The interval from surgery to chemotherapy in the treatment of advanced epithelial ovarian carcinoma.

BACKGROUND: To study the effect of the interval between surgery and the start of chemotherapy in the treatment of patients with advanced ovarian cancer. METHODS: We stratified patients according to the start of platinum-based chemotherapy in group 1 (within 4 weeks from surgery), group 2 (between 4 and 8 weeks) and group 3 (between 8 and 12 weeks). RESULTS: Three hundred and ninty-four stage III ovarian cancer patients were analysed. In the multivariate analysis there were no differences in survival according to the interval between surgery and chemotherapy among the three groups. The independent prognostic variables were type of procedure (p = 0.014), performance status (p = 0.040) and post-chemotherapy CA-125 (p < 0.0001). CONCLUSIONS: The interval between surgery and chemotherapy does not affect outcome.

Balloon ablation: is this an outpatient procedure?

Menorrhagia is associated with considerable health consequences. First-line therapy is medical, but when this proves unsuccessful a surgical procedure is often undertaken. It is estimated that as many as one in five women will have a hysterectomy before the age of 60 years. While a curative procedure this is a major operation with both morbidity and mortality associated with it. More conservative procedures have therefore been sought. Balloon therapy was developed in 1994 and it was introduced to Royal Bolton Hospital in 1998. Initially offered under general anaesthesia, an overall a success rate of 91% was achieved in this study, with amenorrhea in 18% of cases. Dysmenorrhea was improved in 60% of patients. Twenty-eight patients received outpatient therapy, under a paracervical block. All patients were given voltarol pretreatment. Subjectively the procedure was well tolerated by most, and objectively 89% of patients rated the procedure as acceptable. Sixty-one per cent of patients would be happy to undertake the procedure again under local anaesthesia. Findings from this study would indicate that balloon ablation does provide an effective, less invasive, alternative treatment for menorrhagia. Despite limited numbers, it would also seem appropriate, in selected patients, to offer this therapy as an outpatient procedure.

Evaluation of a geriatrics course emphasizing interdisciplinary issues for chiropractic students.

In 1998, the Iowa Geriatric Education Center (IGEC) was funded by the U.S. Health Resources and Services Administration Bureau of Health Professions. The role of the chiropractic institution participating as a partner in the IGEC was to develop and evaluate a model geriatrics course for chiropractic students emphasizing experiential learning and interdisciplinary issues. The evaluation assessed changes in the students' knowledge of geriatrics and their attitudes toward older adults and toward interdisciplinary issues. There were 197 students in the class. The alternate course was offered to 20 volunteers for the pilot test. Score changes from baseline to post-intervention were evaluated using the Wilcoxon signed-ranks test. Instruments were Facts on Aging Quiz (FAQ), Aging Semantics Differential (ASD), and Interdisciplinary Education Perception Scale (IEPS). Median scores improved by 12 percentage points on FAQ (p = 0.002), 18 points on the ASD (p = 0.007), and decreased by 15 points on the IEPS (p = 0.064). Integration of the course into the curriculum is being planned, and the evaluation scheme appears appropriate for other health professions, such as nursing, to use for evaluating interdisciplinary geriatrics courses for their students.

Use of complementary healthcare practices among chiropractors in the United States: a survey.

CONTEXT: Although chiropractic is the most commonly used complementary healthcare practice, chiropractors have not been surveyed in depth about their attitudes toward and practice of complementary and alternative therapies apart from spinal manipulation. OBJECTIVES: To examine attitudes among US chiropractors on the role of their profession in complementary healthcare and to gather data on the types of complementary healthcare practices chiropractors use. DESIGN: Descriptive, cross-sectional study using a mail-in survey. SETTING: United States. PARTICIPANTS: Random sample of US chiropractors stratified by zip code region. RESULTS: A total of 563 surveys were completed, for a response rate of 30%. Respondents were almost equally divided on their responses to the question "Do you feel that chiropractic should at the present time be termed 'complementary'?" Although many respondents (68%) believed that chiropractic was viewed as a therapeutic modality, more (82%) believed that it should be viewed as a complete system. The therapies most commonly used by respondents in their practice were acupressure (72%), massage (72%), mineral supplements (63%), and herbs (56%). CONCLUSION: The disparity between the established view of chiropractic as synonymous with spinal manipulation and the profession's view of chiropractic as a complete system indicates a need for better interprofessional communication.

An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural disaster.

Controlled studies of treatments effective with victims of natural disasters are almost nonexistent. This is a small study conducted under difficult conditions to test the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in treating trauma related reactions following Hurricane Andrew. The results were positive in that EMDR produced significant improvement over wait list controls in perceived posttraumatic avoidance behaviors and thoughts as measured by changes in the Impact of Event Scale and significant improvement in subjective aversive reactions to representative experiences of the hurricane. These results suggest and support other studies that EMDR can be an effective therapeutic intervention for trauma reactions.