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Biomedical subjects

A Leary

Publications and source records attributed to A Leary.

8 recordsLinked to original sources
PubMed2006

Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients.

No national benchmark figures exist for early mortality due to chemotherapy unlike for surgical interventions. Deaths within 30 days of chemotherapy during a 6-month period were identified from the Royal Marsden Hospital electronic patient records. Treatment intention--curative or palliative, cause of death and number of previous treatments--were documented. Between April 2005 and September 2005, 1976 patients received chemotherapy with 161 deaths within 30 days of chemotherapy (8.1%). Of these, 124 deaths (77.0%) were due to disease progression. Of the other 37 deaths, 12 (7.5%) were related to chemotherapy, six each for solid tumours and haematological malignancies, of which seven (4.3%) were due to neutropenic sepsis. For the remaining 25 deaths (15.5%) there was insufficient information. There were more deaths after third and subsequent lines of therapy than with first and secondlines of therapy. Only 12 of the 161 deaths occurred in patients who were receiving potentially curative chemotherapy to give a mortality rate in breast and gastrointestinal malignancy of 0.5 and 1.5%, respectively. It is possible to audit mortality within 30 days of chemotherapy and this should become a benchmark for standard practice nationally. Most deaths were due to disease progression in the palliative setting. We practice this form of audit each quarter and feed back to the treating teams so that deaths are discussed and practice monitored.

Adolescent↗
PubMed2006

Combination therapy with aromatase inhibitors: the next era of breast cancer treatment?

Long-term endocrine therapy with either aromatase inhibitors (AIs) or tamoxifen may lead to endocrine resistance and disease progression. Recent years have seen advances in our understanding of the complex biological mechanisms associated with resistance. Growth factor signaling pathways appear to be upregulated in hormone-resistant tumours and interact with oestrogen-receptor (ER) signaling, which remains functional even after long-term endocrine deprivation. Signaling through the human epidermal and insulin-like growth-factor receptor (HER and IGFR, respectively) pathways may promote ligand-independent ER gene transcription and stimulate growth factor signaling. Therapeutic agents that inhibit these signal transduction pathways, when combined with AIs, may offer breast cancer patients new hope for more robust, longer-term remissions. Preliminary data from phase II studies of combination therapies are encouraging. There is a large programme of ongoing randomised, controlled trials, the results of which should pave the way for integrating combination therapies into clinical practice. To identify which patients will respond best to particular combinations of treatments, biomarkers and gene expression profiles are being investigated as predictors of sensitivity or resistance. In time, breast cancer treatment will become truly individualised because physicians will be able to match patients with a variety of disease phenotypes to optimal combination therapies.

Antineoplastic Agents, Hormonal↗
PubMed2005

5-Fluorouracil can cross brain-blood barrier and cause encephalopathy: should we expect the same from capecitabine? A case report on capecitabine-induced central neurotoxicity progressing to coma.

PURPOSE: Capecitabine is a relatively new oral fluoropyrimidine currently licensed for the treatment of colorectal and breast cancer. RESULTS: It has the advantage of oral administration with good tolerability and comparable activity to intravenous 5-fluorouracil. Central neurotoxicity has been described in 5-fluorouracil-treated patients but there is little data regarding capecitabine. We report here a case of reversible capecitabine-induced encephalopathy progressing to coma. DISCUSSION: Literature on fluoropyrimidine-related neurotoxicity will also be reviewed and possible mechanisms of the drug or its metabolites crossing the blood-brain barrier will be discussed.

Antineoplastic Agents↗
PubMed1999

Dating violence at three time periods: 1976, 1992, and 1996.

Data collected over the past 10 years were used to investigate whether there have been changes in the incidence of violence when dating reported at a large university. Responses to Straus's 1979 Conflict Tactics Scale in 1986 (n = 603), 1992 (n = 414), and 1996 (n = 571) were compared. Analyzes indicated that there has been a reduction in both verbal aggression and violence scores over the 10-yr. period. In addition, the percentage of respondents who reported being in nonviolent relationships increased while the percentage of respondents in the three categories of relationship that include violence (mutual, perpetrator, and victim) decreased. These findings indicate that there may be an over-all reduction in both verbal aggression and violence between dating partners as they attempt to resolve conflicts.

Adolescent↗
PubMed1998

Sharing in nursing governance: creating opportunities for change.

Shared governance has created a radical shift in the management and systems thinking of organisations by empowering employees through increased accountability, ownership and decision making. This paper outlines the process of introducing the concept of shared governance to the nursing division of a large not-for-profit private hospital in Victoria. The objectives for change and the philosophy of shared governance are explained so as to clarify the reasons for selection of the shared governance model. The steps involved in planning for the introduction of the change process, implementation and integration of the model at both organisational departmental levels, and the actual structure of the working model of shared governance are described.

Decision Making, Organizational↗
PubMed1995

Oxygen saturation in children in the postoperative period.

Some adult patients have periods of significant oxygen desaturation after surgery but, other than for immediately after surgery in the recovery room, few data are available in children. We monitored overnight paired preoperative and postoperative oxygen saturations in 19 children, and overnight postoperative saturations in 50 additional children to determine whether children have periods of desaturation in the postoperative period. The children underwent surgery usually associated with moderate to severe postoperative pain, and were treated with epidural, intravenous, or intramuscular opioids. In the group of 19 children mean (SD) preoperative oxygen saturation was 96.6% +/- 1.3%, and the mean postoperative saturation was 95.7% +/- 1.2%. The average change was 0.88% +/- 1.52%. The 95% confidence interval of the paired difference was 0.13% to 1.6%. There was no significant difference in the percent of monitored time that the patients spent with an oxygen saturation less than 95%, 90%, 85%, or 80%. In the 50 children monitored only in the postoperative period, mean (SD) saturation was 97.8% +/- 1.9%. The data show that, in contrast to some reports in adults, this group of children did not have multiple episodes of clinically significant oxygen desaturation in the postoperative period.

Adolescent↗