Showing papers by "Bethesda Hospital published in 1984"
TL;DR: Until results with chemotherapy improve significantly, hormonal therapy is the preferred first‐line management of recurrent breast cancer, according to the authors.
Abstract: The Southwest Oncology Group has completed a study of 213 women with the first recurrence of breast cancer. Eligibility included a radical or modified radical mastectomy for cure and recurrence which had received no other form of therapy. Patients were started on tamoxifen (TAM) 20 mg daily (Phase I). Failures, or responders who subsequently failed, had an oophorectomy if the ovaries were intact, and TAM was continued (Phase II). During Phase III, eligible patients underwent an adrenalectomy, and lastly, in Phase IV, patients received chemotherapy. Responses to TAM were seen in 40% of 56 premenopausal patients, 46% of 95 postmenopausal women, and 44% of 62 patients without intact ovaries. Oophorectomy plus TAM gave responses only in premenopausal women who failed to respond on TAM or in postmenopausal patients who had a prior response to TAM. Adrenalectomy was successful in 7 of 21 patients. Chemotherapy resulted in 13% complete and 47% partial responses. Median overall survival was 108, 155, and 115 weeks, respectively, for the three patient groups. The authors believe that until results with chemotherapy improve significantly, hormonal therapy is the preferred first-line management of recurrent breast cancer.
44 citations
TL;DR: The American Society of Hospital Pharmacists Commission on Credentialing recently voted to withdraw accreditation of their residency "unless significant progress has been made in implementing a housewide unit-dose drug distribution program."
Abstract: TO THE EDITOR: The American Society of Hospital Pharmacists (ASHP) Commission on Credentialing recently voted to withdraw accreditation of our residency \"unless significant progress has been made in implementing a housewide unit-dose drug distribution program.\" This action comes as no surprise to us. We carefully chose not to provide what I call traditional unit-dose in our 360-bed hospital. If this sounds like heresy, let me continue. Our current drug distribution system is modified unit-dose.' We distribute twoto three-day supplies of completely labeled unit-dose medications to unit-dose carts, providing a system that is basically \"unit-dose\" in its presentation to nursing. We avoid liquid unit-dose because of high cost, but do extensive sterile syringe-filling to provide unit-doses of most injectable medications. Our iv admixture and total parenteral nutrition distribution is unit-dose. Modifying unit-dose has been positive for us. Our professional staff consists of 5.5 full-time equivalent pharmacists (including a working director) and one resident. Our personnel cost is 43 percent of most normal hospital pharmacies our size.' This small professional staff is totally involved in patient-oriented services through a clinical-liaison pharmacist approach.' Included in our services are: (1) an accredited poison control center for southeastern Ohio; (2) drug interaction surveillance and follow-up for all patients; (3) pharmacokinetic services-the pharmacy schedules all drug blood levels, interprets most, and provides kinetic consults as required; (4) patient education in diabetic classes, bedside medication instructions, discharge drug instructions for selected patients, and drug histories for selected patients; (5) medical staff involvementour pharmacists serve on seven medical staff committees; and (6) a drug information center for southeastern Ohio. To summarize, we have tried to professionalize our pharmacists' activities by borrowing time from unit-dose distribution methods. We believe that we have not given up effective drug distribution in the process. Abramowitz and Nold, writing in the American Journal ofHospital Pharmacy, discuss changes for drug distribution and clinical programs: \"Hospital pharmacists will be directed to cut costs in all areas, and the innovative abilities of the profession will be .... challenged. Changes in drug distribution systems will be necessary to achieve the goal of reducing costs while maintaining high standards of quality.\" It appears we have been able to accomplish much of what these authors suggest (complete clinical services, operational budget at 43 percent of the norm). I hope this letter serves as a mild form of protest. It is intended to point out the need for the ASHP to reevaluate the inflexibility of the unit-dose residency standard.