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31.
Eric Lim Ziad Ali Ayyaz Ali Reza Motalleb-Zadeh Christopher Jackson Seok Ling Ong James Halstead Linda Sharples Jayan Parameshwar John Wallwork Stephen R Large 《The Journal of heart and lung transplantation》2005,24(8):983-989
BACKGROUND: To ascertain survival of ischemic advanced heart failure patients by treatment allocation, we examined the outcome of transplant assessment patients allocated to medical therapy, high-risk conventional surgery, or transplantation. METHODS: Patients were identified from the Papworth transplant database and excluded if primary etiology was not ischemic. Grouping was undertaken according to treatment allocation at initial assessment, and analysis was performed by intention to treat. Survival was computed from the time of assessment and Cox regression used to stratify patients according risk with the Heart Failure Survival Score. RESULTS: From May 1993 to September 2001, a total of 755 patients were admitted for transplant assessment, with 348 (46.1%) identified as having heart failure of ischemic origin. Variables required for calculation of the Heart Failure Survival Score was available in 273 patients (78.4%), and 20 patients (7.3%) were lost to follow-up. Of the remaining 253 patients, 89 (35.2%) were allocated to medical therapy, 32 (12.6%) to surgery, and 132 (52.2%) to transplantation. The relative risk (95% confidence limit) of death compared with medical therapy was 0.62 (0.28, 1.40) for surgery and 0.38 (0.24, 0.61) for transplantation in medium- to high-risk patients. For low-risk patients, the relative risks for death compared with medical therapy were 1.87 (0.63, 5.60) for surgery and 1.97 (0.79, 4.96) for transplantation. CONCLUSIONS: Transplantation improved survival of medium- and high-risk patients compared with medical therapy. In the low-risk group, this was not evident. However, repeated assessment of risk is required because the hazard for death rises steadily after the third year in these patients. 相似文献
32.
The first 150 words of the full text of this article appear below. Key points Cancer pain management services must integrate withpalliative and primary care. Pain is common in cancer and usuallyoccurs in more than one site. Careful assessment and treatmentsaimed at the causes of the pain are essential. Optimal oralpharmacotherapy manages more than 75% of patients with cancerpain. If specific anti-cancer therapy, drugs, physical andpsychological treatments fail, then more invasive therapiesshould be considered early.
General principles of cancer pain management
Pain management must involve treating the cause of the painwhere possible, for example appropriate use of antibiotics forinfection, fixation for fractures, spinal stabilization. Wherethe cause of pain cannot be removed entirely, treatment shouldbe directed at modifying the disease process if possible, forexample palliative radiotherapy and/or chemotherapy, bisphosphonatesfor hypercalcaemia, surgery for bowel obstruction. Attentionto a patient's physical environment is important and simplemeasures, for example use of appropriate mattresses, orthotics,and mobility or bathing aids, . . . [Full Text of this Article]
Analgesic pharmacotherapy