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Biomedical subjects

R W Frelick

Publications and source records attributed to R W Frelick.

At least 19 recordsLinked to original sources
PubMed1992

Is better access to medical care needed in Delaware?

Improved access will require more primary care providers, a reduction in administrative red tape, and a clientele with healthy lifestyles who know how to use the system appropriately. Prevention is a necessary component of access even though it often takes years to produce results and is usually not dramatic or glamorous (the heart attack which does not occur is hard to measure). Over time, the health of Delawareans should show improvement through appropriate access to medical care, which should not only be cost effective but add to the quality of life.

Delaware↗
PubMed1990

Response of tumors to thermodynamic stimulation of the immune system.

Cytokines such as interferon, interleukin and tumor necrosis factor are natural body defense proteins which have been used individually in recent years to produce a few complete responses of some tumors in a few patients but their overall effect has been limited. The hypotheses is that a biologic stimulus such as endotoxin will stimulate the immune system in a more natural way and hence will be more likely to have an effect especially in the presence of a naturally produced fever than treatment from just one lymphokine. One of the side effects of current lymphokine studies has been fever usually spiking in nature but there has been no obvious effort to relate the extent of the fever to any tumor responses. Clinical experience has shown that increased temperature can enhance the results of radiotherapy and chemotherapy in some situations. Therefore it is logical to put this hypothesis to a test clinically. It is surprising that the combined effect of fever and lymphokine stimulation has not been reported aside from Coley's work, and it is only in retrospect that fever has been suggested to be essential to the tumor control noted. Most of the literature, animal and human, has focused on the destructive effect of temperature on tumor cells and not as part of an immune response to control tumor growth. Endotoxin is the pyrogen on which most current information is available. More effective and more available pyrogens may be developed later.

Combined Modality Therapy↗
PubMed1990

Results of a national survey of characteristics of hospital tumor conferences.

A descriptive survey of hospital tumor conferences, which are also referred to as tumor boards, was conducted by the National Cancer Institute in collaboration with the American College of Surgeons and Roswell Park Memorial Institute. The survey was done to assess the involvement of the tumor conference in the care of the patient with cancer and to lay the groundwork for additional studies of the conference. The data from the descriptive survey are based on questionnaires sent to 1,700 hospitals in the United States. The questionnaires requested information about frequency, attendance, composition, role of the chairman, agenda and other variables that relate to the format and purpose of the conference. From the results, we conclude that tumor conferences are an accepted and established institution for the multidisciplinary care of patients with cancer. They are a major source of consultation and education for physicians and for other professionals involved in oncology. Tumor conferences are conducted in a wide spectrum of hospitals and related institutions that vary in size and function.

Clinical Protocols↗
PubMed1989

Living wills.

Explore the source record for details and available documents.

Delaware↗
PubMed1989

Causes of deaths--testicular cancers in Delaware, 1972-1986.

This analysis of 135 germ cell testicular cancers in a defined population within one state from 1972 through 1986 confirms the reported incidence of seminoma (52%) vs. non-seminoma with significant age differences between the two histologic types, and shows that the adjusted (real) ten year survival from disease in a community setting can be better than 90%. Earlier diagnosis should make some differences and more aggressive therapy and follow-up including restaging especially of the teratocarcinomas, might improve the end results. This is not a benign disease even in seminomas where recurrent slow growing seminomas should also be given curative chemotherapy although the current experience does not specially point to that conclusion. The ACCC is encouraged to stimulate community studies using prospectively designed check lists to allow a more complete analysis of cancers with a high cure rate in order to assure optimum community application of the results of the National clinical trials in which many are now engaged.

Adolescent↗
PubMed1987

Effects of patient management guidelines on physician practice patterns: the Community Hospital Oncology Program experience.

The Community Hospital Oncology Program (CHOP), funded under contracts by the National Cancer Institute (NCI) from 1981 to 1984, was designed to be a model for delivery of the most up-to-date cancer care in the community setting. Site specific patient management guidelines (PMGs) were developed by physicians who saw a majority of cancer patients in each community and represent a consensus of the most current information on pretreatment evaluation and management for each cancer site. There was the potential for PMGs to have a strong effect on physician practice patterns. A patterns of care study (POC) was conducted in the 17 CHOPs to determine the influence of guidelines on practice patterns. The practice elements examined in this report are clinical staging for breast and small-cell lung cancer, medical oncology consultation for breast cancer patients with positive lymph nodes, and radiation therapy consultation for rectal and small-cell lung cancer. These elements were in all CHOP guidelines. Except for physicians most active in the CHOP, the data provide no evidence of diffusion of guideline principles to the majority of practicing physicians. Although all guidelines contained discussion of the importance of staging before definitive treatment for breast cancer, only 33% of the 1,922 charts examined had a stage recorded. In small-cell lung cancer, 67% of the 388 charts examined had stage recorded. The years in practice of the primary physician had an inverse relationship to practice patterns as defined by the guidelines. Physician specialty was also a determinant of practice patterns for small-cell lung cancer. However, participation in guideline development and their dissemination did not significantly influence the patterns of care elements examined in this study.

Breast Neoplasms↗
PubMed1987

Selection factors in clinical trials: results from the Community Clinical Oncology Program Physician's Patient Log.

Between August 1984 and November 1985, data concerning 44,156 newly diagnosed cancer patients were entered in the Community Clinical Oncology Program Physician's Patient Log. Forty percent (17,773 patients) had a National Cancer Institute-approved protocol available for site and stage of disease. Fifty-six percent of patients with a protocol available were clinically eligible and 19% were entered on protocol. Thus, one-third of clinically eligible patients were entered in the study. Age was a major factor influencing eligibility and entry on study. Eighty percent of patients less than 25 years of age with a protocol available were clinically eligible for clinical trials participation, and 58% were placed on protocol. Patients greater than or equal to 65 years of age with a protocol available were less likely to be clinically eligible (48%) or placed on study (14%). A physician's preference for an alternate treatment and patient refusal for protocol treatment were also important reasons that clinically eligible patients were not registered on protocol. Selection for clinical trials participation affects the characteristics of patients under study and may have an impact on the ability to generalize the results of clinical trials.

Adult↗