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PubMedDate not supplied

Comprehensive geriatric assessment basics for the cancer professional.

A comprehensive geriatric assessment (CGA) has been a cornerstone of geriatric practice for many years. However, oncology practitioners are still unfamiliar with it. Yet, recent research has shown an important potential to improve the daily care of older cancer patients. The purpose of this article is to review the basic nature of a CGA, its effectiveness, its applicability to cancer patients, and its cost-effectiveness. Cancer is one of the major health problems in our society. Furthermore, the incidence of cancer increases with age. Nowadays, half of the cancers occur beyond the age of 70. Given the aging of the US population, this proportion is expected to increase in the next decades. A challenge for the oncologists is that older people can have a highly variable health status. Yet little is known yet about how to best assess and integrate into decision making the various health problems patients may have. Taking their clues from the experience of geriatricians, geriatric oncologists advocate the use of a comprehensive geriatric assessment (CGA) as one of the tools to deal with this problem. It is, for example, part of the National Comprehensive Cancer Network (NCCN) guidelines for the elderly'. This article offers a primer on CGA for the reader unfamiliar with the approach in an oncologic setting.

Aged↗

PubMedDate not supplied

Comprehensive care for people living with HIV/AIDS: issues and problems of social integration in Nigeria.

Acquired Immunodeficiency Syndrome (AIDS) pandemic has become a major global public health problem with rising number of cases and associated deaths. Most of the present activities in developing countries, especially in Africa, are aimed at reducing the transmission of the Human Immunodeficiency Virus (HIV) that causes AIDS. Care for people living with HIV/AIDS (PLWHA) is essential not only to mitigate the impacts of HIV/AIDS among PLWHA but is also an important component of prevention of the disease. There is now a general recognition that comprehensive care across the continuum should be provided to PLWHA through all the stages of infection, with a crucial role for community-home based care activities. In addition, AIDS orphans need to be supported Although, documented evidences abound on the utility of comprehensive care and community-home based care approaches outside Africa and in some African countries, there is little information on them in Nigeria. This paper therefore reviews the recent epidemiology of HIV infection, the many currently developed initiatives to deliver comprehensive care for PLWHA in the hospital, community and at home, and the issue of AIDS orphans. In addition, measures to effectively integrate them into the mainstream of societal activities are discussed.

Comprehensive Health Care↗

PubMed2003

Comprehensive treatment for old patients with hip fractures.

OBJECTIVE: To observe the effect of comprehensive treatment for hip fracture in old people. METHODS: Three hundred and seventy-two old patients with hip fractures were randomly divided into two groups, Group A and Group B. Cases in Group A were treated only by operations. Cases in Group B received comprehensive treatment. The Singh Indexes of both uninjured and injured femoral necks were used to judge the osteoporosis levels before operation and one year after the operation. The function of injured hip joints was evaluated one year postoperatively. RESULTS: Complications occurred in 36.56% of the cases in Group A and 5.91% of Group B. One year postoperatively, the Singh Index degree distributions of both uninjured and injured femoral necks in Group A had no significant difference compared with those before the operation (P>0.05). In Group B, there was significant difference between one year postoperatively and before operation, and the Singh Index one year after the operation showed better result than that before operation (P<0.05). One year after operation, there was significant difference in the function of injured hip joints between Group A and Group B (P<0.05). CONCLUSIONS: Hip fracture in old people should be treated comprehensively according to its internal characteristics, osteoporosis.

Aged↗

PubMed2003

Impact of a community-based comprehensive primary healthcare programme on infant and child mortality in Bolivia.

Community-based comprehensive primary healthcare programmes are a widely-promoted strategy for improving child survival in less-developed countries, but limited documentation exists concerning their effectiveness in actually reducing child mortality. This study examined the impact of a community-based comprehensive primary healthcare programme on child survival in Bolivia. Mortality rates from two intervention areas where Andean Rural Health Care (ARHC) had been conducting child-survival activities for 5-9 years were compared with those from two geographically-adjacent comparison areas that lacked such activities and that were virtually identical to the intervention areas in socioeconomic characteristics. Vital events were registered at the time of regular visit to all homes. In the comparison areas, limited services were available which reached only a small percentage of the population, while in the intervention areas, prenatal care, immunizations, growth monitoring, nutrition rehabilitation, and acute curative services were readily available to the entire population. In 1992-1993, the annual rates of mortality of children, aged less than five years, were 205.5 per 1,000 and 98.5 per 1,000 in the comparison and intervention areas respectively. The absolute difference in mortality of 107.0 deaths per 1,000 (95% confidence interval [CI], 72.7-141.3 per 1,000) represented 52.1% (95% CI, 35.2-68.8%) lower mortality of children aged less than five years in the intervention areas compared to the control communities. These results suggest that the provision of community-based, integrated health services can significantly improve child survival in poor countries. Better-designed and larger field trials of community-based comprehensive primary healthcare programmes in multiple regions of the world are needed to provide a stronger scientific basis for developing this approach further in developing countries.

Bolivia↗

PubMed2003

An evaluation of a Medicaid managed maternity program: the impact of comprehensive care coordination on utilization and pregnancy outcomes.

The purpose of this study is to evaluate the effectiveness of the implementation of a Medicaid managed maternity care program in a public health department service population, analyzing race-specific models of WIC participation and risk of small-for-gestational age of term. There were 13,095 singleton deliveries during the period 1987-1990 to women with prenatal care in this managed maternity care program. The research design entailed comparison of the intervention group (those receiving regular prenatal care plus comprehensive care coordination in 1989-90) with an historical comparison group of women who received only regular prenatal care in the two years (1987-88). For the intervention groups, black women were 1.7 times and white women 2.1 times more likely to participate in WIC than their comparison groups. The impact of care coordination on term-SGA births indicates a protective odds ratio of 0.851 for black women. Results for white women were not significant. These findings suggest that care coordination is associated with an increase in WIC participation and with lower risk of term-SGA births for black women but not for white women. The overall results add to growing evidence regarding the efficacy of comprehensive care coordination in improving specific pregnancy outcomes and inform our understanding of the evaluation of a comprehensive approach in preventive, community-based intervention.

Adolescent↗

PubMed1987

The medical and psychosocial impact of comprehensive care on adolescent pregnancy and parenthood.

To assess the medical and psychosocial effects of services provided by a comprehensive adolescent pregnancy and parenthood program, 125 adolescents who received care from a comprehensive program were compared with 135 adolescents who received care from community health providers. Few differences were found in pregnancy outcome measures. At 12 and 26 months after delivery, however, the intervention group scored significantly better on composite measures encompassing medical, psychosocial, and parenting events than did the comparison group, even after accounting for possible confounding factors. This suggests that comprehensive care has little effect on pregnancy outcomes for those adolescents who are already receiving prenatal and nutritional services, but does have a significant effect on events occurring during the first and second postpartum years.

Adolescent↗

PubMed1995

Medical eligibility, comprehension of the consent process, and retention of injection drug users recruited for an HIV vaccine trial.

Injection drug users (IDUs) at high risk for human immunodeficiency virus (HIV) infection are being identified as a population for HIV vaccine trials. We studied willingness of drug users to enroll and their comprehension of consent procedures in the context of a Phase II trial at one site. Of 175 people screened for enrollment and whose data sets were complete, 119 (68%) were IDUs. Of the 71 who were eligible, 39 (55%) were IDUs. Exclusion of IDUs was usually for medical reasons. Using a 17-item true/false test, comprehension of the informed consent procedure was high (median score, 16 of 17 for IDUs and non-IDUs); only three subjects (all of whom were IDUs) were excluded from enrollment due to lack of comprehension. Follow-up rates were similar for IDUs and non-IDUs. These data suggest that recruitment of IDUs into HIV vaccine trials is feasible, that IDUs can comprehend and complete the informed consent procedures, and that they return for follow-up visits.

AIDS Vaccines↗

PubMedDate not supplied

The efficacy of two comprehensive perinatal programs on reducing adverse perinatal outcomes.

Through the collaboration among University of California at Berkeley School of Public Health, Samuel Merritt College, and a private nonprofit, community-based medical center, the adequacy of two perinatal programs was assessed based on the pregnancy outcomes of teenaged Medi-Cal clients. Historical data from June 1991 to June 1992 were compiled on the pregnancy outcomes of 312 Medi-Cal clients, 12-18 years of age, delivering at the study medical center in Oakland, California. The effect of enrollment in two special perinatal programs, Comprehensive Perinatal Services Program (CPSP) and a school-based program, the Comprehensive Teenage Pregnancy and Parenting Program (CTAPPP), on the occurrence of adverse perinatal outcomes was examined. Adverse perinatal outcomes were defined as the occurrence of one of the following: low birthweight (< 2,500 grams), gestational age less than 37 weeks, or admission to the neonatal intensive care unit (NICU), not related to congenital syphilis. The percentage of teens experiencing adverse perinatal outcomes was 10.9% at the study hospital. No significant association was observed between CTAPPP enrollment and reduced adverse perinatal outcomes, but CPSP enrollment was associated with reduced adverse perinatal outcomes. This association persisted after controlling for potential confounders, including substandard prenatal care, which were also found to be risk factors for adverse perinatal outcomes. Enrollment in both programs simultaneously was not associated with a reduction in adverse outcomes. The significant association between CPSP enrollment and reduced adverse perinatal outcomes indicates that a more comprehensive prenatal program may be beneficial in improving birth outcomes, specifically among high-risk teenage populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Hemophilia and von Willebrand's disease: 1. Diagnosis, comprehensive care and assessment. Association of Hemophilia Clinic Directors of Canada.

OBJECTIVE: To present current strategies for the assessment and comprehensive care of patients with hemophilia and von Willebrand's disease. OPTIONS: Hospital care, home care, single-provider care and multidisciplinary care. OUTCOMES: Morbidity and quality of life associated with bleeding and treatment. EVIDENCE: Relevant clinical studies and reports published from 1974 to 1994 were examined. A search was conducted of own reprint files, MEDLINE, citations in the articles reviewed and references provided by colleagues. In the MEDLINE search the following terms were used singly or in combination: "hemophilia," "von Willebrand's disease," "Factor VIII," "Factor IX," "von Willebrand factor," "diagnosis," "management," "home care," "comprehensive care," "inhibitor," "AIDS," "hepatitis," "life expectancy," "complications," "practice guidelines," "consensus statement" and "controlled trial." The in-depth review included only articles written in English from North America and Europe that were relevant to human disease and to a predetermined outline. The availability of treatment products in Canada was also considered. VALUES: Minimizing morbidity and maximizing functional status and quality of life were given a high value. BENEFITS, HARMS AND COSTS: The optimal use of treatment procedures and home care offers patients the advantages of minimized disability, improved survival and financial benefit. It is also cost effective. Potential harm, including the risk of hepatitis B, hepatitis C and HIV infection, has now been minimized through viral inactivation of plasma-derived coagulation-factor concentrates and through the use of recombinant clotting factor concentrates and other non-plasma-derived hemostatic agents. RECOMMENDATIONS: Patients with hemophilia and severe von Willebrand's disease should be followed in comprehensive care centres that offer expertise in the diagnosis, assessment and management of bleeding and complications and that can meet the educational and counselling needs of patients, family members and health care providers. Eligible patients should be enrolled in a home self-infusion program. Patients with hemophilia and von Willebrand's disease should wear or carry Medic Alert identification. They should be vaccinated against hepatitis B and attend for routine follow-up examinations. Laboratory testing should be carried out as required, and dental and surgical care should be undertaken in consultation with a hematologist. VALIDATION: These recommendations were reviewed and approved by the Association of Hemophilia Clinic Directors of Canada (AHCDC) and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society. No similar consensus statements or practice guidelines are available for comparison. SPONSORS: These recommendations were developed at the request of the Canadian Blood Agency, which funds the provision of all coagulation-factor concentrates for people with congenital bleeding disorders, and were developed and endorsed by the AHCDC and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society.

Activities of Daily Living↗

PubMed2004

Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting.

BACKGROUND: The effectiveness and feasibility of a comprehensive strategy to reduce nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a highly endemic setting have not yet been proved. Limited benefits and the high cost of such programs are the main concerns. METHODS: We prospectively evaluated the effect of an aggressive infection control program on transmission of MRSA in the University Clinic of Respiratory and Allergic Diseases. All patients with MRSA carriage during 5 years (January 1, 1998, through December 31, 2002) were included and categorized into imported or hospital-acquired cases. RESULTS: Methicillin-resistant S aureus was recovered from 223 hospitalized patients; 142 cases were imported and 81 were acquired at our institution. After introduction of the comprehensive infection control program in 1999, the annual incidence of MRSA carriage per 1000 admissions increased from 4.5 in 1998 to 8.0 in 1999 (P = .02), and remained stable thereafter. In this period, the proportion of MRSA cases acquired in our institution decreased from 50.0% in 1999 to 6.1% in 2002 (P<.001), whereas the proportion of MRSA cases transferred from other hospitals (P<.001) and nursing homes (P = .03) increased. All 19 MRSA carriers with 3 sets of follow-up cultures were successfully decolonized. CONCLUSIONS: With a comprehensive infection control program, it was possible to reduce nosocomial transmission of MRSA in a highly endemic setting. With good hand hygiene using alcohol handrub, early detection, isolation, and a decolonization strategy, containment of MRSA was achievable, despite a high rate of transferred patients with MRSA.

Adolescent↗

PubMed1990

Comparison of the conventional method of lymph node staging with a comprehensive fat-clearing method for gastric adenocarcinoma.

Discrepant results in long-term survival between United States and Japanese patients with resectable gastric adenocarcinoma may result from more accurate staging in the Japanese series. The authors compared a comprehensive fat-clearing method with the conventional pathology method of lymph node sampling in 11 patients undergoing curative gastrectomy and extended lymphadenectomy at their institution. Comprehensive fat-clearing doubled total lymph node counts (P less than 0.01), identified smaller lymph nodes (P less than 0.001), and identified more histologically involved nodes of significantly smaller size (P less than 0.001). Comprehensive fat-clearing pathologically upstaged 29% of the authors' eligible specimens. Accurate pathologic staging is necessary when comparing Japanese and United States survival data for resectable gastric adenocarcinomas.

Adenocarcinoma↗

PubMedDate not supplied

The reading comprehension abilities of dyslexic students in higher education.

The reading comprehension abilities of a group of dyslexic university students were compared with those of non-dyslexic university students. A 655-word passage, followed by literal and inferential questions, was used to measure reading comprehension. The text was designed to be syntactically complex, yet place relatively modest demands on decoding skills. Although dyslexic students performed at a similar level to the non-dyslexic students on the literal questions, their performance on the inferential questions was poorer. An index of the participants' ability to make inferences was calculated by subtracting the inferential question score from the literal question score. The groups differed significantly on this measure, indicating that the dyslexic students were specifically impaired in constructing inferences when processing complex text. It was concluded that dyslexic students in higher education have reading comprehension difficulties that cannot be accounted for by an inability to decode individual words in the text. The possible contribution that poor lexical automaticity and an impaired working memory make to this impairment is discussed. The implications for the assessment and support of dyslexic students are considered.

Adolescent↗

PubMed2001

A review and update on the practice of evaluating Miranda comprehension.

This article summarizes recent developments in constitutional law relevant to the Miranda warning. We describe the origins of the warning, concerns about the use of the Miranda warning, perspectives on the utility of the warning, and the relevance of the warning. We describe how the warning has changed over time, requirements for administering the warning, and procedures that police use in delivering the warning and obtaining confessions. We review case law relevant to "coerced" Miranda waivers and confessions, changes over time in the court's interpretation of what constitutes "coercion," use of the warning with special populations, and the recent focus in case law on individual factors that might impair Miranda comprehension. We review empirical research on factors associated with deficits in Miranda comprehension. We integrate case law rulings and empirical research into suggested approaches to forensic assessment of Miranda comprehension.

Adolescent↗

PubMed2005

Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy.

BACKGROUND: Malignant peritoneal mesothelioma is a rare and fatal disease. Until recently, the treatment options were very limited and ineffective. The new comprehensive approach of cytoreductive surgery with perioperative intraperitoneal chemotherapy offers improved survival rates at a cost of considerable morbidity and mortality as in other peritoneal surface malignancies. The outcome after these treatments is predominantly dependent on adequate cytoreduction. The aim of the current study was to identify computed tomography (CT) scan images that are useful in patient selection for this comprehensive approach. METHODS: An analysis of the preoperative CT scans of 30 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single institution was performed. Based on the size of residual tumor nodules after cytoreductive surgery, patients were divided into 2 groups: those with residual lesions 2.5 cm (suboptimal cytoreduction). The CT scans for each patient were evaluated by a standardized scoring system with the reader blinded to the operative findings. Thirty-nine CT scan parameters were obtained and statistically analyzed to determine their association with the study outcome variables, namely, adequacy of cytoreduction. RESULTS: Seven patients (64%) in the suboptimal cytoreduction group and 2 patients (11%) in the adequate cytoreduction group had a >5-cm tumor mass in the epigastric region (P=0.004). Nine patients (82%) in the suboptimal group and 2 patients (11%) in the adequate cytoreduction group had CT scans that showed loss of normal architecture of the small bowel and its mesentery (P<0.001). In a composite analysis of these 2 radiologic features, none of the patients with a >5-cm tumor mass in the epigastric region and loss of normal architecture of the small bowel and its mesentery had an adequate cytoreduction. Patients who lacked these two preoperative CT scan findings had a 94% probability of an adequate cytoreduction. CONCLUSIONS: CT scans effectively identified large peritoneal mesothelioma tumors at crucial anatomic sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT scans became an accurate prognostic radiologic test for patient selection for comprehensive treatment.

Adult↗

PubMed2006

Comprehensive long-term follow-up programs for pediatric cancer survivors.

BACKGROUND: The objective of this study was to provide a detailed description of comprehensive long-term follow-up (LTFU) programs for pediatric cancer survivors. METHODS: Program directors from 24 comprehensive LTFU programs in the U.S. and Canada completed a 6-page survey that provided details in 5 categories: description of the program, perceived benefits and strengths of the program, barriers to the development and use of the program, methods to improve the program, and an ideal model of care for pediatric cancer survivors. RESULTS: Participants identified the following primary benefits to health care delivered to survivors through LTFU programs: health care delivered by clinicians familiar with long-term risks of survivors, provision of risk-based screening and surveillance for late effects, and targeted education for risk reduction and healthy lifestyles. Key barriers to the functioning of LTFU programs included system-driven and patient/survivor-driven factors. System-driven factors included inadequate resources and finances to sustain programs, low institutional commitment toward the provision of survivorship care, lack of capacity to care for the growing population of survivors, and difficulties with ongoing communication with community physicians. Survivor-driven barriers included lack of interest and lack of awareness of cancer-related risks. CONCLUSIONS: This report describes the frequency, content, and setting of follow-up care delivered by pediatric comprehensive LTFU programs. Critical challenges as survivorship care evolves will include integrating a structured process of program evaluation and building capacity for care.

Adolescent↗

PubMed2004

Stroboscopic sampling in comprehensive high-performance liquid chromatography-capillary electrophoresis via a pneumatic sampler.

A new approach is presented to solve the problem of a long separation time in the second dimension of comprehensive two-dimensional chromatography. The need for a rapid separation in the second column is overcome by repeating analysis of a sample many times. In each of these individual analysis cases the sample is injected into the first dimension column and after a delay a low amount of the effluent at the end of the first column is sampled to the second-dimensional column. The time interval between the samplings from the first column to the second column is constantly increased. Thus, the system enables a comprehensive analysis of the effluent emerging from the first into the second column. This approach, which we call stroboscopic sampling, is tested for coupling high-performance liquid chromatography (HPLC) to capillary electrophoresis (CE) by an interface which operates on the principle of transporting the effluent from the HPLC column to the capillary inlet by small pressure pulses (0.5 MPa). The performance of the interface for accomplishing the comprehensive HPLC-CE analysis was demonstrated for an on-line connection of a short ion-exchange column and an ion-exclusion column to the CE capillary.

Chromatography, High Pressure Liquid↗

PubMed2003

Comprehensive two-dimensional separations based on capillary high-performance liquid chromatography and microchip electrophoresis.

A novel comprehensive two-dimensional (2-D) separation system coupling capillary high-performance liquid chromatography (cHPLC) with microchip electrophoresis (chip CE) is demonstrated. Reversed-phase cHPLC was used as the first dimension, and chip CE acted as the second dimension to perform fast sample transfers and separations. A valve-free gating interface was devised simply by inserting the outlet-end of LC column into the cross-channel on a specially designed chip. A home-made confocal laser-induced fluorescence detector was used to perform on-chip high-sensitive detection. The cHPLC effluents were continuously delivered to the chip and pinched injections of the effluents every 20 seconds were employed for chip CE separation. Gradient elution of cHPLC was carried out to obtain the high-efficiency separation. Free-zone electrophoresis was performed with triethylamine buffer to achieve high-speed separation and prevent sample adsorption. Such a simple-made comprehensive system was proved to be effective. The relative standard deviations for migration time and peak height of rhodamine B in 150 sample transfers were 3.2% and 9.8%, respectively. Peptides of the fluorescein isothiocyanate (FITC)-labeled tryptic digests of bovine serum albumin were fairly resolved and detected with this comprehensive 2-D system.

Animals↗

PubMed2002

Neural basis for sentence comprehension: grammatical and short-term memory components.

We monitored regional cerebral activity with BOLD fMRI while subjects were presented written sentences differing in their grammatical structure (subject-relative or object-relative center-embedded clauses) and their short-term memory demands (short or long antecedent-gap linkages). A core region of left posterior superior temporal cortex was recruited during all sentence conditions in comparison to a pseudofont baseline, suggesting that this area plays a central role in sustaining comprehension that is common to all sentences. Right posterior superior temporal cortex was recruited during sentences with long compared to short antecedent-gap linkages regardless of grammatical structure, suggesting that this brain region supports passive short-term memory during sentence comprehension. Recruitment of left inferior frontal cortex was most clearly associated with sentences that featured both an object-relative clause and a long antecedent-gap linkage, suggesting that this region supports the cognitive resources required to maintain long-distance syntactic dependencies during the comprehension of grammatically complex sentences.

Adult↗