Biomedical subjects

G Corcoran

Publications and source records attributed to G Corcoran.

7 recordsLinked to original sources

PubMed2006

Posaconazole as salvage therapy for zygomycosis.

Zygomycosis, an infection that is associated with significant morbidity and mortality, is becoming common in immunocompromised patients. Posaconazole is a new extended-spectrum azole antifungal that has demonstrated in vitro and in vivo activity against zygomycetes. This report provides the results from the first 24 patients with active zygomycosis who were enrolled in two open-label, nonrandomized, multicentered compassionate trials that evaluated oral posaconazole as salvage therapy for invasive fungal infections. Posaconazole was usually given as an oral suspension of 200 mg four times a day or 400 mg twice a day. Eleven (46%) of the infections were rhinocerebral. Duration of posaconazole therapy ranged from 8 to 1,004 days (mean, 292 days; median, 182 days). Rates of successful treatment (complete cure and partial response) were 79% in 19 subjects with zygomycosis refractory to standard therapy and 80% in 5 subjects with intolerance to standard therapy. Overall, 19 of 24 subjects (79%) survived infection. Survival was also associated with surgical resection of affected tissue and stabilization or improvement of the subjects' underlying illnesses. Failures either had worsening of underlying illnesses or requested all therapy withdrawn; none of the failures received more than 31 days of posaconazole. Posaconazole oral solution was well tolerated and was discontinued in only one subject due to a drug rash. Posaconazole appears promising as an oral therapy for zygomycosis in patients who receive required surgery and control their underlying illness.

Administration, Oral↗

PubMed2006

Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection.

The pharmacokinetic profiles, safety, and efficacies of different dosing schedules of posaconazole oral suspension in patients with possible, probable, and proven refractory invasive fungal infection (rIFI) or febrile neutropenia (FN) were evaluated in a multicenter, open-label, parallel-group study. Sixty-six patients with FN and 32 patients with rIFI were randomly assigned to one of three posaconazole regimens: 200 mg four times a day (q.i.d.) for nine doses, followed by 400 mg twice a day (b.i.d.); 400 mg q.i.d. for nine doses, followed by 600 mg b.i.d.; or 800 mg b.i.d. for five doses, followed by 800 mg once a day (q.d.). Therapy was continued for up to 6 months in patients with rIFI or until neutrophil recovery occurred in patients with FN. The 400-mg-b.i.d. dose provided the highest overall mean exposure, with 135% (P = 0.0004) and 182% (P < 0.0001) greater exposure than the 600-mg-b.i.d. and 800-mg-q.d. doses, respectively. However, exposure in allogeneic bone marrow transplant (BMT) recipients (n = 12) was 52% lower than in non-BMT patients. Treatment-related adverse events (occurring in 24% of patients) were mostly gastrointestinal in nature. Twenty-four percent of patients had adverse events leading to premature discontinuation (none were treatment related). In efficacy-evaluable patients, successful clinical response was observed in 43% with rIFI (56% of patients receiving 400 mg b.i.d., 17% receiving 600 mg b.i.d., and 50% receiving 800 mg q.d.) and 77% with FN (74% receiving 400 mg b.i.d., 78% receiving 600 mg b.i.d., and 81% receiving 800 mg q.d.). Posaconazole is well tolerated and absorbed. Divided doses of 800 mg (400 mg b.i.d.) provide the greatest posaconazole exposure.

Adult↗

PubMed1994

The impact on community palliative care services of a hospital palliative care team.

This retrospective study examined the influence of a hospital palliative care team on the activity of a local hospice home care team over a four-year period from May 1989 to April 1993 in East Leeds. The increasing referral to death interval observed in home care patients over this period appears to be due to the presence of the hospital team. The increasing work-load of the home care team generated by the hospital team is discussed with reference to solutions to meet this increasing demand. A district or regional planning strategy is recommended to co-ordinate existing and potential palliative care services.

England↗

PubMed1993

Hospice management of patients receiving cytotoxic chemotherapy: problems and opportunities.

In Britain, the specialty of palliative medicine continues to develop, encouraging the referral of patients early in the palliative phase of their illness. This had led to an increased number of patients receiving palliative chemotherapy and hospice care concurrently, posing special problems to the professionals involved. In this retrospective study, 52 patients were identified who received chemotherapy and hospice care simultaneously. Case notes were reviewed to reveal problems arising from sharing the duty of care. The poor quality of communication between professionals, perhaps reflecting a limited understanding of the various roles in patient care, we found to cause significant difficulties. The duration and discontinuation of cytotoxic therapy seems to be a particularly difficult matter. Hospice admission often signalled the end of this treatment. In a third of the patients, no decision was taken to stop chemotherapy despite the last dose being an average of just 1 week before death. The value of chemotherapy for patients who are too ill to return home is questioned. Seven patients were diagnosed as suffering from chemotherapy-induced sepsis and neutropenia either by hospice inpatient or home care teams, and were admitted to their acute centres accordingly. Most patients who died during the study period received terminal care in the hospice. Suggestions are made on improving professional education and communication, including the use of a 'chemotherapy card'.

Adult↗

PubMed1993

Should hospices offer respite admissions to patients with motor neurone disease?

The provision of inpatient respite care for patients with motor neurone disease (MND) in hospices is variable. Some institutions are concerned about accepting patients who may need long-term care. Some see 'respite' care as simply a short residential stay with little nursing or medical input being necessary. Others, however, feel that respite offers the potential for palliative care and should be provided within the spectrum of a hospice service. This retrospective study examines that group of MND patients requesting respite care in terms of demographic details, problems identified and medical and nursing interventions made during respite admissions. The results indicate a great need for symptom management in these patients as well as co-ordination of future community care. Most patients were discharged home after respite admissions and the median stay in the hospice (15 days) was identical to that of cancer patients. We conclude that respite admissions to the hospice were valuable both for MND patients and their carers. Units not currently involved in this work may wish to reconsider their position.

Adult↗

PubMed1993

Spinal cord compression: the hospice perspective.

Spinal cord compression is an important complication of metastatic, malignant disease. It has not been extensively studied in the hospice setting. We conducted a retrospective study of the records of 34 patients with a history of cord compression. Clinical presentation, investigations, treatment, and functional outcome were recorded. Outcome was related to performance status before the development of spinal cord compression, and to motor function at the time of treatment. Patients with low scores were less likely than those with high scores to benefit from attempts to reverse the cord compression. These assessments may help the clinician decide which patients to refer for investigation and treatment. Overall median survival was found to be three months for those who were ambulatory after treatment, but only three weeks for those who were not. Patients who were not ambulatory following therapy suffered a wide range of related problems and required intensive palliative care.

Activities of Daily Living↗

PubMed1991

Hospice care.

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Family Practice↗