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Biomedical subjects

K Trim

Publications and source records attributed to K Trim.

6 recordsLinked to original sources
PubMed2006

Physicians' attitudes, beliefs and knowledge concerning ovarian cancer.

OBJECTIVE: To determine physicians' attitudes, beliefs and knowledge concerning surgical care of women with ovarian cancer. METHODS: A survey was created from items generated from the literature, a focus group and individual interviews. The survey was mailed on two occasions to all practicing gynecologists, general surgeons and urologists in Ontario. RESULTS: 701 responses were received (overall response rate: 43.7%); 293 were eligible responses. The responses were analyzed in terms of four determinants of surgical care: knowledge, practice patterns, perceived goals of surgery and barriers to accessing surgical care. These variables would be influenced by the surgeon's specialty, access to an oncologist (medical or gynecologic) at one's facility and distance of one's facility to the nearest cancer center with a gynecologic oncologist. Surgeon's specialty and distance from the cancer center influenced both the intraoperative surgical plan and referral practices. The most important goals of surgery were survival and optimal debulking. The barriers to care included available operating time and surgical beds. CONCLUSION: We have shown that peer influence has reached a ceiling effect in ovarian cancer and novel approaches are required to ensure appropriate referrals, knowledge transfer and provincial resourcing to expert centers to provide optimal surgical care for women with ovarian cancer.

Adult↗
PubMed2004

Optimal management for surgically Stage 1 serous cancer of the uterus.

OBJECTIVE: To describe the outcomes of patients who have undergone well-conducted surgery and found to have Stage 1 serous uterine cancer. METHODS: This retrospective cohort study includes women who have been treated for Stage 1 serous cancer of the uterus from 1985 to 2001. Cases were included from the regional cancer centers in Hamilton, London, Sunnybrook Toronto and Cancer Care Manitoba. RESULTS: Forty-three women met the inclusion criteria: Complete surgical staging (n = 27), surgery followed by pelvic radiation therapy (n = 4), surgery followed by whole abdominal radiation therapy (n = 6), surgery followed by adjuvant chemotherapy (n = 6). Patient age or depth of invasion did not influence survival. Progression free interval was 22 months (SD = 14.29). Recurrence rate was highest for adjuvant chemotherapy (66%). Survival was assessed by treatment modality and a statistically significant poorer survival was seen in the adjuvant chemotherapy group (OR 17.5; 95% CI 1.3-227.6). No comment can be made on a superior treatment regimen given the small numbers in each treatment strata. CONCLUSION: This study supports the findings of others in the literature. In a group of patients where surgical staging shows limited disease (i.e., surgically Stage 1 disease), then surgery alone appears to be adequate treatment.

Aged↗
PubMed2004

Job satisfaction, stress, and burnout among Canadian gynecologic oncologists.

OBJECTIVES: (1). To provide a job description of Canadian gynecologic oncologists. (2). To assess job satisfaction and job stress, and measure the prevalence of burnout and psychological morbidity. METHODS: A cross-sectional survey was mailed to all Canadian gynecologic oncologists in September 2002. RESULTS: The job profile on Canadian gynecologic oncologists is predominantly clinical with a minor component of administration and to a less extent education or research. Clinically, 80% of the activity is focused on gynecologic cancer care. The majority of physicians (92%) are satisfied with their job, but there are clear concerns raised concerning systems issues in health care delivery. Approximately 26% of physicians are experiencing high stress, and this is strongly associated with emotional exhaustion and high depersonalization. Fourteen percent of Canadian gynecologic oncologists are actively looking for alternative jobs and 45% are trying to decrease the number of hours worked per week. When considering an alternate job, the most important factors are location, colleagues, and potential for personal growth. CONCLUSION: High stress and low personal accomplishment were seen in Canadian gynecologic oncologists. Organizations (i.e., hospitals) and health care funders have the opportunity to incorporate preventative strategies to keep this physician resource healthy.

Adult↗
PubMed2002

Levels of environmental contaminants in human follicular fluid, serum, and seminal plasma of couples undergoing in vitro fertilization.

Environmental chemicals are thought to adversely affect human reproductive function, however there are no studies that have explored the association between failed fertilization and exposure of both partners to environmental contaminants. Therefore, we collected blood and follicular fluid from the female partner and seminal plasma from the male partner of 21 couples attending an in vitro fertilization (IVF) program, in order to determine the extent of the existence of environmental chemicals in these fluids. Any relationship to the outcome of IVF was also considered. Sera and fluids were analysed for a variety of contaminants, including polychlorinated biphenyls, pesticides, cotinine, and the steroids progesterone and estradiol. Of the couples examined, 18 had fertilizations, three of whom became pregnant. There were no fertilizations in three other couples. The contaminants most frequently found in follicular fluid, more than 50% of the samples tested, were p,p'-DDE, mirex, hexachloroethane, 1,2,4-trichlorobenzene, PCB 49, PCB 153, and PCB 180. Cadmium was detected in eight of 21 (38.1%) samples of follicular fluid whereas cotinine was detected in 18 (85.7%). Residue levels of p,p'-DDE, endosulfan I, PCB 99, PCB 138, PCB 153, PCB 180 were quantified in more than 50% of the sera samples examined. Seminal plasma was relatively free of pollutants with mirex being the most frequently detected contaminant found in seven of 21 (33.3%) samples. Mirex could not be detected in the seminal plasma of the husbands whose partner's oocytes failed to fertilize whereas significant levels of mirex were found in the seminal plasma of all couples who had a pregnancy. Cadmium was also found in the follicular fluid of these pregnant subjects. No relationship was found between follicular fluid cotinine in pregnant and non-pregnant subjects. Where identical contaminants were found in both sera and follicular fluids, the levels were about twofold higher in serum and were positively correlated in both fluids. Fertilization was negatively correlated with serum and follicular fluid p,p'-DDE whereas pregnancy was positively correlated with follicular fluid PCB 49. These data reveal that more than 50% of the population of women attending a fertility program have had exposure to environmental chemicals sufficient to produce detectable concentrations in their serum and ovarian follicular fluid. Of the chemical contaminants detected in the serum and follicular fluid of these women, p,p'-DDE was the most frequently detected, had the highest residue levels, and was associated with failed fertilization.

Adult↗