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Biomedical subjects

J K Martin

Publications and source records attributed to J K Martin.

At least 19 recordsLinked to original sources
PubMed1995

Parent and staff behavior, previous child medical experience, and maternal anxiety as they relate to child procedural distress and coping.

Assessed the influence of adult in-session behavior and psychological variables on 77 preschool children's coping and distress during routine immunizations. Maternal anxiety was not related to the behavior of the parent, staff, or child. However, in-session behavior by one person was highly correlated with in-session behavior by the other people in the treatment room. The effects of parent and staff in-session behaviors, previous child medical experience, and maternal anxiety on child distress and coping was examined using hierarchical multiple regression procedures. Child coping was predicted by parent and staff behavior whereas child distress was predicted by parent behavior and by the level of the child's distress during previous medical and dental experiences. Implications for intervention and future research are discussed.

Adaptation, Psychological↗
PubMed1994

The management of patients with advanced carcinoid tumors and islet cell carcinomas.

OBJECTIVE: To determine the effectiveness of hepatic artery occlusion alone and with sequenced chemotherapy for patients with hepatic-dominant metastases of islet cell carcinomas and carcinoid tumors. DESIGN: Nonrandomized, observational study with follow-up from 2.5 to 10 years. PATIENTS: 111 ambulatory patients referred to a multidisciplinary tertiary care center who had histologically proven islet cell carcinoma or carcinoid tumor and symptomatic measurable metastatic lesions in the liver or hormonal abnormalities or both. The patients were ambulatory but were having substantial symptoms because of their endocrine syndromes or their tumors. INTERVENTION: All patients had hepatic artery occlusion done surgically or by catheterization and embolization. After this procedure, 71 patients were selected for chemotherapy with alternating two-drug regimens of doxorubicin plus dacarbazine and streptozocin plus fluorouracil. Main outcome measures of response to therapy were rates of tumor regression, rates of improvement in endocrine abnormalities, symptomatic improvement, and duration of favorable response. RESULTS: Objective regressions were observed in 60% of patients treated with occlusion alone and in 80% with chemotherapy added. Regressions were associated with substantial or complete relief from the endocrine syndromes. With occlusion alone, the median duration of regression was 4.0 months and with chemotherapy added, it was 18.0 months. Any comparative inferences about the two treatment regimens must be guarded, because this was not a randomized trial and marked differences occurred in the distribution of prognostic factors between the patient groups. Side effects of arterial occlusion included fever, nausea, pain, and abnormalities in liver function. Side effects of chemotherapy included nausea, vomiting, leukopenia, and alopecia. CONCLUSIONS: Hepatic arterial occlusion can frequently produce major regression of neuroendocrine tumors with relief from the hormonal syndromes. Sequential chemotherapy may improve the rate and duration of the regression.

Adult↗
PubMed1993

High-dose preoperative external beam and intraoperative irradiation for locally advanced pancreatic cancer.

PURPOSE: To analyze results of high-dose preoperative external beam irradiation followed by surgical exploration and intraoperative radiation therapy in patients with unresectable pancreatic cancer. METHODS AND MATERIALS: From December 1983 through December 1990, 27 patients with primary unresectable but localized pancreatic adenocarcinoma received high-dose (50 to 54 Gy) external beam irradiation with or without concomitant bolus 5-fluorouracil followed by surgical exploration and intraoperative electron beam irradiation (20 Gy) at the Mayo Clinic. RESULTS: Local control was achieved in 21 of 27 (78%) patients. Actuarial local control at 1, 2, and 5 years was 86%, 68%, and 45%, respectively. In 19 (70%) of the 27 patients, distant metastasis developed, and peritoneal or liver progression (or both) was found in 14 (52%). The actuarial distant metastasis rate at 2 and 5 years was 69% and 83%, respectively. Median survival from the date of diagnosis was 14.9 months. Actuarial 2- and 5-year overall survival was 27% and 7%, respectively. These survival rates are higher (p = 0.001) than the 6% and 0% actuarial 2- and 5-year survival observed in 56 patients who underwent intraoperative radiation therapy followed by postoperative high-dose external beam treatment at our institution. CONCLUSION: Administering the full component of external beam irradiation before exploration and intraoperative radiation therapy may be more appropriate because it allows better patient selection. Unfortunately, altered patient selection was not effective in decreasing the relative risk of abdominal failure. Because effective systemic chemotherapy does not currently exist, whole abdominal irradiation alone or in combination with chemotherapy warrants evaluation.

Adenocarcinoma↗
PubMed1993

Drinking patterns and the gender mix of occupations: evidence from a national survey of American workers.

The linkage of the gender mix of occupations to drinking patterns has been suggested by Wilsnack and Wilsnack (1991). Using a national sample of American workers, associations among gender, the gender mix of occupations, occupation, and drinking variables were explored. The results suggest that the relationship between the gender mix of occupations and drinking variables operates through opportunities to drink with coworkers. Gender mix is associated with opportunities to drink with coworkers. Opportunities to drink with coworkers are, in turn, associated with whether respondents drink, who they are with when they drink, average number of drinks per month, and CAGE scores. Gender is associated with opportunities to drink with coworkers, drinks per month, and CAGE scores. Occupation is associated with opportunities to drink with coworkers, drinking patterns, and problem drinking. Further elaboration of the mechanisms linking the gender mix of occupations and drinking patterns is warranted.

Adult↗
PubMed1993

Alcohol consumption and work performance.

This study examines the work performance of 136 males, including both self-reports and reports of workplace collaterals. Comparisons are made on several dimensions of work performance and different levels of alcohol consumption. Different levels of drinking are not associated with scales of self-reported work performance, but relatively heavy drinkers are less frequently absent and late to work than their lighter drinking counterparts. Collateral reports of work performance, however, indicate that heavier drinkers are more likely to score lower on self-direction at work, conflict avoidance at work and interpersonal relations at work. The relationship of alcohol consumption to the technical aspects of work performance is less clear. There is, however, an overall negative relationship between alcohol consumption and technical aspects of work performance as indicated by workplace collateral reports. The implications for the design of workplace intervention programs are considered.

Absenteeism↗
PubMed1992

Analysis of failure after curative irradiation of extrahepatic bile duct carcinoma.

Thirty-four patients with subtotally resected or unresectable carcinoma of the extrahepatic bile ducts received radiation therapy; a minimum of 45 Gy (external beam) to the tumor and regional lymph nodes +/- 5-fluorouracil (5-FU). Seventeen patients received an external beam boost of 5 to 15 Gy to the tumor, and a specialized boost was used in the remaining 17 patients (iridium-192 transcatheter seeds in 10 and intraoperative radiation therapy [IORT] with electrons in seven). The median time to death in all 34 patients was 12 months (range, 4 to 98-months). The only patients who survived longer than 18 months were those either with gross total or subtotal resection before external irradiation (2 of 6) or who received specialized boosts (192Ir, 3 of 10; IORT, 3 of 7). Local failure was documented in 9 of 17 patients who received external beam irradiation alone +/- 5-FU, 3 of 10 patients who received an 192Ir boost, and 2 of 6 patients who received an IORT boost with curative intent.

Adenoma, Bile Duct↗
PubMed1992

'Enabling' of male problem drinkers in work groups.

Theoretical understanding of the effects of groups on the development and the maintenance of adult problem drinking is sparse. Sociological theories predict that adult problem drinkers find support for their behavior among those with similar drinking patterns. By contrast, a widely diffused clinical conceptualization posits that 'significant others' who are not problem drinkers facilitate the maintenance of problem drinking. Several previous lines of research lead to the hypothesis that observed delays in identification and referral of problem drinkers in the workplace may be due to supportive relationships between problem drinkers and their coworkers and supervisors. Data from the 1973-77 Quality of Employment Panel Survey are utilized to provide a longitudinal test of this hypothesis among employed men. Results support the existence of enabling in the workplace. Data comparing 'enabled' and 'non-enabled' problem drinking workers fail to support four possible explanations of enabling.

Adult↗
PubMed1990

Intra-arterial floxuridine vs systemic fluorouracil for hepatic metastases from colorectal cancer. A randomized trial.

Seventy-four patients with liver metastasis from proved colorectal primary adenocarcinoma were entered into a prospective, randomized clinical trial to evaluate treatment with intra-arterial floxuridine compared with standard outpatient therapy with fluorouracil delivered by intravenous bolus injection. Eligible patients were randomized to hepatic arterial chemotherapy with an implanted infusion pump or systemic chemotherapy. No crossover between treatment arms was permitted, and patients were followed up to progression and death. Objective tumor response was observed in 48% of patients receiving intra-arterial floxuridine and in 21% of patients receiving intravenous fluorouracil. Time to hepatic progression was significantly longer in the group given intra-arterial therapy: 15.7 vs 6.0 months. However, time to overall progression (6.0 vs 5.0 months) and survival (12.6 vs 10.5 months) were not statistically different. Based on these data, we cannot recommend treatment with intra-arterial floxuridine as given in this study for metastatic colorectal cancer to the liver.

Adenocarcinoma↗
PubMed1990

Peripheral nerve and ureteral tolerance to intraoperative radiation therapy: clinical and dose-response analysis.

Between April 1981 and July 1984, 51 patients received intraoperative radiation therapy (IORT) as a component of therapy for the management of primary or recurrent pelvic malignancies which were initially unresectable for cure. For these patients, curative surgical alternatives did not exist, or would have involved extensive procedures such as pelvic exenteration, distal sacrectomy, hemipelvectomy, or hemicorporectomy. The primary disease was colorectal in 38 patients. Treatment consisted of external beam radiation (range 3000 to 6890 cGy, median 5040 cGy), surgical debulking when feasible, and an intraoperative electron beam boost to the gross or microscopic residual disease (dose range 1000 to 2500 cGy, median 1750 cGy) utilizing 9-18 MeV electrons. The most common IORT associated toxicities were peripheral neuropathy and ureteral obstruction. None were life-threatening or fatal in severity. Of the 50 patients evaluable for neurotoxicity analysis, 16 (32%) developed peripheral neuropathy consisting of pain in 16 patients, numbness and tingling in 11, and weakness in 8. The pain, numbness and tingling resolved in about 40% of patients, while weakness resolved in only 1 of 8. Sixteen ureters were initially unobstructed by tumor at the time of IORT. Of these, 10 (63%) subsequently showed evidence of obstruction and hydronephrosis. The development of neurotoxicity was more common at IORT doses of 1500 cGy or more versus 1000 cGy. Ureteral obstruction with hydronephrosis occurred more frequently at IORT doses of 1250 cGy or more compared to 1000 cGy. There was no relationship between the likelihood of developing complications and the total external beam dose. The observed dependence of human nerve toxicity primarily on the IORT dose is consistent with data generated from animal experiments.

Colorectal Neoplasms↗
PubMed1989

Randomized trial to evaluate the addition of tamoxifen to cyclophosphamide, 5-fluorouracil, prednisone adjuvant therapy in premenopausal women with node-positive breast cancer.

A randomized clinical trial was performed to determine if the addition of hormonal therapy with tamoxifen to a combination chemotherapy regimen was superior to the chemotherapy alone for adjuvant treatment of premenopausal women after mastectomy for node-positive breast cancer. The chemotherapy regimen utilized consisted of cyclophosphamide (C), 5-fluorouracil (F), and prednisone (P), and the doses employed were: C, 150 mg/m2 IV days 1 to 5; F, 300 mg/m2 IV days 1 to 5; and P, 10 mg orally three times daily on days 1 to 7. A total of ten courses of therapy, given every 6 weeks, was planned. Tamoxifen (T) was given at a dose of 10 mg twice daily and was stopped 6 weeks after the last course of CFP. Four hundred patients are fully eligible and evaluable. With a median observation time of 5.3 years, the proportion of recurrences on each arm were: CFP, 95 of 202 (47%); CFPT, 77 of 198 (39%). The relapse-free survival distribution for CFPT was superior to that for CFP, at a borderline level of significance (two-sided P = 0.06). When significant prognostic factors were considered in covariate analysis, CFPT was not significantly better than CFP (P = 0.43). This marked change in level was due to imbalance in several factors not considered in stratification. Currently, 31% of CFP and 25% of CFPT patients have died, and although there is a slight separation of the survival curves in favor of CFPT, the difference is not significant (P = 0.21). Analysis within receptor subsets also showed no significant advantage for the addition of tamoxifen. This study does not establish a significant advantage for the concurrent administration of tamoxifen with the CFP regimen. It does, however, clearly demonstrate the importance of examination of clinically important prognostic factors, even those not utilized in stratification, and consideration of these factors in covariate analysis if imbalances are present.

Adult↗
PubMed1989

Oncological aspects of immediate breast reconstruction following mastectomy for malignancy.

One hundred eighteen women treated with mastectomy and immediate breast reconstruction for carcinoma were evaluated for recurrence of disease and survival. Fourteen women (12%) suffered relapse of their cancer and 10 patients (9%) died of their disease during a median follow-up of 2.3 years. All seven local recurrences (6%) were detected at an early stage and treated without removal of the prosthesis. Recurrence of disease occurred more frequently in patients with involved axillary lymph nodes and larger tumors. Patient survival was adversely affected by nodal metastasis and the absence of tumor estrogen receptors. Adverse outcome in this series correlated to known prognostic factors for breast cancer. Disease-free and overall survivals were comparable with our previous experience with mastectomy alone for breast carcinoma. In the absence of any apparent negative impact on patient outcome, and because of the well-documented positive psychosocial benefit of immediate reconstruction, this procedure should be routinely offered to women with operable breast cancer.

Adult↗
PubMed1988

External beam versus intraoperative and external beam irradiation for locally advanced pancreatic cancer.

One hundred fifty-nine patients with unresectable but localized pancreatic cancer, as defined at exploratory laparotomy, were treated at the Mayo Clinic between February 1974 to April 1985. Postoperative therapy consisted of 4000 to 6000 cGy external beam irradiation (XRT) alone in 122 patients or 4500 to 5500 cGy XRT in combination with an intraoperative electron boost in 37. In addition, 132 (both groups) received 5-fluorouracil (5-FU) chemotherapy. Local control (LC) at 1 year was 82% with XRT + intraoperative radiation therapy (IORT) versus 48% with XRT and 66% versus 20% at 2 years respectively (P less than 0.0005). Due to the high incidence of hematogenous and/or peritoneal spread in both groups (abdominal failure in 54 and 56% of patients at risk), the decreased frequency of local progression did not translate into an improved survival. Neither median nor long-term survival of the two treatment groups (XRT versus XRT + IORT) was statistically different (median 12.6 months versus 13.4 months, P = 0.25). With tumor arising in the head of the pancreas, survival at 2 years was 18% as opposed to 0% for other locations (P less than 0.01). On the basis of a Cox multivariate analysis, no other treatment or prognostic factor significantly altered survival. Until the problem with systemic failure (usually abdominal) can be resolved, the median and long-term survival of patients with pancreatic carcinoma is likely to remain unchanged. Since IORT appears to improve local control, we will continue to utilize IORT in phase 1, 2 studies which also attempt to decrease the incidence of abdominal failures. Even with IORT + XRT combinations, the incidence of local progression is excessive and radiation dose modifiers need to be evaluated.

Adenocarcinoma↗
PubMed1988

Intraoperative and external beam irradiation for locally advanced colorectal cancer.

In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without 5-fluorouracil (5FU), in 51 patients with locally advanced colorectal cancer (recurrent, 36 patients; primary, 15 patients). Patients received 4500-5500 cGy (rad) of fractionated, multiple field external beam irradiation and an IORT dose of 1000-2000 cGy. Thirty of 51 patients (59%) are alive and 22 patients (43%) are free of disease. In 44 patients at risk greater than or equal to 1 year, local progression within the IORT field has occurred in 1 of 44 (2%) and within the external beam field in 8 of 44 (18%). All local failures have occurred in patients with recurrence or with gross residual after partial resection, and the risk was less in patients who received 5FU during external irradiation (1 of 11, 9% vs. 6 of 31, 19%). The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomized trials are needed to determine whether potential gains with IORT are real.

Colonic Neoplasms↗
PubMed1988

Randomized trial of observation versus adjuvant therapy with cyclophosphamide, fluorouracil, prednisone with or without tamoxifen following mastectomy in postmenopausal women with node-positive breast cancer.

Following mastectomy for node-positive breast cancer, 261 postmenopausal women were randomized to observation or adjuvant treatment with cyclophosphamide, fluorouracil, prednisone (CFP) alone or combined with tamoxifen (T). Doses used were: C, 150 mg/m2 intravenously (IV) days 1 to 5; F, 300 mg/m2 IV days 1 to 5; P, 10 mg by mouth 3 times daily on days 1 to 7; and T, 10 mg by mouth 2 times daily. A total of ten courses of treatment, administered every 6 weeks, was planned and T was stopped 6 weeks after the last course of CFP. Two hundred thirty-four patients were fully eligible and evaluable. With a median observation time slightly in excess of 5 years, the proportion of recurrences on each arm were: CFP, 29 of 75 (39%); CFPT, 29 of 71 (41%); and observation, 50 of 88 (57%). Relapse-free survival distributions for both CFP and CFPT were superior to observation (both two-sided P = .01). Considering prognostic factors in covariate analysis revealed two-sided P = .0006 for CFP v observation and P = .0003 for CFPT v observation. No substantial difference was identified between CFP and CFPT. Survival data are not yet mature with 31% dead; and, although slight separations of the curves exist in favor of the treatment arms, no significant differences in survival have been seen. Both adjuvant therapy programs are well tolerated and there were no treatment-related deaths. Further maturation of the data is required to determine if the advantages in relapse-free survival will be translated into any overall survival benefit which must be considered the goal of primary interest.

Aged↗
PubMed1988

Pharmacist management of antiemetic therapy under protocol in an oncology clinic.

The development of a program for pharmacist prescribing of antiemetic agents for nausea and vomiting induced by antineoplastic agents given to ambulatory patients is described. The oncologist and the pharmacists developed a protocol and submitted it to the Washington State Board of Pharmacy, which can authorize a pharmacist to initiate or modify drug therapy in accordance with written guidelines or protocols. The protocol was approved and the pharmacists developed algorithms for antiemetic therapy, based on the emetic potential of the various antineoplastic agents. The oncologist writes an order for the pharmacist to prescribe antiemetic therapy for an individual patient, and the pharmacists selects an algorithm for each patient based on the antineoplastic agent that has the highest potential for causing emesis. The pharmacist writes orders for antiemetic agents to be administered in the clinic and at home, phones the patient 24 hours after antineoplastic drug therapy, and, if necessary, modifies the antiemetic therapy. Pharmacists have managed antiemetic therapy for more than 1200 patient visits and were able to use the first-line therapy in the selected algorithm in 78% of the cases without serious adverse effects. Pharmacist management of antiemetic therapy for nausea and vomiting associated with antineoplastic drug treatment has been well accepted by patients and professionals in this oncology clinic.

Antiemetics↗
PubMed1987

Intraoperative and external beam irradiation +/- 5-FU for locally advanced pancreatic cancer.

Because of the poor local control rates obtained with external beam irradiation +/- chemotherapy for locally advanced pancreatic cancer, our institution has used intraoperative radiation therapy (IORT) with electrons to deliver a single "boost" dose of radiation in 52 patients with biopsy-proven adenocarcinoma (primary, unresectable-49; primary, residual-2; and recurrent, unresectable-1). Patients received 4500-5000 rad of fractionated external beam irradiation and an IORT dose of 1750 rad (2 patients) or 2000 rad (50 patients). Acute and chronic tolerance have been acceptable. Documented local progression within either the external beam or IORT fields has been infrequent (3 of 42 evaluable patients or 7%), but there has been little, if any, change in median or long-term survival from that seen in external beam series. This is probably because of a high incidence of liver and peritoneal metastases with pancreatic cancer. A phase II pilot trial, which combines upper or total abdominal irradiation and infusion 5-FU with tumor nodal irradiation plus IORT, is in progress in our institution to evaluate tolerance and the relative incidence of abdominal failures.

Adenocarcinoma↗
PubMed1987

Surgical technique and pitfalls of breast reconstruction immediately after mastectomy for carcinoma: initial experience.

Breast reconstruction immediately after mastectomy is being used with increasing frequency. In a study of the first 100 consecutive patients at our institution who underwent this procedure, with (21 patients) or without (79 patients) later nipple reconstruction, 85% responded affirmatively on a follow-up questionnaire when asked whether they would recommend the procedure to other patients. Moreover, 32% rated their cosmetic results as "perfect." No deaths occurred in the immediate postoperative period, but 13 patients had major complications--most commonly, wound infection or displacement or partial extrusion of the implant. All infections, however, occurred early in the study, and with increasing experience and improved selection of patients, the associated morbidity decreased. For the entire group, the mean duration of hospitalization was 7.8 days, similar to that for patients who undergo mastectomy without reconstruction (7.5 days). The high patient acceptance and the overall good results in this preliminary study support the use of breast reconstruction immediately after mastectomy.

Adult↗