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  • 1
    Keywords: CANCER ; SURVIVAL ; tumor ; COMBINATION ; Germany ; PHASE-I ; THERAPY ; TOXICITY ; DEATH ; DISEASE ; RISK ; TUMORS ; TIME ; PATIENT ; RESPONSES ; 5-FLUOROURACIL ; ACID ; TRIAL ; PROGRESSION ; AGE ; chemotherapy ; doxorubicin ; SAFETY ; FLUOROURACIL ; CISPLATIN ; GASTRIC-CANCER ; BOLUS ; PHASE-II ; SINGLE ; ELDERLY-PATIENTS ; SODIUM ; gastric cancer ; INTERVAL ; PHASE ; TOLERABILITY ; PLUS ; EUROPEAN-ORGANIZATION ; NAUSEA ; COOPERATIVE GROUP ; EPIRUBICIN ; GASTROINTESTINAL CANCER ; HIGH-DOSE METHOTREXATE ; mitomycin C ; pegylated liposomal ; phase II ; SUPPORTIVE CARE ; LIPOSOMAL DOXORUBICIN
    Abstract: Mitomycin C (MMC) in combination with infusional 5-fluorouracil (5-FU) is a well-tolerated active combination therapy for advanced gastric cancer. Pegylated liposomal doxorubicin (Caelyx) has been combined with this regimen in a phase I study exhibiting promising activity in patients with upper gastrointestinal tumors. In the present study, we investigated activity and tolerability of this three-drug regimen in patients with gastric cancer. Patients with advanced or metastatic gastric cancer were recruited to receive weekly infusional 5-FU (2000 mg/m(2)) mixed with sodium folinic acid (FA; 500 mg/m(2)) in one pump (days 1, 8,15, 22, 29, 36). On days 1 and 29, Caelyx (20 mg/m(2)) was given as a 1-h, and MMC (7 mg/m(2)) was applied as bolus injection on days 8 and 36. Treatment courses were repeated on day 57. Twenty-seven patients with a median age of 66 years were recruited in a single center; 56% had histologically proven peritoneal carcinomatosis and 26 patients are evaluable for toxicity. Common Toxicity Criteria of the National Cancer Institute grade 3 toxicity was recorded in 34% of the patients (anemia 12%, leukocytopenia 8%, febrile neutropenia 4%, thrombocytopenia 12%, nausea 15%, diarrhea 8% and mucositis 4%). One patient developed hemolytic-uremic syndrome. One complete (5%) and eight partial responses (42%) were observed in 19 patients evaluable for response according to WHO criteria. Seven patients had no change (37%) and three (16%) progressive disease. Six patients with peritoneal carcinomatosis not amenable to WHO response assessment had progression-free intervals between 8 and 21 months. Median survival for all patients was 14.7 months and median time to progression was 8.4 months. We conclude that this new three-drug combination regimen yields a promising overall response rate (47%) in patients with gastric cancer despite the inclusion of a majority of elderly patients at moderate or high risk of death in this trial. Its safety and good tolerability as established in the phase I trial was confirmed. (c) 2005 Lippincott Williams M Wilkins
    Type of Publication: Journal article published
    PubMed ID: 15746580
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Zeitschrift für Medizinische Ausbildung; VOL: 27; DOC11 /20100224/
    Publication Date: 2010-02-25
    Description: Aims: Despite many efforts by support groups, mental health professionals and health care policy-makers, a stigmatization of psychiatry as a specialty and of mentally ill people is still prevalent in the general population. Earlier studies have shown that the stigma is prevalent even among psychiatric professionals and students of medicine and psychology. However, past studies on this issue often used questionnaires with a limited validity. Also questionnaires do not necessarily allow a neutral assessment of the underlying concepts of the student. Methods: In this study 133 students were asked to create mind maps on psychiatry. Results: In a systematic evaluation (based on a consensus of psychiatric concepts) of 1353 concepts we found non-specific associations (N = 431) and five main categories: (i) illness scirpts (n = 487); (ii) therapeutic concepts (n = 241), (iii) and (iv) stigma and forensic psychiatry (81 mentions each); and (v) psychopathology (n = 32). Stigma-associated negative concepts were more prevalent than positive connotations. Conclusions: Overall, it was shown that mind maps can be used with ease and quantified according to constructivist learning theory to explore disease concepts without the need for predefined or poorly validated questionnaires.
    Description: Zielsetzung: Trotz vieler Bemühungen, u. a. von Selbsthilfegruppen, der Fachgesellschaft und der Gesundheitspolitik gibt es in der Allgemeinbevölkerung immer noch eine Stigmatisierung der Psychiatrie als Fachgebiet. Frühere Untersuchungen zeigten, dass auch in der Psychiatrie tätige Menschen und Studierende der Medizin und Psychologie stigmatisierenden Äußerungen zustimmen. Zur genaueren Betrachtung wurden in der Vergangenheit jedoch meist Fragebögen verwendet, die eine begrenzte Validität haben und nicht zwangsläufig eine neutrale Beurteilung der zugrundeliegenden Konzepte der Studierenden erlauben.Methodik: In der vorliegenden Studie wurden 133 Studierende gebeten, Mind-Maps zum Thema Psychiatrie zu erstellen. Ergebnisse: In der systematischen Auswertung (auf der Basis vorher im Konsens bestimmter Konzepte) von 1353 Begriffen ergaben sich neben unspezifischen Assoziationen (n=431) fünf Oberkategorien: 1. Krankheitsbilder (n=487); 2. Therapieformen (n=241); 3. und 4. Stigma-assoziierte Themen bzw. Eigen- und Fremdgefährdung (jeweils 81 Nennungen) und 5. Psychopathologie (n=32). Negativ belegte Stigma-Themen waren wesentlich häufiger als positive Einstellungen zum Thema Stigma und betrafen meist Zwangsmaßnahmen. Schlussfolgerung: Insgesamt zeigte sich, dass Mind-Maps einfach eingesetzt und ausgewertet werden können, um Krankheitskonzepte und assoziierte Begriffe zu einem Fachgebiet im Sinne der konstruktivistischen Lerntheorie zu explorieren, ohne vordefinierte Fragebögen zu verwenden.
    Keywords: constructivism ; concept map ; undergraduate medical education ; Konstruktivistische Lerntheorie ; Concept-Map ; erster Abschnitt der ärztlichen Ausbildung ; ddc: 610
    Type: article
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  • 3
    Keywords: CANCER ; SURVIVAL ; tumor ; carcinoma ; COMBINATION ; Germany ; LUNG ; THERAPY ; TOXICITY ; DISEASE ; liver ; POPULATION ; SITE ; SITES ; TIME ; PATIENT ; 5-FLUOROURACIL ; ACID ; TRIAL ; PROGRESSION ; AGE ; colorectal cancer ; COLORECTAL-CANCER ; EFFICACY ; metastases ; SAFETY ; OXALIPLATIN ; RANDOMIZED-TRIAL ; BOLUS ; REGIMENS ; PHASE-II ; ELDERLY-PATIENTS ; overall survival ; second-line treatment ; intensity ; PHASE ; PLUS ; REMISSION ; phase II ; 2 DIFFERENT SCHEDULES ; capecitabine ; CPT-11 ; FLUOROURACIL-LEUCOVORIN ; irinotecan ; PLUS IRINOTECAN ; salvage chemotherapy
    Abstract: The efficacy of combination therapy with irinotecan and capecitabine has been demonstrated for the first-line treatment of metastatic colorectal cancer (MCRC). The aim of this trial was to evaluate the efficacy and safety of this combination in MCRC as second-line treatment after failure of 24-h infusional 5-fluorouracil (5-FU24h) and folinic acid (FA). Patients pre-treated with 5-FU24h/FA were recruited at two institutions to receive 6 x weekly irinotecan 70 mg/m(2) and capecitabine (1000 mg/m(2) b.i.d. days 1-14 and 22-35). Courses were repeated on day 50. In elderly patients (〉65 years) a 20% dose reduction of both drugs was scheduled. Twenty-eight patients [M/F 20/8; median age 65 years (range 44-79); median ECOG score 1] were enrolled. The most frequent sites of metastases were liver, n = 20, lymph nodes and lungs, n=10, respectively. Half of the patients had two or more metastatic sites. A total of 71 treatment courses (median 2, range 1-8) were administered. Main toxicities [worst per patient (%); CTC grade 1/2/3/4] were: anaemias 18/14/-/-; leukocytopenia 11/21/-/-; thrombocytopenia diarrhea 18/36/21/-; nausea/vomiting 43/29/4/-; mucositis 4/11 /-/-; alopecia 7/25/-/-; hand-foot syndrome 7/21/-/-; fatigue 14/14/-/-; renal insufficiency (caused by diarrhea and exsiccosis) -/-/-/7. Dose intensity in the first course was [median/mean (%)]: irinotecan 92/83; capecitabine 88/82. Twenty-three patients are evaluable for response analysis (five did not complete the first course): three patients showed partial remissions (13%) and 11 patients had stable disease (48%). Median time to progression was 3.0 months for the total population (range 1.4-17.3) and 6.5 months for responders (partial response plus no change). Seventy-four percent of the patients received a third-line therapy. Overall survival was 15.7 months calculated from the start of study treatment. Second-line therapy with irinotecan and capecitabine yielded a tumor control in 61% of patients with MCRC. Efficacy and toxicity data are comparable to 5-FU/irinotecan combinations, although the likelihood of severe diarrhea appears to be higher with capecitabine/irinotecan. (C) 2005 Lippincott Williams Wilkins
    Type of Publication: Journal article published
    PubMed ID: 15613902
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