The caesarean section is the most common medical procedure performed in US hospitals, with 1.2 million performed annually, according to a report released on Tuesday by the... Agency for Healthcare Research and Quality Healthcare Cost & Utilization Project, USA Today reports (Healy, USA Today, 8/3). The report, which is based on data from 38 states representing 90% of all hospital stays, found that at least 20% of the four million infants born annually are delivered by c-sections, according to Anne Elixhauser, an analyst who helped compile the report. "Nearly a quarter of all (U.S.) hospital stays are related to pregnancy and childbirth," Elixhauser said, adding, "Most people don't realize what a big chunk of hospital care that is." C-sections cost about $14.6 billion in total hospital charges in 2003, according to the report. The next most common hospital procedure is upper gastrointestinal endoscopy, which was performed about 712,000 times in U.S. hospitals in 2003 (Reuters, 8/2).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 27 октября 2011 г.
четверг, 20 октября 2011 г.
Women Previously Diagnosed With Cervical Intraepithelial Neoplasia At Higher Risk For Recurrence And Invasive Cancer
Long-term risks of invasive cancer and recurrence of severe cervical intraepithelial neoplasia (CIN) are higher among women previously treated for CIN, compared with those with no CIN diagnosis, according to data from a large, retrospective cohort study published in the May 12 online issue of the Journal of the National Cancer Institute.
The study was undertaken because information on the long-term risks of subsequent CIN or invasive cancer among women previously treated for the disease is limited. More information on long-term risks is needed to help guide long-term follow-up of these patients.
To determine such risks, Joy Melnikow, M.D., of the Center for Healthcare Policy and Research at the University of California, Davis, and colleagues retrospectively identified a CIN cohort of 37,142 women who were treated for CIN 1, 2, or 3 from January 1, 1986, through December 31, 2000, and compared them with a cohort of 71,213 women with no previous CIN diagnosis. Both groups were under active surveillance through 2004.
The researchers found that risk for subsequent CIN or cervical cancer was associated with initial CIN grade, treatment type, and age. The risk of invasive cervical cancer and CIN 2/3 recurrence was highest for women who were older than 40 years, previously treated for CIN 3, or treated with cryotherapy. According to the study, the highest rates of CIN recurrence were observed in the first 6 years after treatment in the CIN cohort, with a majority of those identified in the first 2 years. Recurrence rates for CIN 2 or 3 during this 6 year period ranged from 2.3 % in the lowest risk group to 35% in the highest risk group. Overall incidence of cervical cancer in the CIN group was 37 cervical cancers per 100,000 woman-years compared with six cervical cancers per 100,000 woman-years among women who had not been previously diagnosed.
"This large, population-based cohort study with more than 300,000 women-years of observation in the CIN cohort provided important information that could contribute to evidence-based guidelines for follow-up of women treated for CIN," the authors write. "Future randomized trials will need longer term follow-up to define the impact of treatment choice on subsequent CIN and invasive cancer."
In an accompanying editorial, Edward J. Wilkinson, M.D., of the University of Florida College of Medicine in Gainesville, Fla., points out that these results support evidence that active surveillance has value in identifying most incidences of CIN 2/3 recurrence and early stages of cervical cancer. He also notes that the majority of women who were later diagnosed with CIN had their CIN 2/3 diagnosed a relatively short time later (2 years). This short interval suggests that the subsequent CIN lesion was probably persistent CIN 2/3 rather than a new lesion.
"[T]his work provides evidence that women with CIN who have undergone treatment need long-term surveillance after their therapy and remain at some risk for CIN as well as for cervical carcinoma for 20 years or more," he concludes.
Citations:
Article:
"Cervical Intraepithelial Neoplasia Outcomes After Treatment: Long-Term Follow-up From the British Columbia Cohort Study."
Melnikow et al.
J Natl Cancer Inst 2009, 101: 721-728.
Editorial:
"Women with Cervical Intraepithelial Neoplasia: Requirement for Active Long-Term Surveillance After Therapy"
Wilkinson E.
J Natl Cancer Inst 2009, 101: 696-697.
Source
Journal of the National Cancer Institute
The study was undertaken because information on the long-term risks of subsequent CIN or invasive cancer among women previously treated for the disease is limited. More information on long-term risks is needed to help guide long-term follow-up of these patients.
To determine such risks, Joy Melnikow, M.D., of the Center for Healthcare Policy and Research at the University of California, Davis, and colleagues retrospectively identified a CIN cohort of 37,142 women who were treated for CIN 1, 2, or 3 from January 1, 1986, through December 31, 2000, and compared them with a cohort of 71,213 women with no previous CIN diagnosis. Both groups were under active surveillance through 2004.
The researchers found that risk for subsequent CIN or cervical cancer was associated with initial CIN grade, treatment type, and age. The risk of invasive cervical cancer and CIN 2/3 recurrence was highest for women who were older than 40 years, previously treated for CIN 3, or treated with cryotherapy. According to the study, the highest rates of CIN recurrence were observed in the first 6 years after treatment in the CIN cohort, with a majority of those identified in the first 2 years. Recurrence rates for CIN 2 or 3 during this 6 year period ranged from 2.3 % in the lowest risk group to 35% in the highest risk group. Overall incidence of cervical cancer in the CIN group was 37 cervical cancers per 100,000 woman-years compared with six cervical cancers per 100,000 woman-years among women who had not been previously diagnosed.
"This large, population-based cohort study with more than 300,000 women-years of observation in the CIN cohort provided important information that could contribute to evidence-based guidelines for follow-up of women treated for CIN," the authors write. "Future randomized trials will need longer term follow-up to define the impact of treatment choice on subsequent CIN and invasive cancer."
In an accompanying editorial, Edward J. Wilkinson, M.D., of the University of Florida College of Medicine in Gainesville, Fla., points out that these results support evidence that active surveillance has value in identifying most incidences of CIN 2/3 recurrence and early stages of cervical cancer. He also notes that the majority of women who were later diagnosed with CIN had their CIN 2/3 diagnosed a relatively short time later (2 years). This short interval suggests that the subsequent CIN lesion was probably persistent CIN 2/3 rather than a new lesion.
"[T]his work provides evidence that women with CIN who have undergone treatment need long-term surveillance after their therapy and remain at some risk for CIN as well as for cervical carcinoma for 20 years or more," he concludes.
Citations:
Article:
"Cervical Intraepithelial Neoplasia Outcomes After Treatment: Long-Term Follow-up From the British Columbia Cohort Study."
Melnikow et al.
J Natl Cancer Inst 2009, 101: 721-728.
Editorial:
"Women with Cervical Intraepithelial Neoplasia: Requirement for Active Long-Term Surveillance After Therapy"
Wilkinson E.
J Natl Cancer Inst 2009, 101: 696-697.
Source
Journal of the National Cancer Institute
четверг, 13 октября 2011 г.
Federal Judge Rules That Attorneys For Abortion Provider Tiller Cannot Prevent Grand Jury From Being Formed To Investigate Tiller
U.S. District Judge J. Thomas Marten on Tuesday ruled against a motion to prevent a grand jury from convening in Sedgwick County, Kan., to investigate abortion provider George Tiller, the Wichita Eagle reports (Lefler, Wichita Eagle, 9/12). The antiabortion group Kansans for Life last week delivered a petition that contained 7,857 signatures asking the Sedgwick County District Court to convene a grand jury and appoint an independent prosecutor to investigate Tiller. Petitioners want the grand jury to examine late-term abortions that Tiller performed during the past five years and the reasons cited for the abortions (Kaiser Daily Women's Health Policy Report, 9/7).
Sedgwick County Election Commissioner Bill Gale on Tuesday certified the petition and sent it to Sedgwick County Administrative Judge Michael Corrigan. Gale said the petitioners submitted 6,683 valid signatures, more than the 2,449 needed to convene a grand jury.
Sedgwick County Election Commissioner Bill Gale on Tuesday certified the petition and sent it to Sedgwick County Administrative Judge Michael Corrigan. Gale said the petitioners submitted 6,683 valid signatures, more than the 2,449 needed to convene a grand jury.
Tiller Motion, Reaction
Tiller's attorneys filed a motion requesting that the grand jury not be convened, claiming that Tiller has been investigated several times in the past year and that another grand jury investigation would be "unfair, harassing and bad faith." According to the Eagle, if the grand jury is seated, it will conduct at least the fifth investigation of Tiller since 2006, including a pending case in which state Attorney General Paul Morrison (D) has charged Tiller with 19 misdemeanors for allegedly violating a state law that requires an independent, consulting physician to approve some late-term abortions.
Tiller's attorneys in the motion said the petition to convene a grand jury is "part of a repeated, persistent and harassing effort to induce criminal prosecution" of Tiller "by those who oppose lawful abortion." Marten said that Tiller's lawyers made a strong case, but added, "Frankly, I'm reluctant to jump into the middle of something that is essentially a state matter." Marten suggested that Tiller's attorneys re-file the motion in state court, and Tiller's attorneys said they plan to do so (Wichita Eagle, 9/12).
Kansans for Life leaders said they were unaware that Tiller's attorneys had sought to prevent state courts from convening a grand jury. David Gittrich, development director of Kansans for Life, said that if the motion had been granted, it would have been an insult to those who signed the petition and to state lawmakers seeking to change abortion policy. He added that the group hopes the grand jury will file charges against Tiller similar to those filed by former Attorney General Phill Kline (R) (Wichita Eagle, 9/12).
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 6 октября 2011 г.
Symptoms Of Toxicity Are Markers Of Breast Cancer Treatment Success
An article published early online and in the December edition of The Lancet
Oncology reports that if breast cancer patients who receive endocrine treatment
develop hot flushes, vasomotor symptoms (such as cold and night sweats), and
joint symptoms, then they have a lower likelihood of cancer recurrence. That
is, the toxicity of the treatment is acting as an indicator of treatment
success.
Professor Jack Cuzick (Cancer Research UK and Queen Mary School of Medicine and
Dentistry, London, UK) and colleagues say that the above
symptoms during endocrine treatment are related to estrogen depletion or
estrogen blockage.
Their analysis used data on women who participated in the Arimidex,
Tamoxifen, Alone or in Combination (ATAC) trial, a study designed to assess
tamoxifen or anastrozole for adjuvant therapy of post-menopausal breast cancer.
To test for a relationship between the toxicity symptoms and cancer recurrence,
the researchers compared two groups of women with hormone-receptor-positive
tumors: one group reported symptoms at their first follow-up visit in the ATAC
trial, and the second group did not report symptoms.
After three months of treatment, 37.5% of eligible women reported new vasomotor
symptoms. These women had a 9-year cancer recurrence rate of 23%, while women
without new vasomotor symptoms had a recurrence rate of 18%. The 31.4% of women
who reported new joint symptoms after three months of treatment had a 9-year
cancer recurrence rate of 14%, while those without joint symptoms had a 23%
recurrence rate. Women who received both tamoxifen and anastrozole exhibited
these rate differences, and anastrozole was linked to lower recurrence rates
than tamoxifen independent of the presence of symptoms.
"The appearance of new vasomotor symptoms or joint symptoms within the
first 3 months is a useful biomarker, suggesting a greater response to
endocrine treatment compared with women without these symptoms. Awareness of
the relation between early treatment-emergent symptoms and beneficial response
to therapy might be useful when reassuring patients who present with them, and
might help to improve long-term treatment adherence when symptoms cannot be
alleviated," conclude the authors.
Treatment-emergent endocrine symptoms and the risk of breast cancer recurrence:
a retrospective analysis of the ATAC trial
Jack Cuzick, Ivana Sestak, David Cella, Lesley Fallowfield, on behalf of
the ATAC Trialists' Group
The Lancet Oncology (2008).
DOI:10.1016/S1470-2045(08)70259-6
Click Here to View Journal Website
: Peter M Crosta
View drug information on Arimidex.
Oncology reports that if breast cancer patients who receive endocrine treatment
develop hot flushes, vasomotor symptoms (such as cold and night sweats), and
joint symptoms, then they have a lower likelihood of cancer recurrence. That
is, the toxicity of the treatment is acting as an indicator of treatment
success.
Professor Jack Cuzick (Cancer Research UK and Queen Mary School of Medicine and
Dentistry, London, UK) and colleagues say that the above
symptoms during endocrine treatment are related to estrogen depletion or
estrogen blockage.
Their analysis used data on women who participated in the Arimidex,
Tamoxifen, Alone or in Combination (ATAC) trial, a study designed to assess
tamoxifen or anastrozole for adjuvant therapy of post-menopausal breast cancer.
To test for a relationship between the toxicity symptoms and cancer recurrence,
the researchers compared two groups of women with hormone-receptor-positive
tumors: one group reported symptoms at their first follow-up visit in the ATAC
trial, and the second group did not report symptoms.
After three months of treatment, 37.5% of eligible women reported new vasomotor
symptoms. These women had a 9-year cancer recurrence rate of 23%, while women
without new vasomotor symptoms had a recurrence rate of 18%. The 31.4% of women
who reported new joint symptoms after three months of treatment had a 9-year
cancer recurrence rate of 14%, while those without joint symptoms had a 23%
recurrence rate. Women who received both tamoxifen and anastrozole exhibited
these rate differences, and anastrozole was linked to lower recurrence rates
than tamoxifen independent of the presence of symptoms.
"The appearance of new vasomotor symptoms or joint symptoms within the
first 3 months is a useful biomarker, suggesting a greater response to
endocrine treatment compared with women without these symptoms. Awareness of
the relation between early treatment-emergent symptoms and beneficial response
to therapy might be useful when reassuring patients who present with them, and
might help to improve long-term treatment adherence when symptoms cannot be
alleviated," conclude the authors.
Treatment-emergent endocrine symptoms and the risk of breast cancer recurrence:
a retrospective analysis of the ATAC trial
Jack Cuzick, Ivana Sestak, David Cella, Lesley Fallowfield, on behalf of
the ATAC Trialists' Group
The Lancet Oncology (2008).
DOI:10.1016/S1470-2045(08)70259-6
Click Here to View Journal Website
: Peter M Crosta
View drug information on Arimidex.
Подписаться на:
Комментарии (Atom)