[Patients' satisfaction and waiting time in oncology day care centers in Champagne-Ardenne]. / Programme d'évaluation de l'administration des chimiothérapies en hôpital de jour en Champagne-Ardenne (PEACH) : satisfaction et délais d'attente des patients.

AIM: Quality of life of patients suffering from cancer may be influenced by the way healthcare is organized and by patient experiences. Nowadays, chemotherapy is often provided in day care centers. This study aimed to assess patient waiting time and satisfaction in oncology day care centers in Champagne-Ardenne, France. METHODS: This cross-sectional survey involved all patients receiving ambulatory chemotherapy during a one-week period in day care centers of Champagne-Ardenne public and private healthcare institutions participating in the study. Sociodemographic, medical and outpatient data were collected. Patient satisfaction was measured using the Out-Patsat35 questionnaire. RESULTS: Eleven (out of 16) oncology day care centers and 441 patients participated in the study. Most of the patients were women (n=252, 57.1%) and the mean age was 61±12 years. The mean satisfaction score was 82±14 (out of 100) and the mean waiting time between the assigned appointment time and administration of chemotherapy was 97±60 min. CONCLUSION: This study has shown that waiting times are important. However, patients are satisfied with the healthcare organization, especially regarding nursing support. Early preparation of chemotherapy could improve these parameters.

Economic implications of using pegfilgrastim rather than conventional G-CSF to prevent neutropenia during small-cell lung cancer chemotherapy.

BACKGROUND: For the prevention of chemotherapy-induced febrile aplasia, a single injection of pegfilgrastim per cycle has the same efficacy as six to ten injections of conventional granulocyte colony-stimulating factor (G-CSF). However, there are few data on the economic impact of pegfilgrastim use, especially in the context of small-cell lung cancer. METHODS: This retrospective study involved 31 patients and 129 treatment cycles (32 with pegfilgrastim and 97 with granulocyte colony-stimulating factor (G-CSF)). We estimated the direct costs for preventing and managing febrile aplasia from the payer's perspective and also conducted a willingness-to-pay study with 100 healthy subjects, in order to estimate how highly a single-jab strategy was valued relative to multiple injections. RESULTS: The costs per cycle were respectively 1743 euros+/- 837 euros and 1466 euros +/- 836 euros for the pegfilgrastim and G-CSF strategies (p < 0.001). The excess cost of the pegfilgrastim strategy was partly compensated for by the perceived value of the single-jab strategy: 88% of interviewees would prefer the pegfilgrastim strategy; 16% would be willing to pay all the excess cost (277 euros) and 67% would be willing to pay half the excess cost. CONCLUSION: In this willingness-to-pay survey, the excess cost associated with pegfilgrastim relative to other G-CSF-based prophylactic strategies is partly offset by the perceived convenience of a single injection.

Optometry and ophthalmology relations in managed care.

BACKGROUND: Optometrists and Ophthalmologists have a history of difficult professional relationships. This paper discusses common issues both professions face while working under managed care. CONCLUSIONS: Managed care initiatives may help to improve the ability of Optomotrists and Ophthalmologists to work together to treat the patient's eye problems.

Polyhydroxamic microcapsules prepared from proteins: a novel type of chelating microcapsules.

Microcapsules were prepared from three proteins, namely human serum albumin (HSA), bovine fibrinogen and ovalbumin, by an interfacial crosslinking process using terephthaloylchloride. They were further treated with alkaline hydroxylamine in order to disrupt ester and anhydride bonds in the walls. All microcapsules survived the treatment. They exhibited a significant increase in size and became sensitive to trypsin. The hydroxylamine treatment also resulted in attachment of hydroxamic groups to the membrane, making the microcapsules capable of iron binding. These properties were evaluated after soaking microcapsules in a 140 mumol/l ferric solution and determination of iron in the supernantant. Lower amounts of iron were found to be complexed by HSA microcapsules (mean value: 29.3 mumol iron/g microcapsule dry weight) as compared with fibrinogen and ovalbumin microcapsules (43.7 and 44.9 mumol/g, respectively). Microcapsule chelating properties were further improved by esterification of the free carboxyl groups of the membrane with benzyl alcohol or ethanol using a carbodiimide, prior to the hydroxylamine treatment. Comparable values of iron binding were obtained from esterified and hydroxylamine-treated batches prepared from the three proteins (about 50 mumol iron/g).

A case of Vogt-Koyanagi-Harada syndrome.

A previously healthy 32-year-old female contact lens patient presented with a constant headache of several days duration and a sudden painless loss of vision in the right eye. Examination revealed a serous elevation of the sensory retina with whitish plaque-like lesions and decreased visual acuity. Fluorescein angiography suggested a diagnosis of Vogt-Koyanagi-Harada syndrome (V-K-H). V-K-H syndrome is a chronic bilateral exudative uveitis associated with whitening of the hair and eyelashes and varying signs of meningeal irritation. A discussion of this case with photos and fluorescein angiography results will be presented.

Coordination of primary care providers: a follow-up study.

Surveys were sent to family physicians in North Carolina to determine knowledge and attitudes concerning optometry. A similar survey was performed previously with physicians from Illinois. Responses varied in the states regarding the participants' knowledge and opinions of optometric capabilities, perhaps as a function of the scope of optometric practice according to the individual state laws. Optometry's perceived role as a health care provider seems to be affected by their legally permitted mode of practice.

Coordination of primary care providers.

Surveys were sent to family physicians in Illinois to determine knowledge and attitude concerning optometry. The respondents were knowledgeable in certain aspects of optometry. However, many need to become more aware of the optometrist as a health care provider.