The clinical case for proton beam therapy.

Over the past 20 years, several proton beam treatment programs have been implemented throughout the United States. Increasingly, the number of new programs under development is growing. Proton beam therapy has the potential for improving tumor control and survival through dose escalation. It also has potential for reducing harm to normal organs through dose reduction. However, proton beam therapy is more costly than conventional x-ray therapy. This increased cost may be offset by improved function, improved quality of life, and reduced costs related to treating the late effects of therapy. Clinical research opportunities are abundant to determine which patients will gain the most benefit from proton beam therapy. We review the clinical case for proton beam therapy. SUMMARY SENTENCE: Proton beam therapy is a technically advanced and promising form of radiation therapy.

The left-without-being-seen patients: what would keep them from leaving?

STUDY OBJECTIVE: We determine which services, if any, an emergency department (ED) could provide to help a patient who left the ED without being seen by a physician wait longer to see a physician. METHODS: In this retrospective observational study, patients who had left the Saint Marys Hospital ED without being seen by a physician were surveyed by telephone. The Saint Marys Hospital ED is a 43-bed facility with an annual patient volume of 77600 located in a city of 82000. Responders were questioned regarding 15 specific services the Saint Marys Hospital ED could provide to help them wait longer. Eligible participants included willing adults, parents accompanying patients younger than 18 years of age, and patients between the ages of 13 and 18 years whose parents granted permission. Participants were excluded if they denied research authorization, did not speak English, refused to participate, or were unable to be contacted. RESULTS: Between April 9, 2001, and July 17, 2001, 20494 patients registered, 172 patients left without being seen, and 152 patients approved research authorization; we attempted to contact these patients. In total, 97 patients, their parents, or their caretakers completed the entire interview (56.4% of those who left without being seen, 63.8% of those with whom contact was attempted). Nearly 85% of responders retrospectively identified "more frequent updates on wait time" and 70.1% identified "the availability of immediate temporary treatments" as services that would have helped them wait longer. Other waiting room services were identified by fewer than half of the responders as potentially helpful in allowing them to wait longer. CONCLUSION: Communication of estimated waiting time and the availability of immediate treatments for minor injuries or symptoms might increase the time patients are willing to wait and therefore might decrease an ED's rate of patients leaving without being seen.