Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 9 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Background The effects of Human Immunodeficiency Virus (HIV) on the Overall Survival (OS) in patients diagnosed with Acute Myeloid Leukaemia (AML) are not well documented. All studies to date have been with small sample sizes and based on collections of case studies from different facilities with different treatment protocols, as a result it has been difficult to draw definitive conclusions. Method This retrospective record review of a cohort of AML patients (n=304) treated at a single site between 2000 and 2017 was conducted. Age (16-93 years), gender (Male: n=157 ; Female: n=138), ECOG PS (Eastern Co-Operative Oncology Group Performance Status), FAB (French-American-British) staging, blast count, CD4 count, HIV viral load, financial status, response to treatment as measured on bone marrow biopsy and OS were measured. The OS was compared for HIV status. Further comparisons were conducted in a sub-group where age, ECOG PS and FAB staging were controlled. Results 210 (69.07%) were HIV negative, 31 (10.1%) were HIV positive, 63 (20.7%) had an unknown HIV status. A statistically significant difference was found between HIV negative and HIV positive groups’ OS (563 vs. 121 days ; P<0.01)(HR 2.02 ; 95% CI 1.36 - 2.99) in the main analysis. This difference was also noted when patients who were not treated for AML were excluded from the comparison (OS, 740 vs 194 days, P<0.01)(HR, 2.10 ; 95% CI 1.26-3.50). In the main analysis mean ECOG PS was better in the HIV negative population compared to the positive population (1.80 vs. 2.06). In the controlled group sub-study, where Age, ECOG PS and FAB staging were controlled, the OS between HIV positive and HIV negative patients was not statistically significant (141 days vs. 121 days) (P=0.17; 95% CI). CD4 counts ranged from 29 – 1416, with a mean CD4 of 432 on presentation. No statistically significant difference could be found between CD4 and OS (HR, 1.0 ; 95% CI 0.99-1.00), possibly due to very few patients presenting with a low CD4 count. HIV Viral Loads ranged from <100 – 106640. Similarly, no statistically significant difference was found between HIV Viral Load and OS (HR 0.99 ; 95% CI 0.99-1.00). Conclusion HIV has a negative impact upon the OS of patients with AML. HIV appears to impact on OS as a chronic comorbidity by affecting ECOG PS on presentation, reducing their chance of being treated as well as possibly reducing a patients’ functional reserve. This impact does not appear to be as a result of a direct interaction between the HIV and AML disease processes, as when controlling for other factors that may influence OS there is no statistically significant difference in OS between HIV positive and negative patients. / Dissertation (MSc (Medical Oncology))--University of Pretoria, 2019. / This thesis/dissertation is under embargo until September 2023. / Medical Oncology / MSc (Medical Oncology) / Restricted

nÃo hà / O cÃncer afeta o paciente de forma abrangente, repercutindo na sua qualidade de vida. As tecnologias em saÃde, como a utilizaÃÃo de dispositivos de infusÃo contÃnua na administraÃÃo de antineoplÃsicos, visam favorecer o tratamento, repercutindo positivamente no bem estar dos pacientes. A pesquisa objetivou avaliar a qualidade de vida de pacientes oncolÃgicos que utilizam dispositivo para infusÃo contÃnua de antineoplÃsicos a partir da escala WHOQOL-bref; e os objetivos especÃficos foram: Caracterizar os pacientes oncolÃgicos que utilizam dispositivo para infusÃo contÃnua de antineoplÃsicos, quanto aos aspectos sociodemogrÃficos e clÃnicos; identificar os domÃnios de qualidade de vida afetados nos pacientes que utilizam dispositivo para infusÃo contÃnua antineoplÃsicos; comparar os domÃnios de qualidade de vida dos pacientes no primeiro e terceiro ciclo de aplicaÃÃo dos antineoplÃsicos. Estudo descritivo, exploratÃrio, quantitativo, longitudinal do tipo painel, realizado no perÃodo de abril a julho de 2013, com 28 pacientes em tratamento antineoplÃsico com a utilizaÃÃo de dispositivo de infusÃo contÃnua, de uma operadora de plano de saÃde, em Fortaleza, CearÃ. A coleta de dados ocorreu atravÃs de visita domiciliar, durante o primeiro e terceiro ciclos de administraÃÃo do antineoplÃsico, com aplicaÃÃo de dois questionÃrios: sociodemogrÃficos e clÃnicos; e avaliaÃÃo de qualidade de vida WHOQOL-bref. O tratamento dos dados foi realizado com auxÃlio de um software estatÃstico STATA. Aplicou-se o coeficiente Alfa de Cronbach, para avaliaÃÃo da consistÃncia interna das respostas, o teste de igualdade de mÃdias Wilcoxon para dados pareados e o teste de Qui-quadrado de TendÃncia linear. A correlaÃÃo dos domÃnios foi feita atravÃs do coeficiente de CorrelaÃÃo Linear de Spearman. Predominaram na amostra (n=28), mulheres (53,6%), faixa etÃria 51 a 60 anos (32,1%), casadas (60,7%), catÃlicas (67,9%), exercendo atividade laboral (71,5%). A neoplasia maligna predominante foi a de cÃlon e reto (57,2%), com metÃstase (53,6%) hepÃtica. O tratamento cirÃrgico mais empregado foi a colectomia (39,3%). O protocolo mais utilizado foi o FOLFOX (67,9%), com intenÃÃo paliativa (57,1%). Os efeitos indesejados mais evidenciados foram os gastrointestinais em associaÃÃo com fadiga (39,3%). O Ãndice de alfa de Cronbach atestou a confiabilidade do estudo. Avaliando a qualidade de vida quanto Ãs mÃdias dos itens globais e domÃnios da escala, a percepÃÃo quanto a qualidade de vida foi considerada regular; e a satisfaÃÃo com a saÃde ruim, em ambos os ciclos do tratamento. Quanto a avaliaÃÃo dos domÃnios, o de maior mÃdia foi o das relaÃÃes sociais, e o de menor, o psicolÃgico. A avaliaÃÃo da qualidade de vida foi vista como regular, em ambos os ciclos. O dispositivo favorece aspectos relacionados à independÃncia, desempenho de atividades diÃrias e laborais, porÃm nÃo à isento de aspectos negativos, influenciando a percepÃÃo dos pacientes, pelo medo do desconhecido, presenÃa de um aparato no cotidiano, desconforto quanto à movimentaÃÃo. Foi possÃvel concluir que nenhum fator isoladamente vai influenciar positiva ou negativamente a qualidade de vida de pacientes oncolÃgicos, independente do momento vivido. à importante saber os determinantes neste sentido, permitindo a implementaÃÃo de estratÃgias para preservar a qualidade de vida desta clientela. / Cancer affects the patient in an extensive way, reverberating in his quality of life. The technology in health, such as the use of continuous infusion device in the administration of antineoplastic aimed at favoring the treatment, positively reverberating in the welfare of the patient. The research aimed at evaluating the quality of life of the patient who use an antineoplastic continuous infusion device from the WHOQOL-bref scale; and the specific objectives were: to identify the domains of quality of life affected in the patients who use the antineoplastic continuous infusion device, as to the socio-demographic and clinical aspect; to compare the domains of quality of life of the patients in the first and in the third cycle of application of antineoplastics. It is a descriptive, exploratory, quantitative, longitudinal study of panel type, made from April to July 2013, with 28 patients under antineoplastic treatment with the use of continuous infusion device, of a health plan operator, in Fortaleza, CearÃ, Brazil. The data collection was made through home visits during the first and the third cycle of administration of antineoplastics, with the application of two questionnaires: socio-demographic and clinical; and the WHOQOL-bref evaluation of quality of life. The treatment of the data was made with the help of STATA statistics software. The CronbachÂs alfa coefficient was applied, for the evaluation of the internal consistence of the answers, the Wilcoxon test of average equality for paired data and the Chi-Squared test of linear tendency. The correlation of the domains was made through the coefficient of SpearmanÂs linear correlation. The following items predominated in the sample (n=28) were: women (53.6%), age range from 51 to 60 years (32.1%), married (60.7%), catholic (67.9%), working (71.5%). The predominant malign neoplasia was of colon and rectum (57.2%), with hepatic metastasis (53.6%). The most employed surgical treatment was colectomy (39.3%). The most used protocol was FOLFOX (67.9%), with palliative intention (57.1%). The most evident unwelcome effects were the gastrointestinal ones associated with fatigue (39.3%). The CronbachÂs alfa coefficient attested the reliability of the study. Evaluating the quality of life concerning the average of the global items and domains of the scale, the perception as to the quality of life was considered regular; and the satisfaction with the bad health, in both cycles of the treatment. As to the evaluation of the domains, the highest average was the one concerning the social relations and the lowest average was the psychological domain. The evaluation of the quality of life was seen as regular, in both cycles. The tool favors aspects related to independence, performance of daily and labor activities, but it is not exempt of a negative aspect, influencing the perception of the patients, by the fear of the unknown, the presence of a device in the daily life, discomfort related to moving. It was possible to conclude that no isolated factor will positively or negatively influence in the quality of life of oncological patients, independently of the moment lived. It is important to know the determinants in this sense, allowing the implementation of strategies to preserve the quality of life of this clientele.

Orientador: Antonio Carlos Pereira / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-23T13:25:27Z (GMT). No. of bitstreams: 1 Carvalho_EloisaMullerde_M.pdf: 2697999 bytes, checksum: 9e51d9af8c1c66d77cd1d7a6acd1b261 (MD5) Previous issue date: 2013 / Resumo: Este estudo é composto por um artigo, cujo objetivo principal foi investigar a eficácia dos métodos de prevenção e tratamento da mucosite oral induzida pela terapia do câncer em crianças e adolescentes. Trata-se de uma revisão sistemática de literatura (RSL) realizada por meio da análise retrospectiva de estudos primários que focalizaram a prevenção e o tratamento da mucosite oral. Os procedimentos metodológicos foram baseados nas recomendações da Cochrane Collaboration (Clarke, 2001), caracterizada pela análise criteriosa dos estudos selecionados, conforme o nível de evidência e relevância na área, síntese e interpretação dos dados. Capitulo 1: Um total de 1.394 registros potencialmente relevantes foram encontrados em seis bases de dados. Do total de registros, 254 estavam duplicados. Assim, os resumos de 1.140 estudos foram lidos, dos quais 1.038 referências foram excluídas com base nos resumos, e 102 foram selecionados para análise de texto completo, dos quais 4 foram elegidos para a inclusão da revisão sistemática. Embora a busca tenha sido realizada com a finalidade de encontrar estudos tanto de prevenção quanto de tratamento de mucosite oral, nenhum estudo de prevenção mostrou-se eficaz. As evidências de eficácia desta revisão sistemática foram atribuídas somente a vitamina "E" e laserterapia, ambas modalidades de tratamento para mucosite oral / Abstract: This study consists of an article whose main objective was to identify the effectiveness of the methods of prevention and treatment of oral mucositis induced by cancer therapy in children and adolescents. It is a systematic literature review (SLR) performed by retrospective analysis of primary studies that focused on the prevention and treatment of oral mucositis. The methodological procedures based on the recommendations of the Cochrane Collaboration (Clark, 2001), characterized by careful analysis of the selected studies, as the level of evidence and relevance in the area; synthesis and interpretation of data. Chapter 1): A total of 1,394 entries were found in the potentially relevant six data bases, of which 254 were duplicated. Thus, abstracts of 1,140 studies were read, of which 1,038 references were excluded on the basis of the abstracts, and 102 were selected for full-text analysis, from which 4 were selected for inclusion in the systematic review. Although the search has been performed with the aim of finding studies both as preventive treatment of oral mucositis, none prevention study was effective. The evidence of efficacy of this systematic review were assigned only to vitamin "E" and laser therapy, both treatment modalities for oral mucositis / Mestrado / Odontologia em Saude Coletiva / Mestra em Odontologia em Saúde Coletiva

Background: Few studies have investigated the relationship between physician and patient-assessed performance status (PS) in blood cancers. Methods: Retrospective analysis among 1418 patients with haematologic malignancies seen at Dana-Farber Cancer Institute between 2007 and 2014. We analysed physician-patient agreement of Eastern Cooperative Oncology Group PS using weighted kappa-statistics and survival analysis. Results: Mean age was 58.6 years and average follow-up was 38 months. Agreement in PS was fair/moderate (weighted kappa = 0.41, 95% CI 0.37-0.44). Physicians assigned a better functional status (lower score) than patients (mean 0.60 vs 0.81), particularly when patients were young and the disease was aggressive. Both scores independently predicted survival, but physician scores were more accurate. Disagreements in score were associated with poorer survival when physicians rated PS better than patients, and were modified by age, sex and severity of disease. Conclusions: Physician-patient disagreements in PS score are common and have prognostic significance.

No description available.

Introdução: A reconstrução de cabeça e pescoço é desafiadora por ser região exposta e por abrigar funções essenciais à vida. Apesar de existirem estudos clínicos do uso do retalho supraclavicular, ainda há duvidas sobre o real papel do retalho na reconstrução de cabeça e pescoço. Objetivo: Este estudo avalia as complicações resultantes do uso do retalho fasciocutâneo supraclavicular (RFSC) nas reconstruções de cabeça e pescoço após ressecções oncológicas em pacientes submetidos a reconstruções imediatas ou de resgate. Material e Método: Um estudo retrospectivo, incluindo a casuística de 87 casos de reconstrução de diversos defeitos em cabeça e pescoço, foi realizado. O retalho supraclavicular foi utilizado nas reconstruções imediatas ou em resgate, caso tenha havido alguma complicação na reconstrução primária que necessitasse de novo retalho. Os seguintes dados foram coletados dos registros médicos: idade, diagnóstico, tempo de hospitalização, seguimento e complicações. A análise estatística incluiu o teste exato de Fisher e o teste da razão de verossimilhança para análise dos dados. O nível de significância foi estabelecido em p < 0,05. Resultados: Entre julho de 2008 e março de 2015, dos 87 pacientes estudados, 32 (29,4%) eram do sexo feminino. A idade variou de 29 a 88 anos, com média de 62,55 ± 12,83 anos. Vinte e quatro retalhos supraclaviculares (27,5%) desenvolveram necrose distal, sendo necessária reabordagem cirúrgica em 21 deles (24%). Não foram observadas diferenças estatisticamente significantes na média de complicações entre o grupo de reconstrução primária e de resgate utilizando o RFSC (28% versus 25%, p = 0.816). A comparação da taxa de complicações entre os grupos de reconstruções intraorais e cutâneas também não demostrou diferença significante (27% versus 28%, p = 0.932). A média de internação foi de 17 dias +- 18. Em três casos, foi necessário o uso de enxertia cutânea para fechamento da área doadora. Todos os pacientes tiveram reconstruções funcionais. Alguns fatores, como dobradura da extremidade do retalho (p = 0,002), associação com retalho livre (p = 0,002) e radioterapia previa (p = 0,04) foram associados com aumento significante do número de complicações, enquanto que o tabagismo (p = 0,43) não provocou o mesmo efeito. Conclusão: O retalho supraclavicular é um importante recurso em reconstrução de cabeça e pescoço. Ele pode ser utilizado tanto em reconstruções primárias, associado ou não a outros retalhos, quanto em cirurgias de resgate. Embora o retalho supraclavicular seja confiável, ainda apresenta certa limitação, a fragilidade em sua porção distal, tornando-o vulnerável à dobradura, principalmente em reconstruções tridimensionais. A radioterapia prévia e a associação com retalhos livres podem levar a um maior número de necroses do retalho / Introduction: The reconstruction of head and neck is challenging because it is an exposed region that hosts essential functions of life. Although there are some clinical studies of supraclavicular flap, there are still doubts about its role in the reconstruction of head and neck. Objective: The objective of this study was to assess the complications resulting from the use of the supraclavicular island flap (SCIF) in head and neck reconstructions based on the location of the oncological defect in patients undergoing immediate reconstructions and salvage surgeries. Material and Methods: A retrospective study including a series of 87 cases of reconstruction of various defects in the head and neck was performed. The supraclavicular flap was used in the immediate reconstructions, or in salvage procedures if there were any complications in primary reconstruction requiring a new flap. Patients were grouped according to the region: skin reconstruction and intraoral reconstruction. The following data were collected from medical records: age, diagnosis, hospitalization time, follow-up and complications. Statistical analysis included the Fisher\'s exact test and the likelihood ratio test. The level of significance was set at p < 0.05. Results: Between July 2008 and March 2015, of the 87 patients studied, 32 (29.4%) were female. The age ranged from 29 to 88 years, with a mean of 62.55 ± 12.83 years. Twenty-four supraclavicular flaps (27.5%) developed distal necrosis, 21 of them required new surgical procedure (24%). Overall, we observed no significant difference in mean complication rates of SCIF used for primary or salvage reconstruction (28% versus 25%, respectively, p = 0.816). We also observed no significant difference when we examined the mean complication rate in the groups undergoing cutaneous and intraoral reconstruction (27% versus 28%, p = 0.932). The average hospital stay was 17 days + - 18. In 3 cases, skin grafting was used to the donor area closure. All patients had functional reconstructions. Some factors such as distal flap folding (p = 0.002), association with free flap (p = 0.002) and preoperative radiotherapy (p = 0.04) were significantly associated with higher number of complications, while smoking (p = 0.43) did not have the same effect. Conclusion: The supraclavicular flap is an important resource in reconstruction of head and neck. It can be used in reconstructions with or without the other flaps, primary or in secondary operations. The supraclavicular flap is reliable, but there are certain limitations, such as lack of volume and weakness in its distal portion, making it vulnerable to folding, especially in three-dimensional reconstructions. Radiotherapy and the association with free flaps can lead to higher rate of flap necrosis

Este estudo teve como objetivo compreender a experiência de tornar-se mãe de uma criança com câncer. Foi utilizado como referencial teórico o Interacionismo Simbólico e como referencial metodológico o Interacionismo Interpretativo. Participaram do estudo sete mães de crianças que estavam em tratamento de câncer. As narrativas biográficas revelaram que o papel de mãe é construído num processo articulado, que conjuga a interação entre dois temas: VIVER O TEMPO DA DOENÇA, que representa um olhar da mãe direcionado para si, vivendo agora uma situação nova como mãe, continuamente permeada pelas incertezas inerentes à doença e à necessidade de afastar a ameaça de morte criança e VIVER O TEMPO DE LUTA PELA VIDA DA CRIANÇA, que representa a dimensão dos comportamentos da mãe, que se expressam nas interações consigo mesma, com o filho e com todos os elementos envolvidos na experiência, evidenciando a construção do seu papel de mãe. A descrição dos temas proporcionou a compreensão da experiência de tornar-se mãe de uma criança com câncer através das epifanias: Perceber que seu tempo com a criança está ameaçado, Decidir que este é o tempo da criança e Lutar pela criança movida por amor. Foi possível perceber através desses momentos reveladores que existe uma relação entre a parentalidade e a temporalidade, na qual o tempo se manifesta nesta experiência de transição, como uma das dimensões da construção do papel de mãe de uma criança com câncer / The objective of the present study was to understand the experience of becoming a mother of a child with cancer. The theoretical framework adopted was the Symbolic Interactionism while the methodological one was the Interpretative Interactionism. Seven mothers of children undertaking cancer treatment took part in the study. The biographic narratives expressed that the mother’s role is built in an articulated process that implies the interaction between two themes: LIVING THE TIME OF THE ILLNESS, in which the mother concentrates in herself, now facing a new experience as a mother, continuously permeated by the uncertainties inherent in the disease and the necessity of removing the threats of the child’s death; and LIVING THE TIME OF STRUGGLING FOR THE CHILD’S LIFE, which represents the dimension of the mother’s behaviour, expressed in interactions with herself, her child and all the elements involved in the experience, showing up the development of her role as a mother. The description of the themes allowed the understanding of the experience of becoming a mother of a child with cancer through the following epiphanies: Perceiving that her time with the child is being threatened, Deciding that this is the child’s time and Fighting for the child driven by love. It was possible to observe that there is a connection between the parenting and temporality, in which the time is shown in this transition experience as one of the dimensions in the development of a new role as mother of a child with cancer