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PubMedDate not supplied

What can randomized controlled trials tell us about nutrition and cancer prevention?

Randomized controlled trials are regarded as the most definitive of study designs. The randomized controlled trials that have tested nutritional factors for cancer prevention are reviewed. Trials that have tested the effects of nutrients given as high-dose supplements have been largely disappointing, typically showing either no or harmful effects. Possible benefits of vitamin E for prostate cancer prevention and selenium for prostate, colorectal, and lung cancer prevention have emerged only as secondary endpoints in trials conducted for other purposes; confirmatory new trials for these nutrients are now underway or are planned. The limitations of both past and current randomized controlled trials for studying diet-cancer relationships are discussed. The disappointing findings that have emerged from short-term studies of high-dose supplements cannot be interpreted as direct tests of the diet-cancer relationship because high-dose supplements cannot fully simulate the effects of whole foods on cancer risk. As we await findings from current and future trials, we should not forget that the ample evidence from observational epidemiologic research--suggesting that diets rich in fruits and vegetables can reduce the risk of many of the most common cancers--can provide a sound basis for nutritional recommendations aimed at reducing cancer risk.

Diet↗

PubMed2000

Multimodality treatment of resectable non small-cell lung cancer.

In early-stage, resectable non small-cell lung cancer other than stage IA, survival following surgical resection has been disappointing. Many phase III adjuvant trials using postoperative chemotherapy, radiotherapy, or chemoradiation have had disappointing results results that have been confirmed by two recent meta-analyses. Preoperative radiotherapy combined with surgery has also failed to improve survival following surgical resection. For the past 20 years, several phase II trials have investigated the use of induction therapies (chemotherapy or chemoradiation) prior to surgery in the management of stage IIIA lung cancer. The phase II trials have been encouraging, and two small phase III trials have confirmed the efficacy of the multimodality approach. Newer, more tolerable chemotherapeutic agents are now being investigated. Because of the encouraging results in locally advanced disease, this induction therapy has been used in two trials of early stage (IB, II) disease; both trials have suggested that induction therapy improved patient tolerance to chemotherapy and in one trial perhaps improved survival. Currently, several phase III trials are attempting to confirm these early encouraging reports.

Journal Article↗

PubMed1998

Satisfaction after photorefractive keratectomy.

PURPOSE: To evaluate patient satisfaction one year after photorefractive keratectomy (PRK) for myopia and myopia astigmatism using the Nidek EC-5000 excimer laser. METHODS: This study assessed the level of satisfaction of 6280 patients who underwent PRK after a minimum follow-up of 1 year. All patients were asked to enter their level of satisfaction as excellent, good, worthwhile, or disappointed into a networked computer database. Their responses were subsequently analyzed according to baseline and postoperative refractive data. RESULTS: Patients considered their results to be as follows: 82.3% good or excellent, 14.9% worthwhile, and 2.8% were disappointed with the outcome. CONCLUSION: A high percentage of patients were satisfied with the outcome following PRK. However, a fair number (14%) of patients considered the treatment to be worthwhile but it did not meet their expectations. Extensive counseling and inculcating realistic expectations before treatment is essential in achieving better patient satisfaction.

Astigmatism↗

PubMed1999

Advertisement-induced prescription drug requests: patients' anticipated reactions to a physician who refuses.

BACKGROUND: Drug manufacturers increasingly encourage patient prescription drug demand through the use of direct-to-consumer (DTC) advertisements. We describe patients' forecasts of their reactions if their doctor were to deny an advertisement-motivated drug request and then identify significant predictors of these reactions. METHODS: We conducted a random phone survey of 329 Sacramento adults (response rate = 69%). Key outcomes were respondents' perceived likelihood of reacting to the nonfulfillment of a prescription request by becoming disappointed, trying to persuade the physician to reconsider, seeking a prescription from a different physician, and changing physicians. We also assessed associations between the likelihood of these reactions and respondents' evaluations of their physician's communication skills; attitudes toward, assumptions about the regulation of, and past responses to DTC advertising; health status; and demographic characteristics. RESULTS: Disappointment was the most likely reaction (46%). One fourth of the respondents anticipated resorting to persuasion and seeking the prescription elsewhere, while only 15% considered terminating their relationship with their physicians. Subjects who anticipated reacting in these 4 ways reported lower satisfaction with their physicians, evaluated DTC advertising more favorably, and possessed more confidence in the government's regulation of these advertisements. CONCLUSIONS: A sizable fraction of patients believed they would react negatively if their physician refused to provide a prescription for a drug advertised in the general media. Avenues for dealing effectively with patients' advertising-induced requests for prescription drugs are needed.

Adolescent↗

PubMed1999

[Prognostic factors during rehabilitation after shoulder prostheses for fracture].

PURPOSE: To evaluate the role, the difficulties of rehabilitation and to diagnose the eventual surgical complications after shoulder prosthesis for 4-part fractures. MATERIAL AND METHODS: Forty three patients (46 shoulders) who underwent shoulder arthroplasty after fracture of the proximal humerus underwent rehabilitation and follow-up at a special reeducation center for an average of 3 months (1 to 6). There were 42 four-part fractures (with 22 fracture-dislocation) and 4 three-part fractures. The patients were send by five different hospitals and have all been operated by senior surgeons. Three types of implants were used: the Modular Shoulder prosthesis (27 cases), the Global prosthesis (2 cases), and the Aequalis prosthesis (17 cases). The rehabilitation followed the protocol recommended by Neer (recovery of passive joint movements, muscular strengthening and stretching) to which were added hydrotherapy, physiotherapy and occupational therapy. Forty patients (43 épaules) were reviewed and radiographed with an average follow-up of 29 months (18 to 72 months). RESULTS: The functional results were disappointing with a normalised Constant score of only 60.2 per cent and an average active elevation of only 96 degrees. There appeared to be two factors which explained these poor results. Firstly, the advanced age of the population (52 per cent older than 70) who was often poorly or non-motivated (22 per cent) and debilitated (21 per cent chronic alcoholics) and who had significant medical and neuro-psychiatric histories. Secondly, incompletely resolved anatomical and surgical problems: damage to the circumflex nerve (6.5 per cent), early migration of the greater tuberosity (6.5 per cent), secondary migration with malunion (15 per cent) and/or nonunion (11 per cent) of the greater tuberosity. Migration of the greater tuberosity should be suspected clinically in three circumstances: 1) in patients who have an abnormally painful shoulder in the immediate post-operative period (16 cases in our series); 2) when there is no progression (24 per cent) or regression (9 per cent) of active shoulder mobility after three months of correct supervised rehabilitation; 3) later, if there is a dissociation between active anterior elevation (deficient) and passive anterior elevation (preserved). DISCUSSION AND CONCLUSION: The age and poor general condition of the patients as well as the difficulty of the surgical technique more than the rehabilitation, explain the disappointing results observed after shoulder prosthesis for four-part fractures. The discrepancy between active and passive elevation suggests that limited motion is not caused by a stiff shoulder because of glenohumeral scarring but instead by weakness of the deltoid (because of axillary lesion) and/or of the external rotators (because of greater tuberosity migration). There is some discordance between the necessity to early mobilise the shoulder and the high rate of tuberosity migration.

Adult↗

PubMed2000

Identifying women at risk of postnatal depression: prospective longitudinal study.

OBJECTIVE: To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women. DESIGN: Prospective longitudinal study involving self-report questionnaires and face-to-face interviews. SETTING: University teaching hospital, Hong Kong. PARTICIPANTS: Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997. MAIN OUTCOME MEASURES: Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales. RESULTS: Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn. CONCLUSION: Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.

Adolescent↗

PubMedDate not supplied

Injury in vascular surgery--the intimal hyperplastic response.

Intimal hyperplasia is extensively studied in order to improve arterial reconstruction outcome. The mechanisms leading to stenosis or restenosis may vary according to the technique used for arterial reconstruction. Lesions are mostly made of an accumulation of smooth muscle cells and fibroblasts, with only sparse inflammatory cells. The accumulated material reduces the graft lumen and ultimately induces thrombosis. Intimal hyperplasia with smooth muscle cell and matrix accumulation is the prominent feature in all these situations with evidences of intense cell proliferation and cell death. The purpose of this review is to present the biology of intimal hyperplastic response based on the recently published data. Experiments in the rabbits have shown that the vein wall thickening is mainly regulated by the tangential wall stress which is applied transversely to the vein wall as a blood pressure. Experiments in the rat carotid artery balloon injury suggested that heparin could be used as a treatment to prevent intimal hyperplasia. Treatments for preventing restenosis after angioplasty or stenoses development in bypasses have been disappointing clinical evaluation suffers from insufficient prospective randomized studies. Intimal hyperplasia is the major cause of failure after arterial reconstruction. The biology of intimal hyperplasia is complex, and treatment disappointing. Some types of hyperplasia may need to be preserved in order to prevent functional atrophy and aneurysmal dilatation of vein grafts.

Cell Division↗

PubMed2001

[Cognitive restraint in obesity. History of ideas, clinical description].

AN EXPLANATION OF DISAPPOINTING RESULTS: Handling obesity and moderate overweight with dietary prescriptions or cognitive and behavioral therapies gives unsatisfying results. For some, such treatments even have the drawback of aggravating eating behavioral patterns, not to mention other psychopathological disorders. We believe, on the contrary, that such disappointing results and troubles may be explained by the cognitive restraint theory. COGNITIVE RESTRAINT THEORY: After the radical questioning of a psycho-genic origin to obesity, the efforts made to lose weight have gradually been held responsible for the psychopathological troubles observed in the cases of overweight patients. Herman and Polivy thus consider that slimming diets bring about a state of cognitive restraint, i.e. a way of eating ruled by beliefs of all kinds in the various consequences on the patients' weight of alimentary habits and choices, as opposed to inner criteria of hunger and satiety. DIFFERENT STATES: A person in a state of cognitive restraint can either experience inhibition without loss of control, or a loss both of inhibition and of control. In the former case, one can distinguish: a) a voluntarist stage in which the individual deliberately chooses not to heed his hunger and satiety sensations in order to privilege rules that are supposed to allow him/her to control his/her weight; b) an unconscious stage during which physiological sensations are blurred, and eating habits ruled by unconscious cognitive processes and emotions. The individual thus ends up organising his eating behaviour around his/her fear of lacking, the frustration/guilt doublet and troubles in the comforting pattern. Such a state of inhibition is frequently interspersed with losses of control, described as hyperphagic or bulimic bouts and compulsive eating. THERAPEUTIC STRATEGIES: Certain authors, facing the necessity to bring down their patients' weight, tend nevertheless to advocate restrictive methods, or seem to consider that in spite of the above-mentioned drawbacks, cognitive restraint remains the only extant method to lose weight. An alternative therapeutic strategy is definitely worth exploring: one that consists precisely in helping the overweight patient to deliver him/herself from cognitive restraint. The first target could thus be to restore eating habits in conformity with personal tastes and with the patient's own personal hunger and satiety physiological regulation systems. This implies a questioning of dysfunctioning cognitive processes, and a thorough investigation of upholding factors such as self-esteem or emotional and relational troubles.

Cognition↗

PubMed2002

[Limited relevance of veterinary disciplinary regulations].

After several years of pressure on the part of the KNMvD to establish disciplinary regulations for veterinarians, these were at last incorporated in the Veterinary Practice Act of 1992. This article discusses the extent to which veterinary disciplinary regulations actually meet the expectations of legislators. On the basis of an investigation of the parliamentary passage of the Act, the flood of complaints before disciplinary judges, the nature and magnitude of jurisprudence of the veterinary disciplinary committee, and interviews with those involved, it would appear that results are disappointing. These disappointing results, in particular the one-sided emphasis on companion animals and the continuing misunderstanding about the prescription of veterinary medicines, lead to the conclusion that veterinary disciplinary regulations are currently of limited relevance. The authors consider that insufficient use is made of the potential of disciplinary measures to contribute to the monitoring of the quality of veterinary practice and give recommendations about this.

Animals↗

PubMedDate not supplied

Adjuvant chemotherapy in gastric cancer. The Italian experience and review of the literature.

AIMS AND BACKGROUND: Surgery is the treatment of choice for locally advanced gastric cancer, but the 5-year survival rate is still disappointing. The aim of the present review is to summarize the results of previously performed randomized trials to evaluate the effects of adjuvant therapy in gastric cancer. METHODS: We searched the Medline database for the following items: randomized trial, adjuvant therapy for gastric cancer, stomach neoplasms and adjuvant chemotherapy, meta-analysis of adjuvant chemotherapy for gastric cancer. We also searched the bibliographies of all papers, as well as review articles, to identify other studies. RESULTS: The results of chemotherapy in the adjuvant setting are disappointing and, although some randomized controlled trials have reported positive results, none of them provides strong evidence that adjuvant chemotherapy really works. Therefore, surgery remains the mainstay of therapy of gastric cancer. CONCLUSIONS: Further studies are warranted to identify more satisfactory strategies as well as to identify patients who are more likely to benefit from an adjuvant treatment.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Value of ultrasound in the diagnosis of acute appendicitis: interesting aspects.

OBJECTIVE: The value of ultrasound in the diagnosis of acute appendicitis is still unclear. Both, studies with excellent and such with disappointing results have been published. The aim of this investigation was to answer the question, whether the results of these studies depend on study design, the investigating clinical department, or the number of ultrasound investigators. METHODS: A systematic literature research (PubMed (NLM) database) was performed. Of 99 publications dealing with ultrasound in the diagnosis of acute appendicitis, 69 were relevant to investigate the value of ultrasound in suspected appendicitis. RESULTS: Results of single-center studies (sensitivity 81.6%, specificity 89.8%, accuracy 85.7%) are better then those of multi-center trials (38.3%, 87.6%, 62.9%). There are no distinct differences between the investigating departments (surgeons 78.9%, 88.9%, 86.0%; radiologists 83.1%, 88.1%, 83.5%; mixed 77.8%, 87.1%, 79.4%, no specification 73.8%, 87.1%, 80.45.9%). Less than 10 investigators showed better diagnostic values (84.3%, 86.8%, 85.6%) compared to studies with 10 or more investigators (64.7%, 88.6%, 67.7%). CONCLUSION: The results of multi-center trials are disappointing and the good results of single-center studies do not reflect surgical everyday life. However, excellent results can be obtained if the investigation is restricted to a few specialists irrespectively of the clinical department.

Acute Disease↗

PubMed2004

Translating new understanding into better care for the patient with chronic obstructive pulmonary disease.

Despite an enormous amount of research and many official statements, the definition, diagnosis, and staging of chronic obstructive pulmonary disease (COPD) remain inconsistent, and we have yet to agree on who should be tested with spirometry or on where and how to do it. We know that inflammation, not just airflow limitation, is important in determining the course of COPD, especially with respect to exacerbations. We can detect and treat alpha-1 antitrypsin deficiency, an under-recognized condition, but whether alpha-1 antitrypsin augmentation therapy affects the disease's clinical course remains unclear. Smoking cessation is the most important of all interventions for COPD, with proven techniques and adjuncts, but implementation remains difficult and success rates are disappointingly low. Similarly, pulmonary rehabilitation has well-documented benefits but is grossly underutilized because it is difficult to pay for and is not made available to most patients. Symptoms, costs, and other outcomes can be improved through comprehensive disease management, including the use of practice guidelines, yet multiple barriers prevent the potential benefits of these interventions to patients from being realized. Many patients who do not meet threshold oxygenation criteria for oxygen therapy during the daytime desaturate during sleep, but evidence that nocturnal oxygen administration benefits these patients is lacking. However, other sleep-related breathing disorders are common in COPD patients. Lung volume reduction surgery has recently been shown to improve function and survival for certain COPD patients, but lung transplantation has generally been disappointing. New pharmaceutical agents are being developed for treating COPD, and at least one of them (tiotropium) should soon be available in the United States. Noninvasive ventilation is effective in treating acute decompensations of COPD and should be the standard of care in that setting; evidence supporting its use in stable patients with end-stage disease is scant. Appropriate palliative care can greatly benefit patients and their families in the terminal phase of COPD and needs to be more widely applied.

Comorbidity↗

PubMed2004

Pessimistic mood in decompensated narcissistic patient.

We report the negative emotional state as pessimistic mood of a case with narcissistic personality disorder during the period of narcissistic decompensation. In addition, we identified the clinical differences between pessimistic mood and depressive disorder. An 28-year-old unmarried woman experienced herself, her life and the external object as futile and disappointing after repeated failure to satisfy her grandiose fantasies about the search for ideal love. The patient then gave up her formerly gratifying activities, and fell into a prolonged state of negative emotions and passivity dominated by pessimistic mood characterized by an overwhelming sense of futility. The patient did not respond to medical treatment with antidepressants firstly. However after a 2-year course of intensive psychotherapy, the patient was able to restore her zest to find a new boyfriend with a more rational and realistic attitude. Clinically, decompensated narcissistic patients do not exhibit the typical attitude of worthlessness or guilty feelings, and are devoid of certain specific depressive emotions (e.g., sadness, sorrow, etc.). In contrast, decompensated narcissistic patients with pessimistic mood exhibit a dominant sense of futility and other negative emotions presented as outrage and disappointment. The purpose of this case report was to emphasize the importance to recognize clinical features of pessimistic mood for the differential diagnosis and management of the decompensated narcissistic patient.

Adult↗

PubMedDate not supplied

The management of dural puncture in obstetrics and the efficacy of epidural blood patches.

Epidural blood patch is the definitive treatment for post dural puncture headaches (PDH), providing acceptable short-term relief. Disappointingly however debate exists as to their long-term success. To investigate their efficacy in our practice, a retrospective audit of all epidural blood patches performed over a four year period was performed. Patients were subsequently followed up using a postal questionnaire and persistent symptom relief and patient satisfaction was measured. During the study period 87 patients required an epidural blood patch, 11 required repeat patches. 71.26% of patients had complete symptom resolution on discharge. The response rate to follow up survey was 73.26% with the majority, 57.44%, replying that their symptoms returned following their discharge home. Only 25.53% said they would have an epidural or spinal anaesthetic for future deliveries. Epidural blood patches provide excellent short-term relief but long-term results are disappointing. Patients receiving epidural blood patches need improved long-term follow up.

Adult↗

PubMed1992

Chronic sorrow: a lifespan concept.

Losses are an integral part of chronic illness and disability. The term chronic sorrow, has been used to describe the long-term periodic sadness the chronically ill and their caregivers experience in reaction to continual losses. In this conceptual analysis of chronic sorrow, identified critical attributes are: cyclic sadness over time in a situation with no predictable end; external and internal stimuli triggering the feelings of loss, disappointment, and fear; and, progression and intensification of the sadness or sorrow years after the initial disappointment or loss. Model, borderline, related, contrary, and illegitimate cases illustrate what the concept is and what it is not. The meaning of chronic sorrow is compared to the meaning of unresolvable grief and depression. Chronic sorrow in various stages of life is illustrated in descriptions of: the situation and feelings of parents of handicapped children; multiple sclerosis patients in the middle, productive years; and elderly caregivers of spouses with dementia. Implications for research include the need to study the concept in various populations to determine its prevalence and operation. Through research, the meaning of the concept can be further clarified. This is a beginning step toward developing nursing theory that will give direction for providing care to persons encountering sadness over long periods of time.

Adolescent↗

PubMed1991

Health proposals and NZMA.

NZMA welcomes the opportunity for public debate over the degree to which the community should fund health care for all. It views the attempts to improve the integration of the health service with interest and hopes to enter a vigorous debate with government to ensure that the detailed proposals yet to be formulated will achieve the purpose we both desire. But the association is disappointed to see policies promoted that are often so reliant upon anecdote and a naive theory of economics. It is disappointing to see health policy altered so radically with so little analysis of facts. Waiting lists, as an example, are analysed with no statement of what proportion of hospital admissions are represented by waiting list patients. Part charges have been introduced in areas where there is no experimental justification for supposing that they will usefully alter patient behaviour. A more sophisticated approach is required. Some change must be sought in the so-called nonnegotiable part of the proposals.

Delivery of Health Care↗

PubMed1990

Gene therapy using bone marrow transplantation: a 1990 update.

The use of recombinant retroviruses for gene transfer into the haematopoietic tissue in vivo is still a new area of research. The initial results of in vitro studies were very exciting. In contrast, the early in vivo studies in mice were somewhat disappointing because of the transient and low levels of expression of the transferred gene. Recently, however, better results have been obtained in the murine system in vivo. New packaging cell lines have been constructed, which are safer and still efficient. Better vectors have been designed. Thus, significant levels of expression of the transgene have been achieved in murine long-term transplant recipients. However, the results obtained so far in large animal studies are still disappointing. It should be emphasized that further progress must be based on a simple overall strategy involving better understanding of the functioning of the gene to be transferred by gene expression studies, design of vectors carrying a fully active and correctly regulated minilocus and better knowledge of the biological properties of the target cells, the haematopoietic stem cells.

Animals↗

PubMed1989

Ability of the alpha and beta anomers of chlorozotocin to kill rat 9L tumor cells in vitro.

Chlorozotocin (CLZ), a nitrosourea synthesized in the hope that it would have little bone marrow toxicity, has been shown to be effective against animal tumors and tumor cells in culture. However, the clinical results with CLZ have been disappointing. The original report on the synthesis of CLZ indicated that alpha and beta anomers at the D-glucose moiety should be expected, particularly when CLZ is placed in aqueous solution. In this study, the alpha and beta anomers have been separated by high-performance liquid chromatography and characterized by UV spectroscopy, mass spectroscopy, and nuclear magnetic resonance. The equilibration and decomposition of the anomers in various physiological solutions were determined as a function of temperature, pH, and serum concentration. In Eagle's basal medium (pH 7.2) held at 25 degrees C, CLZ decomposed with a t1/2 of approximately 82 min; at 37 degrees C with serum, CLZ decomposed with a t1/2 of less than 10 min. In these two cases, the beta:alpha ratio reached 1 in approximately 48 min and less than 5 min, respectively. The maximum beta:alpha ratio obtained in all cases ranged from 1.25 to 1.5. After holding CLZ in tissue culture medium and compensating for its decomposition, 9L rat brain tumor cells were treated in vitro with CLZ having different ratios of the alpha and beta anomers. These experiments demonstrated that the beta anomer has little, if any, ability to kill 9L cells. Thus, this anomerization phenomenon may have been responsible for the disappointing clinical results with CLZ. Our data suggest that appropriate preparation, handling, and drug delivery procedures might be devised to minimize this problem in both experimental and clinical situations.

Animals↗