The objective of this study was to estimate the survival time of patients referred to the palliative care unit of the National Cancer Institute of Brazil (INCA), using the Palliative Prognostic (PaP) score, and thereby evaluate this tool in a location and population different from that in which the instrument was originally developed. In this prospective study, the instrument, after translation and adaptation to Brazilian Portuguese, was applied to 250 women consecutively referred to the palliative care unit of INCA, who had been followed up as outpatients between June 2005 and August 2006. The PaP score subdivided a heterogeneous population into three homogeneous risk groups with respect to survival time, and the differences between groups were statistically significant. The median overall survival time, calculated using the Kaplan-Meier method, for the three groups was 142 days (95% confidence interval [CI]: 118-172) for Group A, 39 days (95% CI: 28-52) for Group B, and nine days (95% CI: 1-24) for Group C. The percentage survival at 30 days for the three groups was 91.4%, 57.1%, and 0%, respectively. The longer survival time found in the first group in this study would appear to reflect the referral of patients in better clinical condition for outpatient follow-up in this institute. These data suggest that the PaP score is a consistent and easily applied instrument that allows more accurate prognostication in advanced cancer patients with no possibility of cure, irrespective of the geographical location.
mechanisms of action, and the safety and efficacy of cannabinoid treatment in this and other chronic pain syndromes. The possibility that cannabinoids may have opioid-sparing effects and may ameliorate opioid withdrawal should also be further investigated.
Background: Treatment is an important component of a comprehensive cancer control approach and its outcomes strongly depend on infrastructure, equipment, human and financial resources available. Therefore it is imperative to generate evidence-based tools to assist health policy makers from low resourced countries in planning efficient and equitable treatment services for a defined population based on what it is feasible to these settings. Methods: The intended cancer specific treatment planned and written in the patients' medical record (treatment prescription) of untreated adult cancer cases (≥18 years of age), excluding non-melanoma skin cancer, was recorded in a chronological way from 1 January 2012 onwards in a group of eight comprehensive cancer centres located in middle income countries and offering the main modalities of cancer * Affiliations are as of 1 March 2014. # Corresponding author. R. Camacho et al.990 treatment (surgery, medical oncology and radiotherapy). Results: A total of 17,713 medical records were reviewed, of which 7106 (54.2%) met the eligibility criteria. Prescription of main cancer treatment modalities were distributed as follows: 57.6% for chemotherapy (n = 4093), 56.8% for surgery (n = 4038), and 46.8% for radiotherapy (n = 3327). There was a predominance of plans consisting of combined treatment modalities over monotherapy (55.2% versus 44.8%). At the time of diagnosis 54.3% of the cancer cases had disease that had spread beyond the primary site, 41.2% were considered as having local disease and in 4.5% of the cases the information on disease extension was unknown. Conclusions: The results obtained should be seen as an approximation of cancer treatment service demand based on what it is currently practiced and therefore feasible in developing countries, particularly in middle income countries.
The change in fetal intraperitoneal pressure during intrauterine transfusion was measured in 8 fetuses on 13 occasions. On 1 1 occasions a rise in pressure averaging 7 mm. Hg was found. This was not thought to be sufficient to jeopardize the umbilical circulation seriously,
I The hypnotic efficacy and the effect on the condition after morning awakening of midazolam 15 mg and of triazolam 0.5 mg were studied in a multicentre, double-blind cross-over study in 198 out-patients with sleeping difficulties of various origin. 2 The subjects received each drug for two consecutive nights, and completed a questionnaire each day on awakening. 3 Both midazolam and triazolam significantly shortened the sleep-onset latency, reduced the number of awakenings, and increased the total sleep time. 4 The state on awakening was also significantly improved after both compounds for several self-rated items. There was a difference only with regard to the patients' feeling of being under drug influence, which was reported as being significantly more marked after triazolam. 5 In conclusion, both compounds were effective and well tolerated in the doses used, only a few side-effects being reported.
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