Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians.

Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment.

Class, race and ethnicity and information avoidance among cancer survivors.

BACKGROUND: Information seeking may increase cancer survivors' ability to make decisions and cope with the disease, but many also avoid cancer information after diagnosis. The social determinants and subsequent communication barriers that lead to avoidance have not been explored. The purpose of this study is to examine the influence of social determinants on information avoidance among cancer survivors. METHODS: We examined how health information avoidance is associated with structural and individual factors in a mail-based survey of 519 cancer survivors. Factor analysis was conducted to determine barriers to obtaining cancer information, and multivariable logistic regression models by gender were run to analyze social determinants of avoidance from an intersectional approach. RESULTS: Participants who were younger, female, had greater debt and lower income, and had difficulty finding suitable information were more likely to avoid information. The probability of information avoidance increased when survivors reported barriers to information use or comprehension. CONCLUSION: These results indicate that survivors' information avoidance may be driven, in part, by social determinants, particularly among those at the intersection of multiple social status categories. Customized strategies are needed that maximize the likelihood that information will be used by vulnerable groups such as those from a lower socioeconomic position.

The impact of risk information exposure on women's beliefs about direct-to-consumer genetic testing for BRCA mutations.

Despite an increase in direct-to-consumer (DTC) genetic testing, little is known about how variations in website content might alter consumer behavior. We evaluated the impact of risk information provision on women's attitudes about DTC BRCA testing. We conducted a randomized experiment; women viewed a 'mock' BRCA testing website without [control group (CG)] or with information on the potential risks of DTC testing [RG; framed two ways: unattributed risk (UR) information and risk information presented by experts (ER)]. Seven hundred and sixty-seven women participated; mean age was 37 years, mean education was 15 years, and 79% of subjects were white. Women in the RG had less positive beliefs about DTC testing (mean RG = 23.8, CG = 25.2; p = 0.001), lower intentions to get tested (RG = 2.8, CG = 3.1; p = 0.03), were more likely to prefer clinic-based testing (RG = 5.1, CG = 4.8; p = 0.03) and to report that they had seen enough risk information (RG = 5.3, CG = 4.7; p < 0.001). UR and ER exposure produced similar effects. Effects did not differ for women with or without a personal/family history of breast/ovarian cancer. Exposing women to the potential risks of DTC BRCA testing altered their beliefs, preferences, and intentions. Risk messages appear to be salient to women irrespective of their chance of having a BRCA mutation.

Study of exclusive charmless semileptonic B decays and |Vub|.

We study semileptonic B decay to the exclusive charmless states pi, rho/omega, eta, and eta;{'} using the 16 fb(-1) CLEO Upsilon(4S) data sample. We find B(B0-->pi-l+nu)=(1.37+/-0.15stat+/-0.11sys)x10(-4) and B(B0-->rho-l+nu)=(2.93+/-0.37stat+/-0.37sys)x10(-4) and find evidence for B+-->eta'l+nu, with B(B+-->eta'l+nu)=(2.66+/-0.80stat+/-0.56sys)x10(-4). From our B-->pilnu rate for q2>16 GeV2 and lattice QCD, we find |Vub|=(3.6+/0.4stat+/0.2syst-0.4thy+0.6)x10(-3) [corrected]

Sacrococcygeal chordoma: Report of a case and review of the literature.

A review of 222 patients with sacrococcygeal chordoma from the English language literature since the first American case in 1913 reveals that men are affected twice as frequently as are women after age 40, but not before. A history of prior trauma can be found in about 20 percent of patients, but no clear etiologic relation can be proved. The evidence for a congenital origin from displaced notochordal tissue is equally inconclusive. Metastasis occurs in only about 10 percent of patients, but recurrence of the primary lesion is almost universal. Of 67 patients followed, 11 survived 10 years or longer after diagnosis of chordoma. Resection of the tumor rarely is complete. Preservation of sacral stability and of sacral nerve pathways to the rectum and the bladder limit the extent of permissable surgery. Repeated local excision of the tumor recurring after initial excision and irradiation remains the treatment of choice.

Vascular compression of the duodenum: Presentation of ten cases and review of the literature.

Ten cases of vascular compression of the duodenum are presented, and 125 cases in the literature since 1962 are reviewed. More common in women than in men, the lesion may result from supine immobilization, wearing body cast, or a rapid weight loss. In about one third of the patients, no predisposing factor can be found. Diagnosis is best made by cinefluoroscopy. Although conservative measures will provide relief in a few patients, most will require surgery. Section of the suspensory muscle and relocation of the duodenojejunal junction will relieve the symptoms in many patients. Duodenojejunostomy will be required in some others. Complete relief can be expected in all but a very few patients. Those who have developed neurotic eating habits from years of discomfort may not show immediate improvement. Untreated vascular compression of the duodenum may be chronic or may become acute with fatal results.

Cancer of bile duct with situs inversus.

We present a case of adenocarcinoma of the distal common bile duct in a 68-year-old woman with total situs inversus. Endoscopic retrograde cholangiopancreatography prior to surgery demonstrated segmental obstruction of the distal common bile duct. Obstructive jaundice was observed and the results of liver function studies were abnormal. All biopsy specimens obtained in the operating room were negative. The case met all the criteria of Child and Frey, but at the end of the procedure the tumor was found to involve the superior mesenteric vein, a factor not appreciated during the operative evaluation of the patient. The situs inversus did not produce any technical problems. The patient did not have any surgical complications, but she died 18 months later of the cancer.

Surgical embryology and anatomy of the pancreas.

Knowledge of the surgical embryology and surgical anatomy of the pancreas is vital to the general surgeon. This article discusses the entities related to pancreatic surgery. It also highlights some common embryologic anomalies of the pancreas.

Accessory septum transversum. The first case report.

Duplication of the septum transversum occurred in a newborn with respiratory distress thought clinically to be due to diaphragmatic paralysis. Surgical plication of the "floppy" diaphragm was attempted via a transabdominal approach. The anomalous septum transversum was perceived to be the diaphragm and was plicated. The central tendon of the diaphragm was redundant and surgical plication may have improved respiratory function. In this first case report, embryology of the diaphragm is reviewed and correlated with autopsy findings. A surgical approach to possible correction is proposed.

Clinical considerations of hormonal receptors in breast cancer.

PIP: Focus is on the current concepts of hormone receptors in breast cancer and their significance to the practicing physician. Hormone receptor assays have proven to be valuable to physicians treating patients with breast cancer. About 2/3 of patients with estrogen receptor (ER+) tumors experience palliation of their symptoms after some type of hormonal manipulation. At this time it is believed that estrogen exerts the most powerful effect on the cancer. There are several methods of testing for estrogen receptors. The 1st method involves injection of tritiated hexesterol prior to surgery and subsequent checking for radioactive estrogens in the mammary tissue. More recently, methods are used in which the receptors can be quantified. 1 method uses a sucrose density gradient. Another and less expensive method is the Dextran-coated charcoal test (DCC). Estrogen receptors have been found in 73% of primary and 58% of metastatic breast cancers using the DCC test. The treatment of choice is always dependent on the patient involved. If the lesion is ER+, some type of hormone manipulation may be considered, which type depending on the menopausal status of the women.^ieng

Surgical anatomy of the submandibular triangle.

The topographic anatomy of the submandibular triangle and its contents are described in terms of four surgical planes, with considerations of the anatomic complications during surgery. Attention is called to the importance of identifying and sparing five nerves in this triangle--the mandibular and cervical branches of the facial nerve, the hypoglossal nerve, the lingual nerve, and the chorda tympani.

Embryological considerations of thyroid surgery: developmental anatomy of the thyroid, parathyroids and the recurrent laryngeal nerve.

The surgeon planning a thyroidectomy must be prepared to find variations in three important structures in the neck. He must be prepared to find ectopic thyroid nodules above, below or lateral to the normally located thyroid gland. Any unattached nodule should be considered malignant until proved otherwise. He must identify and preserve parathyroid glands that may not lie in the typical location. He must be prepared to encounter recurrent laryngeal nerves that do not recur. The surgeon who remembers the embryology of the structures in the neck may occasionally be astonished, but never surprised.

Foreign bodies of the gastrointestinal tract.

Gastrointestinal foreign bodies are a common occurrence in most emergency room settings and should be dealt with in an organized manner to bring about their retrieval expeditiously. Approximately 1500 to 1600 persons in the United States die from ingestion or placement of foreign bodies every year. This study of foreign bodies of the gastrointestinal tract reports an 8-year span in which 60 cases were compiled from a 540-bed private, inner city hospital. The average hospital stay was 3.2 days. Foreign bodies were retained in the esophagus in 68.3 per cent of patients, in the stomach in 11.6 per cent, and in the colon or rectum in 13.3 per cent. In 3.3 per cent the object passed spontaneously, and in 3.3 per cent it resulted in perforation.

The duodenum. Surgical anatomy.

The second part of this monograph on the duodenum describes the muscular and mucosal changes observed at the gastroduodenal junction. The structure of the duodenal wall and details of the intramural portion of the common bile and pancreatic ducts are described, together with the surgical anatomy of the four parts of the duodenum. The arterial supply, the venous and lymphatic drainage, and the innervations are described from the surgeon's point of view.

The duodenum. Part 3: Pathology.

Duodenal pathology includes various developmental malformations and acquired lesions. This report provides brief descriptions of various congenital anomalies of the duodenum, including stenosis and atresia, annular pancreas and ectopic duodenal pancreatic tissue, megaduodenum, duodenal diverticula, preduodenal portal vein, and paraduodenal fossae. Acquired lesions, such as duodenal ulcer, tumors, vascular compression, and duodenal trauma are also described.

Distribution of the vagus nerve to the stomach.

Examination of the distribution of vagus nerve fibers to the stomach in 100 cadavers revealed considerable individual variation. No single pattern shown in textbooks or published papers can be accepted as correct for all individuals. The variations encountered are discussed from the viewpoint of the surgeon who wishes to perform highly selective vagotomy.

Internal and external supravesical hernia.

Two cases of supravesical hernia are described. One was a rare posterior internal supravesical hernia discovered only at exploratory laparotomy after exhaustive but fruitless diagnostic procedures. The surgical anatomy of anterior and posterior internal supravesical hernia is discussed and a simplified terminology is proposed.

The recurrent laryngeal nerve.

Nonrecurrence and variations in the ascending course of the recurrent laryngeal nerves make it essential to identify the nerve to avoid injury to it during thyroidectomy. We believe that visual identification of the nerve without undue handling is all that is necessary. The recurrent nerve is no more delicate than other similar nerves. Unilateral injury to the recurrent nerve may result in temporary hoarseness which will improve with time. Some restriction of the airway during exertion may be present. Bilateral injury to the recurrent nerves may produce initially a loss of voice without airway constriction. Later the voice may return, accompanied by serious respiratory embarrassment on exertion.