RESUMO
Counselors now work in about half of all family medical practices in the United Kingdom. This article discusses the reasons for the rapid growth of this new service. Increasing collaboration between counselors and family physicians is already having major effects on health care costs and on existing mental health services. Current problems that hinder further development are identified. Solutions are proposed to help counselors who work collaboratively with family physicians and other members of the primary health care team deliver effective and efficient interventions.
Assuntos
Aconselhamento/organização & administração , Medicina de Família e Comunidade/organização & administração , Serviços de Saúde Mental/organização & administração , Atenção Primária à Saúde/organização & administração , Psicologia Clínica/organização & administração , Comportamento Cooperativo , Eficiência Organizacional , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Reino UnidoRESUMO
The antitumor activity of novel doxorubicin analogues YM1, YM3, YM4 and YM6 was evaluated against drug sensitive U937 monocytic leukemia and CCRF-CEM lymphoid leukemia cell lines, as well as drug resistant CEM/VLB100 lymphoid multidrug resistant leukemia cell line by a [3H]thymidine incorporation assay. Different antileukemic activities of these new anthracyclines were observed in our studies. These novel anthracyclines produced a dose- and time-dependent inhibition in all the leukemic cell lines tested, while YM1 and YM3 were more effective than YM4 and YM6 against all the leukemic cell lines. The antitumor activity of all these novel analogues was lower than that of doxorubicin or epidoxorubicin in drug sensitive leukemic cells. The relative resistance values (IC50 of resistant cell line/IC50 of sensitive parental cell line) of YM1, 3, 4 and 6 were 27, 7, 5 and 14 respectively. These were lower than the resistance values for ADM and EDR which were 45 and 40 respectively. YM3 had a similar antileukemic activity against the CEM/VLB100 drug resistant leukemic cell line to ADM or EDR with a lower relative resistance value and a slightly increased IC50 value. Our results suggest that YM3 may be used in high dose for the clinical treatment of leukemias with possible less cardiotoxicity as well as less drug resistance.
Assuntos
Antineoplásicos/uso terapêutico , Leucemia/tratamento farmacológico , Divisão Celular/efeitos dos fármacos , Doxorrubicina/análogos & derivados , Doxorrubicina/uso terapêutico , Resistência a Medicamentos , Ensaios de Seleção de Medicamentos Antitumorais , Epirubicina/análogos & derivados , Epirubicina/uso terapêutico , Humanos , Leucemia/patologia , Células Tumorais Cultivadas/efeitos dos fármacosRESUMO
We examined the efficacy of ciprofloxacin as an empirical treatment for fever in 97 neutropenic patients in a randomized study of ciprofloxacin and benzylpenicillin versus netilmicin and piperacillin. Benzylpenicillin was included because of evidence of in-vitro resistance to ciprofloxacin in some streptococci. Clinical response rate was similar in the two groups (46% resolution for ciprofloxacin/benzylpenicillin and 52% for netilmicin/piperacillin). Microbiological assessment revealed more pathogens eradicated by ciprofloxacin and benzylpenicillin (66%) and fewer persisting (3%) than in patients receiving netilmicin and piperacillin (52% and 13% respectively). Staphylococcus epidermidis was the commonest pathogen, accounting for 38% of all isolates and 30% of all treatment failures. There were no treatment failures or superinfections due to streptococci. More therapy-related adverse reactions were seen in patients on netilmicin and piperacillin (28%) compared with those on ciprofloxacin and benzylpenicillin (10%). The combination of ciprofloxacin and benzylpenicillin is as effective as a standard regimen of netilmicin and piperacillin, with fewer adverse effects, and is highly attractive as empirical therapy for the febrile, neutropenic host. The inclusion of benzylpenicillin prevents streptococcal-associated treatment failure.
Assuntos
Ciprofloxacina/uso terapêutico , Febre/tratamento farmacológico , Netilmicina/uso terapêutico , Penicilina G/uso terapêutico , Piperacilina/uso terapêutico , Adulto , Infecções Bacterianas/tratamento farmacológico , Ciprofloxacina/administração & dosagem , Ciprofloxacina/efeitos adversos , Quimioterapia Combinada , Humanos , Injeções Intravenosas , Pessoa de Meia-Idade , Neutropenia/complicações , Penicilina G/administração & dosagem , Penicilina G/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
A series of peripheral blood films taken from Gambian children with either acute or low-grade Plasmodium falciparum infections were examined for abnormal features of the red and white cells. Hypochromia and polychromasia with cytoplasmic stippling were predominant features in both groups. Lymphocytosis, granulocytosis and plasmacytosis were common white cell abnormalities. An additional feature in films from patients with acute malaria was the presence of numerous atypical lymphocytes. A comparison of the features in the two groups indicated that some abnormalities are associated with an acute attack of malaria and that others have a nutritional or genetic aetiology.
