Showing papers by "John F. Forbes published in 1992"

The Cost of Stroke to the National Health Service in Scotland

Abstract: Scottish National Health Service (NHS) stroke costs have been estimated for 1988 using accounting methods, updating a similar study for 1974. Stroke mortality in Scotland decreased by 36% between 1974 and 1988, but stroke NHS costs decreased only slightly, from 4.7 to 4.3% of total NHS costs. Stroke bed days as a proportion of total bed days rose from 6.4% in 1974 to 7.5% in 1988 and stroke hospital costs were 5.5% of total hospital costs of £4,600 per discharge. This figure is more than twice a preliminary Diagnosis Related Group (DRG 14) price suggested to Scottish Health Board managers in 1990 as an indicative charge for non-resident stroke patients.

Long-term effects of adjuvant chemotherapy in breast cancer.

Abstract: Late effects of adjuvant chemotherapy (ACT) may include second malignant neoplasms (SMN), cardiotoxicity and ovarian suppression. Effects on the biology of residual tumour may be important in protocol design. Studies of SMN need large and reliable data sets. The leukaemia risk with current ACT is likely to be less than a five-fold increase. Leukaemia is predominantly a result of alkylating agents and peaks before 10 years. Solid SMN result also from radiotherapy and this risk continues after 10 years. Cardiotoxicity can be caused by anthracyclines but should not be a problem with current ACT regimens. It can be reduced by careful monitoring and by the cardioprotector ICRF-187. Amenorrhoea is a crude marker of ovarian suppression which may explain conflicting data on its relationship to outcome after ACT. Ovarian suppression following ACT is more likely and more permanent in older premenopausal women, but only explains a part of the ACT effects on outcome. Effects of early ACT on residual tumour are import...