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Biomedical subjects

E Dajczman

Publications and source records attributed to E Dajczman.

8 recordsLinked to original sources
PubMed1996

Treatment of small cell lung carcinoma in the elderly.

BACKGROUND: The number of elderly people with small cell lung carcinoma (SCLC) is increasing and currently nearly 25% are older than 70 years. Elderly patients may not tolerate intensive therapy and, therefore, often do not receive such treatment. Additionally, age may be an independent predictor for response and survival. We compared the investigation, staging procedure, and management of patients less than 60 years, 60 to 69, and older than 70 years who were diagnosed with SCLC between 1985 and 1991. We hypothesized that elderly patients were investigated and treated less aggressively, and that their outcome was poorer than that of younger patients with SCLC. METHODS: Information on weight loss, performance status, coexisting disease, staging investigations, and treatment was recorded. Treatment was categorized as optimal or suboptimal using predetermined criteria, and correlated with patient age. Toxicity grade, response to treatment, and survival were noted. RESULTS: There were no differences among the 3 age groups with respect to disease stage, and weight loss, although poorer performance status and comorbidity were more common in those patients older than 70 years. Elderly patients were investigated and treated less aggressively than the 2 younger patient groups. The oldest group received smaller chemotherapy dosage, fewer cycles, and had more dose reductions compared to the younger patients. Only 1 of 81 elderly patients was enrolled on an experimental protocol as compared with 19% and 28% of the younger patient groups. Furthermore, elderly patients had the highest frequency of supportive care alone. There was a significant relationship between advanced age and suboptimal treatment, with those older than 70 years having an odds ratio (OR) of 0.30 (95% confidence interval (CI) 0.15-0.61), for having received optimal treatment. Despite this, survival was similar for younger and older groups of patients (OR 0.89, CI 0.6-1.3). CONCLUSIONS: Elderly patients had poorer pre-treatment performance status, greater comorbidity, were more likely to have suboptimal therapy and were almost never entered into clinical trials. Despite this their survival did not differ from that of younger patients with SCLC. Randomized trials of treatment, with assessment of quality of life, are necessary to determine the effect of modified regimens for elderly patients with SCLC.

Aged↗
PubMed1995

Fatal pulmonary toxicity following oral etoposide therapy.

Oral etoposide has considerable activity in small cell lung cancer and the low risk of toxicity has resulted in the frequent prescription of this agent in elderly or infirmed patients. We describe a case of fatal pulmonary toxicity following the administration of oral etoposide. This is the first report of biopsy-proven pulmonary toxicity associated with this agent.

Administration, Oral↗
PubMed1994

Comparison of response evaluation in small cell lung cancer using computerized tomography and chest radiography.

The percentage of patients achieving a complete response (CR) to therapy is often used as a measure of treatment efficacy in SCLC. Chest radiographs are difficult to evaluate following therapy and differences in reported response rates may be due to interobserver variation. CT scans of the thorax are more costly and are not as easily obtained as routine studies. We wanted to determine whether the measurability rate and interobserver agreement on response was superior when using CT scans, compared to chest radiographs alone. Fourteen radiologists with expertise in CT imaging of the thorax, reviewed 15 cases of SCLC pre- and post-chemotherapy (210 observations). In the first session, reviewers were required to measure or evaluate all possible lesions on the plain chest radiograph done at pre- and post-treatment. In the second session, accompanying CT scans were provided in order to make the same assessments. The number of instances in which neoplastic disease was measurable in two cross-sectional diameters on pretreatment films was 164 (79%) on chest radiographs and 202 (97%) on CT scans. Interobserver agreement was assessed by comparing tumour measurements, as well as reports of complete disappearance of tumour (CR) among the 15 observers. The rate of CR ranged from 0 to 87% with the use of the chest radiograph, and from 0 to 95% using the CT scan. Usually after viewing the CT scan, readers changed their opinion as to whether CR had actually occurred. For example, in one case, 87% of readers judged response to therapy as a CR based on chest radiograph; upon reevaluation with a CT scan this figure decreased to 15%. Agreement as to response was better on review of the CT scans, compared to the chest radiograph in all but two cases. It is therefore recommended that pre- and post-treatment CT scans, and not just chest radiographs, be used for assessment of response to therapy.

Carcinoma, Small Cell↗
PubMed1992

Uses and misuses of oxygen in hospitalized patients.

PURPOSE: To document the use/misuse of oxygen therapy as compared with antibiotics in internal medicine inpatients. To determine whether the same care was being taken in the prescription and administration of both forms of therapy. PATIENTS: Ninety-six eligible patients at a university teaching hospital were entered into a study examining the use of oxygen. They were compared with 60 patients for whom antibiotics were prescribed. MATERIAL AND METHODS: Three hundred thirty consecutive newly admitted patients were screened for the presence of either (1) oxygen apparatus at the bedside, (2) physician orders for oxygen, or (3) oxygen orders noted in nursing kardex. Those meeting one of these three criteria were observed on up to four occasions over 48 hours following study entry. Similarly, patients were screened for medical orders or nursing medication kardex notation for antibiotics and were also observed for proper prescription and administration of medication. Procedural errors, determined by kardex audit and direct patient observation, were compared for the individuals with specific oxygen orders and those receiving antibiotics. RESULTS: Oxygen delivery apparatus was found in the room in 17 of 96 patients without it ever having been ordered by the physician or noted in the nursing kardex. In 27 of 96 patients, oxygen was noted in the nursing kardex and administered to patients without a physician order. There were no cases of antibiotic therapy without a physician order. Observations of 47 patients with specific orders for oxygen revealed the following errors: (1) physician order incorrectly transcribed to nursing kardex (16%), (2) flow meter off (34%), (3) oxygen delivery apparatus improperly worn (57%), (4) wrong fractional inspired oxygen concentration (58%). Improper transcription of antibiotic orders occurred on only one occasion (2%), and antibiotics were improperly administered in 5%. Arterial blood gas determinations preceded oxygen orders in 61%, whereas microbiologic cultures preceded antibiotic orders in 87% of the patients. CONCLUSIONS: We conclude that oxygen therapy is neither prescribed nor administered with the same attention that is given to other drugs such as antibiotics. Oxygen prescription and/or delivery is associated with significantly greater error than that seen with antibiotics. Education of medical personnel should stress more prudent prescription and use of oxygen in hospitalized patients.

Anti-Bacterial Agents↗
PubMed1992

Survey of infection control precautions: a comparison to recommended guidelines.

The emergence of acquired immune deficiency syndrome as a new and devastating communicable disease has led to concern among health care workers as to their risk of acquiring human immunodeficiency virus (HIV) in the workplace. Centres for Disease Control, and Health and Welfare Canada guidelines seek to prevent HIV transmission through modification of work practices. A study was performed in the authors' institution to quantitate health care worker compliance with such practice modifications as outlined in the researchers' institutional infection control procedures and to evaluate administrative and engineering controls related to this policy. An infection control program to educate health care workers and modify practices was being implemented prior to commencement of this study. Three areas were studied: emergency room, dental clinic and plastic surgery clinic. Adherence to established procedures was judged as compliant, noncompliant and interpretive compliant. Of 806 observations made on 24 health care workers in the three areas, 31.3% were compliant, 28% were noncompliant and 40.7% were interpretive complaint. The most serious non-compliance was noted in handling and disposal of needles. Use of gloves, eyewear, gowns or masks varied among the three sites. Administrative and engineering controls were lacking for eyewear, gowns, puncture-resistant containers and a written policy in some sites. The lack of compliance with institutional infection control procedures needs to be confirmed in other institutions. If there is generalized compliance failure, then a re-evaluation of the present strategies to reduce risk of HIV infection in health care workers is essential.

Clinical Protocols↗
PubMed1991

Long-term postthoracotomy pain.

We used a pain questionnaire to evaluate the prevalence and functional significance of long-term postthoracotomy pain. Data on 56 patients who were at least 2 months postsurgery were analyzed. Thirty patients (54 percent) with a median follow-up of 19.5 months had persistent pain; 26 others were pain free at a median of 30.5 months postthoracotomy. Pain was reported in 24 of 44 patients (55 percent) who were more than one year after surgery, 13 of 29 patients (45 percent) more than two years, six of 16 (38 percent) more than three years, and three of ten patients (30 percent) greater than four years postthoracotomy. Pain intensity was low, but 13 patients stated that pain "slightly" or "moderately" interfered with their lives. Five of 56 patients had sufficiently severe chronic pain to require either daily analgesic use, nerve blocks, relaxation therapy, acupuncture, or referral to a pain clinic. We conclude that long-term chest wall pain is common postthoracotomy. It is generally not severe, but a small proportion of patients may experience persistent, moderately disabling pain.

Chronic Disease↗
PubMed1989

The relationship between pulmonary function and dyspnea in obstructive lung disease.

Increased importance is now being placed on evaluating dyspnea in patients with obstructive lung disease (OLD). We measured breathlessness at rest, using a Borg scale dyspnea index (BSDI) before and after bronchodilator albuterol [salbutamol] 200 micrograms) in 93 patients with OLD drawn from a larger population undergoing routine spirometry. The median BSDI declined from 3 to 1 before and after bronchodilator, suggesting improvement in dyspnea. However, there was no correlation between initial or postbronchodilator spirometry and BSDI. The change in FEV1 similarly did not correlate with the change in BSDI (r = 0.05). A large bronchodilator response was usually associated with improvement in dyspnea, but the converse was not observed. Thus, of ten patients with an improvement in BSDI of more than two categories, six had a change in FEV1 of 0.1 L or less after bronchodilator. Analyzing a subgroup of 65 dyspneic patients with an initial BSDI of 2 or more revealed the following response groups: those with either a bronchodilator or dyspnea response alone, both together, or neither. Twenty-eight patients (43 percent) responded both subjectively and objectively. Eleven (17 percent) had a bronchodilator response only, 17 (26 percent) had a dyspnea response only, while nine (14 percent) had neither measurable response. We conclude that dyspnea is poorly correlated with results of routine spirometry in patients with OLD. The use of dyspnea ratings may yield information about bronchodilator responsiveness not appreciated by spirometry alone.

Aged↗