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PubMed1990

[A study on differences of opinion on health care care programs among physicians, nurses, non-medical personnel and patients].

The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is: First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to try out the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9, 1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups--nurses, non-medical personnel and patients--gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, reveals that the physicians were least positive for the effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients (who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer.(ABSTRACT TRUNCATED AT 400 WORDS)

Allied Health Personnel↗
PubMed1997

Lee v. Oregon.

Explore the source record for details and available documents.

Adult↗
PubMed1994

Criteria for use of blue "Star of Life" for emergency medical services. National Highway Traffic Safety Administration. Notice.

This notice amends NHTSA's guidelines for the authorized use of the blue "Star of Life" symbols for emergency medical services. Comments received in response to an earlier notice suggested uses for this symbol that were not considered when these guidelines were first developed. These amendments are intended to provide additional flexibility to the States within the purposes for which the blue Star of Life was originally registered as a certification mark.

Emergency Medical Tags↗
PubMed2004

Dissipation of fragrance materials in sludge-amended soils.

A possible removal mechanism for fragrance materials (FMs) in wastewater is adsorption to sludge, and sludge application to land may be a route through which FMs are released to the soil environment. However, little is known about the concentrations and fate of FMs in soil receiving sludge application. This study was conducted to better understand the dissipation of FMs in sludge-amended soils. We first determined the spiking and extraction efficiencies for 22 FMs in soil and leachate samples. Nine FMs were detected in digested sludges from two wastewater treatment plants in Delaware using these methods. We conducted a 1-year die-away experiment which involved four different soils amended with sludge, with and without spiking of the 22 FMs. The initial dissipation of FMs in all spiked trays was rapid, and only seven FMs remained at concentrations above the quantification limits after 3 months: AHTN, HHCB, musk ketone, musk xylene, acetyl cedrene, OTNE, and DPMI. After 1 year, the only FMs remaining in all spiked trays were musk ketone and AHTN. DPMI was the only FM that leached significantly from the spiked trays, and no FMs were detected in leachate from any unspiked tray. While soil organic matter content affected the dissipation rate in general, different mechanisms (volatilization, transformation, leaching) appeared to be important for different FMs.

Adsorption↗
PubMed2002

Chloride, sodium, potassium and faecal bacteria levels in surface runoff and subsurface percolates from grassland plots amended with cattle slurry.

This study investigated the effectiveness of vegetated buffer strips for removing contaminants in runoff from grassed plots (slope 15%) after application of cattle slurry. Plots (8 x 8 m2 or 8 x 3 m2) received slurry or inorganic fertilizer, and then simulated rainfall (1, 7 and 21 days after slurry/fertilizer application); after each event, runoff and percolates were sampled at various distances downslope (2, 4, 6, and 8 m), and analysed for Cl-, Na+, K+ and faecal bacteria contents. Contaminant concentrations were markedly higher in runoff from the slurry-amended plots than in runoff from the fertiliser-amended plots. After the first rainfall event, some contaminant concentrations in runoff from the slurry-amended plots declined with distance downslope (i.e. with buffer strip width), supporting the relative efficacy of the strip for retaining pollutants. After the second and third rainfall events, by contrast, our results suggest remobilisation of contaminants retained during the first event. Faecal bacteria levels (especially streptococcus levels) remained high throughout the study, even in percolates and runoff collected 8 m downslope after the third rainfall event, and indeed even downslope of the adjacent fertilizer-amended plots (indicating lateral movement): this suggests that bacterial contamination may be the most significant risk arising from slurry application.

Agriculture↗
PubMed1997

Phase I studies of fluorouracil, doxorubicin and vinorelbine without (FAN) and with (SUPERFAN) folinic acid in patients with advanced breast cancer.

PURPOSE: The Breast Cancer Site Group of the National Cancer Institute of Canada - Clinical Trials Group (NCIC-CTG) undertook two parallel phase I studies to determine the maximum tolerated dose (MTD) and recommended phase II dose of vinorelbine in combination with doxorubicin and fluorouracil (with or without folinic acid) in metastatic breast cancer. METHODS: Cohorts of five patients were to receive: (a) fluorouracil 500 mg/m2 and doxorubicin 50 mg/m2 on day 1 only and escalating doses of vinorelbine (15, 20, 25, 30 mg/m2) on days 1, 8 and 15 every 3 weeks (FAN regimen), or (b) fluorouracil 340 mg/m2 and folinic acid 200 mg/m2 on days 1, 2, 3, 4 and 5, doxorubicin 40 mg/m2 on day 1 only and escalating doses of vinorelbine (15, 20, 25, 30 mg/m2) on day 1 and again on day 5 every 4 weeks (SUPERFAN regimen). Eligibility included measurable or evaluable metastatic breast cancer and having received neither previous chemotherapy for metastatic disease nor anthracycline-containing adjuvant therapy. RESULTS: Of 26 and 12 patients enrolled in the FAN and SUPERFAN regimens, 26 and 12 were evaluable for toxicity and 21 and 9 for response, respectively. Median ages were 60.3 years (41-71 years) and 64.2 years (51-73 years). Both regimens required amendment after the first cohort with an original day- 15 vinorelbine dose omitted from the FAN regimen and more prolonged nadir granulocyte counts allowed. Myelosuppression was dose limiting. MTDs in the FAN and SUPERFAN regimens were vinorelbine 25 mg/m2 and 20 mg/m2. Other toxicities included mucositis, septicemia and febrile neutropenia. Peripheral neuropathy and constipation were mild. Of the 21 FAN patients evaluable for response, 3 (14%) had complete responses and 7 (33%) had partial responses, for an overall response rate of 48%; 9 (43%) had stable disease and 2 (9%) had progressive disease as their best response. Of the nine SUPERFAN patients evaluable for response, none had a complete response. There were two (22%) with partial responses, and six (67%) had stable disease and one (11%) had progressive disease as their best response. CONCLUSIONS: The SUPERFAN regimen was too toxic to pursue even at the lowest dose. The recommended phase II starting dose for the FAN regimen was vinorelbine 20 mg/m2. Although these were phase I studies response rates in evaluable patients were less than expected and toxicity did not allow the use of as much vinorelbine in the combinations as had been anticipated. The limited response data from our study would imply that combining vinorelbine with more toxic agents may not enhance response rates and may defeat the advantage of tolerability, especially in elderly patients.

Adult↗
PubMed2005

Effects of early intervention with epoetin alfa on transfusion requirement, hemoglobin level and survival during platinum-based chemotherapy: Results of a multicenter randomised controlled trial.

This work was conducted to evaluate the effect of early intervention with epoetin alfa (EPO) on transfusion requirements, hemoglobin level (Hb), quality of life (QOL) and to explore a possible relationship between the use of EPO and survival, in patients with solid tumors receiving platinum-based chemotherapy. Three hundred and sixteen patients with Hb12.1g/dL were randomised 2:1 to EPO 10000 IU thrice weekly subcutaneously (n = 211) or best supportive care (BSC) (n = 105). The primary end point was proportion of patients transfused while secondary end points were changes in Hb and QOL. The protocol was amended before the first patient was recruited to also prospectively collect survival data. EPO therapy significantly decreased transfusion requirements (P < 0.001) and increased Hb (P < 0.005). EPO-treated patients had significantly improved QOL compared with BSC patients (P < 0.05). Kaplan-Meier estimates showed no differences in 12-month survival (P = 0.39), despite a significantly greater number of patients with metastatic disease in the EPO group (78% vs. 61%, P = 0.001). EPO was well tolerated. This study has shown that early intervention with EPO can result in a significant reduction of transfusion requirements and increases in Hb and QOL in patients with mild anemia during platinum-based chemotherapy.

Adult↗
PubMed2004

Arsenic and heavy metal mobility in iron oxide-amended contaminated soils as evaluated by short- and long-term leaching tests.

Several iron-bearing additives were evaluated for their effectiveness in the attenuation of arsenic (As) in various contaminated soils. These were selected for their known or potential ability to adsorb As anions, thus changing the speciation of As in a soil system. Three soils with different sources of As contamination were investigated (canal dredgings, coal fly ash deposits, and low-level alkali waste). The amendments used were goethite (alpha-FeOOH), iron grit, iron (II) and (III) sulphates (plus lime), and lime, applied to the soils at a rate of 1% w/w. A series of leachate extraction tests (UKEA, ASTM and modified Dutch column leaching test) were conducted on the equilibrated amended soils. These were used to firstly evaluate the potential of the amendments as immobilising agents, and secondly to compare the short- and long-term durability of their effects. Column tests demonstrated the efficiency of iron oxides over the longer time scale; these treatments significantly reduced concentrations of arsenic in leachates from all treated soils. Amended soils were also observed to contain higher levels of lead (Pb) and cadmium (Cd) in their leachates, signifying that certain Fe-oxides potentially increased heavy metal mobility in treated soils. The conclusions were that whilst Fe-oxides may be used as effective in situ amendments to attenuate As in soils, their effects on other trace elements, such as Pb and Cd, require careful consideration.

Adsorption↗
PubMed2000

Phase II evaluation of interleukin-4 in patients with non-Hodgkin's lymphoma: a Southwest Oncology Group trial.

We performed a phase II, Southwest Oncology Group (SWOG) clinical trial of recombinant human interleukin-4 (rhuIL-4) in patients with previously treated non-Hodgkin's lymphoma (NHL). We studied 18 eligible patients with low-grade and 21 patients with intermediate- or high-grade NHL. All patients had received prior chemotherapy. A protocol amendment after the first four patients reduced the frequency of s.c. rhuIL-4 administration from daily to 3 times per week at 3 microg/kg and limited the number of prior chemotherapy regimens allowed. We documented no complete or partial responses in the low-grade NHL group [0%; 95% confidence interval (CI) 0-19%]. One patient in the intermediate/high-grade NHL group developed a partial response lasting longer than 15 months (5%; 95% CI 0-24%). Median survivals for the low- and intermediate/high-grade NHL groups were 15 and 13 months, respectively. Common toxicities included: arhralgia/myalgia, fatigue/malaise/lethargy, fever, headache, nausea and rigors/chills. Cardiac toxicity, gastrointestinal ulceration and nasal congestion due to rhuIL-4 were not prominent toxicities in our patients. Our previously treated NHL patients tolerated s.c. rhuIL-4 at a dose of 3 microg/kg given 3 times per week, but objective response rarely occurred. Further evaluation of rhuIL-4 in these patient populations does not appear warranted.

Adult↗
PubMed1983

The Auckland Hospital ethical committee 1977-1981.

The experience of the Auckland Hospital ethical committee during the last five years is reviewed. The committee has dealt with an average of 3.6 new applications per month. The research proposals have been classified according to their major thrust. Forty-five point five percent were drug trials, 12.8% were studies of normal and abnormal physiology and metabolism, 12.3% involved the evaluation of new non-drug therapeutic techniques or programmes, 10.1% were epidemiological and the remainder were psychosocial investigations, studies of drug metabolism and turnover, audit and review, or miscellaneous in nature. The majority of applications (60.4%) were approved unaltered or with only very minor amendments at their first consideration. Thirty-six point four percent were approved subject to the imposition of certain conditions or after revision, and 3.2% were either not approved at all or were withdrawn. Major ethical issues which attracted the committee's attention are briefly outlined and its reaction reported.

Ethics, Medical↗