Wound healing complications in brain tumor patients on Bevacizumab.

Bevacizumab (BEV) is commonly used for treating recurrent glioblastoma (GBM), and wound healing is a well-established adverse event. Retrospective analysis of GBM patients with and without wound healing complications while on BEV treatment is reported. 287 patients identified, majority were males (60 %) with median age of 52.5 years. 14 cases identified with wound healing problems, related to either craniotomy (n = 8) or other soft tissue wounds (n = 6). Median duration of BEV treatment to complication was 62 days (range 6-559). Majority received 10 mg/kg (n = 11) and nine (64.3 %) were on corticosteroids, with median daily dose of 6 mg (range 1-16 mg) for median of 473 days before starting BEV. For dehisced craniotomy wounds, median time for starting BEV from last surgery was 29 days (range 27-345). Median time from starting BEV to developing wound complication was 47 days (range 16-173). Seven (87.5 %) had infected wounds requiring antibiotics, hospitalization. Four (50 %) required plastic surgery. BEV stopped and safely resumed in 6 (75 %) patients; median delay was 70 days (range 34-346). Soft tissue wounds included decubitus ulcer, dehisced striae, herpes simplex, trauma to hand and back, and abscess. Median time from starting BEV to wound issues was 72 days (range 6-559). Five (83.3 %) were infected, requiring antibiotics. While three (50 %) required hospitalization, none required plastic surgery. Treatment stopped in five (83.3 %) and restarted in two (median delay 48 days, range 26-69). Wound healing complications are uncommon but associated with significant morbidity. Identifying those at risk and contributing factors warrants further investigation.

Social factors affecting treatment of cervical cancer: ethical issues and policy implications.

Health care in the United States has become a privilege rather than a right. Patients who have the greatest need are the ones most likely to be denied this privilege. Despite recent advances in disease detection and treatment, many patients do not receive even the bare minimum of care. The high complexity of the health care system in the setting of patients with low levels of health literacy significantly affects the ability to seek and receive treatment in a timely fashion. In addition, lack of insurance, transportation, and social support further complicate access to care. To truly provide a standard of care to all patients, regardless of resources, our health care system must evolve to address the needs of the population. In this paper, we report a tragic case where social factors affected the outcome of a single mother with advanced cervical cancer.

Toddler Emotional States, Temperamental Traits, and Their Interaction: Associations with Mothers' and Fathers' Parenting.

We investigated the degree to which toddlers' observed emotional states, toddlers' temperamental traits, and their interaction accounted for variance in mothers' and fathers' parenting. Main effects of two emotional states (positive emotion and negative emotion), three temperamental traits (negative affectivity, effortful control, and surgency) as well as state-by-trait interactions, were examined in relation to parental sensitivity, positive affect, and negative affect. The hypothesis that toddlers' temperamental traits would moderate the association between their observed emotional states and parenting was partially supported. Significant state-by-trait interactions were found in models predicting the probability that mothers and fathers expressed negative affect towards their toddlers. For parental sensitivity and positive affect, only main effects of temperament and/or emotion expression accounted for variance in parenting.

Screening for disease: making evidence-based choices.

Screening for illness should be an evidence-based activity. Screening tests are useful only if they reduce mortality or morbidity. Therefore, healthcare professionals must know how to evaluate research about screening tests to be sure that, in fact, the tests actually accomplish their goals. Tests that generate many false-positive results may cause harm from anxiety and unnecessary procedures. Tests that generate many false-negative results may worsen outcomes by leading to delayed diagnosis and treatment. Characteristics that make a disease amenable to screening include a significant negative impact on health, an identifiable asymptomatic period, and improved outcomes with early intervention. A useful screening test must have sensitivity and specificity for the disease being screened. It also must be cost effective and acceptable to patients. Sensitivity, specificity, and disease prevalence all interact to determine a test's positive predictive value--the likelihood that a positive test result indicates that the disease is present. Several types of test bias can undermine the validity of a screening trial. Screening bias occurs when the sample of patients used in a trial to evaluate a screening test is not representative of the patient population to be screened. Another bias results from the fact that indolent disease is more likely to be detected in a screening program than aggressive disease. The apparent improved outcome that results is called length bias. Finally, lead-time bias occurs when survival of a screened population is measured from the date of screening, whereas survival of an unscreened population is measured from detection of symptomatic disease. In screening for illnesses, the goal must not be merely to do something. It must be to do something useful.

Ovarian cancer screening: a look at the evidence.

In 2005, more than 22,000 American women were diagnosed with ovarian cancer and 16,000 women died from the disease. The five-year relative survival rate for stage III and IV disease is 31%, and the five-year relative survival rate for stage I is 95%. Early diagnosis should lower the fatality rate. Unfortunately, early diagnosis is difficult because of the physically inaccessible location of the ovaries, the lack of specific symptoms in early disease, and the limited understanding of ovarian oncogenesis. Screening tests for ovarian cancer need high sensitivity and specificity to be useful because of the low prevalence of undiagnosed ovarian cancer. Because currently available screening tests do not achieve high levels of sensitivity and specificity, screening is not recommended for the general population. The theoretical advantage of screening is much higher for women at high risk (such as those with a strong family history of ovarian cancer and those with BRCA 1 or BRCA 2 mutations). However, even for women at high risk, no prospective studies have shown benefits of screening. The public health challenge is that 90% of ovarian cancer occurs in women who are not in an identifiable high-risk group, and most women are diagnosed with advanced-stage disease. Currently available tests (CA-125, transvaginal ultrasound, or a combination of both) lack the sensitivity and specificity to be useful in screening the general population. Ongoing clinical trials are assessing whether new tumor markers, including those generated by proteomic and genomic studies, will prove useful.

Web-based symptom management for women with recurrent ovarian cancer: a pilot randomized controlled trial of the WRITE Symptoms intervention.

CONTEXT: Little research has focused on symptom management among women with ovarian cancer. Written Representational Intervention To Ease Symptoms (WRITE Symptoms) is an educational intervention delivered through asynchronous web-based message boards between a study participant and a nurse. OBJECTIVES: We evaluated WRITE Symptoms for 1) feasibility of conducting the study via message boards, 2) system usability, 3) participant satisfaction, and 4) initial efficacy. METHODS: Participants were 65 women (mean age, 56.5; SD = 9.23) with recurrent ovarian cancer randomized using minimization with race/ethnicity (non-Hispanic white vs. minority) as the stratification factor. Measures were obtained at baseline and two and six weeks after intervention. Outcomes were feasibility of conducting the study, system usability, participant satisfaction, and efficacy (symptom severity, distress, consequences, and controllability). RESULTS: Fifty-six (87.5%) participants were retained, and the mean usability score (range 1-7) was 6.18 (SD = 1.29). All satisfaction items were scored at 5 (of 7) or higher. There were significant between-group effects at T2 for symptom distress, with those in the WRITE Symptoms group reporting lower distress than those in the control group [t(88.4) = -2.57; P = 0.012], with a similar trend for symptom severity [t(40.4) = -1.95; P = 0.058]. Repeated measures analysis also supported a group effect, with those in the WRITE Symptoms group reporting lower symptom distress than those in the control condition [F(1, 56.7) = 4.59; P = 0.037]. CONCLUSION: Participants found the intervention and assessment system easy to use and had high levels of satisfaction. Initial efficacy was supported by decreases in symptom severity and distress.