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Gilbert B Zulian

Publications and source records attributed to Gilbert B Zulian.

11 recordsLinked to original sources
PubMed2006

The multicenter trial SAKK 37/95 of cladribine, cyclophosphamide and prednisone in the treatment of chronic lymphocytic leukemias and low-grade non-Hodgkin's lymphomas.

A multicenter trial was performed to confirm the therapeutic efficacy and the toxicity profile of the combination of cladribine, cyclophosphamide and prednisone in low-grade non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL). Twenty-three adults with previously treated (61%) or untreated (39%) NHL International Working Formulation A or Binet B and C CLL were administered cladribine 0.1 mg/kg/day as a subcutaneous bolus for 5 days, intravenous cyclophosphamide 500 mg/m2 on day 1, and oral prednisone 40 mg/m2 on days 1-5, every 4 weeks. Unexpected early hematological toxicities led to dose modifications for pretreated patients who received cladribine for 3 days only up to a maximum of five courses. Responses were observed in 75%, with 7 patients obtaining a complete clinical and hematological response. Median duration of complete response was 9 months. Median time to progression or relapse was 31 months. Myelosuppression and infections were dose limiting whereas posttreatment complications, including fatalities, resulted from infections. Median overall survival time from trial entry was 60 months. Activity of the combination of cladribine, cyclophosphamide and prednisone was confirmed. However, in the specific setting of a multicenter trial, unexpected fatal infectious episodes occurred in pretreated patients. Great caution is thus required in these susceptible patients and the routine use of corticosteroids should probably be abandoned.

Aged↗
PubMed2006

Impact of a postgraduate six-month rotation in palliative care on knowledge and attitudes of junior residents.

Fifty junior residents completed a six-month training period. An anonymous postal questionnaire was sent to collect the residents' opinions on improvements in their knowledge, perception of priorities and usefulness of training. Responses were rated from 5 (a great deal) to 1 (not at all improved). A total of 33 (66%) questionnaires were returned. A mean score of 4.48 was obtained on general improvement of knowledge, 4.91 +/- 0.29 on pain control, 4.17 +/- 0.58 on neurological symptoms, 4.09 +/- 0.77 on psychological symptoms, 4.64 +/- 0.60 on communication skills and 4.4 +/- 0.91 on physician attitudes. Some 58% of residents began the training with apprehension, 85% outlined their priorities and 76% reached these objectives. A total of 70% were fully satisfied with the tuition and support received and 98% recommended such clinical rotation. Data suggest that a six-month rotation in palliative care results in high levels of perception of improvement in knowledge and satisfaction. Exposure to palliative care patients during clinical rotations in specialized centres must be encouraged.

Adult↗
PubMed2005

Management of patients with amyotrophic lateral sclerosis.

UNLABELLED: Standard recommendations for the clinical management of patient with ALS have been edited in recent years. These documents emphasise the importance of patient's autonomy. AIM OF STUDY: To measure how these different recommendations can be applied in the context of a general hospital without a specific ALS clinic. METHODS: Review of medical records of 21 patients with an ALS diagnosis treated by the University Hospitals Geneva who died from 1996-2002. RESULTS: Patients suffered from distressing symptoms during their last hospitalisation. Artificial nutrition was given to 5 patients. Six patients had non invasive ventilation (NIV). Written advance directives were only available in 2 cases. Discussions about theses issues were also conducted late in the evolution of the disease. CONCLUSION: Some discrepancies between our daily practice and the existing recommendations exist, particularly regarding the key issues of artificial nutrition and ventilatory support.

Aged↗
PubMed2003

Are older French patients as willing as older American patients to undertake chemotherapy?

PURPOSE: A view often held in Europe is that older Europeans are less willing than older Americans to undertake chemotherapy. This study assesses whether this view is valid. PATIENTS AND METHODS: Three-hundred twenty outpatients aged 70 years and older were interviewed via anonymous questionnaires: French patients with and without cancer and American patients with and without cancer. The response rate was 61% (195 of 320 questionnaires). Ages ranged from 70 to 95 years (29% aged 80 years and older). Two scenarios were presented: a strong chemotherapy (platinum/taxane combination-like) and a milder chemotherapy (weekly vinorelbine-like). The options were to refuse chemotherapy or to accept for a threshold chance of cure, of life prolongation, or of symptom relief. Functional status, education, self-rated health, and depression were controlled for. RESULTS: French noncancer patients (34%) were less willing to accept the strong chemotherapy than French cancer patients (77.8%), American noncancer patients (73.8%), and American cancer patients (70.5%) (P <.001 for each pair). This was also true for the moderate chemotherapy (67.9% v 100%, 95.2%, and 88.5%, respectively; P <.001). Age and sex did not correlate with response, but self-rated health, cancer status, and nationality did. Thresholds varied from patient to patient. CONCLUSION: Whereas older French people without cancer are more reluctant than older Americans to envision chemotherapy, older cancer patients in both countries have the same amenability to treatment. Chemotherapy options should be fully discussed with older cancer patients, given that most are willing to consider them.

Aged↗
PubMed2003

Symptom assessment in elderly cancer patients receiving palliative care.

BACKGROUND: The purpose of this study is to examine the concordance of symptom assessment among the multiple raters in French-speaking elderly patients with an advanced cancer benefiting from palliative care. PATIENTS AND METHODS: This study was conducted in a geriatric hospital with palliative care specificity. During 6 months, patient, nurse and physician completed the Edmonton symptom assessment system on two consecutive days. RESULTS: 42 patients with an advanced oncological disease were included. Mean age was 72+/-9.04 (range 52-88) and 23 were females. Mean mini mental status examination (MMSE) was 27.5+/-1.6. First assessment was completed at a median of day 8 after admission. Nurses, physicians and patients assessments were reproducible between days 1 and 2 (P>0.05). Pearson correlation coefficient significantly associated nurse assessment with patient assessment for pain, depression, anxiety, drowsiness, appetite and wellbeing (P<0.05). Physician assessment was associated with patient assessment for pain, depression, drowsiness, appetite, wellbeing and shortness of breath (P<0.05). However, regression analysis looking for patient score from both physicians and nurses scores weakly correlated all these factors (R2<0.6), except for appetite (R2 for day 1/day 2: 0.79/0.64). CONCLUSIONS: French-speaking elderly cancer patients without cognitive failure and in stable general condition are consistent in their symptom assessment, and they have to be considered as the gold standard. Nevertheless, interdisciplinary assessment is probably a valid surrogate to self-assessment by the patient but only when the latter is truly impossible.

Aged↗
PubMed2003

Evaluation of a nystatin-containing mouth rinse for terminally ill patients in palliative care.

PURPOSE: To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care. MATERIALS AND METHODS: 52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days' incubation at 37 degrees C. RESULTS: Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p < 0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores. CONCLUSIONS: No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.

Aged↗
PubMed2002

Geriatric medical oncology in the care of elderly cancer patients.

Most cancers are diagnosed after 70 years of age but standard management and treatment for elderly cancer patients remain to be established. To determine whether the availability and recognition of medical oncology may influence cancer care in this population, five successive periods were studied. The number of formal written consultations given at the geriatric hospital and at the center for continuous care was measured. Over a period of 36 months, the number of consultations rose from an initial 1.5% (n=26) and 3.8% (n=25) to 3% (n=71) and 12.5% (n=103) of the respective total number of admissions. As expected, the increase exactly matched both main geographical location and functional position of the single appointed medical oncologist. However, following the definitive establishment of the medical oncologist at the center for continuous care, the number of formal written consultations markedly decreased. At the geriatric hospital, medical oncology returned to the 'status quo ante' whereas it was quite simply incorporated in the daily care of all cancer patients at the center for continuous care. Thus, improvement of cancer care in the elderly may first depend on human resources such as trained specialists to make a true difference with the prior situation.

Aged↗
PubMed2002

Multiple malignant tumours in the elderly.

Aging of the population and technical improvements may contribute to increase the possibility of multiple malignant tumours to be diagnosed. Over a period of 18 years, 2,749 consecutive autopsies of elderly patients were performed. In addition to macroscopic examination of every single organ, bone marrow and prostate were routinely stained and microscopically examined. One hundred and sixty-seven patients with multiple malignant tumours were found. Mean age was 81.1 years for females and 80.1 years for males. Mean interval between tumours was 2.4 years for females and 1.0 year for males. First tumours were most of the time diagnosed clinically (n = 121 vs. 46) whereas second tumours were diagnosed at autopsy (n = 121 vs. 46). Origin and metastastic sites of tumours were not different between the first and second tumour. Prostate and breast were the most frequent organs involved in males and females. Multiple malignant tumours in the elderly are not rare and the second tumour is frequently diagnosed after death despite occurring relatively soon after the diagnosis of the first tumour. Multiple malignant tumours may represent a significant clinical challenge leading to further diagnostic procedures and differentiated therapeutic approaches.

Aged↗
PubMed2002

[Depression in palliative care: how to identify it, detect it, and treat it].

Psychological symptoms are frequently observed in palliative care, such as anxiety, mood disorders, depression and death request. However, these symptoms are considered most of the time as a natural and emotional process of any terminally ill patient. This may result in under-diagnosis and under-treatment. Recognition early detection of depressive symptoms is necessary to achieve an efficient management. Better information and key skill training should thus be implemented together with screening in order to help depressive patients and their relatives during dying and mourning processes.

Depression↗