Our objective was a retrospective study reporting on ovarian cancer screening in a high-risk female population using both CA-125 and ultrasound over a 7-year period. We used risk estimates of carrying a BRCA mutation that were based on family history. Subjects were screened with CA-125 and ultrasound every 6 months. Each of 311 high-risk subjects had between 1 and 17 screening visits. Overall, 33 of 1209 (2.7%) CA-125 results were abnormal (>35 U/ml); 226 of 1342 (17%) ultrasounds were abnormal, with abnormalities ranging from benign appearing cystic changes to more ominous patterns. Since entry into the program, 29 subjects (9%) have undergone surgery. In 20 of these, the preoperative screening was normal; in six, only the ultrasound was abnormal, and in two, only the CA-125 was abnormal (46-91 U/ml). In only one subject undergoing surgery were both serial CA-125 levels (52-91 U/ml) and ultrasound abnormal. In 7 years of screening, one patient (0.3%) has been diagnosed with ovarian cancer (stage IA, grade 1 endometrioid adenocarcinoma). Overall, 31 (10%) subjects have completed BRCA testing. We conclude that despite screening results comparable to other studies, the detection of only one ovarian cancer over 7 years is lower than expected. Explanations for this observation are discussed. Despite the limitations of CA-125 and ultrasound, we continue to recommend these screening modalities for high-risk women. At the present time, they offer the best opportunity to detect ovarian cancers early. With increasing knowledge of BRCA testing, more women may benefit from this testing in assessing their personal risk.

Adult↗

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Health education goes Hollywood: working with prime-time and daytime entertainment television for immunization promotion.

This article presents an entertainment education strategy used to influence Hollywood prime-time and daytime television programs to add storylines on the importance of immunizations to their shows. Rather than giving information about immunizations to show producers, directors, actors, and writers, we furnished "log lines" and true stories about immunizations that could be used to inspire scripts that included immunization themes. By working through personal contacts within the entertainment television industry's closed system of networks, we were able to gain entree and some airtime for our campaign agenda. Embedded messages aired on eight popular shows in the 1996-1997 broadcast season, with five scheduled to air in the 1997-1998 season. These efforts were evaluated qualitatively, focusing on issues of personal networks, content of aired messages, and comparative costs for paid airtime. The strategy developed can be adapted for a range of entertainment education interventions.

Adolescent↗

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Fatty replacement of spinal bone marrow due to radiation: demonstration by dual energy quantitative CT and MR imaging.

Dual energy CT and quantitative magnetic resonance (MR) imaging were used to evaluate marrow changes due to radiation. The bright signal intensity seen on MR was shown by the two quantitative techniques to be due to a threefold increase in the marrow fat content compared with nonradiated levels and to a normal control. Fat estimates by MR and dual energy CT were in excellent agreement. Single energy CT overestimates the amount of bone loss in the radiation field. Dual energy CT and quantitative MR can be used to correct this error.

Adipose Tissue↗

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Uterine papillary serous carcinoma: evaluation of multimodality treatment with abdominopelvic radiotherapy and chemotherapy.

The aim of this study was to compare overall survival (OS), progression-free survival (PFS), and relapse patterns between different modalities of treatment for uterine papillary serous carcinoma (UPSC). A retrospective review of 124 patients with pathologically confirmed UPSC was performed, of whom, 97 patients were eligible for study. Postoperative treatment groups included adjuvant radiotherapy consisting of whole abdomen and a pelvic boost (abdominopelvic radiotherapy [APRT]) (55 patients), paclitaxel and carboplatin chemotherapy (CT) for six cycles followed by APRT (18 patients), CT only (5 patients), and 19 patients were observed without postoperative adjuvant therapy. Three-year OS was 81% and 63% for the CT followed by APRT and APRT alone, respectively (P= 0.11). After controlling for stage, the group treated with APRT alone had significantly decreased OS and PFS compared to the CT/APRT group (HR 3.6; 1.3-9.8; P= 0.01) and (HR 2.9; 95% CI 1.1-7.3; P= 0.03), respectively. Within the limitations of a retrospective study, the results of this study indicate that multimodality postoperative treatment with paclitaxel and a platinum-based CT followed by APRT may increase the survival of patients with UPSC. However, further prospective studies using these combined modalities are needed to confirm these findings.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

A retrospective analysis of neoadjuvant platinum-based chemotherapy versus up-front surgery in advanced ovarian cancer.

The objective of this study is to compare progression-free survival (PFS) and overall survival (OS) of ovarian cancer patients treated with neoadjuvant chemotherapy and surgery to primary surgery and postoperative chemotherapy. Retrospective analysis from 1998 to 2003 of 116 patients with ovarian cancer was performed. Fifty women diagnosed by positive cytology received three cycles of carboplatin and paclitaxel. Thirty-six patients subsequently underwent cytoreductive surgery and completed three further cycles postoperatively. The OS and PFS were compared in 66 women treated with primary surgery and postoperative chemotherapy. A statistically significant difference was observed for OS (P= 0.03, HR = 1.85, CI = 1.06-3.23) and PFS (P= 0.04, HR = 1.61, CI = 1.03-2.53) favoring the primary surgery group. Due to the small numbers, age, grade, stage, pleural effusions, and histologic cell type were controlled for separately in the bivariate analyses. Controlling for stage made the results weaker. A matched subgroup survival analysis was performed on patients who had surgery following neoadjuvant chemotherapy. After matching for stage and grade and controlling age and pleural effusions (N= 28 matched pairs), there was no statistical difference for OS (P= 0.95, HR = 1.04, CI = 0.33-3.30) or PFS (P= 0.79, HR = 1.11, CI = 0.98-1.04). It is concluded that primary surgery should be considered in all patients. Neoadjuvant chemotherapy may be an alternative in a subset of women with the intent to also perform interval debulking.

Adenocarcinoma↗

PubMedDate not supplied

Compensation, jobs, and gender.

Explore the source record for details and available documents.

Age Factors↗

PubMedDate not supplied

Marketing: a necessary art under DRGS.

Saint Michael's Medical Center, like most healthcare facilities in the country, didn't realize the need for marketing until 1982. At that time, the loss of the surrounding community and a trend toward becoming only a tertiary care facility prompted the parent corporation to look at marketing as a solution to the occupancy and fiscal problems. During the process of development and implementation of the marketing plan, the following issues were identified as needing an immediate answer: 1) What does the hospital stand for? 2) What do we wish to achieve with our marketing plan? 3) How can we identify the hospital's deficiencies? 4) What kind of patient mix is desired? 5) On what type of care should we focus? The marketing plan was based on a full participation of the hospital staff in answering these questions and the developing of a plan of action tailored to the answers. Implementation proved successful. The number of admissions increased by 12% between 1982 to 1984. In addition, the hospital realized a 3% increase in admissions in 1985. Originally, occupancy raised to 92%, but in 1985, one of the goals was to lower the length of stay. At the end of 1985, the occupancy rate fell to 82.5%. But, the number of emergency room visits increased by 3%.

Diagnosis-Related Groups↗

PubMedDate not supplied

Phase-contrast imaging of the parotid region.

Standard T1- and T2-weighted spin-echo acquisitions were compared with T1- and T2-weighted phase-contrast techniques in a series of 10 consecutive patients with parotid masses to assess the role of phase-contrast methods in the evaluation of lesions in the parotid fossa. Greater tissue-lesion contrast was obtained with phase-contrast methods in nine of 10 cases, allowing improved lesion visualization; however, an increase in lesion detectability was not observed in this series. Standard MR imaging methods are sufficient for imaging the parotid region in most cases, but can be quite time-consuming. Recommended screening of the parotid fossa that optimizes tissue-lesion contrast, lesion detectability, and imaging time is performed by combining a standard T1-weighted acquisition with a T1- or T2-weighted phase-contrast acquisition. Selection of a T1- or T2-weighted phase-contrast acquisition is determined by the T1 characteristics of the lesion.

Humans↗