The purpose of this paper is to evaluate the safety and efficacy of deep hyperthermia in conjunction with radiation therapy. This study employed 'second generation' electromagnetic devices which were felt to be better able to confine heating and spare normal tissue than the devices evaluated in a previous study (RTOG 84-01). Sixty six patients at six institutions were enrolled on a prospective Phase I/II study. Eligible deep seated tumours were treated with a combination of external hyperthermia and radiation therapy. Radiation consisted of 1.7-2 Gy per fraction, 4-5 fractions per week, to > 20 Gy (previously irradiated lesions) or > 50 Gy (no previous radiation). Deep hyperthermia was delivered with electromagnetic devices: BSD 2000 for 92% of cases, Thermotron for 5% of cases, other low frequency electromagnetic for 4% of cases. Hyperthermia was delivered < or = twice weekly. Overall complete and partial response rates were 34% and 16% respectively. Response was not correlated with maximum tumour temperature or disease site. There was, however, a strong association with radiation dose: 54% CR with > or = 45 Gy versus 7% with < 45 Gy (p < 0.0001). The achieved temperatures were less than ideal. Although the average maximum tumor temperature was 41.9 degrees C (range 35.7 degrees C-46.7 degrees C), the minimum tumour temperatures were low. The average minimum tumour temperature was 38.5 degrees C and was never > 41.8 degrees C. Treatment was well tolerated with no fatalities. There were four acute grade 3 or 4 toxicities (6% of patients). Patient discomfort resulted in interruption or discontinuation of sessions in 30% of the sessions. In 12 cases (18% of patients) the planned course of hyperthermia was discontinued due to acute discomfort. The devices used in this study were better tolerated than the devices used in the previous Phase I/II deep hyperthermia trial (RTOG 84-01) with less patient discomfort and no problems with severe systemic cardiovascular stress. In the previous study 68% of the hyperthermia courses were prematurely terminated primarily due to patient discomfort and toxicity; in the present study 18% were prematurely terminated. However, as indicated by the low minimum tumour temperature, fundamental problems with achieving acceptable temperature distributions remain.

Adult↗

PubMedDate not supplied

Resting metabolic rate variability as influenced by mouthpiece and noseclip practice procedures.

Mouthpiece and noseclip introduction affect resting physiologic function (i.e., hyperventilation, anxiety), which can influence a resting metabolic rate measurement. It also is obvious that practice is required to minimize this influence when such apparatuses are used. However, the type of practice that best minimizes this influence has not been established. To determine the effect of acute and longer term practice on measurement variability of resting metabolic rate, 27 healthy, premenopausal women were randomly assigned to one of three groups: (1) a practice group, involving three 10-minute practice sessions 1 day to 1 week before resting metabolic rate was measured (n = 9); (2) an acclimation group, in which each subject acclimated to the mouthpiece and noseclip for 5 minutes before the resting metabolic rate measurement (n = 8); and (3) a control group (no practice) (n = 10). Resting metabolic rate was measured three times for each subject via a 5-minute oxygen uptake in the early morning (5:00 to 8:30 am) after a 25-minute supine rest. Resting metabolic rate measurements (kJ/day) and intraindividual variance estimates, adjusted for age and weight, were calculated to determine which practice group had the lowest resting metabolic rate measurement and the lowest variability around each individual's repeated resting metabolic rate measures. Of the three averaged resting metabolic rate measures, significantly lower 24-hour energy expenditures were found with the practice (5647 kJ) and acclimation (5550 kJ) groups when compared with those of the control group (6077 kJ) (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗

PubMedDate not supplied

A model emerges for the community-based nurse care management of older adults.

Changes in the demographics of older adults and the structure and financing of the health care delivery system have created a need to develop alternative models of care delivery for the elderly. The nurse care management model is a potentially cost-effective solution for provision of comprehensive care to this population. By providing timely health promotion and illness prevention education, as well as coordinating community resources, nurses can reduce the health care costs of this growing segment of the population. Funding this model, however, remains a challenge as such services are not directly reimbursed by third-party payers.

Aged↗

PubMedDate not supplied

The child welfare agency as school consultant.

Explore the source record for details and available documents.

Child↗