Interactive Map: (U.S.) AHRQ comparing healthcare stats quality etc

NHQR/DRnet - Select State

 This newly integrated website provides a unified Web tool for investigating information presented in the National Healthcare Quality and Disparities Reports. It allows users to drill down from the broadest picture of healthcare quality and disparities on the national and state levels

 

Principles of Treatment for Borderline, Micropapillary Serous, and Low-Grade Ovarian Cancer

abstract

Borderline ovarian tumors (BOTs) are less common than epithelial ovarian cancers (EOCs). Low-grade EOCs (LG-EOCs) occur even less frequently than BOTs. After primary therapy, recurrence rates of BOTs and LG-EOCs are significantly lower and the stage-adjusted survival is higher than for high-grade EOCs. Thus, determining the best management in terms of traditional ovarian cancer staging and debulking procedures is more challenging and has been recently brought to question. This article reviews the particulars of BOTs and LG-EOCs, their similarities and differences, and how they are best managed and treated, and emphasizes the major role of surgery and the controversial role of chemotherapy. Because these tumors disproportionately affect younger women, this review addresses ovarian preservation in circumstances when fertility or hormonal preservation is desired. 

(less common histopathologies) Ovarian Cancer, V1.2016, NCCN Clinical Practice Guidelines

Ovarian Cancer
  
Abstract

This selection from the NCCN Guidelines for Ovarian Cancer focuses on the less common ovarian histopathologies (LCOHs), because new algorithms were added for LCOHs and current algorithms were revised for the 2016 update. The new LCOHs algorithms include clear cell carcinomas, mucinous carcinomas, and grade 1 (low-grade) serous carcinomas/endometrioid epithelial carcinomas. The LCOHs also include carcinosarcomas (malignant mixed Müllerian tumors of the ovary), borderline epithelial tumors (also known as low malignant potential tumors), malignant sex cord-stromal tumors, and malignant germ cell tumors.

Footnotes

Please Note

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Ovarian Cancer are not printed in this issue of JNCCN but can be accessed online at NCCN.org.

A doctor learns what food means to her patients (eg. NG tubes...)

medical news

When we finally removed the (NG)  feeding tubes from this patient’s throat, the first thing he said was “I haven’t eaten anything in weeks!” The senior doctor reminded him of the role of that feeding tube.

Doctors and patients aren’t always on the same page.

Metformin in ovarian cancer therapy: A discussion

open access
 

Preclinical Studies of Metformin and Ovarian Cancer

Metformin's indirect effect on ovarian cancer

Several preclinical studies demonstrate the metformin's indirect effect on OVC, the mechanism of which includes the inhibition of hepatic gluconeogenesis and increasing peripheral glucose uptake,^{[45],[46],[47]} subsequently resulting in lower glucose, insulin, and IGF-1 levels in circulation.^[48],[49] Hyperglycemia attenuates metformin sensitivity in OVC while stimulating the OVC progression.^[50],[51] Similarly, in hyperinsulinemia, IGF-1 levels also stimulate the risk of OVC by activating PI3K/Akt/mTOR pathway, through IGF-1R signaling.^{[37],[52],[53],[54]} A careful observation of the above data also suggested that the metformin cannot play an indirect effect in nondiabetic patients.^[55]

Conclusion
The epidemiologic and preclinical data evaluated in this review are supportive of the use of metformin for the prevention and treatment of OVC. Preclinical evidence suggests that metformin possesses anticancer effects on OVC. Results of clinical studies, although a few, suggest that using metformin, pertaining to its cumulative dose and duration of therapy, is associated with a decreased incidence of OVC in diabetic population. In addition, it is also found to be associated with a better survival of OVC patients with diabetes. There are many unanswered questions though, including: (1) Whether metformin has anti-cancer activity in nondiabetics? (2) Whether we can use tumor genetic profiling to identify patients who are most likely to benefit from metformin treatment? (3) Considering the supra-clinical doses of metformin used in preclinical in vitro models to obtain an antineoplastic effect, should the optimal dose of metformin for OVC be revised and/or should it need a new route of drug delivery? (4) Do the serious side effects of supra-clinical doses or long-term therapy of metformin exist? If so, how to avoid these side effects? Future studies are hoped to warrant such questions, the results of which should be of value in determining metformin as a standard line of treatment for OVC patients.

FDA Alert: Opioid Pain or Cough Medicines Combined With Benzodiazepines: Drug Safety

(U.S.) FDA Requiring New Boxed Warnings About Serious Risks and Death
 August 31, 2016

ISSUE: FDA review has found that the growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths.  Opioids are used to treat pain and cough; benzodiazepines are used to treat anxiety, insomnia, and seizures. In an effort to decrease the use of opioids and benzodiazepines, or opioids and other CNS depressants, together, FDA is adding Boxed Warnings, our strongest warnings, to the drug labeling of prescription opioid pain and prescription opioid cough medicines, and benzodiazepines. See the Drug Safety Communication for a listing of all approved prescription opioid pain and cough medicines, and benzodiazepines and other CNS depressants.
FDA conducted and reviewed several studies showing that serious risks are associated with the combined use of opioids and benzodiazepines, other drugs that depress the CNS, or alcohol (see the FDA Drug Safety Communication for a Data Summary).......

                         ~~~~~~~~~~~~~~~~~~~~~~~~~

(list) Drugs that contain benzodiazepines

Death, bankruptcy and longer wait times: Ottawa warned about more private health care

Politics - CBC News

Dr. Matthew Yurgelun on Next Steps in Understanding CRC Mutations (BRCA)

video (0:51 min)

 Matthew B. Yurgelun, MD, instructor in Medicine, Harvard Medical School, discusses the next steps in study looking at BRCA1 and BRCA2 mutations and other genetic markers in colorectal cancer.

The study examined over 1000 individuals with colorectal cancer who were seen at the Dana Farber Cancer Institute, and ultimately consented to participation in a sample registry. It found that 10% of patients had pathogenic mutations in one or more cancer susceptibility genes and 7.1% of patients had a mutation in the non-Lynch syndrome cancer susceptibility gene. The most common mutations that were found beyond Lynch syndrome were BRCA1 and BRCA2, which was surprising, says Yurgelun.

Next steps in this study will be to further evaluate the significance of some of these surprise mutations.

There are a lot of genes that are now being tested for where the full spectrum cancer risk that mutations in these genes confer is not understood, says Yurgelun.

The spectrum of cancer risk linked to some genes may be wider than traditionally though, and larger studies looking specifically at whether or not these mutations mean the same things when found in a non-traditional fashion, need to be conducted, he says.
 

Brian Hodges (UHN) is awarded the Karolinska Institutet Prize for (eg. simulated patients) Research in Medical Education

media

Simulated consultations: a sociolinguistic perspective

Full Text

  Whilst simulation undoubtedly has a place in formative learning for professional communication, the simulated consultation may distort assessment of professional communication These sociolinguistic findings contribute to the on-going critique of simulations in high-stakes assessments and indicate that further research, which steps outside psychometric approaches, is necessary.

                                        ~~~~~~~~~~~~~~~~~~~~~~~~~~~

•  In health care, a simulated patient (SP), also known as a standardized patient, sample patient , or patient instructor, is an individual trained to act as a real patient in order to simulate a set of symptoms or problems.
•  McMaster University > CSBL > Standardized Patient Program - Hamilton
  simulation.mcmaster.ca/spp.html
  A standardized patient is a healthy person who is trained to realistically and accurately reproduce a history, physical and/or emotional medical scenario that a real patient would present.
•  Standardized Patient Program | - Toronto
  www.spp.utoronto.ca/
  The Standardized Patient Program (SPP), University of Toronto is a dynamic educational resource dedicated to enhancing all facets and levels of health ... 

  • Standardized Patient Program - Johns Hopkins Medicine
  www.hopkinsmedicine.org › Simulation Center › Training
  Standardized patient simulation involves the use of individuals trained to portray the roles of patients, family members or others to allow students to practice ...

Cochrane - Featured Review: Interventions to reduce corruption in the health sector

Cochrane


Scarce evidence, but pointers to promising strategies to fight corruption in  health care
Corruption can occur in any area of the health sector, and happens when people abuse their own position to benefit themselves, their organization, or other people close to them. It can take many forms, including bribes, theft, or giving incorrect or inaccurate information deliberately. Healthcare officials, for instance, may steal healthcare funds; hospital administrators may change patient records to increase hospital fees; doctors may accept gifts or hospitality from pharmaceutical companies in exchange for using their products; and patients may try to bribe hospital staff to avoid treatment queues. Corruption can therefore take money away from health care, lead to poorer quality care, or make access to health care unfair, and often affects poor people the most.

A team of Cochrane authors based in Chile, India, Norway, and the USA worked with Cochrane Effective Practice and Organisation of Care to assess the effectiveness of strategies to reduce corruption in the health sector.

Molecular alterations in indolent, aggressive and recurrent ovarian low-grade serous carcinoma

Abstract
 

Aims

The clinical course of patients with low-grade serous carcinoma (LGSC) can be substantially different. The purpose of this study was to explore whether molecular or pathological features could identify patients that follow a more aggressive course.

Conclusion

Despite limited case numbers, it appears that current molecular testing is inferior in predicting outcome of LGSCs compared to a pathological parameter or protein expression. Prediction of outcome based on the primary tumour may be confounded by additional acquired changes over time.

Ovarian cancer study dropouts had worse health-related QOL/psychosocial symptoms at baseline and over time

abstract:
Ovarian cancer study dropouts had worse health-related quality of life and psychosocial symptoms at baseline and over time

Conclusions

Poorer HRQOL and higher depression at baseline, and final HRQOL, anxiety, depression and optimism scores were predictive of time of dropout. These results highlight the importance of collecting auxiliary data to inform careful and considered handling of missing PRO (Patient Reported Outcomes) data during analysis, interpretation and reporting.

(2016) Radiation Therapy for Recurrent Clear-Cell Cancer of the Ovary

abstract

Objective: Given the relative chemo-resistant nature of clear-cell gynecologic cancers, we investigated the utility of radiation therapy (RT) to treat recurrent clear-cell carcinoma (CCC) of the ovary.

Methods: A retrospective chart review of patients with recurrent CCC managed from 1994-2012 was conducted at 2 academic medical centers. Demographic and clinicopathologic factors were abstracted and evaluated using Pearson [chi]2 or t tests, Kaplan-Meier and Cox regression analyses.

Results: Fifty-three patients had recurrent CCC, and 24 (45.3%) of these patients received RT. There were no significant differences in age, stage, optimal cytoreduction, platinum response, or the percentage of patients that received more than 3 regimens of chemotherapy between the 2 groups. Patients who received RT for recurrent CCC were more likely to have had a focal recurrence (62.5% vs 10.3%, P <= 0.001) and to have undergone secondary cytoreduction (70.8% vs 10.3%, P <= 0.001). Of patients who received RT, 73.9% underwent surgery with or before their treatment. Five-year survival after recurrence was significantly higher in the group that received RT, 62.9% versus 18.8% (P = 0.002). In a multivariate analysis, platinum-sensitive disease and RT were associated with improved survival from recurrence, (hazard ratio, 0.26; 95% confidence interval, 0.08-0.81; P = 0.02 and hazard ratio, 0.28; 95% confidence interval, 0.09-0.90, P = 0.03, respectively).

Conclusions: In this cohort of patients with recurrent CCC, platinum-sensitive disease and RT are associated with improved survival. However, it is important to note that the majority of these patients underwent surgery along with RT, and it may be that the benefit of RT is limited to those who undergo secondary cytoreduction.

The Use of "Optimal Cytoreduction" Nomenclature in Ovarian Cancer Literature: Can We Move Toward a More Optimal Classification System?

abstract

Objectives: The objective of this study is to explore how cytoreductive surgical outcomes such as residual disease (RD) and use of the term "optimal cytoreduction" (OCR) have changed over time in the ovarian cancer literature.

Conclusions: Optimal cytoreduction terminology remains ambiguous and inconsistently used in the ovarian cancer surgical literature. On the basis of this literature review, we propose a novel classification system to categorize RD without reference to OCR while accurately and succinctly identifying meaningful clinical subgroups and minimizing bias.

Gene Wilder spent decades raising awareness for the ovarian cancer that claimed wife Gilda Radner’s life

media

September is Ovarian Cancer month (U.S./Canada)

OCNA