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Biomedical subjects

J F Forbes

Publications and source records attributed to J F Forbes.

At least 37 records · Page 2Linked to original sources
PubMed1994

Surgery of early breast cancer.

Randomized clinical trials evaluating local treatments for early breast cancer have provided new data on the long-term morbidity and cause-specific mortality associated with radiotherapy combined with different types of mastectomy. The difficulty surgeons have in determining optimal integration of surgery and radiotherapy for breast preservation is demonstrated by the wide variation of radiotherapy schedules, lack of interpretable data to justify a radiotherapy "boost," and data from a randomized trial suggesting that radiotherapy applied only to the excision site might be sufficient. The use of cytology aspirates for tumor grading, the prognostic importance of vascular invasion, and new tumor markers and cancer cells in bone marrow at diagnosis are all reported. New data came from attempts to identify an axillary sentinel node at surgery for breast cancer. Studies of connective tissue disorders in women with silicone implants failed to find evidence of increased risk, but 3-year follow-ups confirmed that surgeons who preferred mastectomy are more likely to have anxious, depressed patients.

Breast Neoplasms↗
PubMed1993

Surgery of early breast cancer.

Randomized trials of treatment have evaluated the role of radiotherapy after breast-preserving surgery for both in situ and invasive cancer. These trials provide treatment guidelines and identified "show biz" questions relating to both therapy and biology. A trial of systemic treatment of premenopausal women with node-positive disease provided compelling reasons to always determine estrogen receptor status before determining adjuvant systemic treatment. Additional data on pathology, needle biopsy, and surgical techniques provide important information for surgeons. New data on breast cancer biology in young women and data suggesting that mastectomy rates are still higher than necessary provide issues on which surgeons can reflect. Evidence that supports marrow biopsy for staging at the time of surgery is important for surgeons. Psychosocial data are partly reassuring in that mastectomy patients, if they choose the procedure themselves, may not be worse off. Finally, a sobering report of the devastating effects of late diagnosis came from Nigeria.

Adult↗
PubMed1993

Cost of stroke.

Explore the source record for details and available documents.

Aged↗
PubMed1992

Promotion of attendance for mammographic screening through general practice: a randomised trial of two strategies.

OBJECTIVE: To compare the effectiveness of two strategies--patient education and practitioner recommendation--in encouraging women to attend for mammographic screening. DESIGN: The study was a prospective randomised controlled trial. Women aged between 40 and 70 years attending a general practitioner participated in the study. Consenting, eligible women were randomly allocated to one of the two strategy groups. SETTING: The study was conducted in private general practice in Newcastle, New South Wales. PARTICIPANTS: The general practitioners who took part in the study were a non-random sample of practitioners: 20 were approached, two declined to participate, and five failed to begin recruitment, leaving 13 practitioners who took part in the study. A total of 302 women aged 40-69 were recorded as attending the surgeries during recruitment sessions. Twenty women did not consent to the study and 73 were ineligible. Thirty-four women were not given the intervention because the general practitioner forgot or did not have time. There were 92 women in the simple recommendation group and 83 women in the patient education group. INTERVENTIONS: An intensive patient education approach based on health belief principles was compared with a simple recommendation by the general practitioner that the woman have a mammogram. MAIN OUTCOME MEASURE: Attendance rates were calculated from screening service attendance records. RESULTS: No significant difference in attendance rates was observed between the two groups, 82% of the simple recommendation group and 91% of the patient education group attended for screening. CONCLUSIONS: These results suggest that mammographic screening can be effectively promoted in general practice without extensive patient education.

Adult↗
PubMed1992

Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group.

PURPOSE: We observed that quality-of-life (QL) scores, collected to evaluate treatment in a randomized trial in advanced breast cancer, predicted survival duration. This report explores the prognostic associations between QL and survival in more detail. PATIENTS AND METHODS: In a randomized clinical trial comparing intermittent and continuous therapy policies for patients with advanced breast cancer, QL was measured by linear analog self-assessment (LASA) and the Quality-of-Life Index (QLI). Baseline scores and subsequent changes were included in statistical models of survival duration, with and without other prognostic factors. RESULTS: Physician assessment of QLI and patient LASA scores for physical well-being (PWB), mood, nausea and vomiting, appetite, and overall QL (but not pain) at the commencement of treatment were significant predictors of subsequent survival. Scores for PWB and QLI were independent of other prognostic factors. Changes in scores were also prognostically important. Both baseline and change in scores for PWB, mood, pain, and QLI after the first three treatment cycles, but before an arbitrary 180-day time point, were significantly predictive of survival beyond that time. Both QLI and PWB were prognostically independent of tumor response. Although QL improvement was correlated with tumor response, continuous therapy yielded significantly better QL scores, even in nonresponders. CONCLUSION: These findings support the validity of the simple QL measures used in the trial. They are compatible with the simple explanation that patients perceive disease progression before it is clinically evident, but also with a causal relationship between QL and survival duration.

Breast Neoplasms↗
PubMed1992

Long-term effects of adjuvant chemotherapy in breast cancer.

Late effects of adjuvant chemotherapy (ACT) may include second malignant neoplasms (SMN), cardiotoxicity and ovarian suppression. Effects on the biology of residual tumour may be important in protocol design. Studies of SMN need large and reliable data sets. The leukaemia risk with current ACT is likely to be less than a five-fold increase. Leukaemia is predominantly a result of alkylating agents and peaks before 10 years. Solid SMN result also from radiotherapy and this risk continues after 10 years. Cardiotoxicity can be caused by anthracyclines but should not be a problem with current ACT regimens. It can be reduced by careful monitoring and by the cardioprotector ICRF-187. Amenorrhoea is a crude marker of ovarian suppression which may explain conflicting data on its relationship to outcome after ACT. Ovarian suppression following ACT is more likely and more permanent in older premenopausal women, but only explains a part of the ACT effects on outcome. Effects of early ACT on residual tumour are important for planning retreatments and combined modality protocols.

Breast Neoplasms↗
PubMed1992

The cosleeping habits of military children.

Cosleeping is a topic frequently of concern to parents; however, little objective evidence exists to support the historical prohibition against children sleeping in the same bed with their parents. Surveys from the parents of 86 children in the clinics of pediatrics and child psychiatry were analyzed to describe patterns of cosleeping in a group of military dependents aged 2 to 13 years. Shown is a significant increase in cosleeping with father absence and that cosleeping is less frequent in the psychiatric subpopulation.

Beds↗
PubMed1991

Surgery for early breast cancer.

Optimal surgery for breast cancer demands effectiveness in local disease control, minimal physical and psychosocial morbidity, and efficient use of resources for assessment, diagnosis, treatment, and follow-up. These issues are addressed below with particular emphasis on the biologic relevance of tumor recurrence for planning local treatment, the management of subclinical radiographic abnormalities, the degree of importance of the timing of surgery in the menstrual cycle, and the value of axillary dissection.

Biopsy↗
PubMed1990

Mammary serum antigen (MSA) in advanced breast cancer.

An Enzyme Linked Immunosorbent Assay (ELISA) based on a monoclonal antibody, 3E1.2, was used to measure circulating Mammary Serum Antigen (MSA) in a study of 123 advanced breast cancer patients. Fifty two patients were monitored serially to investigate whether measurements of circulating MSA levels were of value in the management of advanced breast cancer patients on palliative therapy. Analysis of variance showed that circulating MSA levels at first presentation correlated with disease status both at initial presentation (p = 0.01) and also 4 months later (p = 0.003). At first presentation, the circulating MSA level also significantly correlated with the number of metastatic sites (p = 0.04), but this did not hold at 4 months. The circulating MSA levels did not at any time correlate with the type of treatment given nor age of the patient. We conclude that MSA might ultimately be useful in the management of advanced breast cancer patients as a prognostic marker for the course of the disease and for monitoring patient response to palliative hormonal therapy and chemotherapy.

Adult↗
PubMed1990

Camptocormia.

Camptocormia is a disabling psychiatric condition characterized by a fixed flexion of the spine usually occurring during the stress or anticipation of battle. We present an illustrative case study and a summary of six cases. In this clinical sample the camptocormia was associated with a high likelihood of a history of significant back trauma; this lends to difficulty in assigning a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). Camptocormic patients retained in the military have a poor prognosis; rapid diagnosis and medical separation is recommended.

Adult↗