Updated and expanded study of polycythemia vera and other myeloproliferative neoplasms in the tri-county area.

INTRODUCTION: The results of a 2001-2005 polycythemia vera (PV) investigation in Eastern Pennsylvania revealed a disease cluster plus underreporting and false reporting to the Pennsylvania Cancer Registry (PCR). PURPOSE: The objectives of this study were 1) to assess PV reporting to the PCR in 2006-2009, 2) to determine whether a cancer cluster persisted, and 3) to determine whether other myeloproliferative neoplasms (MPNs), including essential thrombocytopenia (ET), were subject to similar reporting problems. METHODS: Cases were identified from: 1) PCR records from the Tri-County, 2) reviewing billing records at Tri-County hematologist/oncologist offices, and 3) self-identification. An expert panel of physicians reviewed medical records and determined "true," "false," or "indeterminate" cases reported to the PCR. The analyses were conducted to determine sensitivity and positive predictive value (PPV) of case reporting to the PCR, estimate cancer incidence rates, and evaluate the presence of cancer clusters. RESULTS: Of 290 cases identified, 90% were from the original PCR, 9% from billing records, and 1% from self-report. Fifty-five cases consented to participate, and medical records were obtained for 44. The expert panel determined that 45% were true cases, 32% were false cases, and 23% were indeterminate. PV had 100% (95% CI, 59-100) sensitivity, but only 47% PPV (95% CI, 20-70): ET had 78% (95% CI, 47-99) sensitivity and 100% PPV (95% CI, 59-100). Low participation and chart review rates led to rates with wide confidence intervals. We did not identify any PV cancer clusters, but we did identify a cluster of 9 ET cases in the Wilkes-Barre, Pennsylvania area. CONCLUSION: The current study was limited by the low response rate (22%) from MPN patients in the Tri-County area. This study identified 47% PPV for PV reporting and 100% PPV for ET.

Heart-smart service.

Cardiology patients--direct and ED admits--go to Lancaster General Hospital's Cardiology Admissions Unit (CAU) to receive care until a bed is available in an inpatient unit. The CAU yields high patient volume, positive patient and staff feedback, decreased ED length of stay, prompt initiation of treatment protocols, and more effective discharge planning.

Ensuring competencies of multidisciplinary staff in patient-focused care.

Faced with rising health care costs and consumer demands, hospitals are finding creative ways to streamline the delivery of patient care. One such approach is patient-focused care (PFC), in which hospitals bring services to the patient's beside and cross-train staff. The success of PFC depends on training and measuring staff competence in the new skills. This article describes how to implement an educational plan based on competencies for a successful transition to PFC.

Clostridium difficile colitis induced by cytarabine.

Pseudomembranous enterocolitis (PMC) has become a widely recognized syndrome of nausea, abdominal distention, and severe (frequently bloody) diarrhea (1). While this syndrome was first associated with the administration of clindamycin, almost all antimicrobial drugs can serve as predisposing agents (2). We wish to report a patient with typical PMC induced by the administration of cytarabine.

Dibromodulcitol in the treatment of metastatic hemangiopericytoma.

Hemangiopericytoma is an uncommon sarcoma arising from the pericapillary cells. While the rarity of this lesion precludes randomized investigation, metastatic hemangiopericytoma has been noted to respond to a variety of agents, including vincristine, adriamycin, actinomycin, and high-dose methotrexate. We wish to report an unusual case of this disease which failed to respond to the above but then exhibited a marked response to dibromodulcitol. In light of the unusual nature of this response, we would like to suggest a controlled trial of the use of dibromodulcitol in patients with this rare tumor.