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Biomedical subjects

K Macmillan

Publications and source records attributed to K Macmillan.

13 recordsLinked to original sources
PubMed2001

Suppression of ovarian progesterone production in dairy cows using an implant of GnRH-agonist (deslorelin) for the purpose of evaluating progesterone metabolism [corrected].

OBJECTIVE: To evaluate the potential of an implant of a GnRH-agonist (deslorelin) to create a progesterone free animal suitable for studying progesterone (P4) metabolism in intact cows by measuring blood P4 and faecal P4 metabolites. METHODS: Experiment 1: Eighteen non-lactating cycling Holstein-Friesian cows, 4 to 7 years old, were allocated to one of three groups to study plasma P4 concentrations preceding an intravaginal insert. These groups comprised: i) a deslorelin group (GnRH-agonist implanted); ii) a PGF group receiving two injections of prostaglandin (PGF2alpha) 12 days apart; and, iii) an ovariectomised (OVX) group. An intravaginal device (CIDR) was inserted into the vagina of each animal and left in place for 11 days. Plasma P4 concentrations were measured during the study period. Experiment 2: Twelve non-lactating cycling Holstein-Friesian cows, 4 to 7 years old, were allocated to two groups: i) a deslorelin group (GnRH-agonist implanted); and ii) an ovariectomised group. Plasma P4 and faecal P4 metabolites (20-oxo-pregnanes, 20alpha-OH and 20beta-OH) were monitored for a period of 5 weeks. RESULTS: Experiment 1: Average plasma P4 concentration did not differ between the three groups (1.28, 1.43 and 1.55 ng/mL for deslorelin, OVX and PGF cows, respectively, P = 0.8) during the period of supplementation. Experiment 2: There was no difference in plasma P4 (mean plasma P4 < 0.02 ng/mL, P = 0.9) and faecal P4 metabolites between deslorelin and OVX cows 2 weeks after the implantation (P = 0.7). CONCLUSIONS: These data showed that a GnRH-agonist (deslorelin) implant may be used as an alternative to ovariectomy to create a progesterone free animal suitable for studying the metabolism of administered P4.

Administration, Intravaginal↗
PubMed2000

Palliative cancer patients and their families on the Internet: motivation and impact.

Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.

Adult↗
PubMed1994

A prospective comparison study between a butterfly needle and a Teflon cannula for subcutaneous narcotic administration.

To evaluate the hypothesis that subcutaneous sites initiated with the Teflon cannula would have longer durations and be more comfortable for the patient than the butterfly needle, we performed a prospective randomized crossover trial to compare the 25-gauge butterfly needle to a Teflon cannula with a 26-gauge introducer needle and a 24-gauge cannula. The analysis of 20 patients showed that duration of the subcutaneous site was significantly longer with the Teflon cannula. Both patients and nurses preferred the Teflon cannula because it did not need to be changed as frequently. There was no difference reported in the level of comfort.

Aged↗
PubMed1993

Local tolerance to subcutaneous infusions of high concentrations of hydromorphone: a prospective study.

In a prospective open study, 24 patients with cancer pain receiving parenteral opioids were administered highly concentrated solutions of hydromorphone in order to assess the local tolerance to the subcutaneous infusion. Patients received a mean concentration of hydromorphone of 30 +/- 15 mg/mL at a mean rate of infusion of 0.3 +/- 0.25 mL/hr. Of 22 evaluable patients, 17 (77%) had a site duration of more than 7 days with their first subcutaneous site (mean concentration of 34 +/- 8 mg/mL of hydromorphone). Four of the five remaining patients (80%) had site duration of more than 7 days with their second subcutaneous site. Only one patient (5%) did not reach a 7-day duration after three consecutive site changes. Out of 7 subcutaneous sites that presented signs of toxicity before 7 days of infusion, the main problem was erythema in three cases, swelling in two cases, and bleeding in two cases. All sites improved spontaneously and did not require any medical treatment. No correlation was found between the concentration or rate of infusion of hydromorphone and the duration of the subcutaneous site. The duration of the site was significantly correlated with weight, tricep skinfold, subscapular skinfold, and age of the patients. Our findings suggest that hydromorphone can be safely administered in concentrations that are much higher than those commercially available. The availability of highly concentrated formulations of different opioids for parenteral use will make home management simpler and cheaper.

Administration, Cutaneous↗
PubMed1992

Cognitive failure in patients with terminal cancer: a prospective study.

In a prospective open study, 61 consecutive patients with terminal cancer admitted to the hospital underwent cognitive assessment using the Mini-Mental State Questionnaire three times a week between admission and discharge or death. Mini-Mental State Questionnaire score upon admission was 28 +/- 1.5 in patients who were discharged (N = 14), and 25 +/- 3 in patients who died in the hospital (N = 47, P less than 0.01). The forty-seven patients who died in the hospital presented a total of 66 episodes of cognitive failure (CF) that were defined as a score of less than 24 or a drop of greater than 30% in the score on the Mini-Mental State Questionnaire. Of these 47 patients, 39 (83%) presented CF an average of 16 days before death. Upon detection of CF, a complete medical examination, laboratory evaluation, computerized tomography of the brain if indicated by abnormal findings on medical examination, and a complete medication review were performed. The cause of CF could not be established in 37 (56%) cases. Drugs, sepsis, and brain metastasis were the most frequently detected causes and were present in 6, 4, and 4 cases, respectively. In addition, 22 episodes (33%) of CF improved (10 episodes spontaneously and 12 episodes as a result of treatment). Our findings suggest that CF is extremely prevalent during the last weeks of life and, consequently, informed consent for therapeutic or research procedures or resuscitation may be impossible to obtain reliably at that stage.

Aged↗
PubMed1992

A randomized double-blind crossover trial of intravenous lidocaine in the treatment of neuropathic cancer pain.

In a randomized, double-blind, crossover study, we evaluated the effect of intravenous lidocaine (5 mg/kg body weight over 30 min) on the neuropathic pain of advanced cancer patients. Pain intensity, assessed by a visual analogue scale, did not show any significant difference between lidocaine and placebo infusion. The blinded choice of patients and investigators also suggested no significant improvement from lidocaine when given by this regimen. Intravenous lidocaine does not appear to have a significant analgesic effect on neuropathic cancer pain.

Anesthetics, Local↗
PubMed1991

Evaluation of a spring-loaded syringe driver for the subcutaneous administration of narcotics.

A simple spring-loaded syringe driver was tested for the subcutaneous administration of narcotic analgesics and antiemetics. With concentrations of 2 to 10 mg/mL of hydromorphone and 10 to 50 mg/mL of morphine, the infusion rate during preclinical testing was 1.01 +/- 0.1 mL/hr (range 0.70-1.2 mL/hr). The rate of infusion was not modified by the concentration of narcotic in solution. Clinical trials were performed with morphine in 17 patients, and with hydromorphone in 11 patients. The duration of the infusion was 21 +/- 11 days. The most frequent reason for discontinuation was death (22 cases). The average duration of the site of infusion was 6.3 +/- 4 days. When used subcutaneously, the rate of infusion of the device was 1 +/- 0.15 mL/hr (range 0.70-1.30 mL/hr). Patients and nurses were satisfied with the simplicity and safety of the device. Cost analysis shows that this device is significantly less expensive than currently available portable infusion devices. We conclude that the Medifuse Pump is an inexpensive, safe and effective device for the subcutaneous infusion of narcotics and antiemetics.

Adult↗
PubMed1991

The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients.

We describe a simple method for the assessment of symptoms twice a day in patients admitted to a palliative care unit. Eight visual analog scales (VAS) 0-100 mm are completed either by the patient alone, by the patient with nurse's assistance, or by the nurses or relatives at 10:00 and 18:00 hours, in order to indicate the levels of pain, activity, nausea, depression, anxiety, drowsiness, appetite, and sensation of well-being. The information is then transferred to a graph that contains the assessments of up to 21 days on each page. The sum of the scores for all symptoms is defined as the symptom distress score. The Edmonton Symptom Assessment System (ESAS) was carried out for 101 consecutive patients for the length of their admission to our unit. Of these, 84% were able to make their own assessment sometime during their admission. However, before death 83% of assessments were completed by a nurse or relative. Mean symptom distress score was 410 +/- 95 during day 1 of the admission, versus 362 +/- 83 during day 5 (p less than 0.01). Mean symptom distress scores throughout the hospitalization were 359 +/- 105, 374 +/- 93, 359 +/- 91 and 406 +/- 81 when the ESAS was completed by the patient alone, patient with nurse's assistance (p = N.S.), nurse alone (p = N.S.), or relative (p less than 0.01) respectively. We conclude that this is a simple and useful method for the regular assessment of symptom distress in the palliative care setting.

Activities of Daily Living↗
PubMed1990

A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer.

This double-blind, cross-over trial was designed to assess the effects of megestrol acetate (MA) on cancer-induced cachexia. Forty consecutive malnourished patients with advanced non-hormone-responsive tumors receiving no antineoplastic treatment were randomized to receive MA 480 mg/day versus placebo for 7 days. During day 8, a cross-over was made until day 15. Appetite, pain, nausea, depression, energy, and well-being were assessed with a visual analog scale (0 to 100 mm) at 9:00 AM and 4:00 PM during days 6, 7, 13, and 14. Weight (W;kg), tricep skinfold (TS; mm), arm circumference (AC; cm), and calf circumference (CC; cm) were measured at days 1, 8, and 15. Caloric intake (CI; Kcal/day) was determined during days 6, 7, 13, and 14. In 31 evaluable patients, the percentual difference in appetite at 9:00 AM, appetite at 4:00 PM, energy, and well-being after MA was +15.1, +14, +3.2, and +5.2, versus -12 (P = 0.03), -5.1 (P = 0.015), -10 (P = 0.024), and -8.3 (not significant) after placebo. Percentual difference in W, TS, AC, and CC after MA was +0.2, +1, -0.1, and +0.4 versus -0.8 (P = 0.03), -0.8 (P = 0.001), -0.3 (not significant), and -0.5 (P = 0.04) after placebo. CI during MA was 3480 +/- 1574 (48-hour intake), versus 2793 +/- 1542 (P less than 0.001) during placebo. Patients and investigators blindly chose MA in 20 (66%, P = 0.023) and 28 cases (92%, P less than 0.001), placebo in eight and two cases, and made no choice in three and one cases, respectively. Toxicity consisted of mild edema and nausea in three and two cases, respectively. After mean follow-up of 27 +/- 13 days, on an open basis, an average increase in W and AC of 4.8 +/- 1.7 kg and 2.8 +/- 1.7 cm was observed, respectively. The authors conclude that MA is a powerful appetite stimulant with subjective and objective effects on nutritional status.

Appetite↗
PubMed1990

Effects of morphine on the dyspnea of terminal cancer patients.

We report an open, uncontrolled study designed to assess the effects of subcutaneous (SC) morphine on dyspnea of terminal cancer. Twenty patients with dyspnea caused by restrictive respiratory failure received an SC dose of morphine of 5 mg (5 patients who were not receiving narcotics), or equivalent to 2.5 times their regular dose (15 patients who were receiving narcotics for pain). Dyspnea (D) and pain (15 cases) were measured before the dose and every 15 min for 150 min after the injection using a visual analog scale 0-100. Respiratory rate (RR), respiratory effort (RE) (score 1-6), arterial saturation of O2 (SO2) and end-tidal PACO2 were determined before and 45 min after SC morphine. D, RR, RE, SO2, and PACO2 were 68 +/- 32, 32 +/- 7; 3.5 +/- 1.8, 87 +/- 10, and 31 +/- 12, respectively, before SC morphine, and 34 +/- 25 (P less than 0.001), 31 +/- 9 (P:NS), 3.2 +/- 1.9 (P:NS), 86 +/- 11 (P:NS), and 33 +/- 9 (P:NS), respectively, 45 min after SC morphine. Nineteen of 20 patients (95%) reported improved dyspnea after morphine. We conclude that morphine appears to improve dyspnea without causing a significant deterioration in respiratory function in terminal cancer patients. Double-blind placebo controlled studies are needed in this population.

Aged↗
PubMed1990

Treatment of pain and other symptoms in cancer patients: patterns in a North American and a South American hospital.

The charts of 200 consecutive patients with cancer pain admitted to a major teaching hospital in Edmonton, Canada (n = 100) and in Buenos Aires, Argentina (n = 100) were reviewed to assess the differences between North American (NA) and South American (SA) facilities in patterns of treatment of pain and other symptoms. Criteria for eligibility and methods were identical in both hospitals. Characteristics of patients (age, sex, primary tumor, reason for admission) and attending staff were similar between both hospitals. Mean daily equivalent doses of parenteral morphine (mg) were 44 +/- 26 and 9 +/- 10 in NA and SA, respectively (p less than 0.001). Patients in NA, received narcotics every 4 hr and on a regular basis more frequently than in SA. The types of narcotics and the use of adjuvant drugs were significantly different between NA and SA. Nonpharmacologic treatments, antiemetics, and laxatives were more frequently used in NA. These results suggest that there are significant differences in symptomatic management of advanced cancer between institutions in NA and SA.

Adult↗
PubMed1990

Social and demographic characteristics of patients admitted to a palliative care unit.

In this retrospective study we reviewed the charts of 169 consecutive admissions to the Palliative Care Unit, Edmonton General Hospital. Demographic and social characteristics of patients were assessed in order to determine the likelihood that the patients could be managed at home according to currently available services. The mean age of the population was 65 +/- 12 years, 97 (57%) were women, they had a variety of cancers with major prevalence of the most frequent adult tumors, and 72% of patients were coming from acute care hospitals. Each patient had an average of 2.7 +/- 1.8 children (median = 3), a mean of 0.18 +/- 0.6 dependents (median = 0), a mean of 1 +/- 0.9 support persons at home (median = 1), and a mean of 2.6 +/- 1 support persons outside the household (median = 2). Of a total of 119 main caregivers who lived in the same household as the patient, 69 (58%) were not able to take care of the patient. Only 27 patients (16%) considered that there were major financial problems, and all 169 patients had universal health care available (95 patients had additional private health care coverage). Of 125 patients who were asked where they preferred to die, 112 (90%) stated that they did not want to die at home. Our data suggest that the lack of family support and lack of intensive home care services are the main obstacles to home care of terminally ill cancer patients in our province. Home care services as currently available are not able to care for a large number of patients with terminal cancer. More prospective research into this subject is badly needed.

Aged↗