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Biomedical subjects

S E Ward

Publications and source records attributed to S E Ward.

At least 19 recordsLinked to original sources
PubMed2006

The clinical and economic benefits of capecitabine and tegafur with uracil in metastatic colorectal cancer.

Two oral fluoropyrimidine therapies have been introduced for metastatic colorectal cancer. One is a 5-fluorouracil pro-drug, capecitabine; the other is a combination of tegafur and uracil administered together with leucovorin. The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of these oral therapies against standard intravenous 5-fluorouracil regimens. A systematic literature review was conducted to assess the clinical effectiveness of the therapies and costs were calculated from the UK National Health Service perspective for drug acquisition, drug administration, and the treatment of adverse events. A cost-minimisation analysis was used; this assumes that the treatments are of equal efficacy, although direct randomised controlled trial (RCT) comparisons of the oral therapies with infusional 5-fluorouracil schedules were not available. The cost-minimisation analysis showed that treatment costs for a 12-week course of capecitabine (Pounds 2132) and tegafur with uracil (Pounds 3385) were lower than costs for the intravenous Mayo regimen (Pounds 3593) and infusional regimens on the de Gramont (Pounds 6255) and Modified de Gramont (Pounds 3485) schedules over the same treatment period. Oral therapies result in lower costs to the health service than intravenous therapies. Further research is needed to determine the relative clinical effectiveness of oral therapies vs infusional regimens.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Stereotaxic core needle biopsy of breast microcalcifications obtained using a standard mammography table with an add-on unit.

OBJECTIVE: To demonstrate the reliability of stereotaxic biopsy of indeterminate microcalcifications using a standard mammography table with an add-on unit. METHODS: In 121 cases of indeterminate microcalcifications, core biopsy was performed using a standard mammography table with an add-on stereotaxic unit. Microcalcifications were identified on radiography of core specimens. RESULTS: Microcalcifications and a definitive histologic diagnosis were obtained in 112 core biopsies (92.6%), with no significant complications. In 23 lesions frank malignancy was diagnosed, and all of these diagnoses were confirmed on surgery. Pathologic examination suggested carcinoma in 4 lesions, and open biopsy confirmed malignancy in 3 of these cases. Four lesions showed atypical ductal hyperplasia. Benign disease was diagnosed in 81 lesions, of which 78 remained stable on mammographic follow-up (mean 16 months later) and 3 were subjected to surgical biopsy (of which 1 was malignant and 2 were benign). Nine cases were technically unsatisfactory because microcalcifications were not sampled. CONCLUSION: Stereotaxic core biopsy performed with an add-on unit is a safe and reliable technique for biopsy of indeterminate microcalcifications. For successful biopsy, microcalcifications must be harvested. Pathologic results should be correlated with mammographic findings. The accuracy rate compares favourably with results reported using prone biopsy tables. In an era of cost containment, this alternative to prone biopsy tables could result in significant savings in terms of capital investment and use of hospital rooms. In this study, surgical biopsy could have been avoided in 64.5% of cases.

Adult↗
PubMed1999

Decision latencies for phonological and semantic information in object identification.

Several on-line studies in the literature have been cited in support of a two-stage model of name-retrieval in which semantic processing precedes and mediates access to phonology. Because of inconsistencies in prior studies an off-line experiment was designed to provide converging evidence on this issue. An experiment is reported in which young and elderly adults were required to give speeded judgments of whether a pictured object matched a named category, a named physical attribute, or a rhyming cue. Latencies for the young adults were fastest for category judgments and slowest for rhyming judgments. For the elderly adults physical attributes and rhyming judgments were equivalent. Results are discussed in terms of "lemma" theory in object naming.

Adult↗
PubMed1998

The impact on quality of life of patient-related barriers to pain management.

A stress-coping model of relationships between patients' beliefs about pain, coping (analgesic use), pain severity, analgesic side-effects, and three quality of life (QOL) outcomes was tested. Participants were 182 men and women with cancer who completed valid and reliable self-report measures of relevant variables. Antecedent variables (age and education) showed expected relationships with beliefs. As predicted, beliefs were significantly related to analgesic use. Analgesic use was inversely related to pain severity, but was not related to side-effect severity. Analgesic use was inversely related to impairments in QOL before controlling for pain and side-effect severity, but not after these two variables were controlled. Both analgesic side-effects and pain severity were related to impaired QOL outcomes, including difficulty performing life activities, depressed mood, and poor perceived health status.

Adaptation, Psychological↗
PubMed1998

Biodistribution of a radiolabelled monoclonal antibody NY3D11 recognizing the neural cell adhesion molecule in tumour xenografts and patients with small-cell lung cancer.

The neural cell adhesion molecule (NCAM) is highly expressed on the surface of small-cell-lung cancer (SCLC) cells. We have produced a monoclonal antibody, NY3D11, that binds to NCAM to investigate whether this antigen could be used to develop antibody-directed therapy for SCLC. 125I-labelled IgG and F(ab')2 fragments of NY3D11 localized selectively in human SCLC xenografts grown in nude mice. The human biodistribution of 131I-labelled NY3D11 after intravenous administration was investigated by gamma-camera imaging in six patients with SCLC. Three patients received IgG and three received F(ab')2. No evidence of localization to primary tumours or metastases was seen and antibody accumulated rapidly in the liver and bone marrow. The probable explanation for this distribution is that NY3D11 reacted with soluble NCAM or natural killer cells that possess the CD56 (NCAM) antigen.

Adult↗
PubMed1998

Perceived control mediates the relationship between pain severity and patient satisfaction.

The factors that account for patient satisfaction with acute pain management remain a mystery. Consistently, there has been an inverse, but very small association between pain severity and patient satisfaction; most patients are in severe pain, yet report they are satisfied with pain management. The hypothesis that perceived control mediates the relationship between pain severity and patient satisfaction was examined in 137 patients who underwent elective inpatient orthopedic surgery. Postoperatively, patients rated their pain severity (the highest level of pain experienced), their perceptions of control over the pain and taking pain medication, and their satisfaction with the relief they obtained from analgesics. Path analysis using LISREL was used to test for mediation. Pain severity was associated inversely with perceptions of control over pain and with satisfaction. There was a significant association between perceived control and satisfaction and perceived control partially mediated the relationship between pain severity and satisfaction. Although individuals who report experiencing severe pain are less satisfied with pain relief than individuals with less pain, it is the interpretation or perception of having control over the pain that most relates to satisfaction with pain relief. Clinically, it is important to examine ways in which individuals control their pain, teach them methods to exert control, and educate them that it is preferable to not allow pain to become severe--it is easier to "control" pain if you intervene at an early point.

Adolescent↗
PubMed1997

Judgments of concept similarity by normal and aphasic subjects: relation to naming and comprehension.

A study was conducted in which aphasic patients, age-matched normals, and normal young adults performed five types of matching judgments for object pictures. These required matching for physical identity, basic object identity, and membership in the same superordinate category. Spoken name-to-picture matching was tested for the last two conditions. An analogous set of conditions was presented for letters. Latency patterns across the conditions showed general slowing for the aphasic patients, but with a differential decrement in the conditions that involved auditory (spoken name) input for the matching task. Results showed that variations in semantic judgment capability among the aphasics did not predict the patients' object naming ability.

Age Factors↗
PubMed1997

Fertility in schizophrenia: results from a contemporary US cohort.

To investigate procreation in schizophrenia, as well as gender-related differences, female patients with schizophrenia (n = 79, DSM-III-R criteria) were compared with screened female controls (n = 124) and subsequently with male patients (n = 86). Two outcomes were investigated: (i) the proportion of subjects with one or more children (an index of fertility) and (ii) the number of children per subject among those with one or more children (an index of fecundity). Multivariate analysis was used to control for confounding variables. No significant differences in fertility between female patients and controls were detected, but reduced fecundity was noted among female patients past the reproductive period. Male patients showed a significant reduction in both fertility and fecundity compared to female patients. These results suggest that there is a relatively small impairment of fecundity among female patients compared with controls, but that there are more significant gender-related differences in both fertility and fecundity. The latter have important implications for the genetics of schizophrenia.

Adolescent↗
PubMed1996

Concerns about analgesics among patients and family caregivers in a hospice setting.

Patients receiving curative treatment for cancer have concerns about reporting pain and using analgesics. These concerns are associated with underutilization of analgesics. To extend knowledge about such concerns to the context of palliative care, the concerns of hospice patients and family caregivers were compared. Within 5 days of admission to hospice, 35 patients with cancer and their caregivers each completed a measure of eight concerns such as fear of addiction, worry about tolerance, and worry about side effects. There was no correlation between caregiver and patient concerns and means for the two groups were similar, indicating that within a given dyad either the patient or the caregiver may have greater concerns. The findings highlight the need for patient and caregiver education about reporting pain and using analgesics.

Adult↗
PubMed1996

Perceived self-efficacy and outcome expectancies in coping with chronic low back pain.

The purposes of this study were to explore the coping strategies used by patients with chronic low back pain, to test hypothesized mediators of the relationship between self-efficacy and pain outcomes, and to determine the roles of self-efficacy and outcome expectancies in coping with pain in patients (N = 85) with chronic low back pain. The most common coping behaviors were reporting pain, using pain medications, and coping self-statements. Patients' self-efficacy to cope with pain was inversely correlated with pain intensity. Self-efficacy was positively correlated with perseverance of coping effort. Perseverance of coping effort was found to mediate the effects of self-efficacy on pain outcomes; however, level of distress was not found to be a mediator. Outcome expectancies were positively correlated with perseverance of coping effort. These findings are discussed in terms of implications for practice and directions for future research.

Adaptation, Psychological↗
PubMed1996

Patient satisfaction and pain severity as outcomes in pain management: a longitudinal view of one setting's experience.

Longitudinal data from quality assurance studies of pain outcomes (pain severity and patient satisfaction) were critically examined to explore the reasons that patients are satisfied with their care even when they are in pain. Data were acquired from three sources: self-report surveys of patients during inpatient admission or ambulatory clinic visit (N = 306), telephone interviews of patients after discharge (N = 869), and chart reviews (N = 112). These data were compared to baseline data obtained 2 years ago, before the implementation of a number of programs designed to improve pain management. Findings reveal little change from baseline with respect to patient satisfaction with pain management--an overwhelming percentage are satisfied or highly satisfied. Similarly, there has been little change in pain intensity ratings--on average, patients' worst pain is approximately 7 on a 0-10 scale. In addition, almost all analgesic orders continue to be written for "as needed" administration. Based on these findings, we postulate that patients are satisfied even though they are in pain because they experience a commonly expected peak and trough pattern of pain relief, a pattern that occurs with "as needed" administration. That is, we conclude that pattern of pain relief, not pain severity, may be the critical determinant of satisfaction.

Humans↗
PubMed1995

Barriers to pain management in hospice: a study of family caregivers.

Cancer-related pain not only affects the patient but the family/caregiver as well. The purpose of this study was to examine concerns about reporting pain and using analgesics in a sample of primary caregivers of cancer patients receiving care from a hospice program. The Barriers Questionnaire (BQ), an instrument designed to measure eight common barriers to adequate management of cancer pain, was administered to 37 persons identified as primary caregivers. Between 62 percent and 100 percent of the caregivers reported having at least some agreement with the various concerns that are barriers to reporting pain and using analgesics, and 3 percent to 43 percent reported having strong agreement. The subscales with the highest means were fear of opioid side effects, fear of addiction, the belief that increasing pain signifies disease progression, and the fear of injections. Caregivers who were older and less educated were more likely to believe that reporting pain may distract the physician from treating or curing the cancer. In addition, caregivers with lower educational levels had higher scores on the overall BQ. Finally, caregivers of patients who reported pain was not a problem on program admission had greater concerns about tolerance and were more likely to believe that "good" patients do not complain. The caregiver, often, with time and the declining abilities of the patient, becomes the first line decision maker regarding the patient's care and treatment. Understanding caregiver perspectives is important for continued success with managing pain in hospice and, arguably, all settings.

Adult↗
PubMed1995

Patient-related barriers to cancer pain management in Taiwan.

The reluctance of patients with cancer to report pain and to use analgesics hinders the management of their pain. In the United States, this reluctance is related to the patient's misconceptions regarding addiction and tolerance to analgesics and the desire to be a "good patient" who does not complain. Reports in the literature suggest that patients in Taiwan may have these same concerns and misconceptions. This study was designed to explore (a) the concerns of patients in Taiwan about reporting pain and using analgesics and (b) the relationship between these concerns and the adequacy of analgesics used by the patients. Sixty-three patients with cancer completed the Barriers Questionnaire-Taiwan (BTQ) form, a self-report instrument that measures the extent to which patients have eight specific concerns about reporting pain and using analgesics. The responses indicated that patients who were less educated were more likely to have concerns and that patients in general were most worried about tolerance. Patients who were inadequately medicated, as determined by an index of "adequate pain management" constructed for the study, had significantly higher levels of concerns. Open communication between health professionals and patients and educational programs about pain and about the concerns measured in this study could help overcome these concerns and misconceptions and improve pain management.

Adult↗
PubMed1994

Psychological adjustment in adults with cancer: the self as mediator.

The role of the self in adjustment to cancer has been noted but is not well understood. Research and theory on the self suggest that discrepancies between actual and ideal self-conceptions influence adjustment and mediate the effects of disease-related health problems on psychological well-being. This relationship was investigated in a cross-sectional study of 108 persons with cancer. Cancer patients who had more symptoms and worse functional health and perceived their cancer as a chronic rather than an acute disease had higher levels of self-discrepancies and poorer adjustment. Self-discrepancy was a significant mediator of the effects of perceived health status on purpose in life, positive relations with others, and depression.

Adaptation, Psychological↗
PubMed1993

Positive mental attitude and health: what the public believes.

Content analysis was used with the responses of 167 people to open-ended questions regarding their understanding of the term "positive mental attitude" (PMA) and their beliefs about benefits and problems associated with PMA. Participants also responded to a scale which assessed their beliefs about the influence of PMA on illness onset and recovery. Analyses revealed wide diversity in understandings of the term, although a majority indicated that PMA means optimism or hope. The benefits of PMA included happiness, health and improved relationships. The problems included over-confidence and disappointment, but such problems were often said to be associated with over-enthusiastic use of PMA. Seventy-seven percent of the respondents agreed that PMA can prevent illness and 94 percent agreed that PMA can aid in recovery from illness. Fewer agreed that PMA can prevent cancer or aid recovery from cancer.

Adolescent↗