Multidisciplinary care in cancer: do the current research outputs help?

This review examined whether the increased attention on multidisciplinary care (MDC) in cancer over the last 10 years has been underpinned by an increase in methodologically vigorous intervention research in this field. Electronic search of Medline and CINAHL databases. This review examined whether the proportion of (1) data-based and (2) intervention research meeting Cochrane Effective Practice and Organisation of Care (EPOC) criteria increased between two time periods (1997-2001 and 2002-2006). Papers meeting the following inclusion criteria were identified: relevant to MDC for cancer patients; included the term 'multidisciplinary' in the abstract; published in English; published between 1997 and 2006. The proportion of data-based papers did not increase over time, nor did the proportion of intervention papers using EPOC-accepted designs. Only three intervention studies using EPOC-accepted designs were identified, all in the later time period. MDC is widely advocated in cancer care. This review indicates a pressing need to focus attention on the development of rigorous intervention research. Such research should answer important questions such as which models of MDC are most effective, for which outcomes and for which patients.

Determinants of utilization of Tay-Sachs screening.

OBJECTIVE: To identify the characteristics of patients associated with optimal utilization of Tay-Sachs screening. METHODS: Medical records of patients undergoing amniocentesis for genetic diagnosis were reviewed. Three hundred twenty-nine of 537 charts evaluated were from individuals at risk for Tay-Sachs heterozygosity. Among these, 213 couples had previously been screened for Tay-Sachs. In 116 couples, neither member of the couple had been screened before amniocentesis. A concurrent reference group consisted of 208 couples without an indication for Tay-Sachs screening. Patient characteristics, including ethnicity, genetic screening history, parental ages, and pregnancy history, were reviewed for each group. Analysis of variance and likelihood chi 2 test were used for statistical analysis. RESULTS: There were no significant differences in maternal age or reproductive history among the groups. The most common indication for amniocentesis was advanced maternal age for all three groups. However, the previously screened group was more than twice as likely to self-refer because of a positive family history or patient anxiety than was the unscreened group (P = .006). Conversely, the unscreened group was more than twice as likely as screened couples to be referred because of a positive high or positive low maternal serum alpha-fetoprotein level (P = .002). CONCLUSION: Despite 2 decades of professional and lay education, many couples are unaware of their individual risk for Tay-Sachs heterozygosity. Additional education, most likely at the professional level, is needed to maximize informed participation.

Intestinal morphometry and bile acid-induced mucosal injury in chronic experimental renal failure.

To examine whether the intestinal mucosa in uremia is more prone to injury, we studied acute intestinal mucosal injury in rats with experimental chronic renal failure (RF) and sham-operated and starved control animals. Intestinal injury was produced by perfusing intestinal segments in vivo with 5 mmol/L chenodeoxycholic acid. Histologic specimens were then taken from the proximal and distal perfused and unperfused intestinal segments. Quantitative morphometry was done with computerized image analysis, and samples of the unperfused intestine were assayed for protein and DNA content. Chronic RF did not significantly affect the functional or morphologic injury caused by chenodeoxycholic acid. However, it was noted that RF rats had consistently taller villi and deeper crypts in all the samples studied. The protein content and the ratio of DNA to protein was similar among the three groups. The mechanism of the increase in villus height and crypt depth in the RF rats was not related to increases in tissue water content or to alterations in protein or DNA content, and the mechanism thus remains unexplained. This study clearly demonstrates, however, that the intestinal mucosa of rats with chronic renal insufficiency is not more susceptible to mucosal injury by bile acids than is the mucosa of appropriate control animals.