Growth factor usage patterns and outcomes in the community setting: collection through a practice-based computerized clinical information system.

PURPOSE: Although use of colony-stimulating factor (CSF) is widespread and guidelines for use have been disseminated, actual practice patterns of medical oncologists are unknown. The purpose of this study was to collect these data using an office-based computerized clinical information system. PATIENTS AND METHODS: Data were collected on patients at 10 community-based oncology practices. Information regarding CSF use was captured at the time of prescribing through a computerized clinical support tool and stored in a data warehouse, and an analysis was carried out retrospectively. RESULTS: A total of 6,813 cancer regimens administered to 5,034 patients were evaluated for growth factor use. Overall, CSFs were used in 14% of regimens, with breast, lymphoma, lung, and ovarian being the most common cancers for which CSFs were used. In 49.4% of regimens, CSF was initiated during cycle 1, with an average duration of 1 week, and was used in two or three cycles per regimen. Afebrile neutropenia is rarely followed by CSF initiation. Granulocyte colony-stimulating factor (G-CSF) is associated with fewer dose adjustments, delays, and hospitalizations when compared with granulocyte-macrophage colony stimulating factor (GM-CSF). There is wide variation among oncologists in CSF use, and several substantial differences were noted between the prescribing behavior of American Society of Clinical Oncology (ASCO) survey-reported oncologists and actual clinical practice, as captured by the computerized clinical information system. CONCLUSION: Computerized clinical information systems can collect detailed information regarding practice patterns of medical oncologists. ASCO physician practice survey data do not accurately reflect actual practice patterns and must be interpreted with caution. Substantial deviations from ASCO growth factor guidelines remain, and oncologists' use of CSFs demonstrates wide variation. There may be important clinical differences between G-CSF and GM-CSF, but definitive phase III trials are needed for confirmation.

Late cenozoic uplift of denali and its relation to relative plate motion and fault morphology.

Apatite fission-track analysis of samples that cover a 4-kilometer vertical section from the western flank of Denali (Mount McKinley), North America's highest mountain, suggests that the mountain massif was formed by rapid uplift (> 1 kilometer per million years) beginning approximately 6 million years ago (Ma). Uplift was a result of the morphology of the Denali fault and a change in motion of the Pacific plate with respect to North America at approximately 5 Ma, which created opposing tangential vectors of relative movement along the fault and forced the intervening crustal blocks upward.

Early cretaceous uplift in the ellsworth mountains of west antarctica.

Apatite fission-track analysis of samples covering a 4.2-kilometer vertical section from the western flank of Vinson Massif, Antarctica's highest mountain, indicates that the Ellsworth Mountains were uplifted by 4 kilometers or more during the Early Cretaceous following the initial separation of East and West Gondwana and accompanying the opening of the Weddell Sea. Relief of at least 1.8 kilometers has persisted in the Ellsworth Mountains since the Early Cretaceous, and a maximum of 3 kilometers of uplift has occurred since that time.

Early miocene subglacial basalts, the East antarctic ice sheet, and uplift of the transantarctic mountains.

Subglacially erupted volcanic rocks from Mount Early and Sheridan Bluff, Antarctica, yield whole-rock potassium-argon dates and argon-40/argon-39 release spectra of Early Miocene age. Field associations suggest the existence of the East Antarctic ice sheet and significant uplift of the Transantarctic Mountains by that time.

Epidemiological studies on rheumatic heart disease and streptococcal carriers among school-children in Addis-Ababa, Ethiopia. Preliminary communication.

The results of the first part of epidemiological follow-up studies on rheumatic heart disease and streptococcal carriers in Addis-Ababa are presented. In 1012 school-children relatively low morbidity of rheumatic heart disease (0.49%) and relatively small percentage of carriers of A-beta-hemolytic streptococci (4.24%) were found. There was no statistically significant difference in the morbidity of rheumatic heart disease as well as in the percentage of streptococcal carriers between the two basic social groups--children of well-to-do and of poor parents. No correlations with overcrowding were found. Serological types 5/12/27 and 3/13/B3164 of group A-beta-hemolytic streptococci were isolated most frequently.