Emergency departments are
challenging research settings, where truly informed consent can be
difficult to obtain. A deeper
understanding of emergency medical
patients’ opinions about research is needed. We conducted a systematic
review and meta-summary
of quantitative and qualitative studies
on which values, attitudes, or beliefs of emergent medical research
participants influence
research participation. We included
studies of adults that investigated opinions toward emergency medicine
research participation.
We excluded studies focused on the
association between demographics or consent document features and
participation and those
focused on non-emergency research............... We report themes associated
with participation or refusal. Our initial search produced over 1800
articles. A total
of 44 articles were extracted for
full-manuscript analysis, and 14 were retained based on our eligibility
criteria. Among
factors favouring participation,
altruism and personal health benefit had the highest frequency. Mistrust
of researchers,
feeling like a ‘guinea pig’ and risk
were leading factors favouring refusal. Many studies noted limitations
of informed consent
processes in emergent conditions. We
conclude that highlighting the benefits to the participant and society,
mitigating risk
and increasing public trust may
increase research participation in emergency medical research. New
methods for conducting
informed consent in such studies are
needed
Sunday, May 12, 2013
A population-based study of tumours of the renal pelvis and ureter: Incidence, aetiology and histopathological findings (including Blogger's Notes/Opinion - Lynch Syndrome/WAR pelvis)
Blogger's Opinion/Comments: again, in the absence of open text it is not possible to determine if the histopathology included that of Lynch Syndrome patients (eg. MSH2); given the high rate of urothelial (ureter/renal pelvis) carcinomas in Lynch Syndrome patients it would be important to include this criteria; it would also help to define whether it was the Lynch Syndrome mutation and/or the prior radiation therapy which was the cause (if possible); note this is a study of years gone by but reflects the abject lack of research in this particular cancer
~~~~~~~~~~~~~~~~
Abstract
Original article
A population-based study of tumours of the renal pelvis and ureter: Incidence, aetiology and histopathological findings
Posted online on May 2, 2013
Objective.Carcinoma
of the renal pelvis and ureter are unusual tumours and our limited
knowledge comes mainly from case reports and small series from large
academic hospitals, as a rule without histopathological review. This
study reports aetiological and demographical factors as well as
clinicopathological findings of all patients in a large geographical
region.
Material and methods.All patients in western Sweden with a renal pelvic or ureteral tumour diagnosed between 1971 and 1998 (n
= 930) were included. Untreated cases were not excluded. Demographic
data and results of preoperative examinations were retrieved from the
original clinical records. The histopathological slides were reviewed
and tumour stage, grade, configuration, presence of carcinoma in situ
and angiolymphatic invasion were determined
Results.The majority
of patients (80%) had invasive or high-grade tumours. Carcinoma in situ
was present among 30% of patients with non-invasive high-grade tumours.
Angiolymphatic invasion (62%) and solid (non-papillary) growth pattern
(84%) were very common among patients with stage T2–T4 tumours.
Twenty-three women out of 138 (16.7%) with ureteral carcinoma had a
history of abdominal radiotherapy for gynaecological cancer 22 years
(median) earlier. Forty-one patients out of 930 (4.4%) had a history of
abuse of phenacetin-containing analgesics.
Conclusions.This study
demonstrates a very high incidence of high-grade upper tract tumours
with carcinoma in situ, angiolymphatic invasion and solid
(non-papillary) growth pattern, which underscores the malignant
character of the disease. The possible association between pelvic
radiotherapy and ureteral carcinoma warrants further study.
Patients' preconceptions of acupuncture: a qualitative study exploring the decisions patients make when seeking acupuncture
open access
Research article
Background
Like any other form of healthcare, acupuncture takes place in a particular context
which can enhance or diminish treatment outcomes (i.e. can produce contextual effects).
Patients' expectations of acupuncture might be an important component of contextual
effects, but we know relatively little about the origins and nature of patients' expectations
or wider preconceptions about acupuncture. Our aim was to identify the processes the
underpin patients' decisions to try acupuncture and thus begin to tease out the origins
and nature of patients' preconceptions.
Reduction of Claustrophobia with Short-Bore versus Open Magnetic Resonance Imaging: A Randomized Controlled Trial
open access
Background
Claustrophobia is a common problem precluding MR imaging. The purpose of the present study was to assess whether a short-bore or an open magnetic resonance (MR) scanner is superior in alleviating claustrophobia.Methods
Institutional review board approval and patient informed consent were obtained to compare short-bore versus open MR. From June 2008 to August 2009, 174 patients (139 women; mean age = 53.1 [SD 12.8]) with an overall mean score of 2.4 (SD 0.7, range 0 to 4) on the Claustrophobia Questionnaire (CLQ) and a clinical indication for imaging, were randomly assigned to receive evaluation by open or by short-bore MR. The primary outcomes were incomplete MR examinations due to a claustrophobic event. Follow-up was conducted 7 months after MR imaging. The primary analysis was performed according to the intention-to-treat strategy.Results
With 33 claustrophobic events in the short-bore group (39% [95% confidence interval [CI] 28% to 50%) versus 23 in the open scanner group (26% [95% CI 18% to 37%]; P = 0.08) the difference was not significant. Patients with an event were in the examination room for 3.8 min (SD 4.4) in the short-bore and for 8.5 min (SD 7) in the open group (P = 0.004). This was due to an earlier occurrence of events in the short-bore group. The CLQ suffocation subscale was significantly associated with the occurrence of claustrophobic events (P = 0.003). New findings that explained symptoms were found in 69% of MR examinations and led to changes in medical treatment in 47% and surgery in 10% of patients. After 7 months, perceived claustrophobia increased in 32% of patients with events versus in only 11% of patients without events (P = 0.004).Conclusions
Even recent MR cannot prevent claustrophobia suggesting that further developments to create a more patient-centered MR scanner environment are needed.“Apologies” for Pathologists: Why, When, and How to Say “Sorry” After Committing a Medical Error
Abstract
How pathologists communicate an error is
complicated by the absence of a direct physician–patient relationship.
Using 2 examples,
we elaborate on how other physician colleagues
routinely play an intermediary role in our day-to-day transactions and
in the
communication of a pathologist error to the
patient. The concept of a “dual-hybrid” mind-set in the intermediary
physician
and its role in representing the pathologists’
viewpoint adequately is considered. In a dual-hybrid mind-set, the
intermediary
physician can align with the patients’ philosophy
and like the patient, consider the smallest deviation from norm to be an
error. Alternatively, they might embrace the
traditional physician philosophy and communicate only those errors that
resulted
in a clinically inappropriate outcome. Neither may
effectively reflect the pathologists’ interests. We propose that
pathologists
develop strategies to communicate errors that
include considerations of meeting
with the patients directly.
include considerations of meeting
with the patients directly.
Such
interactions
promote healing for the patient and are relieving
to the well-intentioned pathologist.
Enhanced killing of ovarian carcinoma using oncolytic measles vaccine virus
Abstract
Highlights
- •
- A promising approach to treat ovarian cancer is oncolytic virustherapy using measles vaccine virus (MeV)
- •
- Arming of MeV with a prodrug-converting suicide-gene in combination with prodrug treatment highly enhanced ovarian cancer cell killing
- •
- Virotherapy of ovarian cancer using armed measles vaccine virus warrants further clinical investigation
Objective
To
preclinical assess the feasibility of combining oncolytic measles
vaccine virus (MeV) with suicide gene therapy for ovarian cancer
treatment.
Methods
We
genetically engineered a recombinant MeV armed with a yeast-derived
bifunctional suicide gene that encodes for cytosine deaminase and uracil
phosphoribosyltransferase (MeV-SCD). From this suicide gene, a chimeric
protein is produced that converts the non-toxic prodrug
5-fluorocytosine (5-FC) into highly cytotoxic 5-fluorouracil (5-FU) and
directly into 5-fluorouridine monophosphate (5-FUMP) thereby bypassing
an important mechanism of chemoresistance to 5-FU.
Results
MeV-SCD
was demonstrated to infect, replicate in and effectively lyse not only
human ovarian cancer cell lines, but also primary tumor cells (albeit at
lower efficiencies) that were derived from malignant ascites of ovarian
cancer patients. Addition of the prodrug 5-FC significantly enhanced
cell killing. Importantly, precision-cut tumor slices of human ovarian
cancer patient specimens were efficiently infected with MeV-SCD. The
prodrug-converting enzyme SCD was expressed by all infected tumor
slices, thereby ensuring provision of the suicide gene arming function
in patient-derived materials.
Conclusions
With
respect to safety and therapeutic impact, arming of oncolytic measles
vaccine virus warrants further clinical investigation for ovarian cancer
treatment.
The (U.S.) FDA Patient Network Website – Patient-Centeredness that Walks the Walk
e-Patients.net
The FDA launched an impressive patient network website this month, after nearly four years of research, focus groups, usability testing and more. The twin goals for this website are promoting the educational mission of the FDA, and promoting opportunities for patient advocacy within the FDA — and earlier in the policymaking process than has been the case historically. James Valentine, Program Analyst in the Office for Health and Constituent Affairs put it simply and forcefully in a recent telephone conversation: “The idea is to engage the patient community, to have the patient voice heard at the FDA.”
Historically, the agency has been working with patients one-on-one, by phone and email, often when an extremely ill patient is seeking information on clinical trials or access to investigational products. The goal is to broaden the field of engagement........
Embattled Komen CEO Nancy Brinker gets 64% raise (see Blogger's Opinion/Your Comments?)
Blogger's Opinion: it should be obvious to many, aside from this specific example, that some/numerous (?) non-profits have exaggerated salaries for their (paid) executives and yet, survivors seem not to be influenced or influenced by this ?? Much research discusses social economic status in cancer patients and disparities in care - yet there seems to be a disconnect between the real lives of patients/survivors and the NP's who purported advocate on their behalf. Opinions welcome!
~~~~~~~~~~~~
blog
Susan G. Komen for the Cure, the breast cancer “Race for the Cure” organizer, that famously dumped Planned Parenthood as a grant recipient last year in response to religious right and House GOP objections, gave its then- (and possibly still) CEO Nancy Brinker a whopping 64% raise last year.
Brinker’s annual salary went from $417,000 to $684,717.
It’s ironic that in a year in which Nancy Goodman Brinker, a major GOP donor who served as an ambassador in the Bush administration, nearly destroyed the Komen brand by making it political (and far-right political, at that), Brinker’s not rewarded with a pink slip, but rather with a big fat pink check.........
Cancer center studies target immune system, women’s cancers (USC/ovarian cancer - summer 2013)
Health News
"There is good evidence that the human immune system
can fight cancer, but it needs some help. Physician scientists at the
Keck School of Medicine of USC are studying ways to teach the body’s
immune system to fight off cancer.
The USC Norris Comprehensive Cancer Center, part of the Keck
School, has recently begun recruiting female participants for three new
clinical trials studying breast, ovarian and cervical cancer
immunotherapies. It is scheduled to open recruitment for a second
ovarian cancer study over the summer.......
Journal of Ovarian Research: Safe and targeted anticancer therapy for ovarian cancer using a novel class of curcumin analogs
open access
Review
A diagnosis of advanced ovarian cancer is the beginning of a long and arduous journey
for a patient. Worldwide, approximately half of the individuals undergoing therapy
for advanced cancer will succumb to the disease, or consequences of treatment. Well-known
and widely-used chemotherapeutic agents such as cisplatin, paclitaxel, 5-fluorouracil,
and doxorubicin are toxic to both cancer and non-cancerous cells, and have debilitating
side effects Therefore, development of new targeted anticancer therapies that can
selectively kill cancer cells while sparing the surrounding healthy tissues is essential
to develop more effective therapies. We have developed a new class of synthetic curcumin
analogs, diarylidenyl-piperidones (DAPs), which have higher anticancer activity and
enhanced bio-absorption than curcumin. The DAP backbone structure exhibits cytotoxic
(anticancer) activity, whereas the N-hydroxypyrroline (-NOH) moiety found on some
variants functions as a cellular- or tissue-specific modulator (antioxidant) of cytotoxicity.
The anticancer activity of the DAPs has been evaluated using a number of ovarian cancer
cell lines, and the safety has been evaluated in a number of non-cancerous cell lines.
Both variations of the DAP compounds showed similar levels of cell death in ovarian
cancer cells, however the compounds with the -NOH modification were less toxic to
non-cancerous cells. The selective cytotoxicity of the DAP--NOH compounds suggests
that they will be useful as safe and effective anticancer agents. This article reviews
some of the key findings of our work with the DAP compounds, and compares this to
some of the targeted therapies currently used in ovarian cancer therapy.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
A phase II study of modified dose-dense paclitaxel and every 4-week carboplatin for the treatment of advanced-stage primary epithelial ovarian, fallopian tube, or peritoneal carcinoma
Abstract
Cancer Chemother Pharmacol
PURPOSE:
Traditional dose-dense chemotherapy regimens for advanced stage ovarian cancer incorporate weekly paclitaxel on a 21-day cycle and are associated with favorable efficacy but high rates of neutropenia, thrombocytopenia, and anemia. The purpose of this phase II study was to assess the response rate and toxicity of modified dose-dense paclitaxel and every 4-week carboplatin for the treatment of advanced-stage ovarian, fallopian tube, and primary peritoneal carcinoma.METHODS:
All eligible patients were treated with 6 cycles of intravenous dose-dense paclitaxel (80 mg/m2) days 1, 8, and 15 and carboplatin (AUC 5 or 6) Day 1 during a 28-day cycle in accordance with an IRB-approved protocol. Patients who had clinically defined stable disease or better with a CA-125 ≤ 35 U/ml following the completion of primary induction therapy were subsequently administered a planned 12 cycles of paclitaxel (135 mg/m2; every 21 days) consolidation therapy.RESULTS:
Eighty-eight patients received at least 3 cycles of induction dose-dense chemotherapy, of whom 76 completed 6 cycles of chemotherapy; the overall response rate was 84.2 % (56.6 % complete response). Fifty-three patients received an aggregate 473 cycles (median = 9; range 1-12) of consolidation chemotherapy. Grade 3-4 hematological toxicity included neutropenia (22.7 %), thrombocytopenia (7.9 %), and anemia (1.1 %). Further, grade 3 neuropathy developed in one (1.1 %) patient. The patients' median disease-free survival and overall survival were 22.5 and 31.5 months, respectively.CONCLUSIONS:
This phase II study suggests that first-line treatment comprising modified dose-dense paclitaxel and monthly carboplatin chemotherapy with paclitaxel consolidation therapy preserves the efficacy of traditional dose-dense chemotherapy, while minimizing hematologic toxicity.Tumor suppressor genes associated with drug resistance in ovarian cancer (Review/Abstract/technical)
Abstract
Ovarian cancer is a fatal
gynecological cancer and a major cause of cancer-related mortality
worldwide. The main limitation to a successful treatment for ovarian
cancer is the development of drug resistance to combined chemotherapy.
Tumor suppressor genes (TSGs) are wild-type alleles of genes which play
regulatory roles in diverse cellular activities, and whose loss of
function contributes to the development of cancer. It has been
demonstrated that TSGs contribute to drug resistance in several types of
solid tumors. However, an overview of the contribution of TSGs to drug
resistance in ovarian cancer has not previously been reported. In this
study, 15 TSGs responding to drug resistance in ovarian cancer were
reviewed to determine the relationship of TSGs with ovarian cancer drug
resistance. Furthermore, gene/protein-interaction and bio-association
analysis were performed to demonstrate the associations of these TSGs
and to mine the potential drug resistance-related genes in ovarian
cancer. We observed that the 15 TSGs had close interactions with each
other, suggesting that they may contribute to drug resistance in ovarian
cancer as a group.
Diagnostic Ureteroscopy Independently Correlates with Intravesical Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
Blogger's Note: this will be of interest to Lynch Syndrome patients/UTUC/surveillance-diagnostics
Abstract
Ann Surg Oncol. 2013 May 10
BACKGROUND:
Little is known about the effects of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy.METHODS:
This study was designed to determine the effect of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy. From 2004 to 2010, 446 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical center. We included 115 patients who underwent preoperative diagnostic ureteroscopy and 281 patients who did not. This study analyzed the impact of the reported risk factors and diagnostic ureteroscopy for intravesical (bladder) recurrence after nephroureterectomy by multivariate Cox regression model.Adherence to Adjuvant Hormonal Therapy and Its Relationship (North Carolina)
Abstract
Discussion: Hormonal therapy adherence was not associated with breast cancer outcomes in this low-income population with relatively poor adherence. Although suboptimal adherence is considered to be an important clinical problem, its effects on breast cancer outcomes may be masked by patient genetic profiles, tumor characteristics, and behavioral factors.
The Impact of Gender on Outcomes in Patients With Metastatic Urothelial Carcinoma
Blogger's Note: of interest to Lynch Syndrome patients; in the absence of open access, this abstract focuses on treatment-related events as opposed to the inclusion of genetics' role/potential influence on survival - a missing link
Abstract
Background
Although
urothelial cancer is more common in men, women with urothelial cancer
have inferior survival outcomes. The potential existence of
gender-related disparities in patients with metastatic urothelial cancer
has not been extensively explored.
Conclusion
Female
patients with metastatic urothelial cancer tolerate cisplatin-based
chemotherapy similarly to male patients and achieve comparable clinical
outcomes. Although gender-associated survival disparities in patients
with metastatic urothelial cancer cannot be completely ruled out, if
such disparities exist, they are unlikely related to tolerability or
efficacy of chemotherapy.
Written emotional disclosure for women with ovarian cancer and their partners: randomised controlled trial
Abstract
Objective
Written
emotional disclosure for 15–20 min a day over 3 to 4 days improves
physical and psychological health and may benefit cancer patients.
However, no studies have tested the effectiveness of guided writing in
cancer patients and their partners. A randomised controlled trial tested
whether writing about the patient's diagnosis and treatment of ovarian
cancer using the Guided Disclosure Protocol (GDP) is effective in
reducing perceived stress and improving quality of life (QoL) in ovarian
cancer couples. The study also tested two theories that may account for
beneficial effects of written emotional disclosure, the cognitive
processing hypothesis and the social interaction hypothesis.
Methods
Patients and their partners (N
= 102 couples) were randomised to write at home for 15 min a day over
3 days about the patient's diagnosis and treatment using the GDP or what
the patient did the previous day (control). Couples were assessed at
baseline, 3- and 6-month follow-ups on the primary outcomes of perceived
stress and QoL and secondary outcomes of intrusive thoughts (testing
the cognitive processing hypothesis) and illness-related couple
communication (testing the social interaction hypothesis).
Results
There
were no main effects for any outcomes. However, in patients, the GDP
improved QoL if illness-related couple communication improved and
buffered the effect of intrusive thoughts on perceived stress.
Conclusions
The
GDP might benefit patients in certain circumstances, through changes in
communication (in line with the social interaction hypothesis). Further
research is needed to determine whether patients benefit from
interventions to improve illness-related couple communication and under
which conditions.
Review: Immunomonitoring and prognostic relevance of neutrophils in clinical trials
open access
Review
11. Ovarian
Recently,
the result of a large, multicenter, randomized trial of flat dosing
versus intrapatient dose escalation of single-agent carboplatin as
first-line chemotherapy for advanced ovarian cancer has been published [60].
A total of 964 patients were randomized. Dose escalation was achieved
in 77% of patients who had ≥1 cycle. Intrapatient dose escalation of
carboplatin based on nadir blood neutrophils or thrombocytes was
feasible and safe. However, it provided no improvement in PFS or OS
compared with flat dosing. In multivariate analysis, high baseline
neutrophil counts had a significant adverse prognostic value whereas
nadir neutrophils counts were not statistically significantly associated
with outcome. The authors concluded that baseline neutrophils over-ride
nadir counts in prognostic significance and questioned the use of dose
escalation as a standard practice.
12. Concluding remarks
The
clinical relevance of tumor-infiltrating neutrophils has recently begun
to emerge. Direct associations between tumor-infiltrating neutrophils
and poor clinical outcome have now been described for several types of
human cancer. The prognostic role of tumor-infiltrating neutrophils,
elevated blood neutrophils and elevated blood neutrophil/lymphocyte
ratio has been associated with poor clinical outcome, most notably in
renal cell carcinoma, melanoma, colorectal cancer, hepatocellular
carcinoma, cholangiocarcinoma, glioblastoma, GIST, gastric, esophageal,
lung, ovarian and head and neck cancer. A striking finding is the notion
that high baseline neutrophil count in either tumor or blood, or both,
was identified as a strong, independent risk factor for poor outcome and
the negative prognostic impact of neutrophils was not eliminated by
increasing the dose of cytokines, chemotherapy, or targeted therapy. For
several cancers, patients benefit most from therapy if baseline
neutrophil was low. Thus, baseline neutrophils over-ride nadir counts in
prognostic significance. This has especially been shown in kidney
cancer, colorectal cancer, non-small cell lung cancer, ovarian cancer
and nasopharyngeal carcinoma. In other words, a proportion of patients
who do not experience benefit from surgery or medical intervention may
be associated with a worst prognosis because they are characterized by
baseline tumor-related neutrophilia protecting them from benefit from
therapy.
It should been
emphasized that most of these studies have been published within the
last few years, demonstrating an independent prognostic role of
neutrophils in blood or tumor, or both, after correcting for well-known
clinical and pathological features, highlighting the increasing
importance and relevance of neutrophils in cancer biology [61] (Table 1).
Further studies are recommended, examining the therapeutic implication
of the adverse prognostic significance of high neutrophil count. The
existence and properties of N1 and N2 neutrophils in human cancer
related inflammation need to be carefully investigated to provide a
basis for new diagnostic and therapeutic strategies [62].
The Bedside Manifesto | The Health Care Blog
Blog
“Most of us went into medicine because we love spending time with patients,” said Johns Hopkins Hospital’s Leonard Feldman, MD.
Dr. Feldman is co-author of an article published April 18 in the Journal of General Internal Medicine
which reveals that medical interns spend only 12% of their time
examining and talking with patients, and more than 40% of their time on
computer tasks.“Our systems have squeezed [patient contact] out of medical training,” said Dr. Feldman.“ All of us think that interns spend too much time behind the computer. It’s not an easy problem to solve.”
For three weeks a year ago, investigators observed 29 interns at two Johns Hopkins University internal medicine residency programs for a total of 873 hours. Direct patient care accounted for only 12.3% of interns’ time, and computer use for 40%. The paucity of direct interaction may explain previous studies’ findings that only 10% of hospitalized patients know which resident physicians are responsible for their care. “I think we can do better,” said Dr. Feldman.
He’s right. Unless we want healthcare to devolve ultimately into a system of vending machines, we need to restore its traditional personal intimacy.........
Malignant tumors with clear cell morphology: a comparative immunohistochemical study with renal cell carcinoma antibody
Abstract
This
study aimed to identify an immunohistochemical panel to aid in the
differential diagnosis for tumors with clear cell morphology.
Twenty-five clear cell renal cell carcinomas (CCRCCs), 19 clear cell
ovarian carcinoma (CCOCs), 20 cases of adrenal cortical
carcinomas(ACCs), and 10 chordomas were stained for renal cell carcinoma
marker (RCC Ma), Pax8, brachyury, and steroidogenic factor 1 (SF-1).
The extent of stains was scored as focal (<25%), nonfocal (25%-50%),
and diffuse (>50%). The intensity was scored as weak, moderate, and
strong. Twenty-two CCRCCs were positive for RCC Ma (88%) and Pax8 (88%),
respectively. The RCC Ma cytoplasmic staining was largely diffuse (76%)
and strong (76%). The nuclear Pax8 staining was usually diffuse (76%)
and moderate (64%) to strong (8%). All of CCRCCs were negative for
brachyury and SF-1. All of 19 CCOCs were positive for Pax8 nuclear
staining. The staining was diffuse, moderate (21%) to strong (79%). All
of CCOCs were negative for RCC Ma, brachyury, and SF-1. All of 20 ACCs
were positive for SF-1 nuclear staining. The staining was largely
diffuse (95%), moderate (55%) to strong (15%). All of ACC were negative
for RCC Ma, Pax8, and brachyury. All of 10 chordomas were positive for
brachyury nuclear staining. The staining was diffuse and strong. All of
chordomas were negative for RCC Ma, Pax8, and SF-1. In summary, the
panel of RCC Ma, Pax8, brachyury, and SF-1 is useful in the differential
diagnosis of tumors with clear morphology.
Evaluation and Program Planning - The cost of implementing a 2-1-1 call center-based cancer control navigator program
Abstract
Highlights
- •
- An innovative 2-1-1 call center-based cancer control navigator program.
- •
- Evaluate annual total and per participant cost of implementing and maintaining program in metropolitan areas.
- •
- Identify the components of cost and the effects of scale of operations.
- •
- Assess the participant time cost and define the variation in participant time cost.
Objectives
Determine the cost of implementing a call center-based cancer screening navigator program.
Alan Ashworth: Enough of the back slapping, let's find a cure for cancer - Profiles - People - The Independent
Blogger's Note: interesting article with background on Dr (Prof) Ashworth (re: PARP/BRCA/stigmatisation.....
media
"The molecular biologist has revolutionised treatment of breast cancer. His next challenge? The lungs. Steve Connor meets Alan Ashworth." (interview)
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