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Biomedical subjects

D Ash

Publications and source records attributed to D Ash.

At least 19 recordsLinked to original sources
PubMed2005

A randomised study of whole-breast vs tumour-bed irradiation after local excision and axillary dissection for early breast cancer.

AIMS: Whole-breast radiotherapy (WBRT) after conservative surgery for early breast cancer is a routine standard of care. Despite this, a number of uncertainties in management still exist. Over recent years, a number of new technologies have allowed the development of partial-breast irradiation, with the intention of improving the risk-benefit relationship of routine breast radiotherapy. We report the results of a trial comparing partial- with WBRT, with prolonged follow-up. MATERIALS AND METHODS: Between 1986 and 1990, 174 women were randomised to receive conventional whole-breast radiotherapy (WBRT) (40 Gy in 15 fractions), with a tumour-bed boost or partial-breast irradiation by a variety of techniques. Recruitment was problematic, and the trial closed prematurely well before meeting its recruitment target. RESULTS: A trend was observed towards higher local recurrence and a higher locoregional recurrence rate after irradiation of the tumour bed alone. Distant recurrence and survival were the same. CONCLUSIONS: Conclusions are limited in view of the failure to complete accrual of the target of 400 participants, and in the context of the techniques of partial-breast radiotherapy used during this study, which would not compare with those in current use. Tumour-bed irradiation alone cannot currently be recommended as routine treatment outside the context of clinical trial.

Adult↗
PubMed2004

Re-audit of radiotherapy waiting times 2003.

AIMS: There has been increasing concern, by clinical oncologists in the UK, about the continuing long waiting times for radiotherapy treatment. An audit of patients starting treatment in 1 week in 2003 was carried out to determine waiting times and to compare current results with those obtained from a similar audit in 1998. MATERIALS AND METHODS: All centres in the UK completed the audit, which recorded waiting-list status and treatment intent for all new treatments started in 1 week, date of booking form completion and fractionation scheme used. RESULTS: Waiting times have lengthened in most centres for all categories of patients although, for palliative treatments, there was no additional increase in median waiting time compared with the last audit. Fewer patients in all categories are being treated within the Joint Collegiate Council for Oncology (JCCO) guidelines. Single-fraction treatments are now common for palliation. Most adjuvant treatment uses one of three prescriptions. In each Strategic Health Authority (StHA), the same proportion of the total number of patients with cancer seemed to be given radiotherapy. There was no obvious simple correlation of radiographer, physicist or treatment machine numbers with waiting times. CONCLUSION: The results of this survey suggest a continuing mismatch between capacity and demand. Increased complexity of radical treatments, and possibly more patients being referred for treatment, may have been offset in part by reduced fractionation for palliation.

Chemotherapy, Adjuvant↗
PubMed2003

Brachytherapy boost to the tumour bed in high risk patients after limited surgery for breast cancer.

The results of treatment for 174 patients at high risk of local recurrence, referred for radiotherapy after conservative surgery for early breast cancer, are evaluated. Microscopic margin involvement, extensive carcinoma in situ, and vascular/lymphatic invasion were the main risk factors for local recurrence. Whole-breast irradiation (40 Gy in 15 fractions over 3 weeks) followed with a brachytherapy boost (Ir192 wire implant or PDR Ir192) of 25 Gy was applied. Median follow-up was 80 months. The actuarial 6-year overall survival rate was 91% and the within breast recurrence-free survival was 88%. The most common risk factor among those recurring within the breast was involved surgical margins (13 out of 17). Cosmesis was reported to be good or excellent in 79% of cases. In patients at high risk for local recurrence, tumour-bed boost with brachytherapy can provide satisfactory local control after limited surgery and external radiotherapy.

Adult↗
PubMed2002

Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy.

OBJECTIVE: To evaluate the efficacy of a multiple micronutrient fortified beverage containing eleven nutrients at physiological levels in prevention of anaemia and improving iron and vitamin A status during pregnancy. DESIGN: A randomised double blind placebo controlled study. SETTING: Mpwapwa and Kongwa Districts in Dodoma Region of Tanzania. SUBJECTS: Five hundred and seventy nine pregnant women were screened for entry into the study and 439 women who met the study criteria were enrolled. INTERVENTIONS: Study participants received either a fortified (F) or non-fortified (NF) orange flavoured drinks identical in appearance, provided in two self administered servings per day for an eight week period. MAIN OUTCOME MEASURES: Comparison of haemoglobin (Hb), serum ferritin (SF) and serum retinol (SR) at baseline and follow up. RESULTS: After eight weeks of supplementation, the F group (n=129) had a significantly higher Hb increase of 0.86 g/dL compared to 0.45 g/dL in the NF group (n=130) p<0.0001. Gestational age at entry into the study, moderated the effect on Hb of the fortified drink. Women at earlier gestational age upon entry, had a higher rise in Hb than women of late gestational age (0.8 g/dL versus 0.04 g/dL rise respectively, p=0.038, n=188). The risk of being anaemic at the end of the study for those in the F group was reduced by 51% (RR=0.49, CI=0.28 to 0.85). Iron stores (by serum ferritin levels) increased by 3 microg/L in the F group (p=0.012) and a decrease of 2 microg/L in the NF group (p=0.115). The follow up ferritin concentration depended on initial ferritin level. Regardless of treatment group, serum retinol concentrations were significantly higher in mothers who had delivered. Mothers who had adequate levels at entry benefited more from the supplement than those with low levels (0.26 micromol/L versus no significant difference). CONCLUSIONS: The multiple micronutrient-fortified beverage given for eight weeks to pregnant women improved their haemoglobin, serum ferritin and retinol status. The risk for anaemia was also significantly reduced. The important predictors of Hb increase at follow up were the fortified beverage, baseline Hb, serum retinol, baseline ferritin and gestational age at entry into study. Anthropological research showed that the beverage was highly acceptable and well liked.

Anemia, Iron-Deficiency↗
PubMed2001

Micronutrient dietary supplements--a new fourth approach.

Currently the three main widely used strategies to control micronutrient deficiencies are food diversification, fortification, and consumption of medicinal supplements. In Tanzania a fourth strategy has been evaluated in school children, and is to be studied in pregnant and lactating women. The dietary supplement comes in the form of a powder used to prepare a fruit flavored drink. Children consumed for six months 25 grams per school day attended, the powder being added to 200 ml of water. The dietary supplement provides between 40 and 100 percent of the RDA of 10 micronutrients, which includes iron, vitamin A and iodine. Unlike medicinal supplements it provides the multiple vitamins and minerals in physiologic, not megadoses. In a well conducted randomized double blind placebo controlled trial, a dietary supplement in the form of a fortified powder fruit drink produced statistically significant differences not only in vitamin A and iron status, but also in the growth of young school age children.

Beverages↗
PubMed1999

Shared governance: time to consider the cons as well as the pros.

AIMS: This paper aims to provide a critical appraisal of an approach to the management and organization of nursing work known as shared governance (SG). BACKGROUND: This approach has its origins in the USA, where, during the past 20 years it has become increasingly influential. The advocates of SG claim that it can, inter alia, improve recruitment and retention rates, boost morale, and help raise clinical skills. Little wonder that SG in now beginning to make significant inroads into the NHS. ORIGIN OF INFORMATION: However, a trawl through the extensive US literature, using printed and online (e.g. BIDS, CINHAL, MEDLINE, etc.) bibliographical sources, suggests that the claimed benefits of SG should be treated with caution. KEY ISSUES: Much of the existing published research appears to be both methodologically flawed and lacking in any critical edge. While many researchers and commentators appear only too willing to highlight what they see as the promise of SG, they shy away from exploring any potential pitfalls. One consequence of this is that many of the putative benefits SG is said to confer, may in fact be more apparent than real. CONCLUSIONS: Nurses and nurse managers need to be apprised of and consider seriously, the possible cons as well as the potential pros of SG, if any promise it may have is to be realized.

Clinical Competence↗
PubMed1999

Short-term morbidity and acceptability of 125iodine implantation for localized carcinoma of the prostate.

OBJECTIVE: To report the short-term morbidity and acceptability of the first 50 patients treated with the percutaneous implantation of radioactive iodine seeds for localized carcinoma of the prostate at the Cookridge Hospital. PATIENTS AND METHODS: Fifty patients were treated with transrectal ultrasonography-guided percutaneous implants with radioactive (125I) iodine seeds for localized carcinoma of the prostate. The mean hospital stay was 36 h and most patients were able to return to work or normal activity within one week of implantation. RESULTS: All patients developed urethritis which was most marked within the first 3 months of treatment; 8% of patients developed acute retention which resolved after temporary catheterization. At 3 months, 36% of patients still had moderate frequency and 18% moderate dysuria, but by 12 months these had resolved and only 5% of patients still complained of moderate nocturia. There were no cases of incontinence. The incidence of proctitis was very low, with only 2% still complaining of moderate symptoms at one year. Of those potent before implantation, 72% retained potency at one year. CONCLUSIONS: Although it is too early to comment either on late morbidity or on outcome, the results of this study show a side-effect profile similar to that reported by other centres using the same technique.

Aged↗
PubMed1998

Prostate brachytherapy.

In recent years there has been an increase in the number of centres, especially in the USA, using prostate brachytherapy as a means of treating localised prostate cancer. Several centres now have medium term follow up data of large numbers of patients treated with this technique suggesting that outcome in terms of tumour control may be comparable to patients treated surgically. This review summarises results from different brachytherapy series and outlines some of the possible advantages of this technique compared with current conventional treatments for localised prostate cancer.

Journal Article↗
PubMed1997

Crisis beds: the interface between the hospital and the community.

The main role of the crisis unit at a state psychiatric hospital was found to be the provision of brief hospitalisation for patients with adjustment disorders and personality disorders. The four bed crisis unit treated 14% of all patients admitted to the hospital, with an average length of stay less than three days. A study of 78 crisis unit patients found that 77% were able to be discharged directly to the community, and only 18% were readmitted during the following six months.

Acute Disease↗
PubMed1995

Potential disadvantages of post-operative adjuvant radiotherapy after anterior resection for rectal cancer: a pilot study of sphincter function, rectal capacity and clinical outcome.

The aim of this study was to try to gauge the functional effect of post-operative adjuvant radiotherapy after potentially curative anterior resection for carcinoma of the rectum. Anorectal function was studied both in the laboratory and clinically in 59 patients, a median of 12 months (range 6-96) after operation. Nine patients received post-operative radiotherapy and 50 matched patients were treated by surgery alone. Though maximum resting anal pressures and maximum squeeze pressures were similar in the two groups of patients, the length and pressure profile of the anal sphincter were both markedly abnormal after radiotherapy. The capacity and compliance of the neorectum were diminished significantly after radiotherapy (maximum tolerated volume 53 ml vs 110 ml after surgery alone, P = 0.008, compliance 1.5 ml/cm H2O vs 3.7 ml/cm H2O after surgery alone, p = 0.018) and the amount of distension of the neorectum required to produced maximum inhibition of the anal sphincter during the rectoanal inhibitory reflex was also significantly diminished after radiotherapy (P = 0.005). Clinical anorectal function was worse among patients who had received radiotherapy, a greater proportion of whom experienced both urgency of defaecation and varying degrees of incontinence. Major faecal leakage necessitating the use of a pad was recorded in 3 of the 59 patients after radiotherapy (one of whom required a permanent colostomy), but in only 5 of 50 patients after surgery alone.

Adult↗
PubMed1995

Split course radiotherapy for bladder cancer in elderly unfit patients.

Between 1980 and 1987, 89 patients with T1-T4 carcinoma of the bladder were treated with a split course of external beam radiotherapy. All patients were felt to be unsuitable for a prolonged course of radical radiotherapy because of age and/or poor general health. The intention was to provide local control. The majority of patients were treated with 10-12 fractions, with a mean dose of 45 Gy (range 31.5-57.7), within a mean overall time of 48 days. Of the 89 patients only 62 were assessable with a median follow-up of 110 months (range 64-157). In the remainder, poor health, poor performance status, or early (< 3 months) death did not allow assessment of tumour control. Complete remission was achieved in 28/89 (31%) patients. This was highly dependent on T stage: 56% T1/T2, 30% T3a/T3b, 5% T4. Median survival for patients with Stage T1/T2, T3a/T3b and T4 disease was 22, 10 and 8 months respectively. Acute grade 1-2 radiation reactions occurred in 60% of these patients, and only 5/62 (8%) experienced grade 2-3 late complications, assessed according to the RTOG scoring system. No patient had more severe treatment related morbidity.

Adult↗