Showing papers by "Atlantic Health System published in 2005"
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TL;DR: At initial evaluation, children with constipation have a lower quality of life than do children with inflammatory bowel disease or gastroesophageal reflux disease and self-reported lower scores may be a reflection of impaired physical ability.
Abstract: Objective: The objective of this study was to investigate the effect of chronic constipation on children's quality of life Methods: From October 2002 to November 2003, 224 children (140 male, 84 female, aged 106 ± 29 years) and 224 parents were evaluated by a health related quality of life tool during initial outpatient consultation Children with constipation (n = 80) were compared with controls with inflammatory bowel disease (n = 42), controls with gastroesophageal reflux disease (n = 56), and with healthy children (n = 46) Results: Children with constipation had lower quality of life scores than did those with inflammatory bowel disease (70 versus 84; P < 005), gastroesophageal reflux disease (70 versus 80; P < 005), and healthy children (70 versus 88; P < 005) Children with constipation reported lower physical scores than did inflammatory bowel disease patients (75 versus 85; P < 002), gastroesophageal reflux disease patients (75 versus 85; P < 005), or healthy children (75 versus 87; P < 005) Parents of children with constipation reported lower scores than did their children (61 versus 70; P < 005) Children with constipation had longer duration of symptoms than did the controls with inflammatory bowel disease and gastroesophageal reflux disease (438 months versus 142 months; P < 0001) Prolonged duration of symptoms fur children with constipation correlated with lower parent-reported scores (P < 0002) Conclusions: At initial evaluation, children with constipation have a lower quality of life than do children with inflammatory bowel disease or gastroesophageal reflux disease Self-reported lower scores may be a reflection of impaired physical ability Parental perceptions of low quality of life are probably impacted by the duration of their child's symptoms and by family members with similar complaints Practitioners should be aware of the high level of parental concern and the relatively low self-reported and parent-reported quality of life in children with chronic constipation as they plan therapy
221 citations
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TL;DR: A technique is described that corrects for the daily prostate motion, allowing for extremely precise prostate cancer treatment and has significant implications for dose escalation and for decreasing rectal complications in the treatment of prostate cancer.
Abstract: Purpose Multiple studies have indicated that the prostate is not stationary and can move as much as 2 cm. Such prostate movements are problematic for intensity-modulated radiotherapy, with its associated tight margins and dose escalation. Because of these intrinsic daily uncertainties, a relative generous “margin” is necessary to avoid marginal misses. Using the CT-linear accelerator combination in the treatment suite (Primatom, Siemens), we found that the daily intrinsic prostate movements can be easily corrected before each radiotherapy session. Dosimetric calculations were performed to evaluate the amount of discrepancy of dose to the target if no correction was done for prostate movement. Methods and materials The Primatom consists of a Siemens Somatom CT scanner and a Siemens Primus linear accelerator installed in the same treatment suite and sharing a common table/couch. The patient is scanned by the CT scanner, which is movable on a pair of horizontal rails. During scanning, the couch does not move. The exact location of the prostate, seminal vesicles, and rectum are identified and localized. These positions are then compared with the planned positions. The daily movement of the prostate and rectum were corrected for and a new isocenter derived. The patient was treated immediately using the new isocenter. Results Of the 108 patients with primary prostate cancer studied, 540 consecutive daily CT scans were performed during the last part of the cone down treatment. Of the 540 scans, 46% required no isocenter adjustments for the AP-PA direction, 54% required a shift of ≥3 mm, 44% required a shift of >5 mm, and 15% required a shift of >10 mm. In the superoinferior direction, 27% required a shift of >3 mm, 25% required a shift of >5 mm, and 4% required a shift of >10 mm. In the right–left direction, 34% required a shift of >3 mm, 24% required a shift of >5 mm, and 5% required a shift of >10 mm. Dosimetric calculations for a typical case of prostate cancer using intensity-modulated radiotherapy with 5-mm margin coverage from the clinical target volume (prostate gland) was performed. With a posterior shift of 10 mm for the prostate, the dose coverage dropped from 95–107% to 71–100% coverage. Conclusion We have described a technique that corrects for the daily prostate motion, allowing for extremely precise prostate cancer treatment. This technique has significant implications for dose escalation and for decreasing rectal complications in the treatment of prostate cancer.
135 citations
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TL;DR: This work sought to understand how the emergence of VN resistant microbes has changed the antibiotic management of children's febrile neutropenic FN.
Abstract: Purpose
The increasing frequency of Gm+ infections in febrile neutropenic (FN) patients has resulted in increased use of vancomycin (VN). Likely as a result, VN-resistant Enterococcus (VRE) has become a significant concern in FN patients. We sought to understand how the emergence of VN resistant microbes has changed the antibiotic management of pediatric FN.
Methods
A questionnaire was distributed by e-mail to responsible investigators of the Children's Oncology Group.
Results
One hundred and thirty responses were analyzed. Forty-four percent initially used monotherapy, with 82% of those using ceftazidime. Twenty-seven used VN with another agent, generally ceftazidime. After the emergence of VRE and VN-resistant staphylococcus (VRS), monotherapy increased to 58%. Ceftazidime continued to be most frequently used. There was a 57% reduction in the use of VN with 88% of centers not currently using VN in their initial treatment of FN. Forty-seven percent of the centers that continue to use VN have VRE, while 90% that have discontinued its use have VRE/VRS.
Conclusions
Ours is the first study to survey current practices in the treatment of pediatric FN and to document changes in practice patterns due to emerging antibiotic resistance patterns. We demonstrate increased use of monotherapy for FN, and a 57% decrease in the use of VN. Local considerations influence antibiotic choices with a significant difference in VRE prevalence between those centers that continue to use VN as compared to those that have discontinued it. © 2004 Wiley-Liss, Inc.
9 citations