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Biomedical subjects

S Groshen

Publications and source records attributed to S Groshen.

152 records · Page 9Linked to original sources
PubMed1983

Pelvic Ewing's sarcoma. Advances in treatment.

In a study of eighteen patients with pelvic Ewing's sarcoma who were treated with a multidisciplinary approach, chemotherapy was effective in controlling systemic spread of the tumor. Surgery coupled with improved methods of chemotherapy provided results that were statistically superior to those obtained with radiation and chemotherapy alone in control of the local pelvic lesion. A twofold increase in the survival rate was seen at a median follow-up of thirty-six months in the patients who had the resection. Our results suggest that pelvic Ewing's sarcoma is best treated by initial chemotherapy, followed by local wide marginal resection of the pelvic lesion coupled with perimeter radiation therapy and concluded with additional chemotherapy. Survival rates of patients with pelvic Ewing's sarcoma may then approach the excellent survival rates of patients with lesions in more favorable anatomical locations.

Adolescent↗
PubMedDate not supplied

A statistical test for contact among individuals in an epidemic and a pattern among cases of acquired immune deficiency syndrome.

In investigating an epidemic or outbreak of a disease in which patient contact (appropriately defined) is hypothesized to be a factor, investigators may ask patients to provide names of people with whom they have had contact. This paper provides statistical methods for assessing whether or not the number of named contacts who are themselves cases is significantly large. Survey data on the epidemiology of acquired immune deficiency syndrome illustrate the methods.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Measuring the impact of patient counseling in the outpatient pharmacy setting: the research design of the Kaiser Permanente/USC patient consultation study.

This article describes the research method used to measure the impact of three alternative models of patient counseling in the outpatient pharmacy setting. The study was conducted in pharmacies operated by the Southern California region Kaiser Permanente Medical Care Program. Both random assignment and large-scale geographic area research designs were used. The presentation of the research design includes discussions of data collection and patient sampling methods; the measurement of patient outcomes, including measures of health care costs and utilization, patient functional status, and quality of life. Demographic data are presented for the study population, including an analysis of potential biased selection of patients electing to participate in random assignment. Data are also presented documenting potential selection bias across geographically determined treatment groups in the geographic area design arm. Finally, the article presents the analysis plan for the study and discusses study limitations.

Ambulatory Care↗
PubMedDate not supplied

Quantitation of intratumoral thymidylate synthase expression predicts for resistance to protracted infusion of 5-fluorouracil and weekly leucovorin in disseminated colorectal cancers: preliminary report from an ongoing trial.

A clinical trial for patients with measurable, disseminated colorectal cancer is being conducted to determine: (1) if intratumoral expression of thymidylate synthase (TS) affects response to protracted-infusion 5-fluorouracil (5FU); and (2) whether intratumoral expression of TS increases when clinical resistance is found after response to 5-FU. Polymerase chain reaction technology is employed to determine TS expression. Using beta-actin as an internal standard, TS expressions for 26 patients range from 0.5 x 10(-3) to 22.6 x 10(-3). Currently, 22 patients are evaluable for response and TS quantitation of their measurable tumour. 8 patients (36%) have had partial responses; 3 responding patients had been previously treated with 5-FU. A strong statistical association between TS expression and resistance to therapy has been found (P = 0.004). No patient with TS expression of 4.0 x 10(-3) or greater has responded. On average, patients previously treated with 5-FU have slightly higher levels of TS expression in their measurable tumours (P = 0.4). Whether responding patients will develop increased expressions of TS upon clinical progression of their cancer remains to be determined. Confirmation of these results in a larger cohort could lead to a scientific rationale for deciding upon specific therapy for patients with disseminated colorectal cancers.

Adult↗
PubMedDate not supplied

Cost-effectiveness of initial therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors to treat hypercholesterolemia in a primary care setting of a managed-care organization.

From January 1994 through May 1995, Prudential HealthCare-North Texas prospectively studied 299 member patients diagnosed with hypercholesterolemia for whom pharmacotherapy with one of four 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, also known as statins, was prescribed. The purpose of this study was to measure the relative cost-effectiveness (CE) of these drugs in a real-world setting. This study provides information to assist decision makers in managed-care organizations (MCO) in making formulary selections. The study used a prospective, randomized, balanced cohort design, examining patients who had been prescribed initial therapy with a statin drug as monotherapy. Costs (direct medical and indirect costs) and effectiveness (percent reduction in low-density lipoprotein cholesterol levels) were based on approximately the first 6 months of initial therapy. Both the MCO and patient perspectives were considered. In the base case, mean CE ratios were significantly lower for fluvastatin compared with lovastatin, pravastatin, and simvastatin from both the managed-care perspective and the patient perspective. Sensitivity analysis did not alter the CE conclusions, even under conditions of varying cost structures. Although differences were found in the effectiveness of lovastatin, pravastatin, and simvastatin measured in this study versus efficacy measured for these drugs in controlled clinical trials, sensitivity analysis suggests that these differences alone do not determine the superior CE of fluvastatin. Finally, this study supports the idea that well-designed formularies should consider drug CE (based on safety, effectiveness, and cost) and that integration of the pharmacy benefit management with other medical management is essential. These results provide evidence that fluvastatin may represent a more cost-effective formulary choice among statin products used for initial monotherapy of hypercholesterolemia.

Adult↗
PubMedDate not supplied

In vitro flow rates of enteral solutions through nasoenteric tubes.

Enteral solutions must flow freely through nasoenteric tubes selected for gravity drip administration particularly in outpatients receiving nutritional support. This study determined in vitro flow rates of solutions with intact protein and hydrolyzed protein sources with various caloric densities. Each solution was infused through silicone rubber and polyurethane tubes of various lengths and bore sizes. Flow rates were measured five times at 25 degrees C using formula bags and drip sets hung at a uniform height and tubes uniformly positioned in a collecting vessel. Data are presented for tubes and formulas tested. Recommendations for selection of tubes for gravity drip administration are made based on flow rate data, patient comfort, administration convenience, and patient tolerance to osmolality.

Food, Formulated↗
PubMedDate not supplied

A polymorphism of the XRCC1 gene predicts for response to platinum based treatment in advanced colorectal cancer.

Recently, it has been demonstrated that the Arg399Gln substitution in the XRCC1 gene is associated with increased levels of markers of DNA damage. Deficiency in DNA repair pathways has been shown to confer to resistance to several drugs, including platinum compounds. Here we have studied whether this polymorphism of the XRCCI gene will predict response and survival of patients with metastatic colorectal cancer treated with oxaliplatin and 5-FU. Sixty-one patients received a combination of 130 mg/m2 oxaliplatin and continuous infusion 5-FU. The XRCC1 polymorphism was evaluated using a RFLP method. We found 73% (8/11) of responders had an Arg/Arg genotype and three were heterozygous, but 66% (33/50) of non-responders showed a Gln/Gln or Gln/Arg genotype (p=0.038). Patients carrying at least one Gln mutant allele were at a 5.2 (95%CI: 1.21,22.07) fold increased risk to fail the 5-FU/oxaliplatin chemotherapy. The data suggest that the polymorphism in exon 10 of the XRCC1 gene may be associated with resistance to oxaliplatin/5-FU chemotherapy in advanced colorectal cancer.

Adenocarcinoma↗