Articles: patients.
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Bolus thermodilution is the standard bedside method of cardiac output measurement in the intensive care unit (ICU). The Baxter Vigilance monitor uses a modified thermodilution pulmonary artery catheter with a thermal filament to give a continuous read-out of cardiac output. This has been shown to correlate very well with both the 'gold standard' dye dilution method and the bolus thermodilution method. Bioimpedance cardiography using the Bomed NCCOM 3 offers a noninvasive means of continuous cardiac output measurement and has been shown to correlate with the bolus thermodilution method. We investigated the agreement between the continuous bioimpedance and continuous thermodilution methods, enabling acquisition of a large number of simultaneous measurements. ⋯ The Bomed NCCOM 3 bioimpedance monitor shows poor agreement with the Baxter Vigilance continuous thermodilution monitor in a group of general ICU patients and cannot be recommended for cardiac output monitoring in this situation.
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Clinical trials, particularly large cooperative group trials, establish the standards that we use to treat many of our cancer patients. The process by which multi-institutional clinical trials are developed, performed and peer-reviewed in the United States is equaled by few other countries around the world. Our clinical cooperative groups should be considered an important national resource. ⋯ Assuming the ACoSOG initiative is funded by the NCI, the administrative and educational efforts required to establish a successful cooperative group encompassing all surgical disciplines are daunting. Many years will be necessary to bring such efforts to maturity in a smoothly functioning organization. However, the ACoSOG has the opportunity to provide a new force, energy and vision in clinical trials which could radically change our approach to patient care and could greatly strengthen the activities of the current cooperative groups.
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As a physician specializing in the treatment of cancer, I have had to watch hundreds of patients die from cancer because current treatments have limited benefit. I know of no disease that can strike a patient more tragically than cancer. However, I can say with absolute certainty that the medical and scientific communities are on the verge of major breakthroughs in our ability to control this dreadful disease. ⋯ We no longer wonder if we will find a cure for cancer but when. America has an incredible opportunity to conquer this deadly disease. Increasing funds for cancer research could now accelerate by years the development of new and more effective treatments for cancer, literally saving tens of thousands of American lives.
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The current standard treatments for childhood cancers are highly successful. The five-year survival rates for all children diagnosed with cancer in the late 1980s approaches 70%, and the outlook continues to improve. For some types of localized embryonal tumors, such as retinoblastoma and Wilms' tumor, the cure rates approach or exceed 90%. ⋯ It may be more feasible to initially test these new treatment approaches in those cancers in which current standard therapy is less successful. Once they have been demonstrated to have antitumor activity in poor prognosis tumors, they can be applied to the treatment of cancers that respond well to current standard multimodality treatments. With these changes in the patient population entering investigational drug studies and the development of new non-cytotoxic treatment approaches, the design and end-points of conventional phase I and II trials must be adapted to ensure that new therapies are efficiently developed in the pediatric population.
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Randomized Controlled Trial Clinical Trial
Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial.
Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain, a multidisciplinary rehabilitation programme for an outpatient group setting was developed. The main treatment components address the patient's physical functional capacity (functional restoring), cognitive and affective processes (pain management strategies), and behavioural and ergonomical aspects (back school elements). Short-term (immediately after intervention) and long-term effects (at 6-months follow-up) of the intervention were assessed in a randomized controlled study. ⋯ In contrast to post-treatment results, there were also significant improvements in strength and endurance. Overall results testify to the effectiveness of the intervention programme. Future studies (with larger sample sizes) should aim at a further improvement of functional capacity and disability perception, an analysis of differential treatment effects, and strategies for an improved long-term maintenance of the changes induced by the programme.