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At least 235 records · Page 13Linked to original sources
PubMed2000

What common disorders do those reporting limiting long-term illness experience, and what is their survival and health service utilization experience?

BACKGROUND: The aim of this study was to examine the relationships between self-reported limiting long-term illness and other disease-specific symptoms, mortality and use of hospital services. METHODS: A cohort generated by population health survey was linked to information on mortality and health service use, in Sheffield, England, 1994-1998. Limiting long-term illness was assessed using the 1991 Census question wording; specific symptoms were assessed using standard instruments; other outcomes were admission to hospital and mortality. RESULTS: Limiting long-term illness is stated more commonly than in the Census, especially in males and in the young. It is commoner in the presence of some conditions such as angina much more than in others such as gastrointestinal disease. For all age groups, both mortality and, to a lesser extent, hospital admission rates are higher in those responding yes to the long-term illness question. CONCLUSIONS: Limiting long-term illness assessment from the Census acts as a better proxy for some aspects of population health than others although it may underestimate the absolute prevalence. Although it may be of use in identifying relative needs, mortality is associated more strongly with differences in limiting long-term illness than is health service utilization. This may be as much a result of mismatch between use and need as of any deficiency of the measure itself.

Adolescent↗
PubMed1995

Docetaxel (Taxotere): a review of preclinical and clinical experience. Part I: Preclinical experience.

Docetaxel is a taxoid which is currently in phase II/III clinical trials in Europe, the US and Japan. It was found to promote tubulin assembly in microtubules and to inhibit their depolymerization. In vitro, the docetaxel concentrations required to reduce murine and human cell survival by 50% ranged from 4 to 35 ng/ml and the cytotoxic effects were greater on proliferating than on non-proliferating cells. It was also found to be cytotoxic on fresh human tumor biopsies. In vivo, the drug was found to be schedule independent. A total of 13/14 murine transplantable tumors were found very sensitive to i.v. docetaxel and complete regressions of advanced stage tumors were obtained. Activity was also observed in 15/16 human tumor xenografts in nude mice at an advanced stage. In combination studies, synergism was observed in vivo with 5-fluorouracil, cyclophosphamide and etoposide. Pharmacokinetic evaluation revealed linear pharmacokinetics in tumor-bearing mice. There was a good tumor retention with a 22 h elimination half-life. Plasma protein binding ranged from 76 to 89%. Preclinical toxicology evaluation of docetaxel included single-dose toxicity in rats, mice and dogs, 5-day toxicity in mice and dogs, intermittent-dose toxicity in rats, dogs and monkeys, genetic and reproductive toxicity, as well as investigation of the irritation and sensitization potential. The principal toxicities were hematopoietic (all species), gastrointestinal (dog, monkey) and neuromotor (mice). Dogs appeared to be the most sensitive species. The clinical entry dose of 5 mg/m2 was based on one-third of the 'toxic dose low' in dogs (15 mg/m2).

Animals↗
PubMed1995

Docetaxel (Taxotere), a review of preclinical and clinical experience. Part II: Clinical experience.

Docetaxel, a promising inhibitor of microtubule depolymerization has shown significant anti-cancer activity during phase I and early phase II trials. The recommended dosage for phase II trials is 100 mg/m2 every 3 weeks which provides optimal activity with tolerable adverse effects. Docetaxel has shown high single agent activity including use as first- or second-line therapy and in anthracycline refractory breast cancer patients. Results have been comparable to that of established treatments for breast cancer. In addition, docetaxel has shown significant activity in non-small cell lung cancer and a range of other tumors, but no activity in renal or colo-rectal tumors. At present it is undergoing further evaluation in combination therapy. The safety profile of docetaxel is well defined. Major adverse effects include hypersensitivity reactions, fluid retention and neutropenia. Peripheral neuropathy is not a significant adverse effect. The aims of phase II trials with regard to counteracting side-effects are therefore 2-fold: firstly, to evaluate the use of premedication with corticosteroids and antihistamines as a means of counteracting hypersensitivity reactions and fluid retention; secondly, to determine whether granulocyte colony stimulating factor may be useful for attenuating neutropenia.

Antineoplastic Agents↗
PubMed1990

An experiment in psychiatric community care in north Staffordshire: the experience of working with relatives of mentally-ill people.

This paper describes the changing nature of the relationship between the consumers and providers of services, following the transition from a hospital to a community-based service. One aspect of this change, the development of a relatives' group, is considered in more detail. Those attitudes and approaches which help or hinder staff working with relatives are discussed.

Adaptation, Psychological↗
PubMed2001

Initial experience with a low profile, high energy excimer laser catheter for heavily calcified coronary lesion debulking: parameters and results of first seven human case experiences.

BACKGROUND: Excimer laser coronary angioplasty (ELCA) has not been used in the setting of highly calcified, tight stenoses because the energies required to use existing catheters would lead to excessive heat damage and dissection. There are, however, cases that frequently benefit from debulking prior to percutaneous intervention. A new, small laser catheter capable of high energies and repetition was previously examined in vitro. This study describes the first in vivo use. PURPOSE: To determine the safety and feasibility of a new, low profile, high energy laser catheter for creating a pilot hole to facilitate coronary angioplasty and stenting in patients with heavily calcified and occluded coronary arteries where a balloon has either failed to pass or was predicted to perform poorly. These patients represent the first patients treated with this new catheter. METHODS: At a high volume center, seven consecutive patients with anatomy as summarized above were treated and studied with QCA and then followed for 30 days postprocedure for complications and Canadian Cardiovascular Society (CCS) angina class. RESULTS: The laser catheter crossed five out of seven lesions and partially penetrated the remaining lesions. The mean maximum luminal diameter (MLD) postlasing was 1.0 mm with Thrombolysis in Myocardial Infarction (TIMI) 3 flow. It was possible to easily balloon and stent after the pilot hole creation in all but one patient. TIMI 3 was achieved for the final result after adjunct therapy in all patients. All patients except one, who died at 3 months postprocedure of stroke, were improved by an average of two angina classes. No late procedural-related complications developed. CONCLUSIONS: The new, low profile laser catheter is easy to use and achieved good results in cases where a balloon either failed to pass or was predicted to give poor results. Further trials are warranted for this niche technology.

Aged↗
PubMed1995

Clinical experience with a total artificial heart as a bridge for transplantation: the pitie experience.

Since April 1986, 82 patients have received a pneumatic total artificial heart, 62 a JARVIK-7, and 20 a Cardiowest. The duration of support ranged from less than 1 day to 603 days (mean duration: 27 +/- 82). The indications were for acute shock (38 cases) or for chronic deterioration on the transplant waiting list (44 cases). The etiology was mainly due to idiopathic and ischemic cardiomyopathy. With the help of our scoring system, we divided our patients in three groups: Chronic Implantation, represented by two females staying on device for 6 and 19 months, respectively; a High-Risk group of 29 patients characterized by high-risk indications; graft failure, rejection, postcardiotomy patient, postpartum cardiomyopathy, and valvular and congenital reoperation. In addition, the dilated and ischemic cardiomyopathy patients with a score over 6 were included in this group; and an Elective Indication group (51 patients) represented all of the dilated and ischemic cardiomyopathy patients with a score under 6. Due to the shortage of donors, our criteria for transplantation are very strict. Transplants should be made only in cases of hemodynamic stability, on an extubated patient with normal renal and liver functions, without coagulation problems or infection. With such criteria, in the high-risk group, only four patients could be transplanted and of these two are still alive. In contrast, in the elective group, 31 were transplanted (61%), and 71% of these patients were discharged. The rate is improved in the most recent cases, with 90% of the Cardiowest patients being survivors.

Acute Disease↗
PubMed2005

A 20-year experience of combined liver/kidney transplantation for primary hyperoxaluria (PH1): the European PH1 transplant registry experience 1984-2004.

Primary hyperoxaluria (PH1) is a condition caused by a hepatic-based enzyme defect which can lead to renal failure due to oxalate stone disease, obstructive uropathy and nephrocalcinosis. It has been shown that the underlying metabolic defect can be corrected by liver transplantation and in most cases (renal failure having already occurred) is accompanied by a kidney graft. This paper describes the current results of 127 liver transplants performed in 117 patients over a 20-year period from 1984 to 2004 in 35 European centres. The mean age at onset of symptoms was 5.6 +/- 7.8 years and the mean age at which a diagnosis was made was 8.8 +/- 9.5 years. The diagnosis was confirmed by liver biopsy proven decreased AGT activity in 68% of cases, hyperoxaluria in 74%, hyperglycolicaciduria in 37% and hyperoxalaemia in 50%. Patients were transplanted at a mean age of 16.5 +/- 11.4 years following a period of dialysis of 3.2 +/- 3.2 years (range 0-14.4 years). 1-, 5- and 10-year patient survival values were 86, 80 and 69%, respectively, and liver graft survival rates of 80, 72 and 60% at the same time intervals. There have been 27 deaths and 10 liver retransplants have been carried out. Patient outcomes are improved when prolonged periods on dialysis and the complications of systemic oxalosis have not occurred.

Child↗