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PubMed1990

Bladder cancer. Advances in laboratory innovations and clinical management, with emphasis on innovations allowing bladder-sparing approaches for patients with invasive tumors.

In the present decade important progress has been made in the understanding of the biology and management of bladder cancer. Experimental laboratory models and new investigative tools have revealed potentially important prognostic markers and have led to an improved understanding of the histogenesis of the disease. Advances in the management of superficial bladder cancer (intravesical chemotherapy or immunotherapy, improved urinary cytology, laser technology, flexible fiberoptic cystoscopy, and photodynamic therapy) have, in some subgroups, improved tumor control while decreasing patient complications. For invasive bladder cancer (invasive of bladder muscle or beyond) improved techniques of cystectomy and radiotherapy have reduced the complications of treatment and may have contributed small but important improvements in cure. A major improvement in the last decade has occurred in objective remission rates with chemotherapy for patients with metastatic bladder cancer. From 20% to 40% of patients achieve a complete remission, and 10% to 20% may survive for more than 3 years. Randomized Phase III trials are currently in progress and must be completed to define the true role of multidrug chemotherapy in patients with metastatic disease and to validate data from the regimens of cyclophosphamide, methotrexate, and vincristine (CMV) and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) before any of these approaches to treatment can be considered of proven benefit. Preliminary data from the Massachusetts General Hospital are presented of a potentially effective approach to select patients with invasive tumor for successful bladder preservation. In this approach transurethral debulking surgery is combined with upfront CMV chemotherapy plus cisplatin and 4000 cGy. If tumor is found on cystoscopic reevaluation with biopsy and cytology immediately following cisplatin and 4000 cGy, cystectomy is performed; if not, consolidation by a radiation boost to 6480 cGy plus cisplatin is given. The approach is fairly well tolerated, allows cystectomy without undue complications, has yielded a 88% complete response rate in patients selected for bladder preservation, and resulted in 90% of patients free of distant metastases with follow-up ranging from 6 to 30 months. A randomized Phase III trial with and without neoadjuvant MCV chemotherapy for selective bladder preservation is now under way and accruing well.

Actuarial Analysis↗
PubMedDate not supplied

Innovative solutions: leading the way: an innovative approach to support nurses on general care units with an early nursing intervention team.

In an effort to improve patient outcomes, there has been a global initiative to prevent avoidable adverse events. The rapid response team or medical emergency team concept has been in existence for the past several years and there has been a significant improvement in patient outcomes. This article will describe one institution's success in taking this concept even further by rounding on general care units before patient problems are evident. The focus of this discussion will be on the remarkably positive nursing staff outcomes that have been achieved as a result of a program called the Early Nursing Intervention Team, a totally nurse-led program.

Efficiency, Organizational↗
PubMed2000

Development of a Diversity-Based Approach for the Discovery of Stereoselective Polymerization Catalysts: Identification of a Catalyst for the Synthesis of Syndiotactic Polypropylene This work was supported by the Cornell Center for Materials Research (CCMR), a Materials Research Science and Engineering Center of the National Science Foundation (DMR-9632275), and the Exxon Chemical Corporation. G.W.C. gratefully acknowledges an NSF Career Award (CHE-9875261), a Camille and Henry Dreyfus New Faculty Award, a Research Corporation Research Innovation Award, an Alfred P. Sloan Research Fellowship, an Arnold and Mabel Beckman Foundation Young Investigator Award, a Camille Dreyfus Teacher-Scholar Award, a 3M Untenured Faculty Grant, an IBM Partnership Award, and a Union Carbide Innovation Recognition Award.

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Journal Article↗
PubMedDate not supplied

[Innovative technologies and innovative policy in the health system of Ukraine].

In the paper, consideration is given to the conceptual framework of the problem, as to which issue opinions vary among specialists. This has a negative impact on organization of carrying on of innovatory policy in the health service. Factographic data are presented on innovatory technologies in the health service, qualitative and quantitative parameters of such activities. The role is highlighted that the Ukrmedpatentinform has in the formation of the system of means of scientific communication, ways are considered for improvement of such a work, in the first place, at the expense of creation of feedback between "donors" and "recipients" of innovatory processes. It is emphasized that outside innovatory technologies scientific produce loses its value. Indices for innovatory activities are to be regarded as those of immediate importance in assessment of scientific and practical work of an institution.

Communication↗