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Biomedical subjects

M E Charlson

Publications and source records attributed to M E Charlson.

84 records · Page 5Linked to original sources
PubMed1982

Rapid growth rate in breast cancer: a confounding variable in adjuvant-chemotherapy trials.

In randomised trials of adjuvant chemotherapy for node-positive breast cancer, significant benefits has been seen in premenopausal but not postmenopausal patients. A possible explanation for this distinction is that premenopausal groups contain a greater proportion of patients with rapidly growing tumours that respond well to chemotherapy. The purpose of this study was to assess the plausibility of this explanation, using a clinical index to estimate rate of growth. From a cohort of women with primary breast cancer, none of whom had received adjuvant chemotherapy, an adjuvant-treated population was simulated by means of a study of the 164 patients who would have been eligible for entry into an adjuvant trial. The prognosis for each patient was categorised according to premenopausal or postmenopausal status, nodal status (1-3 or greater than or equal to 4), and growth rate of the cancer (non-rapid or rapid). Patients with rapid growth rates comprised a greater proportion of the premenopausal group (32%) than of the postmenopausal group (20%). On the assumption that adjuvant chemotherapy would preferentially benefit the rapid-growth stratum, the potential impact of the disproportionate distribution of the rapid-growth-rate stratum on the results of adjuvant trials was calculated. The results showed that a disparity in distribution of the rapid-growth-rate stratum could account for the apparently greater benefit in premenopausal patients.

Age Factors↗
PubMed1982

Absenteeism and labelling in hypertensive subjects. Prevention of an adverse impact in those at high risk.

In this work-site population, the illness absenteeism of 259 hypertensive subjects was studied in the year after they were screened and labelled. Absenteeism due to illness increased more in 48 patients who were unaware of their hypertension (newly labelled) than in the 211 subjects who were aware. Among the newly labelled subjects, only the young subjects and those with "pure" systolic hypertension experienced increased absenteeism; the older subjects with diastolic hypertension did not. The newly labelled subjects who received active follow-up and treatment with antihypertensive medication had only minimal increases in absenteeism. In contrast, those who received active follow-up without medication, and those who received only episodic follow-up had significantly greater increases. Vigorous efforts are warranted to insure active follow-up and treatment for hypertensive subjects after their condition has been labelled. Caution should be exercised in labelling, however, if no antihypertensive treatment is initiated.

Absenteeism↗
PubMed1980

A new clinical index of growth rate in the staging of breast cancer.

The clinical rate of growth in patients with breast cancer can be auxometrically classified by identifying the first clinical manifestation observed by the patient (or physician) and by then noting the progression interval that elapsed before treatment and the occurrence of prognostically unfavorable transition events during that interval. These two features can be used to demarcate slow, intermediate and rapid auxometric stages, which approximate the cancer's rate of progression. A fourth stage consists of patients who have systemic or metastatic symptoms before treatment. Within any TNM (tumor-nodes-metastases) stage, degree of nodal involvement or treatment, these four auxometric stages delineate patients with distinctly different prognoses. In particular, the slow auxometric stage can be used to identify a subgroup of patients with excellent 10 year survival and other patients who have good outcomes despite an anatomically unfavorable status. Conversely, the rapid and systemic-metastatic stages identify patients with relatively poor prognoses despite an apparently favorable anatomic status. The auxometric classification is easily used, readily available and involves no technologic expense or risk. By improving the accuracy of anatomic staging, auxometry adds an important refinement to the estimation of prognosis and the evaluation of therapy for patients with breast cancer.

Adult↗
PubMedDate not supplied

Compliance with the recommendations of medical consultants.

Compliance with the consultant's recommendations is one measure of the effectiveness of a consultation. A previous study showed that compliance was better when fewer recommendations were made. In the subsequent year, consultants were encouraged to limit their recommendations to five or fewer. Despite a significant decrease in the number of recommendations, compliance rates remained essentially unchanged (72%). Multivariate analysis demonstrated that the clinical severity of the patient's disease and the number of associated problems, as well as the types of recommendations, were significant predictors of compliance. Compliance was best for recommendations involving medications (84%) and worst for recommendations involving diagnostic tests (62%). Compliance was also evaluated in the context of a surgeon's view of the appropriateness of the recommendations. For recommendations felt to be essential to patient care the compliance rate was 75%, but it was only 44% for recommendations judged nonessential (p less than 0.001). The consulting internist should be aware that the surgeon's view of the relevance of the recommendations to patient care needs may have an important effect on compliance.

Analysis of Variance↗
PubMedDate not supplied

Variability of arterial PO2 in hospitalized patients: implications for clinical practice and research.

The effects of position and ventilation on variability of PO2 in hospitalized patients were studied using a cross-over design. Arterial blood gases were obtained for 51 patients while they were lying and while they were sitting, and after five deep breaths (lying). The PO2 generally increased after five deep breaths but was not systematically changed by sitting up. Nineteen patients (37%) had changes in PO2 greater than or equal to 10 mm Hg. The patient's mean PO2 and respiratory rate influenced these differences. Among patients with a mean PO2 less than 85 mm Hg whose respiratory rates were greater than 20/min, only 11% had a change in PO2 greater than or equal to 10 mm Hg. In contrast, among patients with a mean PO2 greater than 85 mm Hg and a respiratory rate less than 20/min, 60% had a change in PO2 greater than or equal to 10 mm Hg. Considerable variability in PO2 is introduced by commonly encountered changes in position and ventilation. These conditions must be standardized when serial blood gas results are used to assess changes in a patient's condition.

Adult↗
PubMedDate not supplied

Diagnostic test restraint and the specialty consultation.

OBJECT: To assess the effect consultants had on the diagnostic process in the management of patients admitted to the medical service of a university hospital. DESIGN: Cohort study utilizing prospective evaluation by residents, retrospective chart review, and direct communication with the patient, a family member, or the patient's physician one year after admission to the hospital. SETTING: The medical inpatient service of an urban university hospital. PATIENTS: The 580 patients admitted to the medical service during one month in 1984 for whom complete data were available. MAIN RESULTS: Sixty-three percent of the patients had consultations. Seventy percent (198/284) of the patients admitted by generalists had consultations, while 57% (170/296) of the patients admitted by subspecialists had consultations. Of the 1,422 major diagnostic tests performed on these patients, 504 (35%) were first recommended by consultants, and the consultants recommended cancellation of only ten major diagnostic tests. Patients who were seen by consultants had a length of stay that was more than double that of patients not seen by consultants. Consultation was associated with prolonged stay when patients were stratified by important clinical variables and remained an important independent factor in a multivariate model. The prolongation of hospitalization was principally due to delays in scheduling and interpreting sophisticated tests recommended by the consultants. When stratified into prognostically similar clinical groupings, there was no significant difference in in-hospital mortality between patients seen and those not seen by a consultant. CONCLUSION: Efforts to foster diagnostic restraint in the management of hospitalized patients should be broadened to include attention to the specialty consultation process.

Clinical Laboratory Techniques↗