Imperfect measure of hospital safety - CIHI

Imperfect measure of hospital safety

Imperfect measure of hospital safety

1. CMAJ

The failure to include hospital-acquired infections or medication errors as a performance indicator limits the utility of the Canadian Institute for Health Information’s (CIHI) new hospital benchmarking tool, critics say....

Predisposed to risk but not change CMAJ (genetic testing series)

......Of course, considering that the predictive power of genetic testing tends to be underwhelming, perhaps it’s no surprise that personalized genetic information induces more shoulder shrugs than lifestyle changes. “One of the challenges is that people are behaving rationally, to a degree, when they don’t change their behaviours. These genetic tests aren’t very predictive,” says Timothy Caulfield, a Canada Research Chair in Health Law and Technology who teaches in the law faculty and school of public health at the University of Alberta. “If you find you have a health risk of 2% instead of 1%, that type of risk is lost in the noise of risk in your life.” 

Editor’s note: Sixth of a multipart series on genetic testing.

Part 1: Separating hype from reality in the era of the affordable genome (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4143).

Part 2: Popping the genetics bubble (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4142).

Part 3: Who should hold the keys to your DNA? (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4141).

Part 4: A race-based detour to personalized medicine (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4133).

Part 5: Race and genetics in the doctor’s office (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4134).

Substantially Modified Ratios of Effector to Regulatory T Cells During Chemotherapy in Ovarian Cancer Patients Return to Pre-Treatment Levels at Completion: Implications for Immunotherapy

Published: 18 June 2012

(This article belongs to the Special Issue Cancer Vaccines and Immunotherapy)

Download PDF Full-Text 

Abstract:  

Ovarian cancer is the leading cause of death from gynaecological malignancy. Despite improved detection and treatment options, relapse rates remain high. Combining immunotherapy with the current standard treatments may provide an improved prognosis, however, little is known about how standard chemotherapy affects immune potential (particularly T cells) over time, and hence, when to optimally combine it with immunotherapy (e.g., vaccines). Herein, we assess the frequency and ratio of CD8+ central memory and effector T cells as well as CD4+ effector and regulatory T cells (Tregs) during the first 18 weeks of standard chemotherapy for ovarian cancer patients. In this pilot study, we observed increased levels of recently activated Tregs with tumor migrating ability (CD4+CD25^hiFoxp3+CD127−CCR4+CD38+ cells) in patients when compared to controls. Although frequency changes of Tregs as well as the ratio of effector T cells to Tregs were observed during treatment, the Tregs consistently returned to pre-chemotherapy levels at the end of treatment.

SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017 Strategic Plan - Partnership Against Cancer Canada (does not include ovarian/gyn)

Blogger's Note: search of 'ovarian'/'ovary'/'gyn' yields null results

SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017  Strategic Plan - Canada

CONTENTS
2 MESSAGE FROM THE CHAIR AND CEO
4 EXECUTIVE SUMMARY
1. 2012–2017 Strategic Plan
10 THE GROWING CHALLENGE OF CANCER
16 ADVANCING A SHARED VISION
34 2012–2017 STRATEGIC FRAMEWORK
38 STRATEGIC PRIORITIES
52 CORE ENABLING FUNCTIONS
2. 2012–2017 Business Plan
64 PLANNING FOR RESULTS
70 STRATEGIC PRIORITIES
103 CORE ENABLING FUNCTIONS
3. Moving Forward Together
122 TRANSFORMING CANCER CONTROL

Ovarian Cancer and Us - blogger's note

short sabbatical - blog postings to return in ~ one week - thanks!

Journal of Experimental & Clinical Cancer Research |- Chemotherapy and skin reactions

Journal of Experimental & Clinical Cancer Research  Chemotherapy and skin reactions

Research

Chemotherapy and skin reactions

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 Journal of Experimental & Clinical Cancer Research 2012

Published: 28 May 2012

Abstract (provisional)

Background

New chemotherapic agents and new protocols in oncology have led to an increasing survival rate in patients affected by tumors. However, this increased use has been accompanied by a growth in the incidence of cutaneous side effects and a worsening of patients' quality of life. Appropriate management of skin toxicity associated with chemotherapic agents is therefore necessary for suitable drug administration and to improve quality of life and clinical outcomes.

Methods

We have clinically examined 100 patients affected by cancer, determining type, frequency, treatment, and evolution of side effects related to chemotherapy.

Results

The prevalent cutaneous side effects in patients undergoing chemotherapy are skin rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis. The clinical cases are reported in detail.

Conclusion

Oncological therapies have become more selective and have low systemic toxicity because of their high specificity, but cutaneous side effects are common and may worsen the quality of life of these patients.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

paywalled: Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line

Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line chemotherapy

Article first published online: 28 MAY 2012

DOI: 10.1111/j.1447-0756.2012.01884.x

© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology

Issue

Journal of Obstetrics and Gynaecology Research

Early View (Online Version of Record published before inclusion in an issue)

Abstract

Aim:  Several previous reports showed that irinotecan hydrochloride plus cisplatin (CPT-P) was a candidate first-line chemotherapy regimen for clear cell adenocarcinoma of the ovary (CCC). However, long-term survival in CCC patients treated with CPT-P as first-line chemotherapy remains to be determined. The aim of the present study was to evaluate the long-term results of CPT-P as first-line chemotherapy for CCC.

Material and Methods:  We performed a retrospective review of 31 patients with CCC who were treated with CPT-P between 1996 and 2004.

Results:  The median follow-up period was 91 months.........

Conclusion:  The long-term results suggest CPT-P as a candidate in first-line chemotherapy for CCC in not only stage I, but also in optimally debulked stage II-IV patients with pT1/pT2 disease.

HRT Risk Holds Steady Based on Updated Review - in OB/Gyn, HRT from MedPage Today

HRT Risk Holds Steady Based on Updated Review - in OB/Gyn, HRT from MedPage Today

Action Points

• A systematic review of papers published since 2002 (post-WHI study) found that the risks of hormone replacement therapy still outweighed any benefits in primary prevention of chronic conditions.
• Point out that both estrogen plus progestin and estrogen alone prevented fractures, but increased the risk of stroke, thromboembolic events, gallbladder disease, and urinary incontinence.

Earlier detection of bone loss may be in future

Earlier detection of bone loss may be in future

“Right now, pain is usually the first indication that cancer is affecting bones. If we could detect it earlier by an analysis of urine or blood in high-risk patients, it could significantly improve their care,” Fonseca said.

Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics - media (c-38 bill/Canadian healthcare)

Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics

"When it comes to politics, Canadians are generally an apathetic bunch. Often, a controversy will brew and within a week or two we forget about it and move on.

It appears Bill C-38 is one issue we're not willing to let go....

Bill C-38

Jobs, Growth and Long-term Prosperity Act

An Act to implement certain provisions of the budget tabled in Parliament on March 29, 2012 and other measures

 

C-38: What it means for health care (media)

IL-13 regulates cancer invasion and metastasis through IL-13Rα2 via ERK/AP-1 pathway in mouse model of human ovarian cancer.

IL-13 regulates cancer invasion and metastasis through IL-13Rα2 via ERK/AP-1 pathway in mouse model of human ovarian cancer

"Taken together, IL-13Rα2 is involved in cancer metastasis through activation of ERK/AP-1 and that targeting IL-13Rα2 might not only directly kill primary tumors but also prevent cancer metastasis."

Health News - Enhanced data access to benefit cancer researchers and patients

Health News - Enhanced data access to benefit cancer researchers and patients

Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment

 Neurocognitive function impairment after wholebrain radiotherapy for brain metastases: actual assessment


 Conclusion
......The results of this review will enable physicians to inform
patients about benefits and risks of these two treatment options.

paywalled: Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients

Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients:

Abstract

Aim

To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.

Methods 

A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer, and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic findings in these patients.

Results  

All 11 patients had findings of GI perforation on CT, or CT and GI contrast studies. CT revealed a localized extraluminal collection containing gas, fluid, and/or contrast material in eight patients (73%) with focal perforation, and free abdominal air and fluid in three (27%) with free perforation The imaging studies also revealed seven fistulas, including two colovaginal, one rectovaginal, one enterocutaneous, one colocutaneous, one gastrocolic, and one colorectal fistula. Eight (73%) of the 11 patients died within 1 year of the development of GI perforation, and the perforation was felt to be the cause of death in four patients (36%).

Conclusion  

Abdominal CT and fluoroscopic GI contrast studies are useful imaging tests for the diagnosis of potentially life-threatening GI perforation as a complication of bevacizumab therapy. When GI perforation is detected on abdominal imaging studies, treatment with bevacizumab should immediately be discontinued.

Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation

Complete clinical responses to cancer therapy caused by multiple diver

Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation (click on 'pdf' for full paper; references to ovarian cancer; hormonal therapy; angiogenesis...)

Abstract:
Over 50 years of cancer therapy history reveals complete clinical responses (CRs) from remarkably divergent forms of therapies (eg, chemotherapy, radiotherapy, surgery, vaccines, autologous cell transfers, cytokines, monoclonal antibodies) for advanced solid malignancies occur with an approximately similar frequency of 5%–10%. This has remained frustratingly almost static. 
However, CRs usually underpin strong durable 5-year patient survival. How can this apparent paradox be explained? 

Single people with cancer often face the toughest battle alone | Health | Macon.com

Single people with cancer often face the toughest battle alone | Health | Macon.com

Does HE4 have a role in the recurrence of ovarian cancer? | 2012 ASCO Annual Meeting Abstracts (+ links to related ovarian abstracts)

Does HE4 have a role in the recurrence of ovarian cancer? | 2012 ASCO Annual Meeting Abstracts

Abstract:
Background: Human epididymis protein 4 (HE4) has been recently described as a new marker for early ovarian cancer, with higher sensitivity (76.9%) compared to CA125. This is the third study in literature on the role of HE4 in recurrence of ovarian cancer and the first evaluating the sensitivity of HE4 and CA125 in these patients  

Methods: Plasma was obtained 24 hours before secondary cytoreductive surgery from consecutive patients with suspicious recurrence ovarian cancer operated from November 2010 to April 2011 at University Campus Bio-Medico of Rome. CA125 levels were evaluated by a one-step "sandwich" radioimmunoassay. HE4 levels were determined using the HE4 enzymatic immune assay. The CA125 cut-off was less than 35 U/mL. Two cut-off were considered for HE4: less than 150 pmol/L (according to the manufacturer's indications) and less than 70 pmol/L.  

Results: Fourteen patients were histologically confirmed as recurrence ovarian cancer. Mean Ca125 plasma concentration was 31.95 ± 22.09 U/mL (range 1.1 – 64.3). Mean HE4 plasma concentration was 225.83± 286.82 pmol/L (range 21.61- 633.6). The sensitivity of CA125 was 35.7 %. The sensitivity of HE4 was 71.4% and 28.6% above the cut-off of 70 pmol/L and 150 pmol/L, respectively. The dual marker combination of CA125 and HE4 at 70 pmol/L cut-off yielded the highest sensitivity (85.7%) to detect recurrence ovarian cancer.  

Conclusions: Even if a standard cut-off point has not been determined, this study suggested that HE4 may potentially be a more sensible marker for recurrence ovarian cancer than CA125 and the association between CA125 and HE4 at cut-off of 70 pmol/L seems to yield the highest sensitivity.

  Other Abstracts in this Sub-Category:

	1. Randomized phase III study of erlotinib versus observation in patients with no evidence of disease progression after first-line platin-based chemotherapy for ovarian carcinoma: A GCIG and EORTC-GCG study. Meeting: 2012 ASCO Annual Meeting Abstract No: LBA5000 First Author: Ignace B. Vergote Category: Gynecologic Cancer - Ovarian Cancer
	2. Olaparib plus paclitaxel plus carboplatin (P/C) followed by olaparib maintenance treatment in patients (pts) with platinum-sensitive recurrent serous ovarian cancer (PSR SOC): A randomized, open-label phase II study. Meeting: 2012 ASCO Annual Meeting Abstract No: 5001 First Author: Amit M. Oza Category: Gynecologic Cancer - Ovarian Cancer
	3. AURELIA: A randomized phase III trial evaluating bevacizumab (BEV) plus chemotherapy (CT) for platinum (PT)-resistant recurrent ovarian cancer (OC). Meeting: 2012 ASCO Annual Meeting Abstract No: LBA5002^ First Author: Eric Pujade-Lauraine Category: Gynecologic Cancer - Ovarian Cancer
	More...

Time to Ovarian Cancer Return Not Tied to BMI - in Meeting Coverage, ASCO from MedPage Today

Medical News: Time to Ovarian Cancer Return Not Tied to BMI - in Meeting Coverage, ASCO from MedPage Today

Action Points

• Note that this study was published as an abstract and will be presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• A study found that obesity did not affect recurrence, time to recurrence, or progression-free survival in women with epithelial ovarian cancer following surgery and adjuvant chemotherapy without evidence of disease during treatment.
• Note that the approximately one-third of patients who had BMI >30 kg/m² had similar recurrence rates and time to recurrence as the two-thirds of non-obese patients.

PLoS ONE: Increased Expression of PITX2 Transcription Factor Contributes to Ovarian Cancer Progression (clear cell ovarian/high grade)

PLoS ONE: Increased Expression of PITX2 Transcription Factor Contributes to Ovarian Cancer Progression

"....According to FIGO grading classification, high-grade ovarian tumor cells are usually poorly histological differentiated [20], grow faster and highly metastatic [7]. In addition, prognosis of high-grade ovarian tumor is poor thereafter it often associates with poor survival rate [21], [22].The clear cell subtype ovarian cancer accounts for approximately 6% of all epithelial ovarian tumors and most cases of this subtype are high-grade tumor exhibiting an aggressive phenotype [3], [22], [23]. Our study showed that both mRNA and protein levels of PITX2 was frequently upregulated in ovarian cancer particularly in the high-grade and clear cell subtypes, indicating that PITX2may play an important role in driving aggressive phenotypes in ovarian cancer.....

see blogger's note: Medical News: More Good Data for PARP Blocker (Olaparib) in Ovarian Ca - in Meeting Coverage, ASCO from MedPage Today

Blogger's Note: see blog postings 'olaparib' (searchable) of March 27th and March 8th and others; also use NEJM search for more information on ovarian cancer/Olaparib

Medical News: More Good Data for PARP Blocker in Ovarian Ca - in Meeting Coverage, ASCO from MedPage Today

not yet recruiting: Cyclophosphamide and Vaccine Therapy in Treating Patients With Stage II-III Breast, Ovarian, Primary Peritoneal, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov

Cyclophosphamide and Vaccine Therapy in Treating Patients With Stage II-III Breast, Ovarian, Primary Peritoneal, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov

This study is not yet open for participant recruitment.

Verified May 2012 by Mayo Clinic

First Received on May 23, 2012.   Last Updated on May 24, 2012   History of Changes

Sponsor:	Mayo Clinic
Information provided by (Responsible Party):	Keith Knutson, Ph.D., Mayo Clinic
ClinicalTrials.gov Identifier:	NCT01606241

Massachusetts Moves to Require End-of-Life Talks

Mass. Moves to Require End-of-Life Talks:
WBUR radio and Kaiser Health News report that the Massachusetts Senate has quietly approved a measure requiring doctors and nurses to discuss end of life options with patients who have a terminal illness. The Palliative Care Awareness bill was included as part of a sweeping health reform measure and, remarkably, was not controversial. It was supported by both Republicans and Democrats and by a wide range of advocacy groups, including leading right-to-life organizations.

pdf: Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations

pdf:  Family perspectives in lynch syndrome becoming afamily at risk, patterns of communication andinfluence on relations 

Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations

Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 Abstract:
Background: A growing number of individuals are diagnosed with hereditary cancer. Though increased levels of anxiety and depression have been demonstrated around the time of genetic counselling, most individuals handle life at increased risk well. Data have, however, been collected on individual basis, which led us to focus on family perspectives of hereditary cancer.

Methods: Lynch syndrome represents a major type of hereditary colorectal and gynaecological cancer. We preformed open-ended interviews with 27 informants from 9 Lynch syndrome families. Inductive content analysis revealed three major themes: transition to a risk family, patterns of communication and influence on family relations and individual roles.

Results: Family members described how learning about Lynch syndrome shifted focus from daily issues to concerns about cancer. Changes in communication related to difficulties in talking to children about heredity and informing new family members and distant relatives about an increased risk of cancer. Influence on relations was exemplified by family members taking on different roles, e.g. females often being responsible for coordinating information about heredity and providing support. Families in which members had experienced cancer at young age typically informed children soon after learning about heredity and at young age, whereas families with experience of cancer at higher age postponed information and thereby also genetic counselling.

Conclusions: Three major family perspectives are described in Lynch syndrome families; becoming a risk family, patterns of communication and influence on family relations. Since these issues are central, our findings suggests that such family perspectives should be considered during genetic counselling in order to contribute to information spread, help family members cope with the increased risk, and motivate family members at risk to undergo surveillance.

What's Hot at ASCO This Year? (Brentuximab/ovarian cancer/CD30)

What's Hot at ASCO This Year?

".... Another study that builds on a previous breakthrough screened more than 1000 patients with nonlymphoma malignancies for high CD30 expression (Abstract 3069). A drug targeting this molecular defect, brentuximab (Adcetris, Seattle Genetics), has recently been approved for Hodgkin's lymphoma, but the new study found the CD30 defect in patients with mesothelioma and in those with testicular and ovarian cancer. The next step will be to see if these patients respond to the drug, Dr. Vogelzang explained.....