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125321. Adjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer: 21-year results of International Breast Cancer Study Group Trial IV. (Abstract)

Adjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer: 21-year results of International Breast Cancer Study Group Trial IV. Increasing numbers of older women are affected by early breast cancer, because of prolonged life expectancy and the increasing incidence of breast cancer with age. The role of adjuvant therapy for this population is still a matter of debate. We reviewed the long-term outcome of a mature trial comparing endocrine treatment (...) continue to be observed in older patients treated for 1 year with p+T. Despite issues relating to competing causes of failure, older breast cancer patients can benefit from treatment and should be considered for trials of adjuvant systemic therapy.

2003 Journal of clinical oncology : official journal of the American Society of Clinical Oncology Controlled trial quality: uncertain

125322. Impact of an encounter-based prompting system on resident vaccine administration performance and immunization knowledge. (Abstract)

Impact of an encounter-based prompting system on resident vaccine administration performance and immunization knowledge. To evaluate an encounter-based immunization prompting system on resident performance in administering vaccines and knowledge of immunization guidelines.Prospective randomized, controlled trial. Subjects were first- and second-year pediatric residents in a hospital-based continuity clinic. The intervention group received manual prompts of immunizations due. Postclinic chart (...) review compared immunizations due with those administered. Acceptable and unacceptable reasons for not administering vaccines were assigned. Resident knowledge was measured by a 70-item examination.The intervention group had significantly less missed opportunities/vaccine administration errors (11.4% vs 21.6%). The most common reason for unacceptable errors in the intervention group: vaccine was given too early; in the control group: vaccine was postponed to next visit. Pre- and postintervention

2000 Pediatrics Controlled trial quality: uncertain

125323. A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP). (Abstract)

A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP). The potential of primary care practice settings to prevent disease and morbidity through health habit counseling, screening for asymptomatic disease, and immunizations has been incompletely met. This study was designed to test a practice-tailored approach to increasing preventive service delivery with particular emphasis on health habit (...) for consecutive patients during randomly selected chart review days.A significant increase (p=0.015) in global preventive service delivery rates at the 1-year follow-up was found in the intervention group (31% to 42%) compared to the control group (35% to 37%). Rates specifically for health habit counseling (p=0.007) and screening services (p=0.048) were increased, but not for immunizations.An approach to increasing preventive service delivery that is individualized to meet particular practice needs can

2001 American journal of preventive medicine Controlled trial quality: uncertain

125324. A retrospective analysis of the relationship between changes in serum PSA, palliative response and survival following systemic treatment in a Canadian randomized trial for symptomatic hormone-refractory prostate cancer. (Abstract)

A retrospective analysis of the relationship between changes in serum PSA, palliative response and survival following systemic treatment in a Canadian randomized trial for symptomatic hormone-refractory prostate cancer. To investigate the relationship between changes in serum PSA, palliative response and survival following systemic treatment for symptomatic hormone-refractory prostate cancer (HRPC).A retrospective review of 161 patients, treated with mitoxantrone and prednisone (M + P) (n = 80

2001 Annals of oncology : official journal of the European Society for Medical Oncology / ESMO Controlled trial quality: uncertain

125325. Initial feasibility study of a sprayable hydrogel adhesion barrier system in patients undergoing laparoscopic ovarian surgery. (Abstract)

Initial feasibility study of a sprayable hydrogel adhesion barrier system in patients undergoing laparoscopic ovarian surgery. To assess the safety and effectiveness of SprayGel as a barrier to reduce the frequency of adhesion formation and reformation after ovarian surgery, and to determine the feasibility of the study design for a larger, multicenter pivotal trial.Prospective, randomized, internally controlled trial (Canadian Task Force classification I).Two metropolitan, academic-affiliated (...) , nonprofit hospitals.Fourteen women.Bilateral adnexal surgery.On completion of surgery, one adnexa was randomized to receive optimal surgical treatment plus application of the adhesion barrier, and the contralateral one to receive optimal surgical treatment alone. Patients returned in 3 to 16 weeks for second-look laparoscopy. All initial and second-look procedures were videotaped and reviewed by a blinded surgeon reviewer, and assessed for frequency, extent, and severity of adhesions. The frequency

2003 The Journal of the American Association of Gynecologic Laparoscopists Controlled trial quality: uncertain

125326. The efficacy of an automated feedback system for general practitioners. (Abstract)

participant groups of GPs in a computer laboratory setting.The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms.Twenty-four randomly selected GPs participated.The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests (...) The efficacy of an automated feedback system for general practitioners. An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs.We used a randomised controlled trial with balanced block design.Five times six

2003 Informatics in primary care Controlled trial quality: uncertain

125327. Neutropenia and the development of the systemic inflammatory response syndrome. (Abstract)

Neutropenia and the development of the systemic inflammatory response syndrome. To determine outcome and natural course of systemic inflammatory response syndrome (SIRS) stages in adult febrile neutropenic patients.Retrospective cohort study in the medicine department and intensive care unit of a university hospital.Adults with cancer-related neutropenia and community-acquired fever.Patients were classified on admission according to SIRS parameters, tumor type, and degree of neutropenia (...) . Records of clinical and laboratory data during hospitalization were reviewed. Univariate and logistic regression analyses were performed. Seventy-nine events in 62 patients were analyzed. Overall mortality rate was 20.2% (16/79). Mortality increased as SIRS stage worsened on admission. No patients with stage 2 SIRS died (neutropenia and fever alone) but 11.1% of patients with SIRS 3, 43.4% with SIRS 4, 66.6% with sepsis induced hypotension, and 90% with septic shock. SIRS stage on admission

2003 Intensive Care Medicine

125328. Challenges in using geographic information systems (GIS) to understand and control malaria in Indonesia. Full Text available with Trip Pro

-prone countries in an effort to battle the disease. Over the past decade, the focus of some of this assistance has been in the provision of geographic information systems (GIS) hardware, software and training. In theory, GIS can be a very effective tool in combating malaria, however, in practice there have been a host of challenges to its successful use.This review is based, in part, on the literature but also on our experience working with the Indonesian Ministry of Health. The review identifies (...) Challenges in using geographic information systems (GIS) to understand and control malaria in Indonesia. Malaria is a mosquito-borne disease of global concern with 1.5 to 2.7 million people dying each year and many more suffering from it. In Indonesia, malaria is a major public health issue with around six million clinical cases and 700 deaths each year. Malaria is most prevalent in the developing countries of the world. Aid agencies have provided financial and technical assistance to malaria

2003 Malaria journal

125329. Detection and clinical implications of early systemic tumor cell dissemination in breast cancer. (Abstract)

Detection and clinical implications of early systemic tumor cell dissemination in breast cancer. Blood-borne distant metastasis is the leading cause of cancer-related death in breast cancer. The onset of this fundamental process can now be assessed in cancer patients using ultrasensitive immunocytochemical and molecular assays able to detect even single metastatic cells. Analyses of bone marrow (BM) samples show that disseminated cells are present in 20-40% of primary breast cancer patients (...) without any clinical or histopathological signs of metastasis. The common homing of circulating breast cancer cells in BM is indicative for systemic tumor cell spread and predictive for growth of overt metastases in relevant organ sites such as bone, lung, or liver. Recent clinical studies involving more than 3000 breast cancer patients demonstrated that the presence of tumor cells in BM at primary diagnosis is an independent prognostic factor for unfavorable clinical outcome. To date, sampling of BM

2003 Clinical Cancer Research

125330. The effects of the levonorgestrel intrauterine system (Mirena coil) on endometrial morphology. Full Text available with Trip Pro

The effects of the levonorgestrel intrauterine system (Mirena coil) on endometrial morphology. The Mirena coil is a levonorgestrel releasing intrauterine device that is in widespread use. This study aims to document the endometrial morphology associated with this device.Endometrial specimens from 75 women with the Mirena coil were reviewed and the histological features detailed.Morphological features found in most of the endometria were decidualisation of stroma (72 of 75 cases), atrophy

2003 Journal of Clinical Pathology

125331. A model structure for an EBM program in a multihospital system. (Abstract)

A model structure for an EBM program in a multihospital system. Evidence-based medicine (EBM) offers a great opportunity to translate advances in medical science into advances in clinical practice. We describe the structure of a comprehensive EBM program in a multihospital community teaching system. This EBM model is distinct and separate from the peer review process and has achieved substantial physician involvement. The program emanates from the Board of Directors Quality of Care Committee

2003 Journal for Healthcare Quality

125332. Drug allergy in a general hospital: Results of a novel prospective inpatient reporting system. (Abstract)

, of drug allergy in inpatients using a network-based electronic notification system. Each notification was evaluated by an allergist-immunologist during the same admission.From December 1, 1997 to December 31, 1999, 366 cases were reported from a total of 90,910 admissions. After review, only 210 cases were verified to have drug allergy. Antimicrobials and anti-epileptic drugs comprised 75% of the drug allergies reported. Cutaneous eruptions were the most common clinical presentation (95.7 (...) Drug allergy in a general hospital: Results of a novel prospective inpatient reporting system. Drug allergies are unpredictable immunologic adverse effects, usually immunoglobulin E-mediated immediate hypersensitivity or T-cell-mediated delayed hypersensitivity. There is a paucity of accurate prospective data on drug allergy in hospitalized patients.To describe the incidence, manifestations, and outcome of drug allergy in hospitalized patients.All newly developed cases, confirmed or suspected

2003 Asthma & Immunology

125333. Breast-feeding, infant formulas, and the immune system. (Abstract)

Breast-feeding, infant formulas, and the immune system. Breast-feeding provides many advantages to the offspring, but presently there is an ongoing debate whether or not it prevents allergy any better than certain formulas. This report reviews the mechanisms involved and discusses how breast-feeding may protect against allergy.The review builds on an internet-based literature search in addition to our own data.Human milk is the food best adapted to the needs of the offspring, also because (...) it provides efficient protection against infections and actively stimulates the development of the infant's own immune system. The major host defense system is provided via the secretory IgA antibodies produced in the mammary glands by lymphocytes, which have migrated there from the mother's gut mucosa. Therefore, these antibodies in the milk are primarily directed against the microbes in the mother's gut and her food proteins. As a result, breast-feeding starting directly after delivery will provide

2003 Asthma & Immunology

125334. Comparison of reliability between the Lenke and King classification systems for adolescent idiopathic scoliosis using radiographs that were not premeasured. (Abstract)

scoliosis have reported reliability improved over that of the King classification system. This newer classification system evaluates three different parameters (curve type, lumbar modifier, and sagittal thoracic modifier) and then combines them. The reliability of both classification systems had been determined using radiographs in which all of the curves had been premeasured (recorded on the radiographs) before review by examiners. However, in a normal clinical situation, spine surgeons need (...) Comparison of reliability between the Lenke and King classification systems for adolescent idiopathic scoliosis using radiographs that were not premeasured. Multisurgeon comparison of two radiographic scoliosis curve classification systems was performed.To determine the reliability of the King and Lenke classifications systems for adolescent idiopathic scoliosis using radiographs that had not been premeasured.Recent studies introducing the new Lenke classification system for idiopathic

2003 Spine

125335. Mortality rates in pediatric septic shock with and without multiple organ system failure. Full Text available with Trip Pro

admissions to the pediatric intensive care unit was queried, and cases with diagnoses of sepsis and septic shock were reviewed. The final study cohort consisted of 96 episodes of septic shock in 80 patients. Septic shock was defined as a clinical suspicion of sepsis manifested by hyperthermia or hypothermia accompanied by hypotension and/or alteration in perfusion. Multiple organ system failure was defined by established criteria. Data were analyzed by using Fisher's exact test. The overall mortality (...) Mortality rates in pediatric septic shock with and without multiple organ system failure. To determine the current mortality rates for pediatric patients with septic shock and the frequency and outcome of associated multiple organ system failure.Retrospective chart review.Multidisciplinary pediatric intensive care unit.Children age 1 month to 21 yrs admitted to the pediatric intensive care unit from January 1, 1998, to December 31, 1999, with a diagnosis of septic shock.None.A database of all

2003 Pediatric Critical Care Medicine

125336. Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25-26, 2000. (Abstract)

. The evaluation of effective therapies has been hampered by limitations in our ability to characterize the process and to stratify patients into more homogeneous groups with respect to pathogenesis.To develop a taxonomy of markers relevant to clinical research in sepsis and to propose a testable candidate system for stratifying patients into more therapeutically homogeneous groups.An expert roundtable discussion and a MEDLINE review using search terms "marker" and "sepsis."Markers provide information in one (...) Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25-26, 2000. Sepsis is not a single disease but a complex and heterogeneous process. Its expression is variable, and its severity is influenced by the nature of the infection, the genetic background of the patient, the time to clinical intervention, the supportive care provided by the clinician, and a number of factors as yet unknown

2003 Critical Care Medicine

125337. Proteomics and systems biology approaches to signal transduction in sepsis. (Abstract)

Proteomics and systems biology approaches to signal transduction in sepsis. Sepsis and resulting multiple system organ failure are the leading causes of mortality in intensive care units. Although it is generally appreciated that rampant, deregulated inflammatory pathways play a major role in sepsis, a comprehensive understanding based on the integrated response of multiple signal transduction pathways has remained elusive. Here we review the main signal transduction pathways involved (...) in the progression from inflammation to sepsis and discuss emerging genomic, proteomic, and systems biology approaches to decipher how these signaling pathways converge to cause the septic state. We propose that an integrative approach involving functional proteomics will provide a quantitative and mechanistic description that unifies inflammatory signaling networks in sepsis and will identify critical regulatory nodes for therapeutic manipulation. These types of systems biology-based approaches may lead to more

2003 Critical Care Medicine

125338. Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Full Text available with Trip Pro

organizations, published review articles, and nonrandomized, historical cohort investigations. With this background, the ACCM writing panel described a three-tiered system of intensive care units determined by service-based criteria.Guidelines for optimal intensive care unit services and personnel for hospitals with varying resources will facilitate both local and regional delivery of consistent and excellent care to critically ill patients. (...) Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. To describe three levels of hospital-based critical care centers to optimally match services and personnel with community needs, and to recommend essential intensive care unit services and personnel for each critical care level.A multidisciplinary writing panel of professionals with expertise in the clinical practice of critical care medicine working under

2003 Critical Care Medicine

125339. The parathyroid hormone-related protein system: more data but more unsolved questions. (Abstract)

The parathyroid hormone-related protein system: more data but more unsolved questions. The present review focuses on recent studies that might be considered as the most relevant advances in the parathyroid hormone-related protein field, with special emphasis on proven functions in renovascular and cardiovascular systems, in physiological as well as pathological conditions. Thus, the questions as to whether and how parathyroid hormone-related protein intervenes in vascular development (...) of these models. However, data accumulated from transgenic animals overexpressing the protein in particular cells have provided considerable support to its physiological and pathological relevance. The recent demonstration that nascent parathyroid hormone-related protein not only follows the secretory pathways, but also directly translocates to the nucleus, is beginning to uncover new actions for the protein in a number of physiological systems such as bone, mammary gland and vascular smooth muscle, as well

2003 Current Opinion in Nephrology and Hypertension

125340. The evolving role of chemotherapy and other systemic therapies for managing localized prostate cancer. (Abstract)

The evolving role of chemotherapy and other systemic therapies for managing localized prostate cancer. The recent literature is reviewed regarding the use of neoadjuvant and adjuvant chemotherapy, and promising new molecular targeted agents in patients with high risk localized prostate cancer.A MEDLINE literature review was performed of studies evaluating chemotherapy and other systemic therapies for localized prostate cancer.Patients with prostate cancer at high risk for recurrence despite (...) , which has led to ongoing clinical trials that are investigating the use of chemotherapy in the neoadjuvant setting. Published and ongoing clinical trials in the use of systemic therapy for localized prostate cancer are reviewed.Systemic therapy for advanced prostate cancer is improving. Efforts to use such therapies for managing localized disease are ongoing.

2003 Journal of Urology

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