Subject(s)
Aromatase Inhibitors/adverse effects , Breast Neoplasms/drug therapy , Estradiol/administration & dosage , Female Urogenital Diseases/chemically induced , Female Urogenital Diseases/drug therapy , Administration, Intravaginal , Aromatase Inhibitors/therapeutic use , Breast Neoplasms/enzymology , Female , Female Urogenital Diseases/enzymology , Female Urogenital Diseases/pathology , HumansABSTRACT
AIMS: As a result of the rising prevalence of breast cancer and improved adjuvant treatment strategies, oncologists are faced with an ever-increasing workload of providing long-term follow-up care for early-stage breast cancer patients. In order to cope with these growing demands, innovative follow-up strategies are urgently required. MATERIALS AND METHODS: To explore if patient transfer back to the family physician for follow-up was a potential option, a prospective programme of planned discharge was established for all patients who had completed adjuvant chemo/radiotherapy or had started adjuvant endocrine therapy. Patient and family physician information packages were also provided. RESULTS: Between April and August 2005, of the 193 patients assessed for transfer back to the family physician for follow-up care, transfer was possible in 43%. Fifty-seven per cent (or 110 patients) were unsuitable for transfer back to the family physician. The reasons cited among those deemed unsuitable for transfer were as follows: clinical trial enrollment (50.9%), ongoing endocrine treatment (31.8%), new symptoms (6.3%), and patient refusal (0.9%). In both discharged and non-discharged groups, patients were also frequently being followed by other oncologists (surgical and/or radiation). CONCLUSION: Transfer of care back to family physicians for follow-up may offer a strategy to control workload volumes, and thus enable oncologists to focus their efforts on newly diagnosed and advanced-stage patients with more complex patient care needs.
Subject(s)
Breast Neoplasms/therapy , Continuity of Patient Care , Long-Term Care/methods , Physicians, Family , Professional Practice , Referral and Consultation , Adult , Aged , Aged, 80 and over , Cancer Care Facilities , Delivery of Health Care/methods , Female , Humans , Medical Oncology , Middle Aged , Patient Discharge , Prospective Studies , WorkforceABSTRACT
We treated 2 male patients with spontaneous bladder rupture following enterocystoplasty. Both adolescents had neurogenic bladders that were managed with enterocystoplasty and an artificial urinary sphincter. With prompt aggressive therapy including intravenous antibiotics, laparotomy and closure of the perforation serious sequelae were averted. Cystography failed to demonstrate the lesion in either case. The failure of cystography to diagnose these ruptures is especially disturbing. These patients demonstrate that in augmented bladders a high index of suspicion may be necessary to diagnose ruptures clinically. Early diagnosis is critical so that aggressive therapy may be instituted.
Subject(s)
Intestines/transplantation , Postoperative Complications , Urinary Bladder, Neurogenic/therapy , Urinary Bladder/injuries , Adolescent , Humans , Male , Rupture, Spontaneous , Urinary Bladder/surgery , Wounds, PenetratingABSTRACT
Following injection of histidine (as 1-histidine monohydrochloride, 500 mg/kg, IP) rats showed a suppression of total food intake within the first 2 hours of a 12 hour daily feeding period but not if the rats were adapted to a 4 hour daily feeding period. Furthermore, rats adapted to a nocturnal as compared to a diurnal 12 hour feeding period showed a greater response (50% vs. 20% suppression of feeding) to histidine. Overall, within an experiment, food intake suppression correlated with the histidine dose (0, 125, 250, 375 and 500 mg/kg; for mean response r(3) = 0.90, p less than 0.05) although the lowest dose measured to be effective in a cross-over design experiment was 375 mg/kg. No differential effect upon protein or carbohydrate intake was observed in any of the studies. The effects of injections of 250 and 500 mg/kg histidine on food intake were associated with significant elevations of brain histidine and histamine. We conclude that histidine, possibly by changes in brain histidine, influences total food intake but not macronutrient selection.
