Prostate cancer treatment ascertained from several sources: analysis of disagreement and error.

BACKGROUND: Treatment data for prostate cancer can be obtained from a variety of sources. Each of these sources has its own strengths and weaknesses and is subject to error. MATERIALS AND METHODS: In a population-based cohort of 319 prostate cancer patients, data on treatment were obtained from five sources: two patient interviews at 6 and 12 months after diagnosis, primary caregiver interviews, physician questionnaires, and medical records. Inter-reporting agreement and accuracy of reporting (compared with medical records) were assessed. Multivariate analyses examined patient, caregiver, and physician characteristics as determinants of reporting error. RESULTS: The agreement among different reporting methods was generally good to excellent for prostatectomy and brachytherapy (kappa range 0.70-0.90) and fair to good (kappa range 0.35-0.75) for external beam radiation and hormonal treatment. Compared with medical records, the interview- and questionnaire-based data collection methods were more accurate for prostatectomy and brachytherapy than for external beam radiation and hormonal therapy. Using medical records as the 'gold standard', patient and caregiver interviews at 6 months after the diagnosis had higher sensitivity and specificity than other reporting sources. CONCLUSION: Interviews of prostate cancer patients and caregivers are useful alternatives to medical record abstraction, particularly if carried out during, or soon after, treatment.

[Multidrug intoxication]. / Intoxication polymédicamenteuse.

The authors report an suicide attempt by a 43 years old woman treated by Previscan, Effexor, Rivotril, and Stilnox for phlebitis anteriority and anxious-depressive disorders. On arrival to the emergency unit, the medical status and the patient history required a cardiovascular reanimation and gastric washing. The haemostasis analysis demonstrates an anticoagulant overdose and the prescription of vitamine K1 and PPSB was necessary. Later, the multidrug poisoning was demonstrated thanks to blood, urinary and gastric fluid high performance liquid chromatography toxicological analyses. This case report points out that biological and toxicological analyses are complementary. The first ones are useful to determine the emergency symptomatic cares, and to check the drugs' efficiency. The second ones, although longer, are necessary to identify with certainty incriminated drugs.

The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics.

BACKGROUND: Large-scale, prospective cohort studies have played a critical role in discovering factors that contribute to variability in cancer risk in human populations. Epidemiologists and volunteers at the American Cancer Society (ACS) were among the first to establish such cohorts, beginning in the early 1950s and continuing through the present, and these ACS cohorts have made landmark contributions in many areas of epidemiologic research. METHODS AND RESULTS: The Cancer Prevention Study II Nutrition Cohort was established in 1992 and was designed to investigate the relation between diet and other lifestyle factors and exposures and the risk of cancer, mortality, and survival. The cohort includes over 84,000 men and 97,000 women who completed a mailed questionnaire in 1992. New questionnaires are sent to surviving cohort members every other year to update exposure information and to ascertain new occurrences of cancer; a 90% response rate was achieved for follow-up questionnaires in 1997 and 1999. Reported cancers are verified through medical records, registry linkage, or death certificates. The cohort is followed actively for all cases of incident cancer and for all causes of death. Through a collaborative effort among ACS national and division staff, volunteers, and the American College of Surgeons, blood samples were collected from a subgroup of 40,000 cohort members and are in storage at a central repository for future investigation of dietary, hormonal, genetic, and other factors and cancer risk. Collection of DNA samples from buccal cells in an additional 50,000 cohort members is underway currently and will be completed in 2002. CONCLUSIONS: This new cohort of both men and women promises to be particularly valuable for the study of cancer occurrence, mortality, and survival as they relate to obesity and weight change, physical activity at various points in life, vitamin supplement use, exogenous hormone use, other medications (such as aspirin and nonsteroidal anti- inflammatory drugs) and cancer screening modalities.

The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics.

BACKGROUND: Large-scale, prospective cohort studies have played a critical role in discovering factors that contribute to variability in cancer risk in human populations. Epidemiologists and volunteers at the American Cancer Society (ACS) were among the first to establish such cohorts, beginning in the early 1950s and continuing through the present, and these ACS cohorts have made landmark contributions in many areas of epidemiologic research. METHODS AND RESULTS: The Cancer Prevention Study II Nutrition Cohort was established in 1992 and was designed to investigate the relation between diet and other lifestyle factors and exposures and the risk of cancer, mortality, and survival. The cohort includes over 84,000 men and 97,000 women who completed a mailed questionnaire in 1992. New questionnaires are sent to surviving cohort members every other year to update exposure information and to ascertain new occurrences of cancer; a 90% response rate was achieved for follow-up questionnaires in 1997 and 1999. Reported cancers are verified through medical records, registry linkage, or death certificates. The cohort is followed actively for all cases of incident cancer and for all causes of death. Through a collaborative effort among ACS national and division staff, volunteers, and the American College of Surgeons, blood samples were collected from a subgroup of 40,000 cohort members and are in storage at a central repository for future investigation of dietary, hormonal, genetic, and other factors and cancer risk. Collection of DNA samples from buccal cells in an additional 50,000 cohort members is underway currently and will be completed in 2002. CONCLUSIONS: This new cohort of both men and women promises to be particularly valuable for the study of cancer occurrence, mortality, and survival as they relate to obesity and weight change, physical activity at various points in life, vitamin supplement use, exogenous hormone use, other medications (such as aspirin and nonsteroidal anti-inflammatory drugs) and cancer screening modalities.

Mock surveys: a proactive approach to the accreditation visit.

Preparing for an accreditation visit is a challenge for the nurse manager. In this article, the authors describe the methods and tools developed to assist the Duke University Medical Center Gastrointestinal Endoscopy Unit in preparing for the Joint Commission on Accreditation of Healthcare Organizations review process.

Effect of degree of uniformity on predicted visual cortical response tuning curves.

The different cortical visual cells exhibit a large repertoire of responses to sinusoidal gratings, depending on their receptive field structure and the stimulation parameters. It has been shown previously that the tuning curves and histogram shapes of cell responses are affected by subunit distances. One receptive field model (Spitzer and Hochstein 1985b) incorporated subunit distance but assigned it as a constant parameter, for ease of calculation. Here we investigate different tuning curve properties of various primary cortical cell types during testing of 10 deg of nonuniform distances of the receptive fields' subunits. The effect of nonuniformity was compared for average responses, tuning curve shapes, maximum peak responses, and bandwidths across four cell types of different sizes. The shapes and other properties of tuning curves are usually found to be retained also when the degree of uniformity is not very high for most of the cell types. In addition, the effect of uniformity is compared across these different response properties. The maximum peak responses of the tuning curve are found to display a lower coefficient of variation than the bandwidth, for all cell types, for most degrees of uniformity.

Clues to patient dissatisfaction with conscious sedation for colonoscopy.

OBJECTIVES: Most colonoscopy is performed using conscious sedation to facilitate the procedure. However, little is known about which patients are dissatisfied with sedation and why. The goal of this study was to examine whether certain patient- and procedure-specific variables are associated with patient dissatisfaction. METHODS: A total of 403 consecutive outpatients underwent colonoscopy during a 4-month study period. Of 342 patients who met entrance criteria, 328 completed the initial questionnaire and were enrolled. Subjects received standard conscious sedation; after colonoscopy, the primary endoscopist and nurse recorded the level of sedation as adequate or inadequate. Twenty-four to 72 hr after the procedure, an independent observer contacted the subjects by telephone and asked whether they were satisfied with the level of sedation achieved during the colonoscopy. A number of patient- (age, gender, anxiety level, and educational background) and procedure-specific variables (waiting time and procedure type, difficulty, and duration) were analyzed to determine their association with patient dissatisfaction. RESULTS: Forty-eight patients (15%) were dissatisfied with sedation. Univariable analysis showed that females, anxiety, higher education (at least 1 yr of college), procedure duration > or = 60 min, and procedure difficulty were all associated with the dissatisfaction with sedation (p < 0.05). Multivariable analysis revealed that only higher education (p = 0.009) and longer procedure duration (p = 0.018) were associated with patient dissatisfaction. CONCLUSIONS: Highly educated patients and those who underwent longer procedures were more likely to be dissatisfied with conscious sedation used for colonoscopy. A thorough discussion of expectations and/or patient-controlled sedation might improve satisfaction with colonoscopy in educated patients. Regular supplementation of sedation, termination of a lengthy procedure with the offer of a further attempt at a later date, and referral to a more experienced endoscopist when appropriate might all improve patient satisfaction with colonoscopy.

Healthcare reform: impact on gastrointestinal endoscopy units.

Healthcare costs, which now comprise 13.4% of the United States gross national product, continue to increase. President Clinton has placed healthcare reform on the national agenda, sparking nationwide debate. The President's plan will have an impact on all healthcare providers. As a result of this proposal, changes in the health care delivery system are occurring. The endoscopy setting will not be immune to these changes. In this article, the authors explore the possible impact of healthcare reform on nurses in general and, in particular, nurses in the endoscopy setting.

A model for the early stages of motion processing based on spatial and temporal edge detection by X-cells.

A model for the early stages of motion processing in the visual cortex is presented. The 'building block' for this model is the 'rebound response', which is the neuronal response evoked when a sufficient inhibitory stimulus is turned off. This response enables detection of temporal changes when the stimulus involves spatial changes. The model suggests that adjacent subunits in primary cortical cells have different weight functions for rebound responses, and thus a synergistic type of response is evoked in the preferred direction, which is predicted for both light and dark stimuli. Predictions of the model for different stimuli and receptive field structures are discussed. It appears to be more economical than previous motion models.

A model for detection of spatial and temporal edges by a single X cell.

When an inhibitory visual stimulus is turned off, an increased rate of spike discharge is evoked which we term the "rebound response". This response exists as a part of different cell responses from the retina to the cortex. The rebound response, with its temporal dependence on stimulus parameters, has not been previously considered in models. Here we present such a model, and also show its dependence on stimulus duration and its turning off rate. The rebound response enables detection of temporal changes when a visual stimulus involves spatial changes. The temporal change detection is affected by the actual stimulus duration, which can also be seen as a cell memory operation.