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Biomedical subjects

D Feuer

Publications and source records attributed to D Feuer.

10 recordsLinked to original sources
PubMed2004

Prostate cancer: palliative care and pain relief.

Metastatic prostate cancer is incurable, and both the disease and other comorbidities as well as side effects from treatments can be very disabling for patients who are generally elderly. Past reviews on palliative care in prostate cancer have tended to concentrate on methods of active intervention with palliative intent rather than the principles of palliative care in a broader context. This paper is intended to introduce the principles and practice of modern palliative care as applied to care of patients with prostate cancer. Current National Institute for Clinical Excellence guidelines for urological cancers recommends provision of palliative care for all patients with prostate cancer, according to need. Palliative care aims to improve the quality of life of patients and their families. It is a holistic and personal approach to patient care, consisting of patient centred multiprofessional teams. Symptoms such as pain, psychological, spiritual and social problems are given equal weighting and tackled simultaneously. When treating pain, hormonal manipulation, radiotherapy, chemotherapy and surgery should always be considered alongside analgesic therapy, with realistic aims in mind. Towards the end of life, palliative care for patients will generally increase in line with increasing symptoms and other problems. Achieving a peaceful and comfortable death for our patients should be a priority in hospitals.

Humans↗
PubMed2004

Has CONSORT improved the reporting of randomized controlled trials in the palliative care literature? A systematic review.

BACKGROUND: In 1996, the CONSORT (CONsolidated Standards Of Reporting Trials) statement for the reporting of clinical trials was produced, based on empirical evidence regarding bias. AIMS: This study assessed the quality of reporting of randomized controlled trials (RCTs) in the palliative care literature. METHODS: Three specialist journals were hand searched for RCTs. A checklist was devised based on CONSORT recommendations. Two investigators independently assessed all the trials against this checklist. The trials were grouped into time cohorts of five years and quality comparisons made. Trials looking at pain were compared with those trials looking at other aspects of palliative care. RESULTS: Ninety-three RCTs were identified. The number of trials has increased over time: nine in the first cohort, 37 in the second and 47 in the last cohort. The number of patients in the individual trials has also increased over time. Generally, the reporting quality was poor, particularly the areas of allocation concealment, randomization technique and intention to treat analysis, where there is empirical evidence, that it leads to trial bias. Although there were more pain papers than non-pain papers, the quality of reporting was only better for blinding and intention to treat analysis. CONCLUSION: The quality of reporting of RCTs in the palliative care literature is generally poor. However, there has been an increase in the number and the size of RCTs being carried out. This shows recognition of the importance of an evidence base in palliative care. However, in order to guide clinical decision making, future trials need to improve the quality of their reporting by adhering to the CONSORT statement.

Guideline Adherence↗
PubMed2001

A prospective survey of the use of dexamethasone on a palliative care unit.

One hundred and six consecutive patients started on glucocorticosteroids (steroids) according to a defined prescription policy were surveyed each week to document the indications for use, any beneficial effect, any toxicity incurred and the reason for stopping. All patients had advanced malignant disease and survived for a median of 40.5 days (range 1-398+ days) from the start of steroid treatment. Fifty-seven per cent of patients completed three or more assessments. The most common specific indications for starting steroids were spinal cord compression, cerebral metastases, lymphangitis carcinomatosa and intestinal obstruction. The most common non-specific indications were anorexia, nausea, low mood, pain and vomiting. The median duration of steroid use was 21.5 days (range 1-89 days). The most common reason for the discontinuation of steroids was death or deteriorating condition. Symptom scores improved at some stage for the majority of patients started on steroids for anorexia, nausea, pain, low mood, vomiting and weakness but not in patients complaining of dyspnoea or poor mobility. The most common side-effects that were most probably attributable to steroid therapy were oral candidosis and proximal myopathy. The benefits of steroids when used according to defined guidelines were thought to outweigh toxicity.

Anti-Inflammatory Agents↗
PubMed1999

Systematic reviews.

Explore the source record for details and available documents.

Information Systems↗
PubMed1983

Unfavorable prognostic significance of hand mirror cells in childhood acute lymphoblastic leukemia. A report from the childrens Cancer Study Group.

The prognostic significance of hand mirror cells (HMCs) in childhood acute lymphoblastic leukemia was determined by quantifying the percentage of these cells in the diagnostic bone marrow aspirates of previously untreated children entered on the Childrens Cancer Study Group protocol 141. Of 664 examinable patients, 39 (5.9%) had greater than 10% HMCs, and only four (0.6%) had greater than 30% HMCs. Compared with the entire study population, a greater proportion of children with more than 10% HMCs were older than 10 years of age, had hemoglobin levels greater than 10 g/dL, and had undifferentiated lymphoblast morphology. The children with more than 10% HMCs had a higher rate of bone marrow relapse, poorer disease-free survival, and shorter survival than patients with less than 10% HMCs. By multivariate analysis, HMC morphology was an independent, unfavorable prognostic factor.

Age Factors↗
PubMedDate not supplied

Extracranial carotid artery in patients with transient global amnesia: evaluation by real-time B-mode ultrasonography with duplex Doppler flow.

Patients with transient global amnesia are often categorized as having cerebrovascular disease. Noninvasive carotid artery testing was performed in 56 patients with transient global amnesia to determine if they had the same incidence of extracranial atherosclerotic vascular disease as patients with focal cerebral transient ischemic attacks. Only 3 of 56 patients had hemodynamic obstruction of flow at the carotid artery bifurcation, and 41 of 56 had no evidence of any atherosclerotic disease. Other risk factors for cerebrovascular disease were present in 24 of 56 patients, but only 1 had a prior cerebrovascular event. The pathophysiology of transient global amnesia appears to differ from the pathophysiology of classical transient ischemic attacks in that there is no clear relation between transient global amnesia and the presence of extracranial atherosclerotic cerebrovascular disease.

Aged↗