Approaches for end-of-life care in the field of gynecologic oncology: an exploratory study.

We sought to explore the Society of Gynecologic Oncologists (SGO) members' opinions and decisions about end-of-life issues and incurable conditions. A survey was mailed to members of the SGO. Their responses were recorded on a Likert scale and entered into a database. The survey explored opinions, experiences, and decisions in managing terminally ill gynecologic oncology patients. Of 900 surveys, 327 were returned (response rate, 36%). Seventy-three percent were men, 89% were white, and 72% were of Christian denomination. Respondents believed that 97% of patients who are dying realize that they are dying but stated only 40% of these patients initiate conversations about end-of-life issues. In contrast, 92% of respondents stated that they initiate end-of-life discussions with patients. Ninety-two percent of respondents thought that the patients should be allowed to make end-of-life choices independently after the facts are given to them. However, 44% thought that it is important to influence the way information is presented, and 54% believe that the gynecologic oncologist (GO) controls the outcome of end-of-life discussions. Although the physicians' sex, race, religion, and age did not correlate with their treatment decisions, religion did correlate with less fear of death (P = 0.011) and less discomfort when talking with patients about death (P = 0.005). Fifty-four percent of respondents believed that the GO controls the outcome of end-of-life discussions, and 40% believe that their actions prolong the process of dying. Expanding our understanding of what motivates GOs to recommend continued treatment over palliation is important for preserving informed patient-motivated end-of-life decisions.

Spirituality in gynecological oncology: a review.

The following is a review of some of the work that has been published on issues related to definitions of spirituality and the many ways in which religious or spiritual concerns inform and can sometimes mold the relationships between gynecologic oncology patients, their physicians, and their health. Moreover, we have raised the question whether there is something specific or unique to the experience of women patients with reproductive cancers? Although it might seem clear to many of us that these patients are unique, it is hard to say exactly why. While there are differences between the various types of reproductive cancers, all share a common thread and all undermine the patient's identity as a woman. For oncologists, exploring the connection between the healing of the body and the healing of the spirit recognizes the comprehensive character of cancer treatment, and furthers the understanding that both physicians and patients share a knowledge that what patients lose in their battle with cancer is more than simply a medical life.

Perinatal outcomes: a comparison between family physicians and obstetricians.

BACKGROUND: This retrospective study compared obstetrician and family physician patient population demographics, obstetric outcomes, delivery methods, and medical risk factors. METHODS: Obstetricians and family practice faculty and residents provided delivery services at an urban community hospital. A retrospective case study of all deliveries by obstetrician-gynecologists and family physicians in a 20-month period was analyzed with descriptive statistics, chi-square analysis, logistic regression, and power analysis. A modified risk score analysis was completed on all patients to assess comparability between the obstetrician and family physician patients. RESULTS: Risk score analysis of the two patient populations demonstrated no difference in high-risk patients (P = 0.102). Family physicians' patients had a lower incidence of Cesarean section, use of forceps, diagnosis of cephalopelvic disproportion, and low-birth-weight babies. They had a higher incidence of spontaneous vaginal delivery, vaginal birth after previous Cesarean section, and vacuum extraction use. The overall Cesarean section rate for family physicians was 15.4 percent, compared with 26.5 percent for obstetricians. CONCLUSIONS: These findings support the high-quality outcomes of perinatal care provided by family physicians. They also provide evidence for training and privileging family physicians to perform their own Cesarean sections.

Sequence analysis, expression and chromosomal localization of a gene, isolated from a subtracted human retina cDNA library, that encodes an insulin-like growth factor binding protein (IGFBP2).

The metabolic functions of insulin-like growth factors (IGFs) I and II are modulated by a family of binding proteins which are present in biological fluids and are synthesized by a variety of cell types. A cDNA clone, isolated at random from a subtracted human retina library, has been identified to code for a novel IGF-binding protein (IGFBP2) by its sequence homology to the peptide sequence of IGF binding proteins purified from bovine MDBK and rat BRL-3A cells. The complete nucleotide sequence of the IGFBP2 cDNA is 1406 bp long, contains 66% G-Cs and an open reading frame of 328 amino acids with a putative signal or pro-peptide of 39 residues. The mature polypeptide of 289 amino acids has 18 cysteines, a putative ATP-binding site and an RGD tripeptide. The 1.4 kb IGFBP2 transcript is expressed in several human tissues including fetal eye and fetal brain, but not in the human lymphoblastoid cell line against which the retinal cDNA library was subtracted. In situ hybridization to sections of mouse retina localized the mRNA for IGFBP2 primarily in the outer nuclear layer of photoreceptors. Southern blot analysis of DNA from human x rodent and mouse x rodent somatic cell hybrids assigned the gene for IGFBP2 to human chromosome 2q33-qter and mouse chromosome 1 in a known conserved syntenic region.