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Biomedical subjects

G Westman

Publications and source records attributed to G Westman.

At least 19 recordsLinked to original sources
PubMed1991

Bladder carcinoma--a 20-year review of radical irradiation therapy.

Between 1967 and 1986, 319 patients, judged unsuitable for cystectomy, were scheduled to receive curative radiation treatment for transitional cell cancer of the urinary bladder. Crude and corrected 5-year survival for all stages were 18% and 28%, respectively. Corrected 5-year survival by stage was: T1-57%, T2-31%, T3-16% and T4-6%. Fifty-seven patients (18%) never completed the scheduled treatment and all but two of them died in a short time from tumour progression. Local response could be evaluated in 179 of the 262 patients, who completed the radiation treatment. In 130 patients (73%) complete local response was observed and 49 patients (27%) had persistent tumour. Corrected 5-year survival in the responder group was 53% compared to 8% in the non-responder group. Intestinal complications occurred in 51 patients, of whom 24 were operated upon and another four died before operation from radiation-induced intestinal complications. More than 80% of all intestinal and/or urinary tract complications were observed within 3 years after irradiation. During this period, special attention should be paid to detect and treat radiation complications to prevent fistula formation or perforation, with poor prognosis. The dose per radiation fraction and the radiation technique appeared to be the most important factors for the development of intestinal complications.

Female↗
PubMed1991

Regional hyperthermic perfusion with melphalan after surgery for recurrent malignant melanoma of the extremities. Swedish Melanoma Study Group.

A prospective randomized trial testing regional hyperthermic perfusion with melphalan has been conducted. Sixty-nine patients with recurrent malignant melanoma of the extremities were randomly allocated to surgery (36 patients) or surgery plus regional perfusion (33 patients). Prognostic variables concerning primary tumor as well as the recurrent disease were evenly distributed in the groups, excluding any bias in the randomization. Median tumor-free survival after randomization was 17 months in the perfusion group and 10 months in the control group. There were 15 locoregional recurrences in the perfusion group and 24 in the control group. The tumor-free survival curve was significantly (P = .044) better for the perfusion group than for the control group. Median survival time after randomization was 57 months in the perfusion group and 35 months in the control group. This difference was not significant. One patient died within 1 month after perfusion of pulmonary embolism. Regional hyperthermic perfusion after surgery of recurrent malignant melanoma should only be recommended in prospective and controlled trials, until its value has been proven in several randomized studies.

Adult↗
PubMed1991

Chronic posttraumatic syndrome after whiplash injury. A pilot study of 22 patients.

Chronic posttraumatic syndrome after whiplash injury presents several problems to the general practitioner, due largely to the discrepancy between the multiplicity of subjective symptoms and the poverty of objective findings. With the aim of analysing the symptoms and signs of this syndrome and of evaluating the significance of extended physical examination, 22 chronically disabled patients were investigated. The chronic syndrome is characterized by widespread symptoms, migrainous headache, and aggravation following physical activity. Extended physical examination, including an analysis of pain reaction elicited by palpation and a nerve tension test of the brachial plexus, together with negative X-ray examination, supports a common origin of symptoms in soft tissue injury and a disturbance of locomotor function. On the basis of this study we propose an alternative approach to diagnosis and care for these patients.

Accidents↗
PubMed1990

Phase II clinical study of toremifene in patients with metastatic breast cancer. Preliminary communication.

Twelve postmenopausal women with inoperable or metastatic breast cancer were given toremifene at a daily dose of 60 mg. The patients had no prior endocrine or cytotoxic therapy and further inclusion criteria were bidimensionally measurable disease, performance status above 50, expected survival of more than 3 months and estrogen receptor status positive or undetermined. Objective response [complete remission (CR) + partial remission (PR)] was achieved in 6 patients (50%) and stable disease was obtained in 5 patients. No side effects of the treatment were noted.

Aged↗
PubMed1990

Phase II clinical study of high-dose toremifene in patients with advanced breast cancer.

Thirteen postmenopausal women with advanced local or metastatic breast cancer were treated with the antiestrogen toremifene at a daily dose of 200 mg. All patients had failed previous treatment with different types of endocrine therapy and/or cytotoxic drugs. Objective response was only seen in one patient. Treatment was usually well tolerated but in three cases the drug had to be withdrawn due to side effects.

Adult↗
PubMed1990

Use of the timeout procedure in a child psychiatry inpatient milieu: combining dynamic and behavioral approaches.

An observational study of naturally-occurring timeouts was conducted in a child psychiatry inpatient milieu over a three-month period. Data from nine children were assessed. Child negative behavior was generally low in the timeout, processing, and return to activity phases. Results from individuals were discussed in terms of their diagnosis and events taking place on the unit. Staff behavior during timeouts were also described. The crucial role of processing after the timeout was discussed.

Behavior Therapy↗
PubMed1990

Optimized urinary microscopy for assessment of bacteriuria in primary care.

Microscopy of wet-stained urinary sediment as an indicator of bacteriuria was evaluated in 418 consecutive primary care visits in a small community. Delivery of morning urine was encouraged and contributed to bladder incubation times of 4 or more hours in 79% of the visits; the overall culture positivity was about 80%. Bacteria or leukocytes alone or together as minimal requirements were suboptimal microscopy criteria for bacteriuria, whereas a minimum of moderate amounts of bacteria or 5 leukocytes per high-power field (x400) as a cutoff point yielded the best diagnostic accuracy. Optimization of urinary sediment microscopy in this way resulted in a desirable high sensitivity (97%) and efficacy (86%) in acutely symptomatic patients, as well as reasonably high efficacy (79%) in other patients, independent of sex or bladder incubation time. The method's simplicity and speed recommend it for use in primary care, particularly in patients with acute symptoms of urinary tract infection.

Bacteriuria↗
PubMed1989

Health care utilization and attitudes to health care before and after development work in a health centre. Results from two independent postal surveys.

In development work at the Vännäs Primary Health Care Centre (VPHCC) in northern Sweden, attitudes towards and the use of health care were studied from 1977 to 1979. Mail questionnaires were sent to random and independent samples of Vännäs inhabitants to collect data. A relative increase in the health centre physician consultancy rate was found when it was compared to other health care facilities. No change was seen in hospital utilization. Attitudes towards health information and health care accessibility were more positive after the development work. No change in attitudes to quality of health care as such was seen. The changes implemented at the VPHCC seemed to be a major cause for the results obtained as no such change was seen in the catchment area of the reference health centre.

Adolescent↗
PubMed1987

Evaluation of provider continuity in primary care: actual versus random and potential continuity.

Continuity of care is an important factor in the quality of primary care. Unfortunately there is no common view about its definition, measurement, determinants or relationship to outcome. Using a visit-based approach to the measurement of continuity, the present study examines the effects of organizational changes, including the introduction of a new appointment system, on physician continuity at a Swedish primary health care centre. This allows the concepts of random and potential continuity to be introduced, providing norms against which the achieved levels of actual continuity can be rated. The results show that the actual physician continuity, although not particularly high, was considerably higher than what could be expected according to chance alone (random continuity). Moreover, actual continuity did appear to increase after the organizational changes were implemented--absolutely as well as in relation to potential continuity. The importance of reducing the mobility of physicians is emphasized in order to further improve the situation.

Adolescent↗
PubMed1987

Utilization of inpatient and emergency care: effects of changes in primary care system.

At the Vännäs Health Centre changes in practice style and work routines were introduced in 1978. The concomitant changes in hospital use in Vännäs and three reference areas were followed. The results were based on recorded visits to the emergency department of the hospital three months each year 1976-1980 and upon all individual admissions to hospital care in the county 1977-1979. We found a decrease in the number of visits to the emergency department and no changes in admissions to inpatient care for inhabitants of the Vännäs catchment area. The question remains unresolved, whether a mere change in the way of working in the health centre, caused a change in hospital use.

Adolescent↗
PubMed1987

Initiating change in primary care, the Vännäs Project. Its realization and evaluation.

It is expected that the development of primary care shall add qualities such as accessibility, continuity and cooperation to the health care system. In Sweden the health care system is mainly based on hospital care, but projects organized outside hospital settings have been tested, the Primary Health Care Center of Vännäs being one of many. This article reports on the aims of the Vännäs Project and the means used to accomplish postulated goals. In a study conducted between 1976 and 1980, we analyzed the interaction of the aims, means and evaluation of the project. The need for a functioning interplay among the three components was emphasized in order to promote sound planning and knowledgeable decisions. A model for development work in primary care is proposed to give stability and structure to thoughts and ideas when changes are being considered. To further primary care, it is necessary to proceed with a clear structure in order to prevent chance and fashion from running the development.

Continuity of Patient Care↗