Biomedical subjects

Mark Graham

Publications and source records attributed to Mark Graham.

24 records · Page 2Linked to original sources

PubMed2003

Use of online resources while using a clinical information system.

BACKGROUND: Clinical information system (CIS) use is likely to evoke information needs, yet information resources use during CIS use has not been studied. METHODS: We used CIS log files and a survey to characterize clinicians' use of resources and infobuttons (context-sensitive links from a CIS to specific resources) while using a CIS. RESULTS: We examined 38,763 uses of resources and infobuttons by 2,607 users to identify specific sources and contexts (CIS functions) in which they used them. Laboratory results review was the most frequent context and Micromedex was the most popular resource. Differences in resource use were related to context and user type. The survey confirmed that resources and infobuttons were perceived as useful for patient-specific questions while using a CIS. CONCLUSIONS: Understanding context- and user-type-specific information needs can guide the development of infobuttons for use in a CIS.

Clinical Laboratory Techniques↗

PubMed2003

Clinical information needs in context: an observational study of clinicians while using a clinical information system.

INTRODUCTION: The development of tools to meet the information needs of clinicians requires an understanding of the clinician and the context in which clinical decisions are being made. METHODS: We conducted an observational study of clinicians' information needs via think-aloud protocols during which we observed physicians and nurses as they used the clinical information system. Protocol analysis was then used to identify the information needs events, the types of questions that were asked, the method of meeting that need, the success or failure of meeting the specific information need, and the context in which it arose. RESULTS: Results indicated that a) unmet information needs occur frequently and that b) the predominant feature of these unmet needs is that they are patient-related or domain-specific. Two categories of context: laboratory and medical communication accounted for more than half of the events.

Hospital Information Systems↗

PubMed2002

Multicenter phase II study of a 28-day regimen of orally administered eniluracil and fluorouracil in the treatment of patients with anthracycline- and taxane-resistant advanced breast cancer.

PURPOSE: Eniluracil (776C85), a potent inactivator of dihydropyrimidine dehydrogenase, allows fluorouracil (5-FU) to be administered orally on a schedule that simulates continuous-infusion 5-FU. The primary objective of this study was to estimate the objective tumor response rate of orally administered eniluracil and 5-FU in the treatment of anthracycline- and taxane-resistant advanced breast cancer. PATIENTS AND METHODS: Patients with anthracycline- and taxane-resistant advanced breast cancer were enrolled onto this open-label, phase II, multicenter study. Patients received orally administered 5-FU 1.0 mg/m(2) with eniluracil given in a 10:1 ratio (eniluracil:5-FU) twice daily for the first 28 days of each 35-day cycle. RESULTS: Eighty-four patients were enrolled. Eight partial responses were observed in 84 patients (10%; 95% confidence interval [CI], 4.2% to 17.9%), and 20 patients (24%) had stable disease. The median duration of partial response was 20.1 weeks (95% CI, 12 to 26.7 weeks). The median duration of progression-free survival and overall survival for all patients was 9.9 weeks and 40.4 weeks, respectively. Most adverse events were grade 1 or 2 in intensity. Diarrhea, nausea, malaise/fatigue, vomiting, and mucositis were the most common treatment-related nonhematologic adverse events. The most frequently occurring grade 3 or 4 treatment-related adverse events were malaise/fatigue and diarrhea, occurring in 17% and 7% of patients, respectively. The incidence of grade 3 or 4 hematologic toxicity was low. Grade 3 or 4 hyperbilirubinemia occurred in 17% of patients. CONCLUSION: Eniluracil-5-FU has modest antitumor activity and an acceptable safety profile in anthracycline- and taxane-resistant breast cancer. Treatment was convenient, and patient compliance was high.

Administration, Oral↗

PubMed2002

Phase II study of low-dose infusional 5-fluorouracil and paclitaxel (Taxol) given every 2 weeks in metastatic breast cancer.

Twenty-one patients with recurrent or metastatic breast cancer were treated with paclitaxel (Taxol) as a 1-hour infusion on day 1 only of a 14-day cycle. This treatment was followed by 5-fluorouracil (5-FU) via a portable home pump, through a central venous catheter at 350 mg/m2 per day over 24 hours for a total of 96 hours, on days 1 to 5 and again on days 8 to 12. Based on reported phase I trials in other organ system cancers, the first 5 patients were treated with paclitaxel at 150 mg/m2 every 2 weeks, but this was associated with excessive toxicity. Subsequent patients received paclitaxel at 135 mg/m2. The FACT-B scale was used to assess quality of life for patients on entry of the study and after three cycles. Treatment was well tolerated, with no grade III or IV hematologic toxicities. Grade III nonhematologic toxicities comprised one patient with fatigue, one with mucositis, and one with diarrhea. Grade IV nonhematologic toxicities included 1 hypersensitivity reaction to paclitaxel. Four of the 16 patients (25%) had pump-related problems resulting in disrupted 5-FU dosing in the home setting. The patients had the following responses to the treatment: complete response 0 (0%), partial response 6 (37.5%), stable disease 4 (25%), progression 4 (25%), unassessable 2 (12.5%)-1 anaphylaxis and 1 thrombocytopenia; overall response rate 6 of 16 (0.37; 95% CI, of 0.57). The median duration of survival was 14 months, 95% CI (5.6-18.24). The FACT-B was assessed in 14 patients at baseline and in 8 patients after 3 cycles. Quality of Life improved in 6 patients, no patients remained stable, and worsened in 2 patients. Biweekly paclitaxel with weekly 4-day continuous infusion 5-FU was associated with minimal toxicity but did not meet the target response rate of 60%. This response rate does not justify use of a complex home infusion of 5-FU.

Adult↗

PubMed2002

Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma: effective clinical downstaging allows breast preservation and predicts outstanding local control and survival.

OBJECTIVE: To review the long-term follow-up data from the authors' institutional experience of 62 patients with locally advanced breast cancer (LABC) treated with a uniform multimodality regimen. The authors determined the rate of breast preservation, the disease-free and overall survival, and the factors associated with locoregional and distant recurrent disease. SUMMARY BACKGROUND DATA: It remains a challenge to achieve local and distant control of LABC. Over the last decade, preoperative or neoadjuvant chemotherapy has emerged as the standard of care for these patients. Successful tumor downstaging has been associated with increased rates of breast-conserving therapy (BCT), but the overall effect on long-term survival remains to be seen. METHODS: This study examines a cohort of 62 patients with LABC treated at the authors' institution from 1992 to 1998. The uniform treatment regimen consisted of neoadjuvant doxorubicin (Adriamycin), followed by operation (BCT if sufficient clinical downstaging), followed by non-cross-resistant cyclophosphamide/methotrexate/5-fluorouracil, followed by radiation therapy. Treatment was both dose-intensive and time-intensive, with a total treatment time of 32 to 35 weeks. RESULTS: In this patient population, the median age was 44 years, with approximately two thirds white patients and one third African American. Eighty-two percent of patients were clinical stage III at presentation, 13 patients had T4d inflammatory cancers, and 3 patients were stage IV at diagnosis. Eighty-four percent of patients demonstrated a significant clinical response to doxorubicin. Twenty-eight patients had sufficient clinical downstaging to attempt BCT, and 22 (45%) of 49 noninflammatory patients underwent successful BCT. Pathologic complete response was seen in 15% of patients. Median follow-up for the cohort was 70 months. The local recurrence rate was 14%, including two ipsilateral breast tumor recurrences (10%) in the BCT patients. Seven (12%) patients developed a new primary cancer in the contralateral breast. Distant metastases occurred in 18 (31%) patients, and the 5-year overall survival rate for the cohort was 76%. Furthermore, in the patients who underwent an attempt at BCT, the survival rate was 96% at 5 years. CONCLUSIONS: Dose-intensive and time-intensive multimodality neoadjuvant therapy was successfully administered to a mixed racial group over shortened times. Patients who had sufficient clinical downstaging to allow BCT have the best long-term outcome. Patients who required mastectomy are at a higher risk of relapse, as well as the development of new contralateral cancers, yet have 5-year survival rates of over 50%.

Adult↗

PubMedDate not supplied

Down-regulation of connective tissue growth factor and type I collagen mRNA expression by connective tissue growth factor antisense oligonucleotide during experimental liver fibrosis.

Transforming growth factor (TGF)-beta 1 is a major mediator of liver fibrosis. Connective tissue growth factor (CTGF) mediates TGF-beta 1 pro-fibrogenic effects in vitro, but its in vivo role is unknown. Both TGF-beta 1 and CTGF are overexpressed in hepatic stellate cells during liver fibrosis. We have used antisense oligonucleotides to examine the role of CTGF in carbon tetrachloride-induced liver fibrosis in mice. Mice received carbon tetrachloride together with CTGF or TGF-beta 1 antisense oligonucleotides for 2 weeks (preventive model), or carbon tetrachloride for 2 weeks followed by carbon tetrachloride and oligonucleotides for 2 more weeks (curative model). In both models, CTGF and TGF-beta 1 oligonucleotides decreased by more than 50 percent the mRNA expression of their targets. Type I collagen mRNA was also decreased by about 40 percent in the preventive experiment. Tissue inhibitor of matrix metalloproteinase-1 mRNA expression and fibrotic deposition evaluated by Sirius red staining were not modified in any group. In summary, our results suggest that hepatic stellate cells can be targeted in vivo with oligonucleotides, and that reducing CTGF levels can lead to a decrease in fibrogenesis as shown by the reduction in type I collagen expression. The lack of effect on fibrosis may be due to the persistence of high tissue inhibitor of matrix metalloproteinase-1 expression.

Animals↗