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PubMed2004

Comparison of the efficacy of 250 mg and 500 mg clarithromycin used with lansoprazole and amoxicillin in eradication regimens for Helicobacter pylori infection.

AIMS AND METHODS: The aim of this study was to compare the efficacy of 250 mg and 500 mg clarithromycin used with lansoprazole and amoxicillin in eradication of H. pylori infection. 235 patients with H. pylori infections and non-ulcer dyspepsia were randomly assigned to one of the following regimens: lansoprazole 30 mg, amoxicillin 1000 mg, clarithromycin 250 mg (LAC250) and lansoprazole 30 mg, amoxicillin 1000 mg, clarithromycin 500 mg (LAC500). All drugs were given twice daily for 7 days. The patients were assessed for prevalence of H. pylori with the CLO test. Gastric biopsy samples obtained during upper gastrointestinal endoscopy before randomization and 4-6 weeks after completion of therapy were used for histology and culture. Bacterial sensitivity to clarithromycin and amoxicillin was determined with the E-test. RESULTS: 101 patients in the LAC250 mg group and 102 in the LAC500 group completed the study. On intention-to-treat analysis, eradication rates were 81% with LAC250 and 82% with LAC500 (p=0.88). On per-protocol analysis, eradication rates were 92% with LAC250 and 96% with LAC500 (p=0.23). Among the 203 patients (86% of the entire study group) for whom H. pylori antibiotic-sensitivity testing was technically feasible, primary resistance to clarithromycin was found in 9% and to amoxicillin in 0%. Eradication of clarithromycin sensitive/resistant strains was 94%/38% for LAC250 (p < 0.001) and 93%/40% for LAC500 (p < 0.001). CONCLUSIONS: The cure rates for the two regimens were similar, although adverse effects were more frequent with the LAC500 regimen, suggesting that 250 mg of clarithromycin b.d. may be sufficient in our patient population.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMedDate not supplied

[The story as a health education technic for schoolchildren].

Schoolchildren health education should begin as early as possible. The objective of this study is to show that to develop health education early in the lifetime is feasible by using the tale/psychodrama as tool for making class explanations more useful. An intervention study was carried out with all the children attending course level 1 of Basic General Education (BGE) in four schools, two from the city of Granada (urban) and two from two surrounding municipalities (semi-urban). They were randomly divided in two groups in order to compare the efficacy of two different health education interventions on taking care of pets: formal explanations at the classroom vs listen to a tale. Evaluation was assessed by a simple 15 yes/no items questionnaire which was administered before and after the intervention. Both interventions resulted in important improvements of children responses. The tale was clearly better than class formal explanations, the differences being statistically significant for 8 of the questions. We conclude that health education is feasible early in childhood and that tales can be more efficient than class explanations.

Child↗

PubMed2004

Follow-up after a pediatric emergency department visit: telephone versus e-mail?

OBJECTIVE: The Internet has become in recent years an unlimited source of health-related information and revolutionized health information access. Follow-up after an emergency department (ED) visit is important for continuity of care but is difficult to achieve. We conducted this study to determine whether e-mail could become a method for a follow-up contact after leaving the pediatric ED. METHODS: Over a 2-month period, parents who had a telephone line and e-mail access and whose child was discharged from the ED at the Hospital for Sick Children in Toronto were randomized to receive an e-mail or a telephone follow-up. Main outcome measure was the response rates by parents to the telephone or e-mail. RESULTS: A total of 265 (79%) of the 337 families who were approached had Internet access, and the majority (75%) check e-mails at least once a day. Eighty-seven percent (85 of 98) and 53% (53 of 100) of the families who were contacted by telephone or e-mail, respectively, were reached within an average of 17 and 46 hours, respectively. Fourteen percent of families from the study population were unreachable either by telephone or by e-mail. Most (57%) parents who did not respond to the e-mail did not check or did not remember reading the e-mail or had trouble with access. Ten percent of the e-mails were undeliverable. CONCLUSIONS: The telephone is better than e-mail as a follow-up channel with families of children who visit the pediatric ED. The main reason for not responding to e-mails is "technical problems." E-mail could be a mean for follow-up contact for part of our patient population, especially for nonurgent purposes.

Aftercare↗

PubMed1978

Cytostatic treatment of glomerular diseases. IV. The effect of combined immunosuppressive treatment on serum creatinine and proteinuria evaluated by sequential statistical analysis. Report from a Copenhagen study group of renal diseases.

Sequential statistical testing of the development of the disease in the single patient was used in the assessment of immunosuppressive treatment of renal glomerular diseases. After an initial period of prednisone (P) treatment, this was supplemented first by azathioprine (A) and later in addition by cyclophosphamide (C). The time of transition from one treatment to another was determined by the result of the current statisical testing of the correlation between serum creatinine concentration and proteinuria on the one hand and the time and the varying doses of the drugs on the other. Twenty-nine patients entered the study. Thirteen were withdrawn, eight for technical reasons, three due to side-effects and two on account of renal deterioration and transfer to dialysis treatment. Eight patients were cured, one during P treatment, five during P + A, and two during the combination of P, A and C. Eight patients completed treatment without being cured. In the overall material no statistically significant change in serum creatinine was noted, whereas the proteinuria decreased during P + A and P + A + C. No dose-dependent therapeutic effect of the drugs was demonstrated. In conclusion, this combined treatment with P, A and C did not seem to yield any major therapeutic progress. The technic of sequential statistical testing may be a useful tool in clinical research.

Adolescent↗

PubMed2005

Botulinum toxin type B for cervical dystonia.

BACKGROUND: Cervical dystonia is the most common form of focal dystonia. It is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. Most cases of cervical dystonia are idiopathic and generally it is a life-long disorder. In recent years, Botulinum toxin type A (BtA) has become the first line therapy. However, some patients become resistant to it. This problem led to the study of another Botulinum toxin (Bt) serotype, Bt type B (BtB) to address the issues of clinical efficacy, effect size, and safety of BtB in the treatment of cervical dystonia. OBJECTIVES: To determine whether botulinum toxin (BtB) is an effective and safe treatment for cervical dystonia. SEARCH STRATEGY: We identified studies for inclusion in the review using the Cochrane Movement Disorders Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE; and by handsearching the Movement Disorders Journal and abstracts of international congresses on movement disorders and botulinum toxin, by communication with other researchers in the field, by searching reference lists of papers found using the above search strategies, and by contacting authors and drug manufacturers. SELECTION CRITERIA: We considered studies eligible for inclusion in the review if they evaluated the efficacy of BtB for the treatment of cervical dystonia in randomized, placebo-controlled trials. DATA COLLECTION AND ANALYSIS: We used a paper pro forma to collect data from the included studies with double extraction by two independent reviewers. Both reviewers assessed each trial for internal validity and settled differences by discussion. The outcome measures used included adverse events, improvement in symptomatic rating scales, subjective evaluation by patients and clinicians, changes in pain scores, changes in quality of life assessments. MAIN RESULTS: Studies were short term (16 weeks) employing a single BtB injection session. All were multicentre and conducted in the US. All patients included had previously received BtA. The trials differed with respect to whether or not the patients were still responding to BtA but other entry criteria were similar. All studies used a dose of 10,000 Units of BtB in one group and the technique of administration was the same. Meta-analysis of three trials enrolling 308 participants showed statistically and clinically significant improvements in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score at week four with a Peto odds ratio (OR) for the number of patients who had at least a 20% improvement of 4.69 (95% CI 2.06 to 10.69) and a weighted mean difference of -5.92 (95% CI -9.61 to -2.23). Subjective rating scales (Patient Global Assessment of Change, Investigator Global Assessment of Change, and Patient Analog Pain Assessment) also improved. Adverse events clearly associated with the mechanism of action of BtB included dysphagia and dry mouth and the number of patients with any adverse event were more frequent in BtB treatment groups. Subgroup analyses showed a clear dose-response relationship for subjective and objective benefit, for frequency and severity of adverse events, and a greater benefit for BtA resistant patients than BtA responders in the primary outcome. The duration of effect was about 16 weeks. We found three eligible studies enrolling 308 participants. Studies were short term (16 weeks) employing a single BtB injection session. All were multicentre and conducted in the US. All patients included had previously received BtA. The trials differed with respect to whether or not the patients were still responding to BtA but other entry criteria were similar. Patient groups were appropriately selected and well matched. From the methodological point of view these trials were probably not subjected to important selection, performance or attrition bias and all studies used an intention-to-treat analysis.The dose varied significantly between studies although all used 10,000 Units of BtB in one group and the technique of administration was the same. The primary outcome in all trials was change in TWSTRS total score at week four and other efficacy outcomes were similar between studies. The number of dropouts was small and balanced in all trials. Reasons for withdrawals were given. One randomized double-blind placebo-controlled study was excluded because data couldn't be extracted for the outcomes. Meta-analysis showed statistically and clinically significant improvements with a Peto odds ratio (OR) of 20% in TWSTRS total score at week four (OR 4.69; 95% CI 2.06 to 10.69) and a weighted mean difference of -5.92 (95% CI -9.61 to -2.23). Subjective rating scales (Patient Global Assessment of Change, Investigator Global Assessment of Change, and Patient Analog Pain Assessment) also improved. The weighted mean difference for changes in these subjective scales varied between -13% to -21%. However, for many of the outcomes, we could not combine data from all studies. Only adverse events clearly associated with the mechanism of action of BtB were more frequent in the treatment group. These included dysphagia and dry mouth. The number of patients with any adverse event was more frequent with BtB. Subgroup analyses showed a clear dose-response relationship for subjective and objective benefit and for frequency and severity of adverse events. Subgroup analyses showed a greater benefit for the BtA resistant patients than BtA responders in the primary outcome. The duration of effect was about 16 weeks. These trials did not measure quality of life nor did they establish the long term duration of effect or immunogenicity AUTHORS' CONCLUSIONS: A single injection of BtB was effective and safe for treating cervical dystonia. Long-term uncontrolled studies suggested that further injection cycles continue to work for most patients. Future research should explore technical factors such as the optimum treatment intervals and use of image or electromyographic guidance for administration. Other issues include service delivery, quality of life, long-term efficacy and safety, and the relative indications for BtA, BtB and other treatments such as deep brain stimulation.

Botulinum Toxins↗

PubMed1994

Randomized phase 2 evaluation of preoperative radiation therapy and preoperative chemotherapy with mitomycin, vinblastine, and cisplatin in patients with technically unresectable stage IIIA and IIIB non-small cell cancer of the lung. LCSG 881.

Between June 1988 and January 1980, 67 patients with pathologic stage III non-small cell lung cancer were randomized to receive either preoperative mitomycin, vinblastine, and cisplatin (MVP) chemotherapy (cisplatin 120 mg/m2, and mitomycin, 8 mg/m2 day 1 + 29, and vinblastine, 4.5 mg/m2 on day 1, 15, 22, and 29 and 2.0 mg/m2 day 8), or preoperative radiotherapy (44 Gy in 22 fractions to the primary tumor and mediastinum). The purpose of this study was to identify a treatment approach that showed sufficient effectiveness and acceptable toxicity to warrant testing by prospective randomized trial against "standard" nonsurgical treatment. All patients had surgical staging of the mediastinum and had either unresectable N2 disease or T4 disease with proximal extension of disease along the pulmonary artery. Response to preoperative therapy was evaluated 8 weeks after beginning treatment and patients with complete or partial radiographic response were to undergo surgical exploration and resection if possible. Fifty-seven patients were eligible and evaluable for response. Of the 67 total patients, 3 were unavailable for follow-up, 4 were ineligible, 1 was canceled, and 2 refused all treatment after having been randomized. Of the eligible and evaluable patients, 49 had stage IIIA and 8 had stage IIIB disease. Randomization was to MVP in 26 cases and to radiotherapy (XRT) in 31. Radiographic response to treatment was virtually identical for the two approaches, with 29 of the 57 evaluable patients achieving objective responses. In patients achieving radiographic response, 24 underwent surgical exploration and 20 underwent resection, of which 18 were complete. The mediastinum was free of tumor in seven patients but only two pathologic complete responses were seen (one each to XRT and MVP). In addition, ten nonresponders underwent surgery; seven underwent resection. Median survival for the entire group is 12 months, with a 27% actuarial survival at 4 years. Two patients died of treatment toxicity during preoperative therapy. Overall toxicity included 2 preoperative toxic deaths and 6 postoperative deaths in 34 patients who underwent surgical exploration (3 each with XRT and MVP) due to adult respiratory distress syndrome (3), myocardial infarction (1), pulmonary edema (1), and esophageal fistula (1), for an overall death rate 8 of 57 (14%) and a perioperative death rate in surgically explored patients of 6/34 (18%). These preoperative regimens, in the population studied herein, were of modest efficacy and substantial toxicity.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1995

The impact of a lecture on AIDS on knowledge, attitudes and beliefs of male school-age adolescents in the Asir Region of southwestern Saudi Arabia.

The aim of this study was to assess the levels of knowledge, attitudes and beliefs and AIDS among secondary school students in the Asir Region of Southwestern Saudi Arabia, and to assess the impact of a one-session AIDS education lecture given in some schools in the region during World AIDS Day, December 1992. An Arabic version of a previously reported self-administered questionnaire including factual and attitudinal items about AIDS was constructed. The questionnaire was given to two randomly selected groups of students; an experimental group of 335 students who had been exposed to a one-session lecture program about AIDS, and a control group of 503 students not previously exposed to the lecture. The results showed marked variability in correct responses to various specific items within and between groups. However, overall, 65% of the experimental group and 63% of the control group gave correct responses (P=0.517). Both groups were particularly less aware that casual contact cannot spread AIDS. However, fear of getting AIDS was significantly less among the experimental than among the control group (47% versus 58%, P = 0.011). Student knowledge about AIDS is inadequate, and the impact of an isolated one-session AIDS education lecture is less than satisfactory. AIDS education through a comprehensive school health program is recommended.

Acquired Immunodeficiency Syndrome↗

PubMed1980

Misonidazole in the preoperative and radical radiotherapy of bladder cancer.

Measurement of intercapillary distances suggests the presence of significant cell hypoxia in Bilharzial bladder cancer. This tumor seems to be capable of reoxygenation in view of the existence of a correlation between prognosis and immediate tumor shrinkage after irradiation. Two programs are presented: 1) Use of misonidazole with concentrated preoperative irradiation where the reoxygenation properties are not used fully. A prospective randomized study is presented whereby cystectomy alone is compared with cystectomy plus preoperative irradiation (6.5 Gy X 2F/1 week) with or without misonidazole. the drug is given either orally (in two doses 3 g/m2 each given 3.5 hours prior to each fraction; blood levels: 90-110 micrograms/ml) or intravesically. The intravesical administration is designed in the light of penetration studies and seems to have the advantage of the complete lack of systemic drug toxicity. Twenty-eight patients were included in this study and no drug toxicity was recorded. A second preoperative irradiation study is presented whereby cystectomy alone is compared with cystectomy plus preoperative irradiation (4.0 Gy X 5F) with or without misonidazole in individual doses of 2 g/m2. 2) Two radical radiotherapy regimes are presented. One protocol involves a split course (SC) protracted regime making full use of spontaneous reoxygenation. The drug is given in 0.5 g/m2 daily doses (total dose 14 g/m2 spread over 61 days, blood level: 15-20 micrograms/ml). A second protocol involves hyperfractionation stimulating continuous low-dose-rate irradiation. Higher blood levels are attained (60-80 micrograms/ml) after daily doses of 2 g/m2 (total dose: 14 g/m2 spread over 35 days). In a phase II study using SC technic, reversible grade 1 peripheral neuropathy was encountered in 5 of 22 patients. Complete tumor regression 3 months after irradiation was achieved in 18 of 22 patients with 3T tumors. No neuropathy was encountered in four patients subjected to the HF regimen who also showed complete tumor regression.

Dose-Response Relationship, Drug↗

PubMed1993

Titration of intravenous anesthetics for cardioversion: a comparison of propofol, methohexital, and midazolam.

OBJECTIVE: To compare propofol, methohexital, and midazolam administered as titrated infusions for sedation during electrical cardioversion. DESIGN: A prospective, randomized, single-blind comparative study. SETTING: Coronary care unit in a military teaching hospital. PATIENTS: Thirty adult patients with atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia. Each patient required electrical cardioversion. Patients were randomized to receive one of the three study drugs. Ten patients composed one drug group. MEASUREMENTS AND MAIN RESULTS: Demographic variables were similar between groups. Patients were randomized to receive propofol (10 mg/mL), methohexital (5 mg/mL), or midazolam (0.5 mg/mL) administered at 10 mL/min until the patients failed to follow verbal commands and demonstrated a degradation of the lid response to stimulation. Dose requirements (mean +/- SD) were propofol 1.69 +/- 0.46 mg/kg, methohexital 1.07 +/- 0.34 mg/kg, and midazolam 0.16 +/- 0.06 mg/kg. Hemodynamic assessment at baseline, after induction, after cardioversion, and at recovery demonstrated no difference in mean arterial pressure between the three groups. The time to awakening was significantly prolonged in the group that received midazolam (33 +/- 11 mins, p < .05) as compared with the times of the groups that received propofol (11 +/- 4 mins) and methohexital (9 +/- 3 min). Side-effects were similar between groups, with the exception of an increase in pain on injection with propofol and an increased frequency of confusion in those patients receiving midazolam. Recall of the electrical discharges at one hour after the procedure occurred in two patients in the propofol group. In both cases, there were technical problems which caused the duration of the procedure to extend into the anticipated recovery period. Unit dose costs at our institution for a 70-kg patient are: methohexitol, $3.14 (500-mg bottle); medazolam, $14.88 (5-mg vials x 3); and propofol, $6.60 (200-mg ampule). CONCLUSIONS: All three drugs are acceptable choices for use during elective direct-current cardioversion. Titration of the agent results in a total drug dose which is usually less than the typical induction dose. There were no significant differences in the hemodynamic actions of these drugs at any time interval. Both propofol and methohexital proved superior in their ability to provide a more rapid anesthetic onset and recovery as compared with midazolam. Propofol offers the advantage of requiring no premixing or dilution, and it is not a controlled substance, although it does result in more pain on injection.

Aged↗

PubMed1989

Endodontic status and suggested treatment in a population requiring substantial dental care.

The purpose of this study was to analyse endodontic status and treatment suggested for Swedish citizens requiring substantial dental care. According to the Swedish dental insurance system, treatment plans including radiographs have to be submitted for approval if the estimated cost of treatment exceeds a certain level (USD 500 in 1977). A sample of 1094 treatment plans received during 1977 and 1978 was randomly selected. In the radiographs the number of remaining teeth was recorded, periapical condition was evaluated and the quantity and quality of previous endodontic treatment were estimated. In addition, treatment plans concerning the teeth with periapical lesions were studied. The results indicated that patients analysed in this study that needed expensive treatment had more missing teeth, more root-filled teeth and more teeth with periapical lesions than what has been reported in previous studies of samples supposed to accurately represent the Swedish population. However, the technical quality of the root fillings and the frequency of periapical lesions in root-filled teeth were the same as in previous studies, with high frequencies of inadequate root fillings and related unfavourable responses. Thus the patients in this study retained a significant need for endodontic treatment despite having already received a great deal of endodontic care. Further, it was found that nearly half of the observed periapical lesions would not be treated based on the submitted plans.

Adolescent↗

PubMed1996

[Impact of anesthetic technic (general anesthesia versus intradural anesthesia) on the immune status].

OBJECTIVE: To study changes in the immune system appearing after general and regional (intradural anesthesia). PATIENTS AND METHODS: Fifty patients scheduled for elective surgery to repair inguinal hernias were studied. The patients were randomly assigned to 2 groups: group A patients received general anesthesia and group B patients received intradural anesthesia. Blood was extracted 5 times to determine levels of lymphocytes, activated T cells and B lymphocytes, and T-suppressant activity: t0 (before surgery), t1 (1 h), t2 (4 h), t3 (24 h) y t4 (7 days). RESULTS: The patients in group A showed slight increases in T lymphocytes, activated T lymphocytes and B lymphocytes, whereas T-suppressant activity decreased significantly. All lymphoid population decreased in group B. Baseline levels had recovered in both groups by 7 days after surgery. CONCLUSION: Anesthetic procedures have an effect on immune responses but the impact is only temporary.

Adult↗

PubMed2006

Connoisseurs of care? Unannounced standardized patients' ratings of physicians.

BACKGROUND: Patient satisfaction surveys can be informative, but bias and poor response rates may limit their utility as stable measures of physician performance. Using unannounced standardized patients (SPs) may overcome some of these limitations because their experience and training make them able judges of physician behavior. OBJECTIVES: We sought to understand the reliability of unannounced SPs in rating primary care physicians when covertly presenting as real patients. STUDY DESIGN: Data from 2 studies (Patient Centered Communication [PCC]; Social Influences in Practice [SIP]) were included. For the PCC study, 5 SPs made 192 visits to 96 physicians; for the SIP study, 18 SPs made 292 visits to 146 physicians. SPs visits to physicians were randomized, thus avoiding mutual selection bias. Each SP rated 16 to 38 physicians on interpersonal skills (autonomy support: PCC, SIP), technical skills (information gathering: SIP-only), and overall satisfaction (SIP-only). We evaluated SP evaluation consistency (physician vs. total variance rho), and SPs' overall satisfaction with specific dimensions of physician performance. RESULTS: Scale reliability varied from 0.71 to 0.92. Physician rhos (95% confidence intervals) for autonomy support were 0.40 (0.22-0.58; PCC) and 0.30 (0.14-0.45; SIP); information gathering rho was 0.46 (0.33-0.59; SIP). Overall SP satisfaction rho was 0.47 (0.34-0.60; SIP). SPs varied significantly in adjusted overall satisfaction levels, but not other dimensions. CONCLUSIONS: These analyses provide some evidence that medical connoisseurship can be learned. When adequately sampled by trained SPs, some physician skills can be reliably measured in community practice settings.

Clinical Competence↗

PubMed2005

Laparoscopic gastrectomy for cancer.

There are three procedures for the management of early gastric cancer (EGC): laparoscopic wedge resection (LWR), intragastric mucosal resection (IGMR), and laparoscopic gastrectomy. LWR or IGMR can be applied to treat EGC without the risk of lymph node metastasis. However, owing to the recent technical advances in endoscopic mucosal resection for EGC, the use of laparoscopic local resection for these lesions has gradually decreased. On the other hand, laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy, is widely accepted for the treatment of EGC with the risk of lymph node metastasis. To establish the acceptability of laparoscopic gastrectomy with D2 lymph node dissection against advanced gastric cancers, safe techniques and new instruments must be developed. The following advantages of laparoscopic surgery for the treatment of gastric cancer have been well demonstrated: clinical course after operation, pulmonary function, immune response. In the future, laparoscopic surgeons have to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes by multicentric randomized control trial studies, and clarify the oncological aspects of laparoscopic surgery in basic studies.

Gastrectomy↗

PubMed2006

Communicating population health statistics through graphs: a randomised controlled trial of graph design interventions.

BACKGROUND: Australian epidemiologists have recognised that lay readers have difficulty understanding statistical graphs in reports on population health. This study aimed to provide evidence for graph design improvements that increase comprehension by non-experts. METHODS: This was a double-blind, randomised, controlled trial of graph-design interventions, conducted as a postal survey. Control and intervention participants were randomly selected from telephone directories of health system employees. Eligible participants were on duty at the listed location during the study period. Controls received a booklet of 12 graphs from original publications, and intervention participants received a booklet of the same graphs with design modifications. A questionnaire with 39 interpretation tasks was included with the booklet. Interventions were assessed using the ratio of the prevalence of correct responses given by the intervention group to those given by the control group for each task. RESULTS: The response rate from 543 eligible participants (261 intervention and 282 control) was 67%. The prevalence of correct answers in the control group ranged from 13% for a task requiring knowledge of an acronym to 97% for a task identifying the largest category in a pie chart. Interventions producing the greatest improvement in comprehension were: changing a pie chart to a bar graph (3.6-fold increase in correct point reading), changing the y axis of a graph so that the upward direction represented an increase (2.9-fold increase in correct judgement of trend direction), a footnote to explain an acronym (2.5-fold increase in knowledge of the acronym), and matching the y axis range of two adjacent graphs (two-fold increase in correct comparison of the relative difference in prevalence between two population subgroups). CONCLUSION: Profound population health messages can be lost through use of overly technical language and unfamiliar statistical measures. In our study, most participants did not understand age standardisation and confidence intervals. Inventive approaches are required to address this problem.

Adult↗

PubMed1989

[Methods and clinical results of interstitial thermoradiotherapy].

Besides percutaneous hyperthermia techniques, some new interstitial procedures have been developed and included into the arsenal of radiotherapists. As compared to percutaneous techniques, considerable benefits are offered by interstitial methods: a more homogeneous distribution of therapeutical temperatures, a better sparing of normal tissue, the possibility to treat deep tumors, and better therapy control and evaluation by extensive "thermal mapping" within the target volume. This study presents the technical principles and the clinical possibilities of the interstitial hyperthermia methods developed hitherto: resistive radiofrequency hyperthermia, radiative microwave hyperthermia, inductive ferromagnetic seed hyperthermia, and conductive hot-water perfusion hyperthermia. Until now, interstitial thermo-radiotherapy was only performed during some phase I/II studies. It was applied for palliative reasons in persisting and recurrent tumors accessible for implantation and situated in superficial to semi-deep locations with no or insufficient response to differently combined treatment modalities (surgery, radiotherapy, or chemotherapy). The preliminary clinical results obtained in almost 300 patients are quite promising: complete remission rates up to 70% have been achieved. Interstitial hyperthermia represents an effective and safe therapy modality, especially when combined with radiotherapy in palliative tumor therapy. At present, several prospective randomized multicentric studies are conducted to investigate its value as adjuvant therapy modality.

Brachytherapy↗

PubMed1994

Study of referral process between general practitioners and specialists in health insurance clinics in Alexandria.

The present study was designed to investigate the reasons for which patients are referred by G.Ps to G.M. specialists, and to assess the extent to which referred cases need specialist care. The study sample included specialists of general medicine working at 4 of the H.I.O. polyclinics and all G.Ps who referred cases that were considered as inappropriate referrals by the study specialists, as well as 20% of Patients referred to G.M. specialists by G.Ps. were systematically randomly selected during a period of 10 consecutive days. The results indicated that the rate of inappropriate referral to G.M. specialists was high, the rate of discrepancy between G.P. and specialist diagnoses was generally high, there was a high discrepancy between G.Ps and specialists regarding the reason for inappropriate referral, and there was poor communication from the lower (G.P.) to the higher (specialists) levels in the referral process. Reasons for referral to specialists were not recorded by G.Ps in 100% of cases. To overcome these problems H.I.O. should place special emphasis on the professional training and continuing education of G.Ps, with special attention to the few common conditions that were responsible for the greater proportion of referral problems. At the same time, H.I.O. should strengthen the technical and administrative control over G.P. referral behavior.

Clinical Competence↗

PubMed1981

Subchronic administration of technical pentachlorophenol to lactating dairy cattle: immunotoxicologic evaluation.

Eight lactating Holstein-Friesian dairy cattle were randomly allotted as pairs to eight a control or a treatment group fed technical pentachlorophenol (penta) from 6 +/-1 wk postpartum for about 135 d (0.2 mg/kg.d for 75-84 d followed by 2.0 mg/kg.d for 56-62 d). Jugular blood was drawn periodically for immunologic studies. Leukocyte differentials and lymphocyte subpopulations (e.g., T and B cells) were enumerated for each blood specimen. Several in vitro and in vivo assays were conducted to evaluate lymphocyte functions, including (1) quantitation of serum immunoglobulins G, M, and A; (2) induction of blastogenesis in vitro, using concanavalin A and leukoagglutinin as mitogens; (3) measurement of extent of skin reaction to injected purified protein derivative in BCG-sensitized cattle to evaluate delayed hypersensitivity; and (4) quantitation of antibody formation in response to injected sheep red blood cells. Neutrophil function was evaluated by latex particle phagocytosis and chemiluminescence. The results showed no statistically significant differences between control and pent-treated cattle during eigher treatment period. Also, no histopathologic changes were noted in lymphoid tissues including spleen, thymus, and lymph node.

Animals↗

PubMed1981

[Simultaneous radio-chemotherapy of advanced epithelial ovarian cancer--results after three years (author's transl)].

An interdisciplinary prospective, non-randomized study was performed at the University Clinic for Radiotherapy and Radiobiology of Vienna in 26 patients with advanced epithelial ovarian cancers (FIGO stage III and IV) from February 1977 until February 1980. All patients underwent a combined radiotherapy-chemotherapy programme. In those 12 patients in whom at the time of the first operation only a biopsy was possible, the aim was to achieve early operability for a second-look operation (with removal of the internal reproductive organs, the omentum and remaining tumour masses). In 8 of theses 12 patients it was technically possible to perform radical surgery or to reduce tumour masses to under 2 cm. Of 20 evaluable patients 14 had stage III and 6 had stage IV cancer. In patients with stage III the response rate was 100% and the complete remission rate (with or without second-look operation) was above 70%. The duration of complete remission exceeded 10 months, median survival is at present 17 months. Patients with stage IV had a response rate of 66% (but mainly partial remissions), with significantly shorter survival times. Bowel complications occurred in one quarter of the patients and led to a revision of our therapeutic concept and the time sequence of the combined modality treatment. The importance of significant prognostic factors is stressed. The study indicated the superiority of the combined treatment approach in patients with stage III cancer. Patients with stage IV cancer, are, on the other hand, best managed primarily by chemotherapy; palliative irradiation and a second-look operation should be reserved only for selected patients.

Adult↗