Chemoradiation with and without adjuvant extrafascial hysterectomy for IB2 cervical carcinoma.

The optimal treatment strategy for stage IB2 cervical carcinoma that maximizes survival while minimizing toxicity remains controversial. The purpose of this study was to compare survival and toxicity in stage IB2 cervical cancer patients treated with chemoradiation and adjuvant extrafascial hysterectomy (cRT + H) versus definitive chemoradiation (cRT). Data were abstracted from patients with IB2 cervical carcinoma primarily treated at a single institution from January 1994 to December 2004. All patients received chemotherapy concurrent with external beam radiation therapy. Patients were subsequently treated with either a single low-dose rate brachytherapy applicator followed by adjuvant extrafascial hysterectomy (n = 24) or a second brachytherapy application to complete full-dose definitive chemoradiation (n = 30). Analyses were conducted using Kaplan-Meier survival and Chi-square statistics. Groups did not differ demographically with the exception of smoking. Smokers were significantly (P = 0.04) more likely to have been treated with definitive chemoradiation. Median tumor size was similar between groups. There was no difference in overall or disease-free survival between patients who received cRT + H versus cRT (P = 0.82 and 0.75, respectively). All recurrences in the cRT arm were in smokers. There were two grade 3-4 toxicities in each group. No treatment-related deaths occurred. In this small retrospective cohort study, we observed no difference in survival between patients treated with cRT + H versus cRT. These data complement published results of Gynecologic Oncology Group studies in patients with IB2 cervical cancer. Definitive comparison between the two treatment strategies would require a randomized prospective trial with stratification based on smoking.

Using quality of life measurement to enhance interdisciplinary collaboration.

The use of quality of life (QOL) measurement in the End-Stage Renal Disease (ESRD) setting can be useful to measure the impact of interventions on outcomes. Using QOL results can also increase patient participation in care planning and, thus, increase patient satisfaction with care. Clinical indicators can be developed to trigger further assessment of various patient needs.

A model for patient participation in quality of life measurement to improve rehabilitation outcomes.

Health-related quality of life (HRQOL) measurement is being used to assess end-stage renal disease (ESRD) patients' functional status and well-being from the patient's perspective. Research shows that HRQOL can screen for patients at high risk for death, hospitalization, treatment adherence, and depression. This study investigated whether patient goal setting and interdisciplinary collaboration and support could increase HRQOL scores in ESRD patients on chronic maintenance hemodialysis. Differences were found to be statistically significant in two of the MOS Short Form 36 (SF-36) categories (role physical and role emotional) following the intervention at the 95% confidence interval using a t-test statistic. This indicates that the intervention had a positive impact on patient perceptions of their health status. Eighty-seven percent indicated that there had been at least some progress made in reaching the goal. The results of this study support the utilization of HRQOL data at the facility level to improve patient's perceptions of their health status. A further study is needed to examine the long-term impact on HRQOL and other patient outcome measures through consistent use of this intervention.

The role of the health care team in the implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: a case study.

The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) provides an opportunity to review multidisciplinary practice in end-stage renal disease settings across the country. The role of the nephrology nurse, nephrology technician, renal dietitian, and nephrology social worker are reviewed through a case presentation referencing NKF-DOQI Guidelines. Each discipline provides an overview of its respective assessments and interventions focused on improving the patient's outcome.

Atherosclerosis, peripheral arterial disease and the vascular response to ketanserin.

Platelet activation releases thromboxane A2 and serotonin, which acts on blood vessels through a specific, 5-hydroxytryptamine (5-HT2) receptor. The development of ketanserin, the selective 5HT2 receptor blocker, has made it possible to explore the role of serotonin in patients with advanced atherosclerotic disease. Ketanserin in low doses (3 to 30 micrograms/kg) was administered intra-arterially to 23 patients with symptomatic peripheral occlusive vascular disease during peripheral angiography: an additional seven patients received a placebo. The angiographic response was evaluated by coded reading and by computer-assisted measurement of arterial segments in four anatomical regions (pelvis, thigh, knee, and lower leg). Hemodynamic changes were assessed by mercury strain gauge plethysmography and Doppler pressure measurement. Unequivocal vasodilatation was observed in zero of seven placebo-treated patients and in 13 of 23 (57%) treated patients primarily at the level of collateral vessels. Dilation of the geniculate arteries, a major source of collaterals to the calf, was associated with a significant increase in the blood flow delivery to the calf. There was a moderate drop of systemic blood pressure in patients who failed to respond with peripheral vasodilatation. Ketanserin induces hemodynamically significant vasodilatation in some patients with peripheral vascular disease, suggesting that serotonin may contribute to ischemia in some patients with advanced atherosclerosis.