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Biomedical subjects

M Law

Publications and source records attributed to M Law.

At least 19 recordsLinked to original sources
PubMed1995

An analysis of the effectiveness of interventions intended to help people stop smoking.

In a systematic review of the efficacy of interventions intended to help people stop smoking, data have been analyzed from 188 randomized controlled trials. Following personal advice and encouragement to stop smoking given by physicians during a single routine consultation, an estimated 2% (95% confidence limits, 1%, 3%; P < .001) of all smokers stopped smoking and did not relapse up to 1 year as a direct consequence of the advice. The effect is modest but cost-effective: the cost of saving a life is about $1500. Supplementary interventions (follow-up letters or visits, demonstration of spirometry, etc) have an additional effect--variable in extent. Advice and encouragement are particularly effective for smokers at special risk--pregnant women (efficacy; 8%) and patients with ischemic heart disease. Behavior modification techniques (relaxation, rewards and punishment, avoiding "trigger" situations, etc), in group or individual sessions led by a psychologist, have an effect that is statistically significant (P = .05) but no greater than simple advice by a physician (2%); yet, these techniques are several times more expensive. The effect of hypnosis is unproved (no trials have used biochemical markers). Nicotine replacement therapy is effective in an estimated 13% of smokers who seek help in cessation; the effect is greater in those who are nicotine-dependent. Other pharmacological treatments are not of proven efficacy, and acupuncture is ineffective. Sudden cessation or gradual reduction in smoking are similar in their efficacy on average. Physicians should take time to advise all their patients who smoke to quit. Smokers who are intent on stopping should be given additional support and encouraged to use nicotine replacement therapy.

Cost-Benefit Analysis↗
PubMed1995

Expression of 2 variant forms of fibroblast growth factor receptor 1 in human breast.

The expression of variant mRNAs encoding isoforms of fibroblast growth factor receptor (FGFR)1 with either 2 or 3 Ig-like loops in the extracellular domain was investigated in human breast tissues and cell lines using a polymerase chain reaction amplification method. Almost all tissues contained both forms of FGFR1, but cancers (n = 137) had a significantly lower proportion of the transcript that encoded the full 3-loop form compared with non-malignant biopsies (n = 34). This was confirmed using microdissected populations of normal and cancerous cells from frozen tissue sections. A high ratio of the 2- to 3-loop form was found to be predictive of reduced relapse-free survival. In both groups, however, the predominant form of FGFR1 was that encoding the 2-loop receptor. Cell lines derived from a variety of tissues, including breast, also co-expressed both variants of FGFR1, suggesting their presence within the same cell type. Again, there was a similar preponderance of the shorter isoform. Our results were confirmed at the protein level, where out of 5 cancers analysed 4 expressed more of the 2-loop form than the 3-loop form. Our findings suggest that cells may normally simultaneously express several splice variants of FGFR1, and aberrant expression or a change in their relative amounts (i.e., in malignancy) could contribute to modified responses to either autocrine or paracrine factors.

Adult↗
PubMed1992

Mitozantrone and methotrexate chemotherapy with and without mitomycin C in the treatment of advanced breast cancer: a randomised clinical trial.

Patients with advanced breast cancer were randomised to 3M (mitozantrone 6.5 mg/m2q 21 days, methotrexate 30 mg/m2q 21 days, mitomycin C 6.5 mg/m2q 42 days) or 2M (as 3M but without mitomycin C). The objective response rates of 30% in 51 evaluable patients receiving 3M and 26% of 54 patients receiving 2M were not significantly different. 4/16 patients not responding to 2M responded to 3M on crossover. Both regimes were well tolerated but there was significantly less haematological toxicity and fewer dose reductions and delays with 2M. We conclude that patients should initially be treated with 2M and that non-responding patients should be crossed to 3M.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Anticipatory nausea and emesis, and psychological morbidity: assessment of prevalence among out-patients on mild to moderate chemotherapy regimens.

The prevalence of nausea and emesis among a series of out-patients (n = 95) receiving mainly mild-to moderately-emetic cytotoxics, was assessed, along with levels of psychological morbidity. Particular focus was given to the rates of psychologically-based (anticipatory) nausea and emesis. Results indicated that 23% of patients experienced anticipatory nausea and the majority reported that this occurred before at least half of the previous treatment cycles. Both emetic challenge of chemotherapy regimen and younger age were linked to this anticipatory effect. The data clearly indicated that nausea and emesis, both post-treatment and in anticipation of treatment, carried a psychological cost with anxiety being highest in those experiencing anticipatory nausea and/or emesis. The role of anxiety in the aetiology of psychologically-based nausea and emesis was not evaluated and it is considered that a prospective study is needed to clarify the exact contribution of psychological factors in the incidence of both post-treatment and anticipatory side-effects.

Adult↗
PubMed1992

Prognostic factors in hormone-resistant progressing cancer of the prostate.

In 224 consecutive patients with hormone-resistant prostatic cancer referred to 2 European Cancer Centres for palliation of painful bone metastases the one year survival for all patients was 24% (2-year survival: 7%). The median survival was 8 months. In univariate analyses the following prognostic factors were identified: performance status, serum creatinine, alkaline phosphatase, duration of response to primary hormone treatment, degree of bone scan involvement and hemoglobin. Multivariate analyses confirmed the four first parameters to be independent factors. A prognostic model was established (no or one risk factors vs 2 risk factors vs 3 or 4 risk factors) based on performance status, creatinine, alkaline phosphatase and hormone response duration. The median survival of these groups was 10 months, 6 months and 3 months, respectively. This model proved to be discriminative in an external data set of 214 patients with hormone-resistant prostatic cancer entered in two prospective trials. The above differences in outcome between readily and simply defined prognostic groups are greater than the differences one can realistically hope to produce using new treatment strategies. These prognostic factors should be taken into account both in the design and interpretation of clinical studies dealing with the treatment of hormone-resistant progressing prostatic cancer and painful bone metastases.

Adult↗
PubMed1992

Adjuvant aminoglutethimide for postmenopausal patients with primary breast cancer: analysis at 8 years.

PURPOSE: The study purpose was to evaluate aminoglutethimide (AG) as adjuvant therapy in patients with primary node-positive breast cancer in a randomized double-blind placebo-controlled trial. PATIENTS AND METHODS: In a multicenter trial, 354 postmenopausal women with early breast cancer and histologically confirmed positive axillary lymph nodes were randomized after surgery to received aminoplac. Patients were prescribed either AG 250 mg four times per day and hydrocortisone 20 mg twice per day or placebos of identical appearance for 2 years. RESULTS: After a median follow-up of 8.1 years, there has been no overall benefit for AG in terms of either event-free survival or overall survival (OS). However, the results are consistent with interim analyses with a significantly improved event-free survival for patients who received AG for up to 4 years, although this benefit subsequently disappears. Similarly, there is an improved OS for patients who received AG for up to 4 years, but this also subsequently disappears. There was a marginal advantage for estrogen receptor (ER)-positive patients who received AG (n = 74; P = .054). There was no difference in the sites of relapse. There was a significant increase in toxicity for patients who received AG. CONCLUSION: The lack of survival benefit with long-term follow-up for AG may indicate that aromatase inhibitors have less of an impact on early breast cancer than tamoxifen and may imply different biologic mechanisms of action.

Aged↗
PubMed1992

Reliability and construct validity of the Clinical Observations of Motor and Postural Skills.

The Clinical Observations of Motor and Postural Skills (COMPS) is a screening tool for children with motor incoordination. A study of reliability (test-retest, interrater, and internal consistency) and construct validity with 132 children, both with and without developmental coordination disorder, is reported here. Test-retest reliability over 2 weeks was high: .92 for a group of 48 children. Interrater reliability for occupational therapists experienced in pediatrics was also excellent: .87 for a group of 72 children. Internal consistency of the COMPS was high, particularly when one of the seven items (Schilder's arm extension) was deleted. The test discriminates well between children with and without motor problems and has many properties of a good screening test.

Child↗
PubMed1991

Neurodevelopmental therapy and upper-extremity inhibitive casting for children with cerebral palsy.

The purpose of this research was to study the effect of intensive neurodevelopmental therapy (NDT) and upper-extremity inhibitive casting, separately or in combination, on hand function, quality of upper-extremity movement and range of motion of 73 children with spastic cerebral palsy aged 18 months to eight years. There was no significant difference between intensive or regular therapy and casting or no casting for hand function, between intensive and regular NDT, or between intensive NDT plus casting and the other groups for quality of movement and range of motion. Casting led to increased quality of movement and wrist extension after six months. Casting with NDT improved the quality of upper-extremity movement and range of motion. There appear to be no immediate benefits from intensive therapy alone.

Arm↗
PubMed1989

Criteria mapping: a method of quality assurance.

Criteria mapping is a flexible and responsive method of chart audit that allows the simultaneous assessment of both the process and the outcome of care by means of health record abstraction. This method of audit is particularly suited to occupational therapy because it includes branching to reflect the sequential judgments of therapists and does not penalize the clinician for omitting unnecessary procedures. The purpose of this study was to determine the utility and reliability of the criteria mapping process in evaluating the quality of care for a self-care disability in an acute care setting. Three occupational therapists and one independent abstractor evaluated 12 charts twice. Intraobserver reliability calculated with intraclass correlation coefficients was .77 for the therapists and .65 for all observers. Interobserver reliability was .73 for the therapists and .72 for all observers. The criteria map provided comprehensive and relevant information about each chart. This paper discusses the implications of these findings for the ongoing monitoring of the quality of care in occupational therapy.

Disability Evaluation↗
PubMed1989

A critical review of scales of activities of daily living.

Occupational therapists routinely perform activities of daily living (ADL) assessments. Although the literature contains many ADL scales, few sources summarize and review the measurement properties of such scales. In this paper, standard criteria are used to review scales of basic self-care. Each scale is critically appraised regarding its purpose, clinical utility, construction, standardization, reliability, and validity. Recommendations are made regarding the ADL scales that are most suitable for describing, predicting, or evaluating ADL function. This review is intended to help therapists in selecting the most appropriate ADL measure to use in their clinical practice.

Activities of Daily Living↗
PubMed1987

A primary genetic linkage map for human chromosome 12.

A primary genetic map for human chromosome 12 has been constructed from data on 23 restriction fragment length polymorphic systems collected in 38 normal families with large sibships. Linkage analysis of the genotypic data has ordered 16 loci into a continuous genetic map of 111 cM in males and 258 cM in females. Although most of the genetic map reflects a higher rate of recombination in females relative to males, significantly more frequent recombination was observed in males than in females in intervals between loci on the distal portion of the short arm of the chromosome. The mapping data shown here will serve as a first step toward a high-resolution genetic map for human chromosome 12.

Animals↗