairs. There is an urgent need for additional research into the meaning of life and health that the diagnosis of cancer generates. There are obvious dangers in relying on scales that do not reflect the patient's perception of quality of life. A number of instruments are available, and some of these are adequate in selected contexts. Poor psychometric testing and absence of evidence of predictive validity of existing or newly developed instruments may be expected to lead to false negative findings, however, when the impact of treatments on quality of life are compared. Following instrument development will be the incorporation of questionnaires into study design, which will represent a large task for many individuals. And last, but probably most important, we will have to determine how the results of QOL trials will be interpreted. The first important step towards incorporation of QOL/functional status as outcome measures in cancer clinical trials has occurred. To reach this goal will undoubtedly require a positive commitment from both medical and research staffs.

Clinical Trials as Topic↗
PubMed1985

Methods of inventory control.

Various methods for controlling inventory are described, and the advantages and disadvantages of each are discussed. The open-to-buy (OTB) budget method limits purchases to a specific amount of funds available for purchasing pharmaceuticals during a specified period. The emphasis of the OTB method is financial control of the pharmacy inventory. Although it is useful in monitoring and adjusting the dollar value of the inventory, it should be combined with other methods for a total inventory control system. The primary emphasis of the short-list method is to provide accurate and timely inventory information to the person responsible for order placement. The short list identifies the items that are in short supply. It is the most common feedback and control mechanism in use, but it is best suited for settings where duplicate or reserve stock is maintained and monitored by more rigorous methods. The main objective of the minimum and maximum method is to determine when and how much to order of each item. It also provides limited dollar control. The major disadvantage of this method is the time it requires to establish the minimum and maximum levels and to update them regularly to reflect changes in demand. The stock record card method is used to record information on the movement of goods in and out of the storage area. Stock cards can also be used to monitor inventory levels and facilitate order initiation. It is probably the optimum method to be used alone. The most effective system of inventory control is one employing a combination of these methods tailored to meet the institution's needs and available resources.

Budgets↗
PubMedDate not supplied

Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support.

BACKGROUND: Over the past decade, high dose chemotherapy with autologous bone marrow (HDC-ABMT) support has been used increasingly in the treatment of patients with breast cancer. In evaluating the results of HDC-ABMT in patients with breast cancer, an assessment of quality of life can add to the traditional endpoints (toxicity, and disease-free and overall survival) that are routinely assessed in clinical trials. PURPOSE: This study evaluated the quality of life (QOL) of breast cancer patients who had survived 1 or more years following high dose chemotherapy with autologous bone marrow transplant (HDC-ABMT) support. METHODS: Eighty-two patients who had undergone HDC-ABMT were surveyed by written questionnaire and follow-up telephone interview at least 1 year following HDC-ABMT. Patients were asked to complete the Functional Living Index-Cancer (FLIC), the Symptom Distress Scale (SDS), and a survey of sexual function developed as part of the study. RESULTS: The mean FLIC score among all patients was 130 +/- 19.1 (possible range 22-154). FLIC scores were significantly lower in patients with evidence of recurrent disease than in patients who were free of disease. The most commonly reported symptoms after HDC-ABMT were insomnia, fatigue, and pain. Sexual interest and sexual activity were reported to be lower after participation in HDC-ABMT than prior to the procedure. The majority of patients who were employed outside the home prior to HDC-ABMT returned to work with a median time away from work of 48 weeks. CONCLUSIONS: Patients with breast cancer who survive 1 or more years following HDC-ABMT rate their QOL at a relatively high level and frequently return to work. Less than one-third of patients who were interviewed reported moderate to severe symptoms. Problems with sexual functioning were common. IMPLICATIONS: Future research is needed on long-term outcomes after HDC-ABMT and on specific areas of concern, such as sexual functioning.

Adult↗
PubMedDate not supplied

Perception of chemotherapy side effects cancer versus noncancer patients.

PURPOSE: This study was conducted to identify and compare perceptions regarding the disruption in quality of life caused by chemotherapy side effects in patients with cancer receiving chemotherapy and in noncancer, chemotherapy-naive patients. DESCRIPTION OF STUDY: One hundred forty-six patients with cancer and 224 patients without cancer completed two instruments to assess the perceived magnitude of 41 physical and psychosocial chemotherapy side effects. Instrument 1 used a 5-point Likert scale (1 = not at all; 2 = a little bit; 3 = somewhat; 4 = quite a bit; and 5 = very much) to summarize patient responses to the question, "How much did or would each of the following side effects of chemotherapy bother you?" Instrument 2 was a serial ranking questionnaire that asked patients to select the 10 most bothersome side effects to numerically rank the top five. An index of the relative magnitude of chemotherapy side effects was calculated for each instrument. RESULTS: For patients with cancer, loss of hair 50%), changes in taste (46%), constantly being tired (42%), affects work duties (39%), changes in smell perception (35%) were most frequently perceived as bothering them "quite a bit" or "very much." Nausea and vomiting were ranked 11th and 22nd, respectively. With instrument 2, the five side effects perceived as most troublesome were, in decreasing order: nausea, loss of hair, constantly tired, vomiting, and changes in the way things taste. For noncancer patients, those factors potentially bothersome "quite a bit" or "very much" were: financial hardship (82%), hardship on family (78%), vomiting (73%), shortness of breath (70%), and ability to perform work duties (69%). Via instrument 2, the top five side effects, in decreasing order were: vomiting, hardship on family, loss of hair, financial hardship, nausea, having to move close to a treatment center. CLINICAL IMPLICATIONS: Noncancer, chemotherapy-naive patients perceived most chemotherapy-associated side effects as having greater impact on the quality of life than did cancer patients who had received chemotherapy. These findings can be used to direct patient education, education of the public, specific materials concerning cancer chemotherapy. The expertise of various members of the healthcare team can maximize the patient's comprehension of the adverse effects of the treatment options. The physician's knowledge of the overall treatment plan can assist in patient understanding; oncology pharmacists nurses are in a unique position to educate patients their families regarding potential chemotherapy side effects.

Adult↗
PubMedDate not supplied

Hospital-based HMO: an outpatient study.

With the increasing pressure from managed care companies and in cooperation with its medical staff's independent practice association, the Vista Hill Foundation formed its own specialty health maintenance organization. This is a report on an outpatient study of treatment satisfaction among 124 mental healthcare providers (50% of whom were psychiatrists) and their 218 patient experiences. Treatment outcome was rated as "very satisfactory" or "satisfactory" in 82% of the studied cases. Managed care was found to cause "mild" to "moderate" treatment interference in 26% of the cases and "significant" to "major" interference in 6%. There was no interference reported in 60% of the cases studied. Our study demonstrates that a hospital provider and its managed care system can provide satisfactory care, but it also reveals the need to constantly review treatment programs to reduce interference. The study and report are part of Vista Hill Foundation's ongoing quality review efforts.

Attitude of Health Personnel↗
PubMedDate not supplied

Comparison of PT, aPTT, and factor VII values obtained by concurrent sample collection by direct venipuncture and peripheral venous catheters.

STUDY OBJECTIVE: To compare prothrombin time (PT), activated partial thromboplastin time (aPTT), and factor VII values in concurrent blood samples obtained by direct venipuncture and from a peripheral venous catheter. DESIGN: Concurrent samples obtained from catheters and by direct venipuncture were studied. In a separate crossover bioequivalence assessment of DNA-derived factor VIIa (rFVIIa) from two different batches, sample results of each technique were compared. SETTING: University hospital clinical research unit. PATIENTS: Six patients with hemophilia A under nonbleeding conditions. INTERVENTIONS: The patients received a single dose of rFVIIa 70 micrograms/kg administered by intravenous push over 2 minutes. Concurrent blood samples were collected at 2, 3, 4, 6, 8, 10, and 12 hours after rFVIIa administration. Catheter blood samples were drawn from a three-way stopcock attached to an 18-gauge peripheral venous catheter in the patient's forearm and connected to an intravenous solution of 5% dextrose with half normal saline maintained at a rate of 30 ml/hour. Venipuncture samples were drawn from the opposite arm. MEASUREMENTS AND MAIN RESULTS: The PT and aPTT values were determined by using a BBL Fibrometer (PT) and a Coagamate X-2 with automated aPTT reagent. Blood samples were analyzed for factor VII concentration using the Novo Clot assay. The mean venipuncture-obtained PT (8.9 +/- 1.0 sec) and aPTT (48.7 +/- 13.6 sec) values were numerically equivalent to mean catheter-derived PT (9.0 +/- 1.0 sec) and aPTT (48.3 +/- 12.5 sec) results, as were mean venipuncture and catheter-obtained FVII:C values. CONCLUSIONS: The PT and aPTT values determined after venipuncture and through the peripheral catheter were not statistically different (p > 0.05) when compared by paired or unpaired analysis. Similarly, values of FVII:C measured after venipuncture were statistically equivalent to those after sampling through the peripheral catheter. All six patients preferred the catheter method of blood collection over venipuncture.

Adult↗
PubMedDate not supplied

Precipitous fall in platelet count with anagrelide: case report and critique of dosing recommendations.

Thrombotic and hemorrhagic events may result from high circulating concentrations of platelets (> 1,000,000/mm3), and measures to reduce the platelet count are indicated in symptomatic or extreme thrombocytosis. The platelet count can be decreased quickly by plasmapheresis, but the effect is transient. Patients with thrombocytosis secondary to a myeloproliferative disease, such as chronic myelogenous leukemia (CML), frequently require more sustained suppression of the platelet count. Hydroxyurea, busulfan, and interferon are used to maintain a lower platelet count but are occasionally ineffective or intolerable. An alternative to these therapies is anagrelide, a quinazolin derivative that was approved by the Food and Drug Administration in March 1997. Because current dosing guidelines for anagrelide are scarce, the dosing method of the Anagrelide Study Group that published the largest study to date on the drug's efficacy in thrombocytosis was followed. Two unexpected episodes of anagrelide-induced thrombocytopenia occurred despite following these dosing methods. This prompted a critical evaluation of the pharmacodynamic response and the appropriateness of anagrelide dosage recommendations. A case of thrombocytosis treated with anagrelide in a patient with CML is described.

Adult↗