ABSTRACT
To analyse the causes that prompted health care professionals to select naltrexone to treat alcoholism. One-year multicentric, prospective study conducted with 221 doctors specialized in alcoholism treatment and analysis of data derived from 1,396 patients attended. Naltrexone was not prescribed to 446 patients. The medical barriers to the prescription of naltrexone included the mode of understanding alcoholism by doctors (20 % of doctors), patients reluctance to take naltrexone (26.9 % of patients), the presence of a concomitant condition (27.6 %) and barriers associated with health care system (6 % of patients). The logistic regression model explained why doctors tended not to prescribe naltrexone when patients had a long course of their disease or had previously received acamprosate.
Subject(s)
Alcoholism/drug therapy , Naltrexone/therapeutic use , Narcotic Antagonists/therapeutic use , Adult , Drug Utilization , Female , Humans , Male , Middle Aged , Practice Patterns, Physicians' , Prospective Studies , SpainABSTRACT
El objetivo del presente estudio es analizar algunas de las causas de la selección de naltrexona por parte de los médicos de nuestro país para el tratamiento de la dependencia alcohólica. Se diseñó un estudio prospectivo y multicéntrico en el que se incluyeron 221 médicos dedicados al tratamiento de la dependencia alcohólica y datos dobre 1.396 pacientes atendidos a lo largo de un año. En 446 casos no se prescribió naltrexona. Las barreras para dicha prescripción por parte de los médicos radicaban en su forma de entender el alcoholismo (20 por ciento de los médicos), las resistencias de los pacientes a tomar la medicación (26,9 por ciento de los pacientes), la presencia de patología concomitante (27,6 por ciento de los pacientes) y las derivadas del sistema sanitario (6 por ciento de los pacientes). El modelo de regresión logística para explicar la prescripción de naltrexona indicaba que los médicos tendían a no prescribir dicho fármaco cuando los pacientes tenían una prolongada evolución o habían recibido anteriormente acamprosato (AU)
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Spain , Narcotic Antagonists , Naltrexone , Prospective Studies , Drug Utilization , Alcoholism , Practice Patterns, Physicians'ABSTRACT
PURPOSE: Urinary retention requiring catheterization is a known complication among prostate cancer patients treated with permanent interstitial radioactive seed implantation. However, the factors associated with this complication are not well known. This study was conducted to determine these factors. METHODS AND MATERIALS: Ninety-one consecutive prostate cancer patients treated with permanent interstitial implantation at our institution from 1996 to 1999 were evaluated. All patients underwent pre-implant ultrasound and postimplant CT volume studies. Isotopes used were (125)I (54 patients) or (103)Pd (37 patients). Twenty-three patients were treated with a combination of 45 Gy of external beam radiation therapy as well as seed implantation, of which only 3 patients were treated with (125)I. Mean pretreatment prostate ultrasound volume was 35.4 cc (range, 10.0-70.2 cc). The mean planning ultrasound target volume (PUTV) was 39.6 cc (range, 16.1-74.5 cc), whereas the mean posttreatment CT target volume was 55.0 cc (range, 20.2-116 cc). Patient records were reviewed to determine which patients required urinary catheterization for relief of urinary obstruction. The following factors were analyzed as predictors for urinary retention: clinical stage; Gleason score; prostate-specific antigen; external beam radiation therapy; hormone therapy; pre-implant urinary symptoms (asymptomatic/nocturia x 1 vs. more significant urinary symptoms); pretreatment ultrasound prostate volume; PUTV; PUTV within the 125%, 150%, 200%, 250%, 300% isodose lines; postimplant CT volume within the 125%, 150%, 200%, 250%, 300% isodose lines; D90; D80; D50; ratio of post-CT volume to the PUTV; the absolute change in volume between the CT volume and PUTV; number of needles used; activity per seed; and the total activity of the implant. Statistical analyses using logistic regression and chi2 were performed. RESULTS: Eleven of 91 (12%) became obstructed. Significant factors predicting for urinary retention were the total number of needles used (p < 0.038); the pretreatment ultrasound prostate volume (p < 0.048); the PUTV (p < 0.02); and the posttreatment CT volume (p < 0.021). Two of 51 patients (3.9%) requiring 33 or fewer needles (median) experienced obstruction vs. 9 of 40 (22.5%) requiring more than 33 (p < 0.007). If the pretreatment ultrasound prostate volume was 35 cc or less (median), 3 of 43 (7%) vs. 8 of 36 (22%) with a volume greater than 35 cc experienced obstruction (p < 0.051). CONCLUSION: The number of needles required (perhaps related to trauma to the prostate) and the prostate volumes were significant factors predicting for urinary retention after permanent prostate seed implantation.
Subject(s)
Brachytherapy/adverse effects , Prostatic Neoplasms/radiotherapy , Urinary Retention/etiology , Hormones/therapeutic use , Humans , Male , Prognosis , Prostatic Neoplasms/drug therapy , Time Factors , Urinary Catheterization , Urinary Retention/therapyABSTRACT
PURPOSE: To describe our approach to intraoperative preplanning (INTRA-OP) for prostate implants and compare it to our standard method using a pre-implant volume study (STAND). METHODS AND MATERIALS: Twenty patients (10 STAND, 10 INTRA-OP) were evaluated. Time required for each step of the INTRA-OP procedure was recorded. Overall procedure times and operating room times were obtained for all sessions. Postimplant dosimetry was CT-based. RESULTS: Mean times required for each stage of the INTRA-OP procedure were as follows: Pre-implant TRUS/prostate stabilization, 26 min; image transfer, 4 min; volume outlining, 8 min; plan generation, 18 min; initial needle loading, 17 min; seed implantation, 57 min. Mean time for the implantation session was 150 min for the INTRA-OP and 120 min for the STAND groups (p = 0.002). However, this difference is negated if the preplanning volume study is included. In addition, there was a trend toward a shorter time for the INTRA-OP patients when evaluating mean total operating room times (200 min vs. 220 min; p = 0.07). The mean postimplant %D80 for the INTRA-OP patients was 104. 8% vs. 116.2% for the STAND group (p = 0.1). The corresponding %D90 values were 85.3% and 94.6%, respectively (p = 0.08). CONCLUSION: Intraoperative preplanning increased the time required for the implantation session, but appeared to decrease overall operating room time. The overall convenience of the procedure makes intraoperative preplanning an attractive technique for transperineal ultrasound-guided prostate brachytherapy.
