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59 - Wilms' tumor
- from Part VI - Oncology
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- By Michael L. Ritchey, Department of Surgery and Pediatrics, Division of Urology, University of Texas – Houston Medical School, USA, Nadeem N. Dhanani, Department of Urology, University of Texas – Houston Medical School, USA, Patrick G. Duffy, Department of Paediatric Urology, Great Ormond Street Hospital, London, UK, Gill A. Levitt, Department of Paediatric Urology, Great Ormond Street Hospital, London, UK, Anthony J. Michalski, Department of Paediatric Urology, Great Ormond Street Hospital, London, UK
- Edited by Mark D. Stringer, Keith T. Oldham, Pierre D. E. Mouriquand
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- Book:
- Pediatric Surgery and Urology
- Published online:
- 08 January 2010
- Print publication:
- 09 November 2006, pp 759-781
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- Chapter
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Summary
Wilms' tumor therapy
Prior to the modern era of cancer treatment, the only opportunity for cure of Wilms' tumor was complete surgical excision. Wilms' tumor was one of the first pediatric malignancies found to be responsive to systemic chemotherapy. Since the initial report by Farber, there has been a dramatic improvement in survival of children with this tumor. Many of these advances have occurred as a result of collaborative efforts of large pediatric cooperative cancer groups, such as the National Wilms Tumor Study Group (NWTSG) and the International Society of Pediatric Oncology (SIOP), which have been able to enroll large numbers of patients treated in a standardized manner since 1969. Now that more than 90% of children with Wilms' tumor can expect cure, these groups are focusing their attention to reducing the intensity of therapy in order to minimize treatment-related toxicity that may adversely affect long-term survival and quality of life. Damage to normal organs and tissues occurs and the effects may not become apparent for many years after treatment.
Tracking the late effects of Wilms' tumor treatment has been an integral part of the NWTSG for many years. Long-term toxicities of treatment are studied in a systematic way among uniform populations of children treated with similar therapies. This has helped to define the long-term adverse effects of treatment in patients alive 5 years or longer after the diagnosis of Wilms' tumor.
Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment
- Conor O'Neill, Patrick Heffernan, Ray Goggins, Ciaran Corcoran, Sally Linehan, Dearbhla Duffy, Helen O'Neill, Charles Smith, Harry G Kennedy
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- Journal:
- Irish Journal of Psychological Medicine / Volume 20 / Issue 4 / December 2003
- Published online by Cambridge University Press:
- 13 June 2014, pp. 119-125
- Print publication:
- December 2003
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- Article
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Objectives: To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted.
Method: All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort.
Results: There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years.
Conclusions: Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.