498 research outputs found
Physical and Psychosocial Correlates of Rehabilitation, Survival and Relapse in Head and Neck Cancer Patients
The number of new patients in the Netherlands each year diagnosed with
head and neck cancer is about 21 00.1 This number will increase in the coming
years because of progessive aging of the population and the particularly high
birthrate post second world war, producing a cohort of children who are now
at risk for developing head and neck cancer. Moreover, patients are currently
'in medical hands' for a longer time than before because of the introduction
of treatment techniques for more advanced tumors and better palliative care.
In 1995 the estimated number of patients alive with carcinoma of the most
common sites of head and neck cancer was 9125.2
Traditionally, the medical treatment of head and neck tumors has been
directed at irradicating the disease and aiming for a longer survival of the
patient. Therefore, the main focus has been on clinical data such as localization,
type and staging of the tumor and the effect of treatment, demonstrated
by loco-regional control and survival.
As Bailar and Gornick stated recently, the effect on mortality of new
treatments, in the period 1970 through 1994, has been disappointing for most
cancer sites.3 Also, the survival rate for head and neck cancer in 1994 was
found largely unchanged since 1973. In the Netherlands, the 5-year overall
relative survival for oral cavity cancer improved from 52 to 58%, for
oropharynx cancer decreased from 38 to 30% and remained unchanged
(70%) in laryngeal cancer.2 For the patients both quantity and quality of life
are important.
Today head and neck cancer patients and their healthcare providers are
confronted with the effects of more aggressive treatment modalities introduced
since the 70's. Fundamental life functions, like breathing, eating and
speaking, and the bodily appearance of the patient, are often largely affected
by tumor and treatment, often with severe consequences for daily life and
social interaction
Possible lack of full cross-resistance of 5HT3 antagonists; a pilot study
We investigated the potential of cross-over to the serotonin receptor (5HT3) antagonist ondansetron after protection failure with tropisetron. Several cases of complete protection were observed. These limited data suggest that there is an indication for retreatment with a different 5HT3 antagonist after an initial failure to another and also stress the need and relevance for comparative studies between 5HT3 antagonists
Selection by AZT and Rapid Replacement in the Absence of Drugs of HIV Type 1 Resistant to Multiple Nucleoside Analogs
We studied the intrahost evolution and dynamics of a multidrug-resistant HIV-1, which contains an insertion
of two amino acids (aa) and several aa changes within the reverse transcriptase (RT) gene. From an individual
receiving intermittent therapy, sequences of 231 full-length molecular clones of HIV-1 RT were obtained
from serum-derived viruses at 12 consecutive time points over a period of 6 years, 17 to 20 clones per time
point. In the 3.5-year period prior to the first course of therapy, only wild-type (wt) viruses were found. As
soon as 6 months after the start of zidovudine (AZT) monotherapy, all viruses contained an insertion of two
aa between positions 68 and 69 of the RT and aa changes at positions 67 and 215, a combination conferring
resistance to multiple nucleoside analogs. After termination of therapy, the insertion mutants were rapidly
and completely replaced by the wt viruses. In turn, the insertion mutants replaced the wt viruses after initiation
of therapy with 3TC, d4T, and saquinavir. After termination of triple therapy, the wt viruses completely
replaced the mutants within 1 month, which is markedly faster than has been observed earlier for the replacement
of AZT-resistant viruses. Fast replacements of the mutant virus populations after termination of
therapy indicate gross competitive disadvantage of the insertion mutant in the absence of therapy, which we
estimated by using several models. The insertion mutants attained high virus loads, demonstrating that virus
load cannot be used as a direct measure of virus fitness
Communication of prognosis in head and neck cancer patients
Objectives: In shared decision making it is important to adequately, timely and actively involve patients in treatment decisions. Sharing prognostic information can be of key importance. This study describes whether and how prognostic information on life expectancy is included during communication on diagnosis and treatment plans between physicians and head and neck (H&N) oncologic patients in different phases of disease.
Methods: A descriptive, qualitative study was performed of n = 23 audiotaped physician-patient conversations in which both palliative and curative treatment options were discussed and questions on prognosis were expected. Verbatim transcribed consultations were systematically analyzed. A distinction was made between prognostic information that was provided (a) quantitatively: by giving numerical probability estimates, such as percentages or years or (b) qualitatively: through the use of words such as ‘most likely’ or ‘highly improbable’.
Results: In all consultations, H&N surgeons provided some prognostic inform
Dilemmas in counselling females with the fragile X syndrome
The dilemmas in counselling a mildly retarded female with the fragile X
syndrome and her retarded partner are presented. The fragile X syndrome is
an X linked mental retardation disorder that affects males and, often less
severely, females. Affected females have an increased risk of having
affected offspring. The counselling of this couple was complicated by
their impaired comprehension which subsequently impaired their thinking on
the different options. The woman became pregnant and underwent CVS, which
showed an affected male fetus. The pregnancy was terminated. Whether
nondirective counselling for this couple was the appropriate method is
discussed and the importance of a system oriented approach, through
involving relatives, is stressed
Effectieve strategieën en programma’s voor klassenmanagement in het primair onderwijs: Handreikingen voor de onderwijspraktijk op basis van een meta-analyse
Effectieve strategieën en programma’s voor klassenmanagement in het primair onderwijs: Handreikingen voor de onderwijspraktijk op basis van een meta-analyse
Involving the patient: A prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care
Objective: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. Design: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers and between health care providers and patients, (2) information for health care providers and patients, (3) contact with fellow sufferers and (4) monitoring of discharged patients by means of electronic questionnaires. Evaluation of the system was done both objectively using automatically created log files and stored messages, and subjectively by using paper questionnaires from patients and general practitioners (GPs). Setting: Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary health care centre in the Netherlands. The system was put at patients' disposal for a period of 6 weeks following discharge from the hospital after surgery for H&N cancer, and was additional to standard care. Participants: Head and neck cancer patients, hospital physicians, members of a hospital-based support team, GPs, district nurses and speech therapists. Main outcome measures: Actual use of the system by patients and health care providers. Patients' appreciation for each of the system's four different functions. GPs' appreciation for the system. Capability to detect potential patient problems with the system. Results: The system was used by 36 H&N cancer patients, 10 hospital physicians, 2 members of the support team, 8 GPs, 2 district nurses and 2 speech therapists. The total number of patient-sessions was 982: an average of 27.3 sessions per patient during the 6 weeks study period. In total, 456 monitoring questionnaires were completed. The support team in hospital responded with 231 actions. In 16 cases, an extra appointment was made for a patient with the hospital physician. Out of these cases, immediate action was considered necessary eight times. Patients appreciated the system highly, rating it with an average score of 8.0 on a 10-point scale. All patients used the monitoring function, and rated 'monitoring' with a mean score of 8.0 on a 10-point scale. Least used and appreciated was the 'contact with fellow sufferers' function. Only 8 out of possible 36 GPs used the system, rating it with an average of 5.6 on a 10-point scale. Conclusions: The electronic health information support system was used intensively and highly appreciated by H&N cancer patients. The system enabled the early detection of occurring health problems that required direct intervention. ICT can play an additional role in the management of patients, also in a relatively elderly and computer illiterate patient population
On A Superfield Extension of The ADHM Construction and N=1 Super Instantons
We give a superfield extension of the ADHM construction for the Euclidean
theory obtained by Wick rotation from the Lorentzian four dimensional N=1 super
Yang-Mills theory. In particular, we investigate the procedure to guarantee the
Wess-Zumino gauge for the superfields obtained by the extended ADHM
construction, and show that the known super instanton configurations are
correctly obtained.Comment: 22 pages, LaTeX, v2: typos corrected, references adde
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