LOPP alternating with EVAP is superior to LOPP alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation trial.

PURPOSE: The purpose of this randomized trial was to compare the efficacy of eight cycles of chlorambucil, vincristine, procarbazine, and prednisone (LOPP) with four cycles of LOPP that alternate with four cycles of etoposide, vinblastine, Adriamycin (doxorubicin; Familitalia Carlo Erba, Ltd, UK), and prednisone (EVAP) in patients with advanced Hodgkin's disease. PATIENTS AND METHODS: Between June 1983 and December 1989, 594 patients were entered onto the study. Of the 594, 295 patients were allocated to receive LOPP, and 299 were allocated to receive LOPP/EVAP. RESULTS: The complete remission (CR) rates were 57% and 64%, respectively, after initial chemotherapy (difference not significant [NS]), and 65% and 75%, respectively, after the subsequent administration of radiotherapy to residual masses (P less than .01). The procedure associated mortality in the LOPP and LOPP/EVAP arms was 1% and 3%, respectively. The actuarial CR relapse-free survival was significantly greater in the LOPP/EVAP arm (P less than .001) as was the overall survival (P less than .05). The CR relapse-free rate, disease-free survival (DFS) rate, and overall survival rate at 5 years were 52%, 32%, and 66%, respectively, in the LOPP arm, compared with 72%, 47%, and 75% in the LOPP/EVAP arm, respectively. CONCLUSION: These results indicate that LOPP and EVAP is superior to LOPP alone as initial treatment for advanced Hodgkin's disease.     

Post-myocardial infarction ventricular remodeling: Animal and human studies

Summary Segmental alterations in left ventricular function are generally present in patients who suffer an acute myocardial infarction. Regional wall motion abnormalities in left ventricular systolic function can be identified in the hyperacute period and generally persist in patients who complete a myocardial infarction. Through the process of infarct expansion, the infarcted territory may thin and lengthen in the short term following a myocardial infarction. Some infarct survivors are also prone to further progressive alterations in the shape and size of the left ventricle, a process that has been termedpostinfarction ventricular remodeling. Although left ventricular remodeling appears to represent an adaptive process serving to preserve stroke volume (and cardiac output) following myocardial injury, the enlargement process may have undesirable long-term effects on global left ventricular function and on clinical prognosis. Fortunately, recent experimental and clinical evidence demonstrates that ventricular remodeling and its deleterious consequences may be preventable.     

Salivary gland dysfunction (‘dry mouth’) in patients with cancer: a consensus statement

DAVIES A., BAGG J., LAVERTY D., SWEENEY P., FILBET M., NEWBOLD K., DE ANDRÉS J. & MERCADANTE S. (2010) European Journal of Cancer Care 19 , 172–177
Salivary gland dysfunction (‘dry mouth’) in patients with cancer: a consensus statement A group of interested professionals was convened to develop some evidence‐based recommendations on the management of salivary gland dysfunction (SGD) in oncology patients. A Medline search was performed to identify the literature on SGD. The abstracts of all identified papers were read, and the full texts of all relevant papers were reviewed. The evidence was graded according to the Scottish Intercollegiate Guidelines Network grading system for recommendations in evidence‐based guidelines. The summary of the main recommendations are: (1) patients with cancer should be regularly assessed for SGD (grade of recommendation – D); (2) the management of SGD should be individualised (D); (3) consideration should be given to strategies to prevent the development of radiation‐induced SGD (C); (4) consideration should be given to treatment of the cause(s) of the SGD (C); (5) the treatment of choice for the symptomatic management of SGD is use of an appropriate saliva stimulant (C); (6) consideration should be given to prevention of the complications of the SGD (D); (7) consideration should be given to treatment of the complications of the SGD (D); and (8) patients with SGD should be regularly reassessed (D).     

Nocturnal sleep, daytime sleepiness, and napping among women with significant emotional/behavioral premenstrual symptoms

The objective of this study is to examine daytime sleepiness and alertness and nap characteristics among women with significant emotional/behavioral premenstrual symptoms, and to determine their relationship with nocturnal sleep. Participants spent one night during the follicular phase and two nights during the late-luteal phase, one of which occurred after a 40 min opportunity to nap, sleeping in the laboratory. Subjective measures of sleepiness and alertness were completed during the afternoon of each recording. Setting took place at the sleep laboratory at the University of Ottawa. A total number of participants were 10 women with significant and nine women with minimal emotional/behavioral premenstrual symptoms (mean age 26 years). The results were compared with the follicular phase, both groups of women had less slow wave sleep and more stage 2 sleep at night, as well as a higher daytime and nocturnal mean and maximum temperature during the late-luteal phase. Women with significant symptoms were sleepier and less alert during the late-luteal phase and had a higher overall mean nocturnal temperature compared with women with minimal symptoms. No significant differences were found between the two groups on nap characteristics and nocturnal sleep characteristics. Results show that women with more severe premenstrual symptoms are sleepier during the late-luteal phase than women with minimal symptoms. The increased daytime sleepiness seems to be unrelated to nocturnal sleep or nap characteristics.     

Nutrition and involuntary weight loss: a pilot study of an educational intervention for nursing home surveyors

OBJECTIVE: To describe the knowledge and attitudes of nursing home (NH) surveyors before and after a brief educational intervention related to nutrition and involuntary weight loss in nursing home residents. DESIGN: A questionnaire covering knowledge and attitudes about nutrition was given 1 month before and 6 months after a targeted educational intervention. PARTICIPANTS AND SETTING: State of Maryland nursing home surveyors. MEASUREMENTS: A 24-item questionnaire of NH surveyor knowledge (11 items) and attitudes (13 items) regarding issues related to nutrition and involuntary weight loss in NH residents. RESULTS: Overall surveyors' knowledge scores increased from 68% (SD, 17%) pre-intervention to 76% (SD, 18%) post-intervention (P = .11). Knowledge related to the lack of the effect of tube feeding on survival in NH residents with end-stage dementia was the only knowledge item that improved significantly with the intervention (39% correct pre-intervention and 68% correct post-intervention, P = .04). There were no changes in attitudes toward the diagnosis or treatment of nutrition after the intervention. CONCLUSION: Overall, NH surveyor knowledge related to nutrition and involuntary weight loss varied widely across topic areas. Neither knowledge nor attitudes were substantially affected by a brief educational intervention. Development of effective educational interventions for NH surveyors should be a priority for stakeholders in NH care.     

Patient satisfaction in 21st century medicine: revolution or evolution?

The Moment-of-Truth (MOT) patient satisfaction system was created to address each patient's medical care and service needs at the "point-of-care," before the patient leaves the medical facility. The MOT system is patient-centered by actively involving each patient in his or her own healthcare evaluation, planning, and continuous quality improvement. Patient needs are aligned with the required healthcare resources, which simultaneously produce information that can be acted upon "immediately," at the point-of-care, with "a sense of urgency"-addressing patient expectations each and every time the patient encounters the healthcare system. Major changes that occurred in medical service delivery at Hudson Hospital after implementation of the MOT system included a change in the focus of healthcare delivery toward the patient each and every time medical care or service occurred by placing the patient at the center of the care continuum; the ability to capture and react to what the patient needed at the place and time the patient needed it; and the incorporation of patient satisfaction as a way of doing business, throughout the healthcare organization. Results in 2007 to date have averaged 98% among responding patients indicating that they would recommend the Hudson Hospital to family and friends.