RESUMEN
OBJECTIVES: This study aimed to assess head and neck cancer patient satisfaction with the use of a touch-screen computer patient-completed questionnaire for assessing Adult Co-morbidity Evaluation 27 co-morbidity scores prior to treatment, along with its clinical reliability. METHODS: A total of 96 head and neck cancer patients were included in the audit. An accurate Adult Co-morbidity Evaluation 27 co-morbidity score was achieved via patient-completed questionnaire assessment for 97 per cent of participants. RESULTS: In all, 96 per cent of patients found the use of a touch-screen computer acceptable and would be willing to use one again, and 62 per cent would be willing to do so without help. Patients were more likely to be willing to use the computer again without help if they were aged 65 years or younger (χ2 test; p = 0.0054) or had a performance status of 0 or 1 (χ2 test; p = 0.00034). CONCLUSION: Use of a touch-screen computer is an acceptable approach for assessing Adult Co-morbidity Evaluation 27 scores at pre-treatment assessment in a multidisciplinary joint surgical-oncology clinic.
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Recolección de Datos/instrumentación , Documentación/métodos , Neoplasias de Cabeza y Cuello/psicología , Satisfacción del Paciente , Encuestas y Cuestionarios , Interfaz Usuario-Computador , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Computadores , Autoevaluación Diagnóstica , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radioterapia Asistida por Computador , Reproducibilidad de los Resultados , TactoRESUMEN
OBJECTIVE: The complexity of radiotherapy planning is increasing rapidly. Delivery and planning is subject to detailed quality assurance (QA) checks. The weakest link is often the oncologists' delineation of the clinical target volume (CTV). Weekly departmental meetings for radiotherapy QA (RTQA) were introduced into the Royal Wolverhampton Hospital, Wolverhampton, UK, in October 2011. This article describes the impact of this on patient care. METHODS: CTVs for megavoltage photon radiotherapy courses for all radical, adjuvant and palliative treatments longer than five fractions (with the exception of two field tangential breast treatments not enrolled into clinical trials) were reviewed in the RTQA meeting. Audits were carried out in January 2012 (baseline) and September 2013, each over a 4-week period. Adherence to departmental contouring protocols was assessed and the number of major and minor alterations following peer review were determined. RESULTS: There was no statistically significant difference for major alterations between the two study groups; 8 alterations in 80 patients (10%) for the baseline audit vs 3 alterations from 72 patients (4.2%) in the second audit (p = 0.17). A trend towards a reduction in alterations following peer review was observed. There has, however, been a change in practice resulting in a reduction in variation in CTV definition within our centre and greater adherence to protocols. There is increasing confidence in the quality and constancy of care delivered. CONCLUSION: Introduction of a weekly QA meeting for target volume definition has facilitated consensus and adoption of departmental clinical guidelines within the unit. ADVANCES IN KNOWLEDGE: The weakest areas in radiotherapy are patient selection and definition of the CTV. Engagement in high-quality RTQA is paramount. This article describes the impact of this in one UK cancer centre.
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Neoplasias de la Mama/radioterapia , Auditoría Clínica , Mejoramiento de la Calidad , Planificación de la Radioterapia Asistida por Computador/normas , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Natural Killer (NK) cells have been implicated in the development of allergic airway inflammation. However, the in vivo role of NK cells has not been firmly established due to the lack of animal models with selective deficiencies in NK cells. OBJECTIVE: To determine the specific contribution of NK cells in a murine model of allergic airway disease (AAD). METHODS: The role of NK cells in AAD was studied using NK-deficient (NKD) mice, perforin(-/-) mice, and mice depleted of Ly49A/D/G(+) NK cell subsets in an ovalbumin-induced model of allergic airway disease (OVA-AAD). RESULTS: Induction of OVA-AAD in C57BL/6 wild-type (WT) mice resulted in the expansion of airway NK cells and the development of pronounced airway eosinophilia. In the absence of NK cells or specific subsets of NK cells, either in NKD mice, or after the depletion of Ly49A/D/G(+) NK cells, the development of OVA-AAD was significantly impaired as seen by decreased airway inflammation and eosinophilia, decreased secretion of the Th2 cytokines IL-4, IL-5 and IL-13 and diminished OVA-specific antibody production. Furthermore, while OVA-exposure induced a dramatic expansion of dendritic cells (DCs) in WT mice, their induction was significantly attenuated in NKD mice. Development of OVA-AAD in perforin(-/-) mice suggested that the proinflammatory role of NK cells is not dependent on perforin-mediated cytotoxicity. Lastly, induction of allergic disease by OVA-specific CD4 T cells from WT but not NK-depleted or NKD mice in RAG(-/-) recipients, demonstrates that NK cells are essential for T cell priming. CONCLUSIONS AND CLINICAL RELEVANCE: Our data demonstrate that conventional NK cells play an important and distinct role in the development of AAD. The presence of activated NK cells has been noted in patients with asthma. Understanding the mechanisms by which NK cells regulate allergic disease is therefore an important component of treatment approaches.
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Células Asesinas Naturales/inmunología , Hipersensibilidad Respiratoria/inmunología , Traslado Adoptivo , Animales , Citotoxicidad Inmunológica , Células Dendríticas/inmunología , Células Dendríticas/metabolismo , Modelos Animales de Enfermedad , Eosinofilia/inmunología , Inflamación/inmunología , Células Asesinas Naturales/metabolismo , Pulmón/inmunología , Pulmón/patología , Activación de Linfocitos/inmunología , Ratones , Ratones Noqueados , Células T Asesinas Naturales/inmunología , Ovalbúmina/inmunología , Hipersensibilidad Respiratoria/patología , Hipersensibilidad Respiratoria/terapia , Bazo/inmunologíaRESUMEN
BACKGROUND: Chronic cough is common, and medical treatment can be ineffective. Mindfulness is a psychological intervention that aims to teach moment-to-moment non-judgemental awareness of thoughts, feelings and sensations. METHOD: 30 healthy subjects and 30 patients with chronic cough were studied in two sequential trials. For both studies, cough reflex sensitivity to citric acid (C5) was measured on two occasions, with urge to cough rated following each inhalation; between challenges subjects were randomised to (1) no intervention, (2) mindfulness or (3) no intervention but modified cough challenge (subjects suppress coughing). For the healthy volunteers, measures were 1 h apart and mindfulness was practised for 15 min. For the patients with chronic cough measures were 1 week apart and mindfulness was practised daily for 30 min. RESULTS: In healthy volunteers, median change (interquartile range (IQR)) in cough reflex sensitivity (logC5) for no intervention, mindfulness and suppression was +1.0 (0.0 to +1.3), +2.0 (+1.0 to +3.0) and +3.0 (+2.8 to +3.0) doubling concentrations (p = 0.003); there were significant reductions for both mindfulness (p = 0.043) and suppression (p = 0.002) over no intervention. In patients with cough, median change (IQR) in logC5 for no intervention, mindfulness training and voluntary suppression was 0.0 (-1.0 to +1.0), +1.0 (-0.3 to +1.0) and +1.0 (+1.0 to +2.0) doubling concentrations (p = 0.046); there was a significant reduction for suppression (p = 0.02) but not mindfulness (p = 0.35). Urge to cough did not change after mindfulness compared with control in either healthy subjects (p = 0.33) or those with chronic cough (p = 0.47). CONCLUSION: Compared with control, mindfulness decreased cough reflex sensitivity in healthy volunteers, but did not alter cough threshold in patients with chronic cough. Both groups were able to suppress cough responses to citric acid inhalation.
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Tos/terapia , Meditación , Reflejo/fisiología , Terapia por Relajación , Pruebas de Provocación Bronquial , Enfermedad Crónica , Ácido Cítrico , Tos/inducido químicamente , Tos/psicología , Femenino , Humanos , Masculino , Meditación/psicología , Persona de Mediana Edad , Reflejo/efectos de los fármacos , Sensibilidad y EspecificidadAsunto(s)
Neoplasias de la Mama/patología , Neoplasias Pulmonares/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/inducido químicamente , Vinblastina/análogos & derivados , Femenino , Humanos , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Vinblastina/efectos adversos , VinorelbinaAsunto(s)
Neoplasias del Ano/etiología , Neoplasias del Ano/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por VIH/complicaciones , Enfermedad de Hodgkin/etiología , Enfermedad de Hodgkin/virología , Adulto , Neoplasias del Ano/radioterapia , Progresión de la Enfermedad , Resultado Fatal , Enfermedad de Hodgkin/radioterapia , Humanos , Masculino , Fístula Rectal/etiología , Sepsis/etiologíaRESUMEN
AIMS: No randomised trials have addressed the use of external beam radiotherapy (EBRT) in the treatment of differentiated thyroid cancer. The indications for EBRT, the technique and recommended dose all remain controversial. MATERIALS AND METHODS: We included patients treated with EBRT with curative intent from two cancer centres between 1988 and 2001. Data were collected from hospital notes, radiotherapy prescriptions and local cancer registry. RESULTS: The indications for treatment in the 41 identified patients were macroscopic residual disease 23 (56%), microscopic residual disease 10 (25%), Hurthle cell variants 3 (7%), multiple lymph-node involvement 3 (7%) and other 2 (5%). Delivered doses ranged from 37.5-66 Gy over 3-6.5 weeks. Rate of local recurrence and overall survival at 5 years were as follows: papillary 26% and 67%; follicular 43% and 48%; well differentiated 21% and 67%; focus of poor differentiation/Hurthle cell variants 69% and 32%; complete excision 25% and 61%; residual disease 37% and 59%; EBRT total dose < 50 Gy 63% and 42%; 50-54 Gy 15% and 72%; > 54 Gy 18%, and 68%. CONCLUSIONS: The results in this study are consistent with previous retrospective studies of EBRT. The wide range of indications and doses used with radical intent highlights the lack of clinical and radiobiological data on the response of differentiated thyroid cancer to EBRT. Despite the small study size, the 5-year local recurrence results indicate a possible dose response within the dose range used.
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Carcinoma Papilar Folicular/radioterapia , Neoplasias de la Tiroides/radioterapia , Carcinoma Papilar Folicular/mortalidad , Carcinoma Papilar Folicular/secundario , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Metástasis Linfática , Masculino , Recurrencia Local de Neoplasia/epidemiología , Radioterapia Conformacional/métodos , Estudios Retrospectivos , Análisis de Supervivencia , Tasa de Supervivencia , Neoplasias de la Tiroides/mortalidad , Reino Unido/epidemiologíaRESUMEN
Investigations of the title reaction, carried out by plotting logs of the relative reaction rates vs IPs, vs HOMOs, and vs LUMOs, reveal multiple nearly parallel lines of correlation with small negative slopes in each. Overall, the natural grouping into monosubstituted and disubstituted alkenes gives better correlations than that obtained by using all alkenes. Comparison with analogous plots for other reactions indicates that the mechanism for this reaction has similarities to that for hydroboration, the major difference being that the lines in the plots for hydroboration have positive slopes, indicating an electrophilic rate-determining step involving the pi electrons, while those for the title reaction have small negative slopes, indicating a nucleophilic rate-determining step. Of the two reaction mechanisms proposed for the title reaction, only one has a nucleophilic attack at the complexed alkene as the rate-determining step, and therefore, this work supports that reaction mechanism.
RESUMEN
Plots of log k(rel) versus IP or versus HOMO for the title reactions are presented; similarities and differences among the reactions are discussed. The Cl2 and Br2 data each show a single line of correlation with positive slope for all alkenes regardless of the steric requirements; increasing substitution at the double bond increases the reaction rate, indicating an electrophilic reaction. Each plot of the I2 data calculated for adsorption exhibits a natural separation into groups of similarly substituted alkenes, in which increased substitution reduces the rate. Within each group, a good-to-excellent correlation is observed, with a lower IP generally corresponding to a higher relative rate. The results indicate that the relative magnitude of the steric requirements about the double bond is similar to that of the electronic effects in iodination. Plot shapes for iodination are compared to those of other reactions, such as hydroboration, oxymercuration, complexation with Ag+, and complexation with MeHg+.
RESUMEN
The majority of patients with lung cancer have incurable disease from presentation and a survival measured in months. Treatments offered to these patients are aimed at the palliation of symptoms with either radiotherapy or chemotherapy, or with supportive measures. It has been traditional to offer regular outpatient follow-up after initial palliative treatment. Further treatment options, which may be limited, are usually reserved for the recurrence of troublesome symptoms. A pilot 'open access' lung cancer clinic has been set up. Rather than have regular follow-up at the hospital, patients who have completed initial palliative treatments are discharged to the community with follow-up by their general practitioner and Macmillan nurse. Review at the open access clinic can be arranged at short notice if requested by the patient, carers, general practitioner or Macmillan nurse. The outcomes and level of satisfaction of patients, their relatives and staff to this method of follow-up were found to be positive. Open access follow-up may be useful for many patients after the completion of initial palliative treatment.
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Carcinoma de Pulmón de Células no Pequeñas/terapia , Carcinoma de Células Pequeñas/terapia , Neoplasias Pulmonares/terapia , Mesotelioma/terapia , Satisfacción del Paciente , Actitud del Personal de Salud , Medicina Familiar y Comunitaria , Estudios de Seguimiento , Accesibilidad a los Servicios de Salud , Humanos , Servicio Ambulatorio en Hospital , Cuidados Paliativos , Proyectos Piloto , Atención Primaria de Salud , Derivación y Consulta , Encuestas y CuestionariosRESUMEN
Antisense oligodeoxyribonucleotides (ODN) targeted against the breakpoint in BCR-ABL mRNA will specifically decrease BCR-ABL mRNA, provided cells are first permeabilised with streptolysin-O (SL-O). We used 18-mer chimeric methylphosphonodiester: phosphodiester linked (4-9-4) ODN complementary to 9 bases either side of the BCR-ABL junction to purge harvests ex vivo in three CML patients who remained completely Ph positive after multiple chemotherapy courses. After CD34+ cell selection and SL-O permeabilisation, harvests were purged with 20 microM ODN. After purging, all individual CFU-GM colonies grown from the two b3a2 breakpoint cases remained positive for BCR-ABL mRNA. In contrast, all 24 colonies grown from the b2a2 breakpoint case were BCR-ABL mRNA negative. Patients were conditioned with busulphan 16 mg/kg. The initial post-transplant course was uneventful, although the time to return to 0.5 x 10(9)/l neutrophils was slow at 25-51 days. Both chronic phase patients remain in haematological remission at +724 and +610 days, although each has cytogenetic evidence of relapse. The b2a2 accelerated phase patient died of myeloid blast transformation at day +91. The present SL-O-facilitated ODN purging strategy appears to be without significant toxicity, and offers considerable improvements in ODN delivery to the cytosol.
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Proteínas de Fusión bcr-abl/genética , Trasplante de Células Madre Hematopoyéticas/métodos , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Oligonucleótidos Antisentido/uso terapéutico , Acondicionamiento Pretrasplante/métodos , Antígenos CD34 , Movilización de Célula Madre Hematopoyética , Humanos , Leucaféresis , Oligonucleótidos Antisentido/administración & dosificación , Evaluación de Resultado en la Atención de Salud , Análisis de Secuencia de ADNRESUMEN
Following mobilising chemotherapy and myeloid growth factors, some heavily pretreated patients do not mobilise adequate numbers of peripheral blood progenitor cells (PBPC). It would be clinically useful to identify such patients in advance. A recent scoring system based on previous therapy may be useful in predicting CD34-positive cell yield. In this study we validated this scoring system on an independent group of 99 patients undergoing 103 harvesting episodes. In 61 patients mobilised with cyclophosphamide 1.5 g/m2 and G-CSF, those with treatment scores less than 21 yielded significantly more CD34-positive cells than patients with scores greater than 63 (P = 0.0012). Previous treatment with melphalan or carmustine was associated with a significantly lower yield of CD34-positive cells (P= 0.0001). No relationship was seen between the time from previous chemoradiotherapy and harvest outcome. Patients with treatment scores less than 21 required a shorter duration of G-CSF therapy (P = 0.05). Similar findings were seen in 42 further mobilisation cycles undertaken with alternative mobilisation schedules. The present data suggest that a score summarising previous treatment can be used to predict CD34 yields, and could be of clinical use to identify poor PBPC mobilisers in advance.
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Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Movilización de Célula Madre Hematopoyética , Trasplante de Células Madre Hematopoyéticas , Neoplasias/terapia , Carmustina/farmacología , Carmustina/uso terapéutico , Terapia Combinada , Ciclofosfamida/farmacología , Ciclofosfamida/uso terapéutico , Factor Estimulante de Colonias de Granulocitos/farmacología , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Melfalán/farmacología , Melfalán/uso terapéutico , Valor Predictivo de las Pruebas , Trasplante AutólogoRESUMEN
Fourty-five patients with progressive FIGO IIIc (36/45 pts.) and IV (9/45 pts.) ovarian cancer, who were in progression under prior cisplatin-based chemotherapy, were submitted to aortic infusion and stop flow infusion with the same drugs. 36/45 patients (80%) had four-quadrant and 9/45 patients (20%) had two-quadrant peritoneal carcinosis, 33/45 with severe ascites. Overall clinical response was 93%: 5/45 CR (11%), 21/45 PR (47%), 16/45 MR (35%). Complete resolution of ascites occurred in 9/33 patients (27%), a substantial reduction of ascites of more than 50% in 14/33 patients (43%). Median survival time was 12.5 months, median time to progression 8.6 months. Toxicity was minimal and in most patients performance and quality of life improved shortly after therapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Neoplasias Ováricas/tratamiento farmacológico , Ascitis/etiología , Resistencia a Antineoplásicos , Femenino , Humanos , Infusiones Intraarteriales/métodos , Persona de Mediana Edad , Neoplasias Ováricas/patología , Neoplasias Peritoneales/secundarioRESUMEN
Body donation files from the Department of Anatomy at Northeastern Ohio Universities College of Medicine were reviewed from the 569 donors used in our program from 1978-1993. The data were entered into a computerized database to evaluate the characteristics of people who have contributed to the body donation program for cadaveric dissection. The purpose of this review was to reveal a profile of the people who have contributed to our program and enable us to identify any deficiencies or disproportionate representation of donors which can be used when targeting future applicants. Donors to our program were predominantly male (58%), although there was a clear trend for increasing numbers of females over the latter period of the program. Donors were almost exclusively white (98%) with an average age at death of 73 years (range 18-98 years). The combination cardiovascular (46%), cancer (27%), and pulmonary dysfunction (16%) accounted for nearly all deaths of our donors. Approximately half of the donors (49%) were married and they completed an average of 12.5 years of education. The typical donor bequested at, or near, the time of death. From these data we conclude that certain characteristics of our donors can be primarily attributable to the population base of our sample. Other characteristics, for example, gender, age at death of females, and educational level, show marked departures from population values and suggest some unique attributes of our donors. Bequests to our body donation program do not appear to represent a long-term plan, but rather a decision made just prior to death.
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Cadáver , Donantes de Tejidos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anatomía/educación , Educación Médica/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We report a patient with controlled coeliac disease but severe dermatitis herpetiformis who was intolerant of dapsone and sulphapyridine. She ultimately had to be treated with parenteral heparin which brought about involution of the skin lesions with symptomatic relief within 1 week. The mechanism of action of heparin is uncertain but may be related to the inhibition of the formation of proteases generated from polymorphs by the clotting process. The treatment is associated with great difficulties in administration over the long term and associated with the risk of haemorrhage. This case illustrates these problems.