Search PubMed⌕ Search

Biomedical subjects

D Walsh

Publications and source records attributed to D Walsh.

At least 91 records · Page 5Linked to original sources
PubMed2000

Symptom control in advanced cancer: important drugs and routes of administration.

Aggressive symptom control is a vital component of palliative medicine. Frequently both physicians and patients focus on pain control, forgetting the broader issues of symptom control. Pain and other symptoms are inextricably linked. Common symptoms include constipation, nausea and vomiting, insomnia, anorexia, weight loss, and cough. All oncologists should be familiar with the indications, doses, and unwanted effects of drugs commonly indicated for symptom control. This article will discuss some drugs presently available to achieve good symptom control. At the correct dose and dosing schedule, these agents can have a significant impact on quality of life. As in all areas of medicine, it is best to know the benefits and unwanted effects of a few drugs, rather than randomly prescribing different agents for similar clinical situations. This is rational prescribing. While the list presented here is not exhaustive, it does reflect core drugs currently available in the United States.

Drug Administration Routes↗
PubMed2000

The dying cancer patient.

Cancer patients often die with serious unrelieved symptoms causing a distressing death for them and needless added suffering for their families. Many physicians have not been trained to care for the dying patient. This chapter reviews the common symptoms and describes the methods to control them and support the patient and family through this difficult time. These symptoms are so characteristic of the dying process that all physicians should recognize them, be skilled in providing appropriate care, and prepare for problems that may arise.

Attitude to Death↗
PubMed2000

Bioethics: communication and decision-making in advanced disease.

Effective communication is the cornerstone of excellence in patient care, and breakdown in communication is a common problem leading to requests for bioethics consultation. In palliative medicine, issues involving end-of-life decisions inherently involve many potential ethical concerns. Ensuring good communication among the physician, health care professionals, patient, and family will facilitate care, and avoid ethical problems. This chapter will address communication with patients, families, and health care professionals. Common ethical concerns such as withholding and withdrawing treatment modalities, medical futility, euthanasia, and assisted suicide will be discussed.

Bioethics↗
PubMed2000

Symptom control in the pregnant cancer patient.

While much attention has been devoted to cytotoxic drugs and radiation therapy in the pregnant cancer patient, the drugs used for management of symptoms and complications related to cancer during pregnancy have been overlooked. There is substantial overlap between the symptoms of cancer and cancer management and the symptoms related to pregnancy. The mainstay of symptom management is drug therapy and the potential for a drug to be embryotoxic or teratogenic depends on when it is given. In general, drugs not proven safe in pregnancy should be withheld, especially during the first trimester. The few drugs that have been proven to be teratogenic are alcohol, thalidomide, the folic acid antagonists (which includes methotrexate), diethylstilbestrol, and the vitamin A isomers, but there is a good deal of uncertainty about many other therapeutic agents. Placental transport of drugs from mother to fetus must be taken into consideration from the fifth week of gestation to parturition. Although the first trimester is the time of most organ development in the fetus, the brain continues to develop throughout pregnancy and may be damaged later in pregnancy, resulting in diminished intelligence or behavioral problems. This review will focus on the treatment of the most common symptoms of cancer in a pregnant patient and the potential for fetal damage.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2000

Influence of biological, behavioural, health service and social risk factors on the trend towards more frequent.

OBJECTIVES: To analyse the trend in rising acute hospital admission rates in the Renfrew Paisley MIDSPAN cohort and assess the influence of baseline risk factor data, morbidity patterns, deprivation category and characteristics of GP practice on the increase. DESIGN: Cohort analysis which, using a linked data set covering a 23 year follow-up period, combined original 'risk'-related data with subsequent routine hospital admissions data. A multiple logistic regression model predicted changes in hospital admissions patterns. SETTING: Renfrew and Paisley, two post-industrial towns in Scotland. SUBJECTS: Eight thousand three hundred and fifty four women and 7,052 men, aged 45-64 in the early 1970s. MAIN OUTCOME MEASURES: The contribution that each of the factors investigated made to the likelihood of admission over time. RESULTS: While risk status in middle life, diagnosis reached after admission, deprivation category and characteristics of GP practice influence the absolute chance of being admitted to hospital, changes in these factors do not explain much, if any, of the quite marked increase in admission rates observed during the last 10 year of the follow-up period. CONCLUSIONS: Whatever the reasons for the trend of rising admission, the most likely explanation appears to be a combination of social and health service related factors. For the Paisley-Renfrew cohort, factors like smoking status, FEV1, deprivation category and GP practice remain important predictors of admission throughout the time period but changes in these factors explain little of the rising trend in admissions.

Adult↗
PubMed1999

Study on genotoxic effects of the space environment: a comparison between experienced cosmonauts and unexposed Russian twins.

The molecular analysis of T-lymphocytes from experienced cosmonauts and seven pairs of unexposed twins was performed [M. Khaidakov, D. Young, H. Erfle, A. Mortimer, Y. Voronkov, B.W. Glickman, Molecular analysis of mutations in T-lymphocytes from experienced soviet cosmonauts, Environ. Mol. Mutagen, 30 (1997) 21-30; J. Curry, G. Bebb, J. Moffat, D. Young, M. Khaidakov, A. Mortimer, B.W. Glickman, Similar mutant frequencies observed between monozygotic twins, Human Mutation, 9 (1997) 445-451]. Hprt mutant frequencies (MF) in both datasets were considerably higher (38.0+/-14.6x10(-6) in cosmonauts, and 18.5+/-8.9x10(-6) in twins) than in the background Western control (8-12x10(-6)), [A.D. Tates, F.J. van Dam, H. van Mossel, H. Shoemaker, J.C.P. Thijssen, V.M. Woldring, A.H. Zwinderman, A.T. Natarajan, Use of the clonal assay for the measurement of frequencies of HPRT mutants in T-lymphocytes from five control populations, Mutation Res., 253 (1991) 199-213; R.F. Branda, L.M. Sullivan, J.P. O'Neill, M.T. Falta, J.A. Nicklas, B. Hirsch, P.M. Vacek, R.J. Albertini, Measurement of HPRT mutant frequencies in T-lymphocytes from healthy human populations, Mutation Res., 285 (1993) 267-279]. The distribution of mutations by class in the twin dataset was essentially similar to the background Western control, whereas cosmonaut samples demonstrated a significant excess of splice errors and complex mutations. The distribution of base substitutions showed similar trends in both the cosmonaut and twin samples, which are quite distinct compared to those seen in the Western control. The differences observed between cosmonaut and twin samples (a 2-fold higher MF and an excess of complex mutations in cosmonaut mutational spectra) could be an indication of possible effects of the space environment. However, these changes could also be age-related because the twin group was, on average, 17 years younger. Moreover, very similar patterns of base substitution distribution in both datasets suggest the involvement of certain region-specific factors reflected in mutational spectra. In order to discriminate between occupation and region-specific factors contributing to mutagenesis, an additional study involving trainees and cosmonauts with recent long-term flight experience is required.

Adult↗
PubMed1999

HLA and schizophrenia: refutation of reported associations with A9 (A23/A24), DR4, and DQbeta1*0602.

The aim of this study was to test previous hypotheses of association between schizophrenia and human leukocyte antigen (HLA) specificities A9 (A23/24), DR4, and allele DQbeta1*0602. Using sequence-specific oligonucleotide probes, 256 familial schizophrenic patients and 261 unrelated controls were genotyped at polymorphisms for HLA-A, DRbeta1, and DQbeta1 loci. No significant (p < 0.05) differences in the allele frequencies between schizophrenics and controls were found, either when examining the sample as a whole or when subdivided by clinical subtype or gender. The present data do not support association between these HLA specificities and schizophrenia, and our review of previous studies suggests that reported associations may well be false positive results.

Case-Control Studies↗
PubMed1999

Schizophrenia and HLA: No association with PCR-SSOP typed classical loci in a large Irish familial sample.

Susceptibility to autoimmunity is strongly influence by genes clustered in the MHC region, particularly class I and class II antigens. It has been proposed that there is an immune component in the aetiology of schizophrenia, and the distribution of human leukocyte antigens (HLA) in schizophrenic patients and controls has been investigated in numerous studies. Positive associations have been reported between schizophrenia and the HLA-A1, A2, A9, B5, Cw4, and DR8 and negative associations with HLA-DR4 and HLA-DQbeta*0602. Small sample size, variable diagnostic methodology, unreliable laboratory and statistical procedures, and possible mismatching of cases and controls may have contributed to a lack of consistency of results to date. Therefore, in this investigation we used a large and carefully diagnosed homogeneous Irish familial schizophrenic sample compared with ethnically matched controls. All alleles were determined using polymerase chain reaction amplification followed by short specific oligoprobes. We found no evidence of association with 80 HLA alleles (some previously not examined) from 4 genes. Our data therefore do not support the involvement of these classical HLA loci in the aetiology of schizophrenia at least in these Irish families. The remaining classical HLA loci (HLA-B and HLA-C) should be typed when reliable DNA-based methods become available.

Alleles↗
PubMed1999

Marker-to-marker linkage disequilibrium on chromosomes 5q, 6p, and 8p in Irish high-density schizophrenia pedigrees.

Linkage disequilibrium (LD) is a potentially powerful tool for the localization of disease genes for complex disorders. Most prior studies of the relationship between genetic distance and LD have examined only very short distances, focusing on the role of LD in fine-mapping and positional cloning. We examine here the relationship between marker-to-marker (M-M) LD and somewhat greater genetic distances. We analyzed 622 M-M pairings on chromosomes 6p, 8p, and 5q in 265 native Irish pedigrees ascertained for a high density of schizophrenia. LD, significant at the 5% level, was found for 96% of all M-M pairings within 0.5 cM, for 67% within 0.5-1 cM, for 35% within 1-2 cM, for 15% within 2-4 cM, for 8% within 5-10 cM, and for 7% above 10 cM. Thus, in Irish families selected for a high density of schizophrenia, M-M LD may be very common within 0.5 cM and frequent up to distances of 2 cM.

Chromosomes, Human, Pair 5↗
PubMed1999

A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma.

PURPOSE: This study was designed to compare prospectively the effects of augmented biofeedback with those of sensory biofeedback alone on fecal incontinence and anorectal manometry after obstetric trauma. METHODS: A consecutive cohort of 40 females with impaired fecal continence after obstetric anal sphincter injury were recruited from a dedicated perineal clinic. Patients were randomly assigned to receive either augmented biofeedback or sensory biofeedback alone. All patients were assessed before and after twelve weeks of biofeedback training, using a fecal continence questionnaire and anorectal manometry. RESULTS: Thirty-nine of 40 females recruited completed the study. Continence scores improved in both treatment groups, but the results were better for those who received augmented biofeedback. Anorectal manometry was unchanged by sensory biofeedback, whereas anal resting and squeeze pressures increased with augmented biofeedback. No change in anal vector symmetry was observed in either group. CONCLUSION: Augmented biofeedback training is superior to sensory biofeedback alone in the treatment of impaired fecal continence after obstetric trauma.

Adult↗
PubMed1999

An ethnographic study of women's experience of partnership caseload midwifery practice: the professional as a friend.

OBJECTIVES: To explore the experience of a known midwife for labour and birth as provided through the partnership caseload model of care in women who had a previous baby under an alternative system of care. DESIGN: A qualitative study using an ethnographic approach. Data were collected by tape-recorded interviews. SETTING: The maternity unit at Leicester Royal Infirmary NHS Trust, Leicester, UK in 1998. PARTICIPANTS: 10 multiparous women cared for by Birth Under Midwifery Practice Scheme (BUMPS) midwives were interviewed between eight- and 12 weeks' postpartum. KEY FINDINGS: Women's perceptions and experiences were predominantly influenced by the relationships they had with their midwives who they described as 'friends'. All other themes were filtered through these relationships, including previous negative experiences of maternity care, the valuing of a known midwife for labour and birth, their positive birth experiences, expressions of delight at their care, their liking of home antenatal care, and the appreciation of their existing children and partners meeting their midwives. IMPLICATIONS FOR PRACTICE: Partnership caseload midwifery practice has significant positive impact on women's experience of childbirth. The midwife/woman relationship that has evolved in this context is highly valued by women and challenges traditional professional roles. The model should be explored in other settings to see if its benefits to women are transferable.

Anthropology, Cultural↗
PubMed1999

Opioid-induced itching: morphine sulfate and hydromorphone hydrochloride.

We describe a case of severe morphine-induced itch unrelieved by antihistamines, which responded to a change to hydromorphone. The possible mechanisms of opioid-induced itch are briefly discussed. It is unclear if it is due to histamine release, an opioid-receptor mediated effect, or idiosyncratic drug reaction.

Analgesics, Opioid↗
PubMed1999

The relative potency between high dose oral oxycodone and intravenous morphine: a case illustration.

Oxycodone is an effective opioid analgesic for cancer pain. In the United States, it is available exclusively as an oral formulation, predominantly in fixed dose combination with acetaminophen or aspirin. The latter limits its use in cancer pain due to the potential toxicity of the nonopioid component. Oxycodone is now available as a single agent, controlled release formulation. The following case report of an opioid tolerant cancer patient taking repeated high doses of oral oxycodone supports the use of a 1:1 milligram conversion ratio for oral morphine and oral oxycodone. This patient's clinical course indicates that oral oxycodone can be used safely and to good effect at high dose, that the milligram relative potency ratio for oral oxycodone to parenteral morphine during repeated dosing is 3:1, and suggests that availability of multiple formulations of oxycodone may benefit cancer patients.

Administration, Oral↗
PubMed1999

Morphine-induced ventilatory failure after spinal cord compression.

We describe a patient who required large doses of parenteral morphine for severe pain secondary to epidural spinal cord compression caused by metastatic cancer. The pain improved suddenly after neurological progression to a complete cord compression. Shortly afterwards, the patient developed acute respiratory depression caused by an apparent relative overdose of morphine. Our hypothesis is that the cord compression relieved the pain by interrupting the nociceptive pathway. The dose of morphine was then physiologically excessive once the neurologic damage was completed and the pain had been relieved. We advise caution in patients receiving high doses of opioids in which a change in disease status or a pain-relieving intervention may produce rapid pain relief.

Analgesics, Opioid↗
PubMed1999

Seasonal influences on admissions for affective disorder and schizophrenia in Ireland: a comparison of first and readmissions.

Although genetic and environmental factors operating before or around the time of birth have been demonstrated to be relevant to the aetiology of the major psychoses, a seasonal variation in the rates of admission of such patients has long been recognised. Few studies have compared first and readmissions. This study examined for seasonal variation of admission in the major psychoses, and compared diagnostic categories by admission status. Patients admitted to Irish psychiatric inpatient facilities between 1989 and 1994 with an ICD-9/10 diagnosis of schizophrenia or affective disorder were identified from the National Psychiatric Inpatient Reporting System (NPIRS). The data were analysed using a hierarchical log linear model, the chi-square test, a Kolmogorov-Smirnov (KS) type statistic, and the method of Walter and Elwood. The hierarchical log linear model demonstrated significant interactions between the month of admission and admission order (change in scaled deviance 28.77, df = 11, P < 0.003). Both first admissions with mania, and readmissions with bipolar affective disorder exhibited significant seasonality. In contrast, only first admissions with schizophrenia showed significant seasonal effects. Although first admissions with mania and readmissions with bipolar disorder both show seasonality, seasonal influences appear to be more relevant to onset of schizophrenia than subsequent relapse.

Hospitalization↗