Inaug.-diss.--Halle-Wittenberg. / Lebenslauf. "Literaturübersicht": p. [11]-17. Bibliographical foot-notes.

Inaug.-diss.--Halle-Wittenberg. / Lebenslauf. "Literaturübersicht": p. [11]-17. Bibliographical foot-notes.

The adoption of the Lions Gate Hospital Drug Formulary by the British Columbia Hospital Association for distribution and use in all provincial hospitals endorses the growing trend toward regionalization of drug information. Several aspects of this Formulary were investigated in the present study with the objective of designing a text even more applicable to the varied needs of the province. The format of the Formulary and a mechanism for regularly evaluating and updating the information therein were the major areas receiving consideration. One major change in format proposed is the increase in the number of drug monographs to approximately 600 from the present 300 entries. This increase is based on the requests for additional drugs from the representative hospitals sampled in the province. Changes in the format of individual monographs include an expansion of information under the heading "Mode of Action", that an additional section on "Instructions to the Patient" be added to facilitate effective instructions for self-administration in ambulatory services, that each monograph receive a Canadian Drug Identification Code reference and that the information in each monograph be referenced where possible to the primary literature source. Changes in the format of the overall Formulary include a cross-index of monographs to manufacturers' brand names, a bibliography of the referenced information and a "Mini" Formulary format for use on individual hospital wards. The latter recommendation is made in recognition of the potential bulk of the overall Master Formulary which would make it awkward for efficient and frequent use. In this respect, it is anticipated that one Master Formulary containing all 600 eventual monographs, the bibliography for each and the various indices be made available in each hospital for resource reference. On each ward a complete Formulary of all drug monographs but not the accompanying bibliographies would be available. Studies showed that something less than 100 of these drugs (less than 20 percent) were used with any frequency on any specialty ward studied. Therefore, a "Mini" Formulary containing only the monographs of drugs frequently used in a specialty area would make the information more readily available in that service. Changes in printing format also are recommended with the objective of reducing the bulk of the proposed Formulary. A regular updating mechanism must be activated to keep the information in the Formulary current. Such a mechanism related to an annual literature evaluation assignment by the senior students of the Faculty of Pharmaceutical Sciences, University of British Columbia, is proposed. Based on this academic exercise, two types of updating are identified. First, a complete evaluation and referencing of the existing monograph information is required. Second, annual updating of this information from current literature should be maintained. To evaluate, revise and condense the students' evaluations to monograph format, a "service" component of faculty instructor time and of stenographer time have been projected. It is anticipated that the provision of approximately one-half time instructor per year and one-tenth time stenographer will be required on a "service" basis to enable the regular updating of the current Formulary as defined above. The arrangement for a Medical Review Board to review the evaluated monographs from a clinical validity standpoint also should be made. The above projections are based on studies related to the evaluation and updating of 100 drug monographs during 1972-73. A final recommendation is that the basis for generating, updating and additional referencing of the Drug Formulary should be a provincial Drug Information Centre. / Pharmaceutical Sciences, Faculty of / Graduate

Spec. Litt. Inaug.--Amsterdam. / Includes bibliographical references.

No

At present, there is no cure for bone metastasis. The current goals in patient care are to palliate pain, prevent pathological bone fracture and increase the strength and function of bone, so as to extend the life expectancy and maintain a good quality of life. Bisphosphonate treatment is the currently standard therapy of bone metastasis and is commonly used by physicians; it alleviates the tumour-induced hypercalcemia in 90% of patients and reduces the metastatic bone pain in 50% of patients. Moreover, it also prevents the pathological fracture of the affected bones. However, while effective, bisphosphonate injections are very costly, though its oral formulation is less expensive it is also less efficacious, and causes gastrointestinal discomfort. Furthermore, prolonged use of bisphosphonate treatment may lead to certain adverse effects, including hypocalcemia. These factors will prohibit the longterm use of such medication as it can negatively affect the treatment outcome. / Based on enormous medical potentials illustrated by the aforementioned findings, BBYNG deserves wider clinical application, large-scale clinical study on its preventive effect against bone metastasis and detailed investigation of its mode(s) of action in the body. / Based on the above-described understanding of Chinese medicine and bone metastasis, supplementing the kidney and strengthening bone could be the basic principle for the treatment of bone metastasis using Chinese medicine. In view of this theory, and in addition to the clinical observation and a thorough search of the available literature, we selected relevant kidney-tonifying Chinese herbs, namely (Fructus Ligustri Lucidi), (Rhizoma Drynariae), (Herba Epimedii), (Psoralea Corylifolia) and wide-spectrum anticancer herbs (Herba Hedyotidis Diffusae) for the preparation of a combined formula--BBYNG. / Chinese medicine has long been used to treat cancers. Its advantages reside in its holistic properties, which bring palliative, corrective and convalescing functions against damage caused by radiotherapy, chemotherapy and surgery. These features position Chinese medicines as the adjuvant to orthodox cancer treatment. During the late stage of tumour development, when standard therapy is no longer effective, Chinese medicine plays a critical role as an integrated therapy. Searching for a safe, inexpensive and effective Chinese medicine preparation suitable for prolonged use as adjunct therapy in late cancer cases is of paramount importance. / Clinical results. Both Chinese medicine and Western medicine treated patients showed no significant change in their blood parameters or liver and kidney examinations before and after drug administration; Male subjects on BBYNG, their bone mass density remained stable after 6 months treatment and the subjects on OSTAC showed slightly decreased In females, subjects on BBYNG remained stable, but subjects on OSTAC slightly increased. / Clinical study. The study was designed as a randomized, parallel-group comparison between BBYNG formula and Bisphosphonate. The patients who meet the inclusion/exclusion criteria were randomly assigned to receive either BBYNG granules, which was prepared by a GMP manufacturer, or Clodronic acid. The treatment period was 6 months (24 weeks). For both groups, various clinical parameters such as body functions, blood examinations, bone density (BMD) assessment, X-ray examinations, pain intensity and quality of life were evaluated and compared. / Conclusions. (1) As an adjuvant to patients with bone metastases, BBYNG is effective in relieving the metastatic bone pain, improving the quality of life. (2) In the animal model, BBYNG reduced the metastatic bone damage, prolonged the survival and enhanced the T lymphocyte immunity in the tumour-bearing mice. (3) In vitro study on the breast and lung cancer cell lines showed that BYYNG could induce apoptosis and prevent tumour cell invasion. It suggests that BYYNG may restrict tumour growth and development, thus reducing the occurrence of bone metastasis. / In accordance with Chinese medicine, bone metastasis can be categorized into "bone tumour" "bone erosion" "bone wilting" "bone necrosis" and "bone impediment". The main cause of bone metastasis is twofold: cancer toxicity, and in Chinese medicine theory, the kidney governs the bone marrow, if the kidney is not functioning in balance, then the bone will become weak. Cancer toxicity is the "pathogenic cause" to skeletal metastases, while kidney weakness decreases the body defence against the cancer. A vicious cycle ensues when cancer and kidney deficiency and bone weakness occurs simultaneously coincidently and worsens the conditions. / In vitro study on tumour cell lines. The anticancer effects of different concentrations of BBYNG formula and various single components against human breast cancer and lung cancer cell lines were evaluated by cell viability test (MTT assay), cell apoptosis test and invasion suppression test. / In vitro study results. BBYNG and the aqueous extracts of its component herbs at very low drug concentrations stimulated the growth of three tumour cell lines tested. When the concentrations were slightly increased, they showed an inhibitory effect on cancer cell proliferation. As the drug concentrations further increased, the extracts showed cytotoxic effects on these tumor cells. At the noncytotoxic dose, the extracts could trigger apoptosis and enhance the caspase-3 activity in all three tumour cell lines. In addition, at this "non toxic" concentration, the extracts markedly inhibited the in vitro invasive property of the 4T1 breast cancer cell lines in our Matrigel invasion model. Thus these in vitro results suggested that BBYNG possess anticancer, invasion-inhibitory and anti-metastatic activities. / In vivo animal study results. (Tumour growth was slower in the BBYNG treatment group when compared to the OSTAC and control groups, but this was not significantly difference) BBYNG significantly delayed tumour growth in tumour bearing mice, but it did not minimize the tumour size markedly. Moreover, BBNYG did minimize the mobility restriction caused by tumours, reduce the damage to bones, prolong the survival time and enhanced the T lymphocyte immunity. / In vivo animal study. A well-established animal model for breast cancer was used to evaluate and compare the pharmacological effects of BBYNG formula and Clodronic acid, as shown by different indicators such as tumour progression, animal's mobility, survival time, bone metastasis-induced fracture intensity and the immunological status of the tumour-bearing mice. / Malignant tumour is characterized by early metastasis. Among them 37 to 80 (depending on which type of cancer) patients show tendency of bone metastasis. Bone metastasis is usually accompanied by various complications, such as severe pain, pathological bone fracture, hypercalcemia, and bone marrow suppression, which can substantially affect the quality of life of the patients. Thus, the prevention and treatment of bone metastasis in cancer is an issue worth pursuing. / Malignant tumours leading to high mortality and morbidity are a serious threat to human health. It is the leading cause of death in China. In Hong Kong, there are over 20 thousand new cancer cases and more than 1100 people die due to cancers every year. / Study objectives. To elucidate the efficacy and some pharmacological aspects of BBYNG in regard to the treatment of bone metastasis through clinical observation and different laboratory experiments. This study would be of significant reference value to the disease-oriented drug formulation and application, mechanistic study and research methodology of the treatment of bone metastasis using Chinese medicines. / The clinical and laboratory experimental results are summarized as below: / The research study is composed of three parts, the clinical study, in vivo animal study and in vitro study on tumour cell lines. The research methods used are as follows: / Those on BBYNG treatment showed more a stable and satisfactory quality of life than those in the Western medicine-treated group. For the Clodronic acid treatment group, patients generally showed worsened symptoms and quality of life deteriorated. The ECOG index of the BBYNG group was statistically better than that of the Clodronic acid group. Within the 72-week clinical observational period, the mortality of Clodronic acid group is significantly higher that of the BBYNG group. The effects of BBYNG group as presented in relieving the pain-induced influence on patients' emotion, interpersonal relationship and entertainment was more pronounced than that in the Clodronic acid group. / Wu Ka. / 論文(哲學博士)--香港中文大學, 2006. / 參考文獻(p. 299-324). / Adviser: Leung Ping Chung. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1570. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / School code: 1307. / Lun wen (zhe xue bo shi)--Xianggang Zhong wen da xue, 2006. / Can kao wen xian (p. 299-324). / Wu Ka.

Thesis (doctoral)--University of Arizona, 2002. / Includes bibliographical references (p. 464-478).

The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.