Thursday, May 24, 2012
Does journal endorsement of reporting guidelines influence the completeness of reporting of health research? A systematic review protocol
Does journal endorsement of reporting guidelines influence the completeness of reporting of health research? A systematic review protocol
Background: Reporting of health research is often inadequate and incomplete. Complete and transparent reporting is imperative to enable readers to assess the validity of research findings for use in healthcare and policy decision-making. To this end, many guidelines, aimed at improving the quality of health research reports, have been developed for reporting a variety of research types. Despite efforts, many reporting guidelines are underused. In order to increase their uptake, evidence of their effectiveness is important and will provide authors, peer reviewers and editors with an important resource for use and implementation of pertinent guidance.....
Clinical Care Options - OCEANS: PFS Improvement of 4 Months With the Addition of Bevacizumab to Carboplatin/Gemcitabine in Patients With Platinum-Sensitive Recurrent Ovarian Cancer ASCO 2011
Blogger's Note: requires registration (free) to view
Clinical Care Options - Oncology CME - OCEANS: PFS Improvement of 4 Months With the Addition of Bevacizumab to Carboplatin/Gemcitabine in Patients With Platinum-Sensitive Recurrent Ovarian Cancer
CCO Independent Conference Coverage of the 2011 American Society of Clinical Oncology Annual Meeting*
*CCO is an independent medical
education company that provides state-of-the-art medical information to
healthcare professionals through conference coverage and other
educational programs.
OCEANS: PFS Improvement of 4 Months With the Addition of Bevacizumab to Carboplatin/Gemcitabine in Patients With Platinum-Sensitive Recurrent Ovarian Cancer
Posting Date: June 15, 2011- OCEANS: randomized, double-blind, placebo-controlled phase III trial[1]
Summary of Key Conclusions
- Addition of bevacizumab to carboplatin/gemcitabine yielded
significant benefits vs carboplatin/gemcitabine alone in patients with
platinum-sensitive recurrent ovarian cancer
- Median PFS improved by 4 months
- Objective response improved by 21%
- Median duration of response improved by 3 months
- Trend toward improved OS
- Data not yet mature
- Safety profile of bevacizumab plus carboplatin/gemcitabine consistent with previous reports
- No new safety signals observed
- No gastrointestinal (GI) perforations reported
Background
- Carboplatin/gemcitabine US Food and Drug Administration approved in 2006 for treatment of platinum-sensitive recurrent ovarian cancer based on improvement in PFS vs carboplatin alone in phase III clinical trial[2]
- Bevacizumab: humanized anti-VEGF monoclonal antibody
- Demonstrated single-agent activity in recurrent ovarian cancer[3,4]
- Current study assessed carboplatin/gemcitabine chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent ovarian cancer...............cont'd
Wednesday, May 23, 2012
Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”
Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”
References:
- K. Luk, S. Boatman, and K. N. Johnson, “Influence of morphine on pericyte-endothelial interaction:implications for antiangiogenic therapy,” Journal of Oncology, vol. 2012, Article ID 458385, 10 pages, 2012.
- K. Gupta, S. Kshirsagar, L. Chang et al., “Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth,” Cancer Research, vol. 62, no. 15, pp. 4491–4498, 2002. View at Scopus
- M. Farooqui, Y. Li, T. Rogers et al., “COX-2 inhibitor celecoxib prevents chronic morphine-induced promotion of angiogenesis, tumour growth, metastasis and mortality, without compromising analgesia,” British Journal of Cancer, vol. 97, no. 11, pp. 1523–1531, 2007. View at Publisher · View at Google Scholar · View at Scopus
- B. Biki, E. Mascha, D. C. Moriarty, J. M. Fitzpatrick, D. I. Sessler, and D. J. Buggy, “Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis,” Anesthesiology, vol. 109, no. 2, pp. 180–187, 2008. View at Publisher · View at Google Scholar · View at Scopus
- B. Mathew, F. E. Lennon, J. Siegler et al., “The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation,” Anesthesia and Analgesia, vol. 112, no. 3, pp. 558–567, 2011. View at Publisher · View at Google Scholar · View at Scopus
- P. A. Singleton, M. W. Lingen, M. J. Fekete, J. G. N. Garcia, and J. Moss, “Methylnaltrexone inhibits opiate and VEGF-induced angiogenesis: role of receptor transactivation,” Microvascular Research, vol. 72, no. 1-2, pp. 3–11, 2006. View at Publisher · View at Google Scholar · View at Scopus
- S. Leo, R. Nuydens, and T. F. Meert, “Opioid-induced proliferation of vascular endothelial cells,” Journal of Pain Research, vol. 2, pp. 59–66, 2009. View at Scopus
Register now to receive the next Current Controlled Trials (CCT) newsletter
Register now to receive the next Current Controlled Trials (CCT) newsletter:
The first edition of the Current Controlled Trials quarterly
newsletter was published in April 2012, and we hope that our users find this
newsletter informative. If you missed it, you can register to receive future editions. We
encourage you to share these updates with friends and colleagues and to send
any feedback you may have on the current issue or on content that you would
like to see in future issues.
The ISRCTN register works
closely with the Department of Health and has been involved in a national
initiative, ‘UK Clinical Trials Gateway (UKCTG)’, which aims to bring clinical
trials to the attention of a wider audience. The key to the success of the
UKCTG is providing the public with easy to understand information about
clinical trials running in the UK. In June 2011, the ISRCTN register introduced
a new lay summary field to include a plain English description of the trial,
which is unique amongst trial registries.
To further promote transparency
in clinical research and reduce reporting bias, in 2011 BioMed Central launched
the initiative ‘threaded publications’, which puts trial registration – the first
in a sequence of publications about a trial which might also include protocols
and results – at the forefront of transparent reporting.
Finally, in 2012 we will be
surveying our users on the functionality of the ISRCTN database and are eager
to hear from trialists, researchers, systematic reviewers, health policy
makers, patients and health professionals about how we can improve the
database. To find out more please register to receive the newsletter, or submit
your feedback online.
Medscape: Ovarian Cancer Survivors Experience Long-Term Distress
Ovarian Cancer Survivors Experience Long-Term Distress
May 21, 2012 (San Diego, California) — Ovarian cancer survivors continue to have psychological distress even 5 or more years after completing their treatment and have undiagnosed anxiety about the possibility of recurrence, according to researchers here at the American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting......
"Few women confided even to their family members or friends about their fears. More than 59% of survey respondents said they do not talk with others about their fears of recurrence, and only 6.3% had ever joined a support group for women with ovarian cancer."
paywalled: Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Health Expectations
Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Wendt - 2011 - Health Expectations
Abstract
Objective
This paper examines how negative experiences with the health-care
system create a lack of confidence in receiving medical care in seven
countries: Australia, Canada, Germany, the Netherlands, New Zealand, the
United Kingdom, and the United States.
Methods
The empirical analysis is based on data from the Commonwealth Fund
International Health Policy Survey 2007, with nationally representative
samples of adults aged 18 and over. For the analysis of the experience
of cost barriers and confidence in receiving medical care, we conducted
pairwise comparisons of group percentages as well as country-wise
multivariate logistic regression models.
Results
Individuals who have experienced cost barriers show a significantly
lower level of confidence in receiving safe and quality medical care
than those who have not. This effect is most pronounced in the United
States, where people who have foregone necessary treatment because of
costs are four times as likely to lack confidence as individuals without
the experience of cost barriers (adjusted odds ratio 4.00). In New
Zealand, Germany, and Canada, individuals with the experience of cost
barriers are twice as likely to report low confidence compared with
those without this experience (adjusted odds ratios of 1.95, 2.19 and
2.24, respectively). In the Netherlands and UK, cost barriers are only a
marginal phenomenon.
Conclusions
The fact that the experience of financial barriers considerably lowers
confidence indicates that financial incentives, such as private
co-payments, have a negative effect on overall public support and
therefore on the legitimacy of health-care systems.
paywalled: Postrecurrent Oncologic Outcome of Patients With Ovarian Clear Cell Carcinoma
Postrecurrent Oncologic Outcome of Patients With Ovarian Cle... : International Journal of Gynecological Cancer
Abstract
Objectives:
To estimate the long-term clinical outcome of
patients with recurrent clear cell carcinoma (RCCC) of the ovary in
comparison with those with recurrent serous adenocarcinoma (RSAC).
Conclusions: The long-term clinical outcome of patients
with RCCC was extremely poor. We confirmed that RCCC (recurrent clear cell carcinoma) should be
investigated as a different malignancy compared with RSAC.
Twitter Emerges as Health Policy Sounding Board - in Meeting Coverage, AUA
Medical News: Twitter Emerges as Health Policy Sounding Board - in Meeting Coverage, AUA from MedPage Today
"Social media, such as Twitter, are a useful way to gauge public sentiment," said Prabhu, a medical student at New York University in New York City. "Social media may also have a role in influencing public sentiment and altering policy."
PLoS ONE: Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines
PLoS ONE: Conflict of Interest Policies for Organizations Producing a Large Number of Clinical Practice Guidelines
"COI policies among organizations producing a large number of CPGs (clinical practice guidelines) currently do not measure up to IOM standards. Policy-makers, guideline funders, sponsors, and developers, as well as users need to address and demand improvements. Patients and populations need trustworthy CPGs, and the accurate disclosure and subsequent management of COI is essential to achieve that goal."
Seth's blog: Ranking for signal to noise ratio
Ranking for signal to noise ratio:
A whisper in a quiet room is all you need. There's so little noise, so few distractions, that the energy of the whisper is enough to make a dent.
On the other hand, it's basically impossible to have a conversation (at any volume) in a nightclub.
Signal to noise ratio is a measurement of the relationship between the stuff you want to hear and the stuff you don't. And here's the thing: Twitter and email and Facebook all have a bad ratio, and it's getting worse.........
Until you remove the noise, you're going to miss a lot of signal.
On the other hand, it's basically impossible to have a conversation (at any volume) in a nightclub.
Signal to noise ratio is a measurement of the relationship between the stuff you want to hear and the stuff you don't. And here's the thing: Twitter and email and Facebook all have a bad ratio, and it's getting worse.........
Until you remove the noise, you're going to miss a lot of signal.
Comparative Effectiveness of Filgrastim, Pegfilgrastim, and Sargramostim as Prophylaxis Against Hospitalization for Neutropenic Complications in Patients With Cancer Receiving Chemotherapy
Comparative Effectiveness of Filgrastim, Pegfilgrastim, and... : American Journal of Clinical Oncology
Conclusions: Risk of hospitalization for neutropenic complications during cancer chemotherapy is lower with pegfilgrastim prophylaxis than with filgrastim or sargramostim prophylaxis.
Dr Curiel/Viral Genetics' P-IND Clears FDA To Commence Clinical Trials (ovarian cancer/Sorafenib) in Humans - MarketWatch
Viral Genetics' P-IND Clears FDA To Commence Clinical Trials in Humans - MarketWatch
Viral Genetics' P-IND Clears FDA To Commence Clinical Trials in Humans
Set to Begin First Ovarian Cancer Study Test Site for Metabolic Disruption Technology (MDT) Combination Therapy
SAN MARINO, Calif., May 21, 2012 (BUSINESS WIRE) --
A physician-initiated Investigational New Drug (P-IND) application
submitted to the FDA in late April, 2012, has cleared the FDA's
screening process with the requirement for a regular IND application
being waived, resulting in the company being able to begin the first of
at least two proposed clinical trial sites to investigate a potential
oncology treatment developed from Viral Genetics' (pinksheets:VRAL)
Metabolic Disruption Technology (MDT), which is licensed exclusively to
the Company. The P-IND -- part of a larger, coordinated research effort --
was submitted by the first test site at the Cancer Therapy & Research
Center (CTRC) at The University of Texas Health Science Center at San
Antonio, which includes patient enrollment at Scott and White Hospital
(S&W) in Temple, Texas. Additional test sites may also be added in the
future.
Enrollment and treatment of patients is expected to commence upon
completion of internal hospital Institutional Review Boards (IRBs),
which are already underway. The UT Health Science Center portion of the
study will commence when all approvals are finalized.
This clinical trial -- a milestone in the Company's transition from
preclinical to clinical-stage -- will be the first for the intellectual
property developed by Dr. M. Karen Newell Rogers, Viral Genetics' Chief
Scientist and licensed exclusively by the Company. It will examine the
safety and efficacy of one of Viral Genetics licensed MDT compounds in
combination with an existing cancer drug, sorafenib (marketed as
Nexavar(TM)) in the treatment of patients resistant or otherwise unsuitable
for standard treatments for stage III or IV ovarian cancer and related
carcinomas.
The Primary Investigator on the trial is Tyler Curiel, M.D., MPH, a
medical oncologist affiliated with the CTRC at the UT Health Science
Center. Dr. Curiel is leading this study as he investigates the efficacy
of combining two compounds in a cancer treatment that is hoped to cause
the starvation of tumor cells and enhanced anti-tumor immunity, leading
to the reduction of tumor size and reduced disease progression.....
Tuesday, May 22, 2012
paywalled - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer
Gynecologic Oncology - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer
Abstract
Introduction
The
aim of this study was to assess the influence of video-assisted
thoracic surgery (VATS) on our treatment decisions in FIGO III and IV
ovarian cancer patients.
Highlights
►
Preoperative chest CTs is not an appropritate staging tool for the
evaluation of intrathoracic tumorload in advanced Ovarian Cancer
patients
► Video-assisted thoracic surgery can be performed quickly and safely before deciding about primary cytoreduction or neodadjuvant chemotherapy in advanced Ovarian Cancer patients
► Video-assisted thoracic surgery can be performed quickly and safely before deciding about primary cytoreduction or neodadjuvant chemotherapy in advanced Ovarian Cancer patients
The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on? (note blogger's opinion)
Blogger's Note/Opinion: at the time of the initial publication this blogger attended numerous meetings which critically analyzed the WHI study; fear, poor communication and media hype led to many poor choices without any indepth analysis even at the time; most often the WHI/media were quoted to refer patients to their physicians; those physicians were in the same dilemma as the patients - a mess, in fact; to this day patients/consumers, led by fear, choose to ignore/not believe (?) post-WHI findings and analyses - more on these issues in this article as below
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on?
Public release date: 21-May-2012
International Menopause Society
The Women's Health Initiative study and hormone therapy -- what have we learned 10 years on?
In July 2002 the publication of the first Women's Health Initiative (WHI) report caused a dramatic drop in Menopausal Hormone Therapy (HT ) use throughout the world. Now a major reappraisal by international experts, published as a series of articles in the peer-reviewed journal Climacteric (the official journal of the International Menopause Society), shows how the evidence has changed over the last 10 years, and supports a return to a "rational use of HT, initiated near the menopause".The reappraisal has been carried out by some of the world's leading experts in the field, including clinicians who worked on the original WHI study. Summarising the findings of the special issue, authors Robert Langer, JoAnn Manson, and Matthew Allison conclude that "classical use of HT" – MHT initiated near the menopause – will benefit most women who have indications including significant menopausal symptoms or osteoporosis.
Dr. Robert Langer, Principal Scientist at the Jackson Hole Center for Preventive Medicine, Jackson Wyoming, was the Principal Investigator of the WHI Clinical Center at the University of California, San Diego. He said
"With 10 years hindsight we can put the lessons learned from the WHI HT trials into perspective. In some ways we've come full circle – studies in recently menopausal women that suggested protection against major diseases led to testing whether that would carry over to older women who have even greater risks of heart attacks and fractures. That hope proved false. Unfortunately the results were wrongly generalized back to women like those who inspired the study. Information that has emerged over the last decade, shows that for most women starting treatment near the menopause, the benefits outweigh the risks, not just for relief of hot flashes, night sweats and vaginal dryness, but also for reducing the risks of heart disease and fractures".
Langer continued:
"Overgeneralizing the results from the women who were -- on average -- 12 years past menopause to all postmenopausal women has led to needless suffering and lost opportunities for many. Sadly, one of the lessons from the WHI is that starting HT 10 years or more after menopause may not be a good idea, so the women who were scared away by the WHI over this past decade may have lost the opportunity to obtain the potential benefits."
Professor JoAnn Manson (Harvard Medical School and Brigham and Women's Hospital, Boston, MA), who has been one of the WHI Principal Investigators since the study started, said:
"An important contribution of the WHI was to clarify that, for older women at high risk of cardiovascular disease, the risks of HT far outweighed the benefits. This halted the increasingly common clinical practice of prescribing HT to women who were far from the onset of menopause. Unfortunately, these findings were extrapolated to newly menopausal and healthy women who actually had a favourable benefit: risk ratio with HT. The WHI results point the way towards treating each woman as an individual. There is no doubt that HT is not appropriate for every woman, but it may be appropriate for many women, and each individual woman needs to talk this over with her clinician".
The authors note that the initial press reaction, following the lead
of the WHI press release, over-emphasised a relatively small increase
in breast cancer, so distorting the overall view of the report.
WHI researcher Professor Matthew Allison (University of California, San Diego), said:
"It is important to put the results of the WHI trials into context. That is, being obese, not exercising or excess alcohol consumption confer higher absolute risks for breast cancer than HT use."
###
Note that a brief summary of the papers in this special issue of Climacteric appears below.This special issue, "The Women's Health Initiative – a decade of progress" will appear in the June 2012 issue of Climacteric (vol 15, issue 3). This goes on line on 22nd May, at this URL: http://informahealthcare.com/cmt. Climacteric is the official journal of the International Menopause Society (IMS).
ABSTRACT:
Have we come full circle-or moved forward? The Women's Health Initiative 10 years on", by R.D Langer, J.E Manson, and M.A. Allison, Climacteric Vol15 no 3 pp206-213
In mid-summer 2002, the announcement that the Women ' s Health Initiative (WHI) trial of combination hormone therapy (HRT) had stopped jolted the field of women's health. It set off a cascade that first stunned, then meaningfully changed the future for millions of women, their partners, and tens of thousands of clinicians and scientists. With 10 years' hindsight, we can begin to put the lessons learned from the WHI HRT trials into perspective. These trials were primarily designed to test whether women initiating HRT considerably past menopause, and mostly asymptomatic, experienced treatment benefits from HRT expected from studies of generally symptomatic women who started near menopause. The definitive answer was ' no ' . Unfortunately, the findings were generalized to all postmenopausal women regardless of age. Data accumulated from the WHI and other studies over the past decade have shown that, in women with symptoms or other indications, initiating HRT near menopause – the classic pattern of use – will probably provide a favourable benefit : risk ratio. Spurred by the WHI, many hypotheses and some insights about potential mechanisms for HRT effects on diverse organ systems have emerged, along with new perspectives on regimens, compounds, and routes of administration. This overview provides an historical perspective on the WHI design and the evolution of its message; summarizes current perspectives and insights contributed by eminent colleagues; reviews the state of the art; and looks to the future. We have come full circle in some ways, with mounting evidence supporting benefit for HRT started near menopause and with hard lessons learned about pathophysiology, publicity and interpreting data. Now we move on.
Summary of papers This special issue of Climacteric contains a series of articles reviewing the position of HRT, 10 years after the WHI. There is a wealth of information here, which is impossible to communicate in a single press statement. Here are simplified summaries of each article, please refer to each individual article for more details.
Quality of Life The WHI study suggested that HRT use led to minimal improvement in quality of life (QoL). As the WHI study wasn't designed to look at women going through the menopause, it underestimated the real extent of effect of HRT on QoL. This has caused suffering to many women (Pines et al).
HRT for Urogynecological and sexual health Around 50% of postmenopausal women will suffer urogenital atrophy. Studies indicate that locally applied hormone therapy is generally more effective than systemic HRT for urogenital symptoms, including dyspareunia, which can be a critical determinant of a woman's interest in sex.(Nappi & Davis)
Timing of HRT initiation, and cost effectiveness The weight of evidence now supports a ' window-of-opportunity ' for women taking HRT before the age of 60 and/or within 10 years of the menopause. This reduces the risk of coronary heart disease and overall mortality. HRT is more effective for this than other medicines such as statins and aspirin, and is cost-effective. Starting HRT later than this increases risks to women (Hodis et al).
Stroke There is a modest increase in stroke risk with HRT use if stated near the menopause. This risk rises considerably in women who start at older ages. There is some evidence that use of HRT patches (as opposed to pills) may not increase stroke risk, but this needs to be confirmed (Henderson and Lobo).
Venous Thromboembolism There is an increased risk of venous thromboembolism with oral HRT. This may be increased with age and obesity, and may vary by the progestogen used. Observational studies suggest that it may not be associated with transdermal HRTs (patches), but this needs confirmation (Archer and Ogar).
Breast cancer There is an increase in breast cancer with E+P HRT, but this is small. It has also been exaggerated by press reports, causing fear in many women. They conclude that large numbers of women with substantial menopausal symptoms and low breast cancer risk will benefit from HRT use (Gompel and Santen).
Colorectal Cancer This is the second most common cancer in women (after breast cancer). Evidence from the WHI and other trials suggests that current HRT users have a 40% reduction in colorectal cancers. The authors say that it is too early to consider HRT use in the prevention of colon cancer (Barnes and Long) Dementia Initial WHI results showed an increase in dementia for both E+P and E alone users. This review including recent publications from other studies suggests that this may be influenced by the timing of the HRT initiation, with benefits for those starting nearer the menopause, but increased risks for women starting at older ages (Maki and Henderson).
Fractures The WHI "Global Index", which looked at the balance of risks and benefits, inappropriately downgraded the importance of fractures. The authors argue for a more rounded view. They say that that HRT gives more bone benefits than many other drugs (e.g. bisphosphonates), and so restrictions on HRT use as a first-line therapy are not appropriate (de Villiers and Stevenson)
Overall effects of the drop in HRT use This is difficult to gauge, because data varies from country to country. In one large study HRT discontinuation led to a 55% increase in fractures after 6.5 years. There was also a small drop in breast cancers after the drop in use in HRT, most notably in the US, but not seen in all countries, that was consistent with an effect on existing tumours. HRT discontinuation may lead to an increase in cardiovascular disease, but given the long lag time for cardiovascular events this would take substantial time to become apparent (Burger et al)
The WHI and media The author suggests that the WHI's dramatic presentation of the initial findings set the subsequent tone for the way that the media came to view the HRT issue (Simon Brown).
case report - Granulosa cell tumor of the ovary after long-term use of tamoxifen and toremifene - Journal of Obstetrics and Gynaecology Research
Granulosa cell tumor of the ovary after long-term use of tamoxifen and toremifene - Tanaka - 2012 - Journal of Obstetrics and Gynaecology Research
Abstract
The relation between the use of tamoxifen and gynecologic tumors has been documented. In this case, a 58-year-old postmenopausal woman had been treated with tamoxifen for 5 years followed by toremifene for 1.5 years due to the presence of stage II estrogen receptor-positive breast cancer. The patient was found to have a stage Ic granulosa cell tumor of the ovary despite undergoing annual gynecologic examinations. This report presents a case of granulosa cell tumor of the ovary after the long-term use of tamoxifen and toremifeneJCO The Art of Oncology "Blindness: Looking but Not Seeing"
JCO: Blindness: Looking but Not Seeing
"...Blindness can be a metaphor for failed communication.
To see can mean to look with one’s eyes,
but it can also mean to understand. Thus, a person
may be symbolically blind (ie, not understanding,
not connecting) or may be physically without sight....."
Addressing Spirituality Within the Care of Patients at the End of Life: Perspectives of Patients With Advanced Cancer, Oncologists, and Oncology Nurses [Palliative and Supportive Care]
Addressing Spirituality Within the Care of Patients at the End of Life: Perspectives of Patients With Advanced Cancer, Oncologists, and Oncology Nurses [Palliative and Supportive Care]:
Purpose
Attention to patients' religious and spiritual needs is included in national guidelines for quality end-of-life care, but little data exist to guide spiritual care.
Conclusion
Most patients with advanced cancer, oncologists, and oncology nurses value spiritual care. Themes described provide an empirical basis for engaging spiritual issues within clinical care.
Editorial: Pseudomyxoma Peritonei: More Questions Than Answers (appendix/ovarian
JCO: Pseudomyxoma Peritonei: More QuestionsThan Answers
"Chances are, if you ask most physicians and surgeons about
pseudomyxoma peritonei (PMP), they will respond with more questions
than answers. The confusion that surrounds PMPis not surprising
because the origin, pathology, treatment, prognosis, and very
definition of PMP are still under debate. PMP is a clinical syndrome
that is characterized by mucinous ascites that result from rupture of a
mucin-producing neoplasm, typically of appendiceal origin....."
"...The appendix is the primary cause of PMP; the ovaries are typically
only secondarily involved...."
paywalled: Original Article Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients
Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients
Purpose
Febrile neutropenia (FNP) is a frequent complication of cancer care and evaluation often fails to identify a cause. [18
F]FDG PET/CT has the potential to identify inflammatory and infectious
foci, but its potential role as an investigation for
persistent FNP has not previously been explored. The
aim of this study was to prospectively evaluate the clinical utility
of FDG PET/CT in patients with cancer and severe
neutropenia and five or more days of persistent fever despite antibiotic
therapy.
Conclusion
This
study supports the utility of FDG PET/CT scanning in severely
neutropenic patients with five or more days of fever. Further
evaluation of the contribution of FDG PET/CT in the
management of FNP across a range of underlying malignancies is required.
'Discharge bias' disproportionally hurts large and academic hospitals
'Discharge bias' disproportionally hurts large and academic hospitals
"State and national programs that use in-hospital mortality to benchmark hospitals should note how discharge bias unfairly disadvantages certain types of hospitals," concluded Dr. Reineck. "Discharge bias must be accounted for to prevent unfair performance assessments."
Future studies are planned to assess the effects that using this measure in public reporting has on outcomes of ICU patients"
Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period - Frontline Gastroenterology
Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period -- Frontline Gastroenterology
Conclusion
"....Endoscopists performing low
volume colonoscopy (<100 per annum), have CIR of <90%.
Endoscopists with low volume practice who
do not meet the quality standards
should engage in skills augmentation plus further training and increase
volume of colonoscopy
with local mentorship, or stop
performing colonoscopy."
Subscribe to:
Posts
(
Atom
)
