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Biomedical subjects

J Moore

Publications and source records attributed to J Moore.

At least 235 records · Page 13Linked to original sources

Patient preferences for chemotherapy schedules used in the treatment of advanced colorectal cancer--a pilot study.

Patient preferences in cancer chemotherapy are an increasingly important issue and need to be better understood. In this pilot study, 45 patients with advanced colorectal cancer were shown 'blinded' descriptions of four different chemotherapy regimens [three 5-fluorouracil (5-FU)-based regimens and Raltitrexed (Tomudex)] and asked to select which they most and least preferred assuming equal efficacy and safety. Patients also rated how troublesome were factors associated with attending hospital and/or receiving chemotherapy. The Raltitrexed regimen was most preferred by 87% of patients, generally because the visit schedule for administration was more convenient. In most cases, patients expressed a strong preference. Continuous 5-FU administered via a Hickman line and portable infusion pump was the least preferred treatment (80%), and the factors associated with wearing a Hickman line permanently were rated as 'very troublesome' or 'fairly troublesome' by 98% of patients. In conclusion, patients prefer convenient chemotherapy regimens which cause minimal disruption of their normal daily routine.

Adult↗

Recalling demonstrated and guided movements using imaginary and verbal rehearsal strategies.

This study investigated the recall of movement patterns presented either by demonstration or guided movement with vision eliminated. Participants were instructed to rehearse and remember each of the 12 patterns using one of four strategies: imagery, verbal labeling, imagery and verbal labeling, or no rehearsal strategy (i.e., control condition). Recall was better for patterns that were demonstrated than for those presented via guided movement. In addition, more patterns were remembered if a combination of imagery and verbal labeling were employed as a rehearsal strategy compared to using imagery alone. These results are discussed using Annett's (1994) model showing the relationships between action, language, and imagination in the acquisition of motor skills.

Analysis of Variance↗

Trends in survival from colonic cancer: the impact of subspecialization.

BACKGROUND: Data from population-based registries have demonstrated a recent increase in case survival for colonic cancer which has been attributed to earlier diagnosis. The present study was performed to identify time trends in case survival for patients with colonic cancer in a single institution, and to identify factors associated with any such improvement. METHODS: Data regarding 1264 patients with colonic cancer who were diagnosed between January 1981 and December 1995 were obtained from the Royal Adelaide Hospital Cancer Registry. Prognostic factors examined were age, sex, Australian clinicopathologic stage (ACPS), differentiation and year of diagnosis. Survival analyses were performed using the Kaplan-Meier method, and differences between patient subgroups were tested using univariate and multivariate Cox analyses. Patterns of adjuvant therapy were stable throughout the study period. RESULTS: The study group comprised 1264 patients. Key independent predictors of case survival after controlling for covariables were found to be earlier-stage disease (P < 0.001), moderately or well differentiated tumours (P < 0.001), and more recently diagnosed tumours (P = 0.011). Specifically, the 5-year survival rates (+/- SE) increased from 40.3% (+/- 3.2) for 1981-83 to 48.3% (+/- 3.3) for 1984-86 and 51.6% (+/- 2.1) for 1987-95. This increase in case survival was temporally associated with the establishment of a specialty colorectal surgical unit within the Royal Adelaide Hospital. CONCLUSIONS: This study of patients with colonic cancer from a single institution confirms previously observed, population registry-based, increases in case survival over recent years. Such improvement was independent of trends in tumour stage and differentiation and the use of adjuvant therapies. This provides evidence that survival outcomes for colonic cancer are influenced by surgical expertise.

Australia↗

Evidence that plasma leptin and insulin levels are associated with body adiposity via different mechanisms.

OBJECTIVE: Like insulin, the adipocyte hormone, leptin, circulates at levels proportionate to body adiposity. Because insulin may regulate leptin secretion, we sought to determine if plasma leptin levels are coupled to body adiposity via changes in circulating insulin levels or insulin sensitivity and whether leptin secretion from adipocytes is impaired in subjects with NIDDM. RESEARCH DESIGN AND METHODS: We used multiple linear regression to analyze relationships between BMI (a measure of body adiposity) and fasting plasma levels of leptin and insulin in 98 nondiabetic human subjects (68 men/30 women) and 38 subjects with NIDDM (27 men/11 women). The insulin sensitivity index (Si) was also determined in a subset of nondiabetic subjects (n = 38). RESULTS: Fasting plasma leptin concentrations were correlated to both BMI (r = 0.66, P = 0.0001) and fasting plasma insulin levels (r = 0.65, P = 0.0001) in nondiabetic men and women (r = 0.58, P = 0.0009 for BMI; r = 0.47, P = 0.01 for insulin). While the plasma leptin level was also inversely related to Si (r = -0.35; P = 0.03), this association was dependent on BMI, whereas the association between insulin and Si was not. Conversely, the relationship between plasma leptin and BMI was independent of Si, whereas that between insulin and BMI was dependent on Si. The relationship between plasma leptin levels and BMI did not differ significantly among NIDDM subjects from that observed in nondiabetic subjects. CONCLUSIONS: We conclude that 1) body adiposity, sex, and the fasting insulin level are independently associated with plasma leptin level; 2) because NIDDM does not influence leptin levels, obesity associated with NIDDM is unlikely to result from impaired leptin secretion; and 3) insulin sensitivity contributes to the association between body adiposity and plasma levels of insulin, but not leptin. The mechanisms underlying the association between body adiposity and circulating levels of these two hormones, therefore, appear to be different.

Adult↗

Early high dose chemotherapy intensification with autologous bone marrow transplantation in lymphoma associated with retention of fertility and normal pregnancies in females. Scotland and Newcastle Lymphoma Group, UK.

As more centres consider autologous bone marrow and peripheral blood stem cell transplantation for patients with high risk Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in first complete remission (CR1) the long term sequelae of such treatments have to be considered. One of the most important side effects of such intensive treatment is loss of fertility. Sperm banking before treatment commences is available for males but unfortunately cryopreservation of ova/ovarian tissue is not yet possible for females. We have transplanted 30 women, 23 were under 40 years and report ten females who have had successful pregnancies (including two twin pregnancies and one triplet pregnancy), leading to live births following autologous bone marrow transplantation (ABMT) for poor prognosis HD and NHL in first or second complete remission. None of these children have shown evidence of birth defects (median follow up of two years). Of the twenty one pregnancies reported to the European Bone Marrow Transplantation Registry (EBMTR) following ABMT for lymphoma, eight of the seventeen unassisted cases came from our centres. The Newcastle/SNLG autotransplant differs from the approach in many EBMTR centres in that it uses melphalan or melphalan/etoposide alone instead of the more common four drug containing regimens and yet sustained complete remission rates indicate that the non-ablative approach is equally effective as more aggressive regimens on the disease with the huge advantage of preserved fertility in females. This approach to conditioning for ABMT should be considered when treating women in the reproductive age group.

Adult↗

Taxane/platinum/anthracycline combination therapy in advanced epithelial ovarian cancer.

A combination of platinum and a taxane is regarded by many as the optimum treatment for advanced epithelial ovarian carcinoma. A recent meta-analysis has suggested that the addition of an anthracycline to platinum-based chemotherapy is associated with a significant survival advantage. We are therefore conducting an ongoing phase I/II study combining drugs from these three classes. We report here the first phase using carboplatin at an area under the concentration-time curve of 7, doxorubicin 50 mg/m2, and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) 175 mg/m2 over 3 hours. The treatment was given on a 3-weekly cycle and granulocyte colony-stimulating factor was given if the nadir neutrophil count fell below 0.5 x 10(9)/L and was continued until recovery. Toxicity was assessed according to the Common Toxicity Criteria. All patients were required to have advanced ovarian cancer (stage IC to IV) but be ineligible for standard chemotherapy trials or to have advanced gynecologic malignancy, such as mixed mullerian tumor, fallopian tube carcinoma, coelomic carcinoma, or primary peritoneal carcinoma. To date, seven patients have been treated, and all were of performance status 0 to 2, 18 to 70 years old, with a life expectancy of > or = 3 months. Hematologic toxicity was significant, with all patients having grade 3/4 thrombocytopenia and six of seven grade 3/4 leukopenia. There was, however, only one grade 3/4 infection. Three patients have experienced fatigue, which in two cases was severe, and one patient had grade 3/4 stomatitis. Dose reduction was due to myelosuppression and was required in five patients. Five patients were evaluable for response, all of whom have obtained complete or partial response. There has been no clinical evidence of cardiotoxicity, but four patients had grade 1/2 cardiotoxicity as measured by left ventricular ejection fraction. We conclude that this combination is active and has acceptable but significant toxicity. It is only suitable for very fit patients, and we are currently assessing ways of reducing toxicity.

Antineoplastic Combined Chemotherapy Protocols↗