Undiagnosed Behçet's Disease Presenting as Fournier's Gangrene in a Young Male.

Behçet's disease is rare, especially in the paediatric population. In this case, a healthy 16-year-old made presented with discrete scrotal ulcers and systemic illness. He was found to have Fournier's gangrene and with subsequent investigation was diagnosed with Behçet's disease as an underlying cause. A PubMed search reveals no similar case reports. His only risk factors for Fournier's gangrene was his raised body mass index. His only risk factor for Behçet's disease was his ethnic origin. An understanding of risk factors and epidemiology can raise suspicion of these rare pathologies.

The Prostate Care Questionnaire for Carers (PCQ-C): reliability, validity and acceptability.

BACKGROUND: Patient experience is commonly monitored in evaluating and improving health care, but the experience of carers (partners/relatives/friends) is rarely monitored even though the role of carers can often be substantial. For carers to fulfil their role it is necessary to address their needs. This paper describes an evaluation of the reliability, validity and acceptability of the PCQ-C, a newly developed instrument designed to measure the experiences of carers of men with prostate cancer. METHODS: The reliability, acceptability and validity of the PCQ-C were tested through a postal survey and interviews with carers. The PCQ-C was posted to 1087 prostate cancer patients and patients were asked to pass the questionnaire on to their carer. Non-responders received one reminder. To assess test-retest reliability, 210 carers who had responded to the questionnaire were resent it a second time three weeks later. A subsample of nine carers from patients attending one hospital took part in qualitative interviews to assess validity and acceptability of the PCQ-C. Acceptability to service providers was evaluated based on four hospitals' experiences of running a survey using the PCQ-C. RESULTS: Questionnaires were returned by 514 carers (47.3%), and the majority of questions showed less than 10% missing data. Across the sections of the questionnaire internal consistency was high (Cronbach's alpha ranging from 0.80 to 0.89), and test-retest stability showed moderate to high stability (intraclass correlation coefficients ranging from 0.52 to 0.83). Interviews of carers indicated that the PCQ-C was valid and acceptable. Feedback from hospitals indicated that they found the questionnaire useful, and highlighted important considerations for its future use as part of quality improvement initiatives. CONCLUSIONS: The PCQ-C has been found to be acceptable to carers and service providers having been used successfully in hospitals in England. It is ready for use to measure the aspects of care that need to be addressed to improve the quality of prostate cancer care, and for research.

The prostate care questionnaire for patients (PCQ-P): reliability, validity and acceptability.

BACKGROUND: In England, prostate cancer patients report worse experience of care than patients with other cancers. However, no standard measure of patient experience of prostate cancer care is currently available. This paper describes an evaluation of the reliability, validity and acceptability of the PCQ-P, a newly developed instrument designed to measure patient experience of prostate cancer care. METHODS: The reliability, acceptability and validity of the PCQ-P were tested through a postal survey and interviews with patients. The PCQ-P was posted to 1087 prostate cancer patients varying in age, occupation, and overall health status, sampled from five hospitals in England. Nonresponders received one reminder. To assess criterion validity, 935 patients were also sent sections of the National Centre for Social Research Shortened Questionnaire; and to assess test-retest reliability, 296 patients who responded to the questionnaire were resent it a second time three weeks later. A subsample of 20 prostate cancer patients from one hospital took part in qualitative interviews to assess validity and acceptability of the PCQ-P. Acceptability to service providers was evaluated based on four hospitals' experiences of running a survey using the PCQ-P. RESULTS: Questionnaires were returned by 865 patients (69.2%). Missing data was low across the sections, with the proportion of patients completing less than 50% of each section ranging from 4.5% to 6.9%. Across the sections of the questionnaire, internal consistency was moderate to high (Cronbach's alpha ranging from 0.63 to 0.80), and test-retest stability was acceptable (intraclass correlation coefficients ranging from 0.57 to 0.73). Findings on criterion validity were significant. Patient interviews indicated that the PCQ-P had high face validity and acceptability. Feedback from hospitals indicated that they found the questionnaire useful, and highlighted important considerations for its future use as part of quality improvement initiatives. CONCLUSION: The PCQ-P has been found to be acceptable to patients and service providers, and is ready for use for the measurement of patient experience in routine practice, service improvement programmes, and research.

Men's and carers' experiences of care for prostate cancer: a narrative literature review.

OBJECTIVE: To review studies of patients' and carers' experience of prostate cancer care. DESIGN: Narrative literature review. METHODS: Search strategies were developed for the following databases: MEDLINE (1966-2006), EMBASE (1980-2006), CINAHL (1982-2006) and PsycINFO (1987-2006). A search of SIGLE (System for Information on Grey Literature in Europe) was also undertaken. Experience was defined as patients' and carers' reports of how care was organized and delivered to meet their needs. A narrative summary of the included papers was undertaken. RESULTS: A total of 90 relevant studies were identified. Most studies reported on experiences of screening, diagnosis, the treatment decision, treatment and post-initial treatment. Few studies reported on experiences of the stages of referral, testing, and further treatment and palliative care, and no studies reported on monitoring or terminal care. CONCLUSIONS: Although some phases of care have not been investigated in detail, there is evidence that: (i) many patients have a low level of knowledge of prostate cancer; (ii) patients with prostate cancer and their carers need information throughout the care pathway to enable them to understand the diagnosis, treatment options, self-care and support available; and (iii) increasing patient knowledge and understanding of prostate cancer (e.g. through interventions) are often associated with a more active role in decision making (e.g. screening, treatment decision).

Combined treatment of bladder cancer cell lines with lapatinib and varying chemotherapy regimens--evidence of schedule-dependent synergy.

OBJECTIVES: ErbB family members present an attractive target for therapeutic manipulation in bladder cancer. Lapatinib is an oral, small molecule, reversible dual inhibitor of ErbB1 (epidermal growth factor receptor) and ErbB2 (HER2) tyrosine kinases. Cisplatin-based combination chemotherapy has proven benefit in palliating symptoms and prolonging survival in patients with metastatic bladder cancer. In this study, we investigated the potential utility of lapatinib as an adjunct to chemotherapy in human bladder cancer cell lines. We also assessed whether these interactions were schedule dependent and synergistic. METHODS: We chose two bladder cancer cell lines, one (RT112) with high expression of ErbB1 and ErbB2 and one (J82) with low expression of these receptors. These cell lines were used to determine the growth inhibitory effects of lapatinib and the clinically relevant combination of gemcitabine and cisplatin (GC) chemotherapy. Four different schedules were assessed: GC alone (no lapatinib); lapatinib before and during GC; lapatinib concomitant with GC; and lapatinib after GC. RESULTS: Lapatinib reduced cell viability in both cell lines in a dose-dependent fashion. The values for the 50% inhibitory concentration for RT112 and J82 cells after lapatinib were similar. In both cell lines, the addition of lapatinib to GC potentiated the efficacy. The optimal sequence consisted of lapatinib before and during GC. Using this schedule, cooperation was synergistic. CONCLUSIONS: Our data present evidence that lapatinib cooperates with clinically relevant cytotoxic agents and may have therapeutic utility in the management of chemotherapy-naive metastatic bladder cancer. Lapatinib may also enable reduced-dose chemotherapy, a potential toxicity-sparing strategy.