Patients are selected for admission to rehabilitation centers. Some patients are too sick or medically unstable to treat; others' disabilities are irremediable. Resources should not be expended upon patients who will not benefit from treatment. The current process of patient selection requires providers to consider both medical and nonmedical factors. Medical factors include diagnosis, prognosis, secondary complications, functional performance and prognosis, and ability to learn. Nonmedical assessment includes social, vocational, financial, and personal factors. There is a potential for subjectivity in the way these variables are considered. Practitioners may be unaware of bias in their decision-making. Patients may be disadvantaged by lack of family or financial resources. Both providers and patients suffer when providers are forced by expectations of utilitarianism to deny treatment to deserving patients. It would be helpful if patients and families were informed about the process of selection of rehabilitation candidates and given the right of redress if rejected. Guidelines delineating standards for admission to rehabilitation centers could assist patient selection. Finally, rehabilitationists must seek to further demonstrate the efficacy of their treatment in order to better identify persons who will benefit from rehabilitation services.

Beneficence↗

PubMed1987

Risk of leukaemia in ovarian tumour and breast cancer patients following treatment by cyclophosphamide.

A case-control study was conducted to determine whether the development of leukaemia was associated with chemotherapy for neoplasms of the ovary or breast, in a population where most such chemotherapy consisted of cyclophosphamide alone. Cases and controls were identified from the National Cancer Registry of the German Democratic Republic. Cases were women who had developed leukaemia as a second primary after an initial diagnosis, at least one year before, of an ovarian or breast tumour. Controls were patients with an ovarian tumour or breast cancer who had survived to the year when the case developed a leukaemia but who had not themselves developed a second malignancy. Controls were matched to cases by the site of the first primary and its year of diagnosis, as well as year of birth. The relative risk for acute leukaemia following treatment with cyclophosphamide alone was significantly elevated (P less than 0.05), at 14.6 for ovarian tumour patients and 2.7 for breast cancer patients. Among breast cancer patients the increased risk of leukaemia associated with chemotherapy was confined to women who had been under 50 years of age at the time of diagnosis of the breast cancer (for whom the relative risk was 13.1). No excess risk of leukaemia was observed in association with radiotherapy for either ovarian or breast cancer patients. The present findings strongly suggest that cyclophosphamide as a single chemotherapeutic agent is capable of inducing leukaemia in humans.

Acute Disease↗

PubMed1987

Premorbid prevalence of poor academic performance in severe head injury.

A study of 80 head injured patients revealed poor premorbid academic performance in up to 50% of the sample. Poor academic performance, as defined by diagnosis of learning disability, multiple failed academic subjects, or school dropout during secondary education, is not a previously cited risk factor for head injury. These findings have important implications in the identification of a high risk population and in the subsequent ability to reduce the incidence of head injury.

Achievement↗

PubMed1986

Newly diagnosed primary intracranial neoplasms in pregnant women: a population-based assessment.

The presence of a pregnancy at the time of the initial diagnosis of an intracranial neoplasm was studied using material from a population-based tumour registry. Seventeen malignant neoplasms of the brain (ICD 191), three meningiomas, three acoustic neurinomas and a pituitary adenoma associated with pregnancy were reported to the National Cancer Registry of the GDR from 1961-1979. Observed cases were compared with those expected based on the number of births and the incidence rates for intracranial tumours among women of childbearing age during the same time period. Observed to expected ratios were substantially reduced for malignancy of the brain and meningioma but not for acoustic neurinoma. Review of this uniformly collected material did not provide support for the view that intracranial neoplasms present more often during pregnancy.

Adolescent↗

PubMed1986

A case-control study of leukaemia as a second primary malignancy following ovarian and breast neoplasms.

The National Cancer Registry of the German Democratic Republic identified 105 leukaemias which had developed during 1968-1980 as second primary malignancies in women previously registered with a tumour of the breast or ovary. Matched controls were selected who had been diagnosed with the same first tumour, but had survived without further malignancy as long as the corresponding case. Treatment records were abstracted for leukaemia cases and controls, and a comparison made of the therapy received. There was a ten-fold increase in the risk of leukaemia following ovarian cancer among those treated with chemotherapy, which was almost exclusively cyclophosphamide. Among the breast cancer survivors, the relative risk of acute leukaemia associated with cyclophosphamide was 2.7.

Age Factors↗

PubMed1986

Time trends in cancer incidence in the German Democratic Republic 1968-1981.

Cancer incidence data from the National Cancer Registry of the German Democratic Republic were analyzed over the period 1968-1981. A regression model of the form log y = a + bx was fitted to the annual age-standardized incidence rates. The average annual percentage change in rates was used to summarize the temporal trend in cancer incidence. The greatest increase in incidence occurred for cancers of the oral cavity and pharynx. The greatest decrease was seen for stomach (females), small intestine (males) and cervical cancers.

Esophageal Neoplasms↗

PubMed1986

Epidemiologic characteristics of gastric stump cancer in the GDR 1971-1980.

Epidemiologic features of carcinoma of the gastric remnant are described based on 3024 such cases reported to the National Cancer Registry of the German Democratic Republic from 1971 to 1980. Although the incidence of gastric cancer in general declined during this period this was not the case with gastric stump carcinoma. The sex ratio of gastric stump carcinoma showed a male predominance of 5.9: 1(2,583: 441). The age at diagnosis of gastric remnant cancer was somewhat lower than that of other gastric cancers. Some regional differences were discerned in its frequency which could not readily be explained. Approximately 20% of cases were diagnosed in stages I and II but radical surgery was only possible on 14% of all cases. The crude five year survival rate in 1975 was 2.5% overall and 15% on the radically operated patients. The epidemiologic data concerning gastric stump cancer demonstrate its importance in the context of the entire picture of stomach cancer and make clear the unsatisfactory diagnostic and therapeutic situation with respect to this form of carcinoma.

Adult↗

PubMed1986

Ethics in rehabilitation medicine.

Explore the source record for details and available documents.

Chronic Disease↗

PubMed1985

Neuropharmacologic management of behavior sequelae in head injury: a case report.

A patient with traumatic head injury was confused, agitated, and belligerent. Initial treatment with sedatives (diazepam) and antipsychotics (haloperidol and thioridazine hydrochloride) did not diminish this irritability or destructive behavior. A single case experimental methodology was adopted to evaluate the behavioral response to other sequentially introduced neuroactive drugs. Methylphenidate produced increased agitation. No response was noted to propranolol. Lithium, however, was associated with significant calming of the patient, successful completion of rehabilitation, and discharge to home where the patient safely cared for himself while his wife worked.

Adult↗

PubMed1985

[Epidemiology of colorectal tumors with special reference to the status in East Germany].

Colorectal cancers are a major cause of morbidity and mortality in the GDR and affect almost 3% of the population by age 75. The age-standardized incidence rate has increased and this probably reflects a true rise in the frequency of carcinomas of these sites. At the beginning of the treatment only 42% were in a sufficiently localized stage of the disease so that curative radical surgery might be attempted. Such operations are widely decentralized in the GDR. Only 15% of all patients were alive 5 after treatment was initiated.

Adult↗

PubMed1984

Pregnancy in association with a newly diagnosed cancer: a population-based epidemiologic assessment.

Cancer patients who were pregnant at the time of cancer diagnosis were identified by the National Cancer Registry of the German Democratic Republic for the years 1970 through 1979. A total of 355 such cases occurred in women aged 15-44, and during the same period 2, 103, 112 live births were registered. Rank by site in order of decreasing frequency was cervix, breast, ovary, lymphoma, melanoma, brain and leukemia. On the basis of general female population rates, 555.8 cases were expected, giving a significantly reduced observed to expected ratio (O/E) of 0.64. O/E ratios rose with age. The O/E for invasive carcinoma of the cervix was significantly elevated at 1.15; carcinoma in situ of the cervix occurred significantly less frequently than expected (O/E = 0.57). For breast, brain, melanoma and leukemia, significantly fewer cases were observed than expected. Explanations considered for the low number of pregnancy-associated incident cancer cases include underreporting of pregnancy-associated cancer, altered tumor progression in pregnancy or decreased fertility in women with early neoplastic disease.

Adolescent↗

PubMed1984

Primary central nervous system tumors in stillborns and infants. Epidemiological considerations.

An epidemiologic investigation of true neoplasms of the central nervous system in fetuses and infants in the German Democratic Republic (GDR) was undertaken. Since all fetal deaths and all deaths in the first year of life are subject to a full postmortem examination and since all cancer cases or deaths are reported to a central registry, the prerequisites for a valid assessment of the incidence of these tumors are present. During the years 1960-1979, 55 histopathologically verified tumors of the central nervous system were identified in the GDR, a frequency of approximately 1.1 per 100 000 births. Unexpectedly, medulloblastoma (13 cases) was the most frequent tumor type.

Brain Neoplasms↗

PubMed1984

Epidemiologic investigations on brain tumors in the GDR: possibilities and limits.

Animal experiments and recent industrial medicine investigations suggest that chemical carcinogens in the environment could be responsible for some types of human brain tumors. Confirmation demands data on the epidemiology of human tumors of a precision which has been unavailable. Prerequisites for valid epidemiologic studies are presented and the current situation in the GDR is critically evaluated in that context. The conditions for such studies are met fully only in early childhood. Based on files of the National Cancer Registry of the GDR, 1960-1979, 55 children with histopathologically confirmed tumors of the central nervous system prior to the end of the first year of life have been identified. The overall frequency was 1.1 per 100,000 births. Males were affected more than twice as often as females. Incidence for the years 1970-1979 was significantly higher than for 1960-1969. Possible explanations are critically explored and it is concluded that further epidemiologic studies of brain tumor etiology in early life must also consider children with onset of tumor symptoms during the first year of life but in whom histological confirmation was secured thereafter.

Brain Neoplasms↗