SJS/TEN 2019: From science to translation.

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. SJS/TEN 2019: From Science to Translation was a 1.5-day scientific program held April 26-27, 2019, in Vancouver, Canada. The meeting successfully engaged clinicians, researchers, and patients and conducted many productive discussions on research and patient care needs.

The significance of combination chemotherapy in epithelial ovarian cancer.

OBJECTIVE: Since the publication of International Collaborative Ovarian Neoplasm 3, various practice patterns have evolved with respect to practice patterns and survival among women with epithelial ovarian cancer in British Columbia, Canada. The objectives of this study were to evaluate different strategies for first-line chemotherapy in ovarian cancer and to determine their effect on survival at a population level. METHODS AND MATERIALS: This was a retrospective population-based cohort study of 854 women with epithelial ovarian cancer in British Columbia from 2005 to 2008. Details were ascertained on stage, grade, histotype, performance status, surgeon type, extent of debulking, first-line chemotherapy including type and number of cycles, and cause and date of death. A Cox regression model was used to evaluate the association of covariates on overall survival. RESULTS: Of the 817 women eligible for chemotherapy, 729 (89.2%) received treatment, including 106 (14.5%) women who received single-agent carboplatin and 623 (85.5%) women who received combination platinum-based chemotherapy. Chemotherapy was evaluated as a time-varying covariate. Median numbers of single-agent carboplatin and combination chemotherapy cycles were 5 (range, 1-11) and 6 (range, 1-12), respectively. After adjustment for demographic, disease, and treatment factors, the covariates significantly associated with survival were stage, performance status, extent of debulking, and chemotherapy type. Single-agent carboplatin had a mortality hazards ratio of 5.15 (95% confidence interval, 2.39-11.11) relative to combination chemotherapy. CONCLUSIONS: In this population-based study, first-line platinum-based combination chemotherapy was associated with improved survival compared with single-agent carboplatin after adjustment for covariates in ovarian cancer. Higher rates of combination chemotherapy may improve outcomes at a population level.

The impact of geographic variations in treatment on outcomes in ovarian cancer.

OBJECTIVE: There are significant regional differences in survival outcomes across British Columbia among women with ovarian cancer. The age-adjusted hazard ratio for mortality is 1.27 (95% confidence interval, 1.08-1.49) in 1 health authority region compared to the provincial mean. The objective of this study was to look at variations in the treatment of epithelial ovarian cancer among the 5 health authority regions in the province of British Columbia and determine their effect on survival. METHODS AND MATERIALS: This was a population-based retrospective cohort study of all incident cases of epithelial ovarian cancer diagnosed in British Columbia from 2005 to 2008. Health authority regions were compared with the χ(2) test for demographic and disease characteristics, as well as treatment practices including assessment by a gynecologic oncologist, rate of optimal debulking, and proportion receiving platinum-based combination chemotherapy. Multivariable Cox regression analysis evaluated the effect of covariates on survival. RESULTS: There were 854 evaluable patients. Across health authority regions, there were significant differences in disease characteristics, including the proportion with serous histotype (44.0%-60.7%, P = 0.043) and stage IIIC/IV disease (50.3%-69.4%, P = 0.0048). There were also significant differences in treatment, including the proportion of patients assessed by a gynecologic oncologist (56.8%-79.4%, P = 0.0003), rate of suboptimal debulking, (21.4%-60.2%, P = 0.0036), and the proportion receiving combination chemotherapy, (61.5%-81.9%, P < 0.0001). Cox regression model revealed that stage, grade, optimal debulking, and combination chemotherapy were significantly associated with survival. The health authority region with the highest mortality had the lowest rate of optimal debulking and combination chemotherapy. CONCLUSIONS: Differences in survival rates for ovarian cancer across British Columbia can be attributed to variations in disease characteristics and treatment, particularly rates of optimal debulking and combination chemotherapy.

Blood pressure measurement for hypertension in pregnancy.

OBJECTIVE: Ambulatory BP monitoring (ABPM) has been proposed as a logical approach to overcoming many of the problems associated with clinical BP measurement. The extent of its use in diagnosing hypertension in pregnancy is unknown. The objective of this study was to identify the practices surrounding use of ABPM by practitioners to diagnose hypertension (HTN) and white coat hypertension (WCH) in pregnant women. METHODS: We mailed questionnaires to all obstetricians and family doctors practising obstetrics who were listed in the online medical directory of the College of Physicians and Surgeons of Alberta. Data were analyzed using SPSS. RESULTS: Completed questionnaires were received from 81 obstetricians and 86 primary care physicians who manage hypertension in pregnancy. The majority of obstetricians (83%) and primary care physicians (79%) indicated that they "almost always" or "often" attempt to differentiate WCH from true HTN in pregnancy. The most popular method identified to differentiate WCH from true HTN in pregnancy was self (intermittent) home BP monitoring (78% of obstetricians and 69% of primary care physicians, P = 0.18). A minority of physicians in each group reported using ABPM to evaluate HTN in pregnancy, with significantly fewer obstetricians using ABPM diagnostically than primary care physicians (12% vs. 26%, P = 0.04). CONCLUSION: Obstetrical care providers in Alberta are aware that WCH is an issue among pregnant women. While ABPM is chosen in a minority of cases, both obstetricians and primary care physicians appear to have a strong preference to use self BP monitoring for further BP evaluation.

Court reporters: a viable solution for the challenges of focus group data collection?

Focus group interviews are a common approach to data collection in qualitative research projects. They are, however, a method with the potential for methodological and pragmatic difficulties, many of which stem from transcribing focus group data from an audiotape. An alternative to postinterview transcription is the use of a court reporter. Advantages found using court reporters were increased accuracy, timely receipt of transcripts, less distraction for focus group facilitators, guaranteed confidentiality, time saved reviewing transcripts, and convenience. Because court reporters do not traditionally work in health research, there might be issues with medical terminology that require diligence on the part of the researcher to ensure that jargon is appropriately identified and transcribed. Using court reporters in rural areas might be cost-prohibitive because of travel expenses. Court reporters offer a viable and worthwhile approach to data transcription, and in our experience, have provided our research team with rich and accurate data.