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Biomedical subjects

R E Enck

Publications and source records attributed to R E Enck.

At least 19 recordsLinked to original sources
PubMed2000

An alternative algorithm for dosing transdermal fentanyl for cancer-related pain.

Many cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines emphasize individualization of opioid treatment to provide the drug and route of administration that meet the needs of the particular patient. Intolerable side effects, ineffective pain relief, or a change in the patient's clinical status can dictate the need for a new pain management regimen. Physicians must be able to readily quantify relative analgesic potency when converting from one opioid to another or from one route of administration to another. Transdermal fentanyl (Duragesic) is an opioid agonist that has been shown to be safe and effective for the treatment of cancer pain. However, clinicians should realize that the manufacturer's recommendations for equianalgesic dosing of transdermal fentanyl may result in initial doses that are too low in some patients, and in a titration period that is too long. Under these circumstances, the patient is likely to experience unrelieved pain. An alternative dosing algorithm that considers both a review of the literature and our combined clinical experience with transdermal fentanyl should help clinicians individualize the treatment of pain.

Administration, Cutaneous↗
PubMed1994

Physicians, palliative care, & health care reform.

As hospice programs have grown, they somehow left physicians out of the loop. As the health care system faces reform proposals and eventually undergoes changes, physicians need to be more involved in what happens to hospice care.

Health Care Reform↗
PubMed1992

Cytarabine plus idarubicin or daunorubicin as induction and consolidation therapy for previously untreated adult patients with acute myeloid leukemia.

The purpose of this study was to determine the relative merits of idarubicin and daunorubicin in acute myeloid leukemia (AML) therapy. Thirty-two sites provided 214 previously untreated adults with AML aged 15 years or more who were randomized to receive for induction therapy cytarabine 100 mg/m2/d as a continuous 7-day infusion plus either daunorubicin 45 mg/m2/d (A + D) or idarubicin 13 mg/m2/d (A + I), daily on the first three days of treatment. Postremission therapy consisted of two courses of the induction regimen at the same daily doses, with the anthracycline administered for 2 days and cytarabine for 5. The complete response (CR) rates for evaluable patients were 70% (A + I) and 59% (A + D) (P = .08). The difference in CR rates was significant in patients aged 18 to 50 years (88% for A + I, 70% for A + D, P = .035). Resistant disease was a significantly more frequent cause of induction therapy failure with A + D than with A + I. Hyperleukocytosis (white blood cell count greater than 50,000/microL) unfavorably affected the attainment of CR with A + D but not with A + I. CR duration was significantly greater after A + I. CR duration was significantly greater after A + I treatment, and the survival of all randomized patients treated with A + I was significantly better than that observed after A + D treatment (median 12.9 months v 8.7 months, respectively, P = .038). Toxicity of the two treatments was similar, although A + I patients experienced more prolonged myelosuppression during consolidation therapy, and a greater incidence of mild chemical hepatitis was observed in the A + I group. It is concluded that, at the doses and schedule used in this study, A + I is superior to A + D for induction therapy of AML in adults.

Adult↗
PubMed1991

Pain control in the ambulatory elderly.

Pain control in the elderly, no matter what the etiology or setting, can be a major clinical challenge. Aging causes unique physiologic changes, eg, a decreased perception of pain and an enhanced sensitivity to opioid analgesics. Principles regarding evaluation of patients with pain are reviewed, including the use of an objective instrument for pain assessment from the viewpoint of both physician and patient. Good pain control can be achieved with the nonopioids, such as acetaminophen and the nonsteroidal anti-inflammatory drugs, the opioid analgesics, and, in some cases, adjuvant agents. Discussed also are the concerns for patient addiction and the WHO Cancer Pain Relief program.

Aged↗
PubMed1984

Tamoxifen treatment of metastatic breast cancer and antithrombin III levels.

Reported in the literature are several cases of thromboembolic complications occurring in patients on tamoxifen citrate for metastatic breast cancer. In view of this literature, a study of patients on tamoxifen was initiated to determine if a paradoxical estrogenic effect was present as evidenced by lowered levels of antithrombin III (AT III). Both functional and immunologic levels were assayed. Twenty-four women with metastatic breast cancer (predominantly bone, 83%) on tamoxifen 10 mg by mouth twice daily were studied. The mean duration of tamoxifen therapy at the time of the AT III determination was 36 weeks (range, 2-87 weeks). The mean age of the group was 64 years with a mean functional AT III of 86% (normal, 82%-120%). Ten of 24 (42%) had low levels of functional AT III (mean, 75%), whereas, the remaining 14 (58%) had normal levels of functional AT III (mean, 94%). Immunologic AT III levels were normal in 23 patients (mean, 26 mg/dl; normal range, 17-30 mg/dl) and elevated in 1 patient. Similarly, functional and immunologic AT III levels were determined in 11 women with metastatic breast cancer on no hormonal therapy. One of 11 (9%) had a low level of functional AT III with a mean of 102% for the entire group. The mean immunologic AT III was 28 mg/dl with two elevated. The poor correlation between functional and immunologic AT III levels may be similar to the disparity noted in women using estrogen-containing oral contraceptives. The finding of lowered functional activity of AT III in 42% of tamoxifen-treated patients is preliminary in nature and will require larger confirmatory studies, including further clinical correlation of this observation.

Antithrombin III↗
PubMed1983

How to promote hospice to hospital medical staffs.

Integration of hospice into the health care system rather than in isolation is often critical for program success. When hospice is seen as part of a continuum of care, medical staffs will much more readily accept the addition of hospice as a specialized hospital service.

Continuity of Patient Care↗