How distant? An experimental analysis of students' COVID-19 exposure and physical distancing in university buildings

Closed university buildings proved to be one of the main hot spots for virus transmission during pandemics. As shown during the COVID-19 pandemic, physical distancing is one of the most effective measures to limit such transmission. As universities prepare to manage in-class activities, students' adherence to physical distancing requirements is a priority topic. Unfortunately, while physical distancing in classrooms can be easily managed, the movement of students inside common spaces can pose high risk of close proximity. This paper provides an experimental analysis of unidirectional student movement inside a case-study university building to investigate how physical distancing requirements impact student movement and grouping behaviour. Results show general adherence with the minimum required physical distancing guidance, but spaces such as corridors pose higher risk of exposure than doorways. Doorway width, in combination with group behaviour, affect the students' capacity to keep the recommended physical distance. Furthermore, questionnaire results show that students report higher perceived vulnerability while moving along corridors. Evidence-based results can support decision-makers in understanding individuals' exposure to COVID-19 in universities and researchers in developing behavioural models in preparation of future outbreaks and pandemics.

Release-Recapture Test of Dispersal and Survival of Sterile Males of Ceratitis capitata (Diptera: Tephritidae)

The sterile insect technique is used around the world to suppress or eradicate populations of Ceratitis capitata (Wiedemann) with successful results. It consists of inundative releases of sterile insects into a wide area to reduce reproduction in a field population of the same species. It is necessary to know the dispersion of the sterile males in the field in order to define the maximum distance between the release points that ensures the distribution of the sterile flies in the entire target area. The release methods may vary depending on the area to be covered and the resources available. Manual ground release requires less technology. The aim of this research was to estimate the ability of sterile males to survive and disperse in the field, in the two main areas of citrus production in Uruguay. A release of 20,000 sterile males of C. capitata TslV8 (-inv D53) was performed at the central point of each area defined for the trials. Around these points, a network of 54 Jackson traps baited with trimedlure was installed forming five concentric rings, which were placed on days 1, 3, 5, and 7 after the release and were removed at 24 h in all cases. The emergence rate, flight ability, dispersion, and longevity were estimated. The standard distances obtained by the regression models were 127 m and 131 m for Salto and San José respectively. In Salto, the traps had catches until the eighth day, and in San José, there were no catches after the sixth day.

A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer

BACKGROUND

Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race.

METHODS

We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as "cancer survivors" and those without a history of cancer as "no cancer history." We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race.

RESULTS

There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race.

CONCLUSION

Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.

Quantitative Synthesis of Timed 25-Foot Walk Performance in Multiple Sclerosis

OBJECTIVE

To provide a meta-analysis of articles that have included the timed 25-foot walk (T25FW) in persons with multiple sclerosis (MS), quantify differences in T25FW scores between those with MS and controls without MS, and quantify differences between categories of disability status and clinical disease courses within MS.

DATA SOURCES

The literature search was conducted using 4 databases (Google Scholar, PubMed, Cumulative Index to Nursing and Allied Health, EBSCO Host). We searched reference lists of published articles to identify additional articles.

STUDY SELECTION

A systematic literature search identified articles reporting average T25FW performance in seconds between those with MS and controls without MS, between those with MS who had mild and moderate and/or severe disability status, and between relapsing-remitting and progressive clinical courses of MS.

DATA EXTRACTION

Information was extracted and categorized based on reported data: comparisons of controls without MS and MS, comparisons of mild and moderate and/or severe MS based on study-defined Expanded Disability Status Scale groups, and comparisons of relapsing-remitting and progressive MS clinical courses.

DATA SYNTHESIS

We performed a random effects meta-analysis to quantify differences between groups as estimated by effect sizes (ESs). We expressed the differences in Cohen d as well as the original units of the T25FW (ie, seconds).

CONCLUSIONS

There was a large difference in T25FW performance in MS compared with controls without MS (ES=-0.93, mean difference=2.4s, P<.01). Persons with moderate and/or severe disability walked substantially slower compared with mild disability (ES=-1.02, mean difference=5.4s, P<.01), and persons with progressive courses of MS walked substantially slower than relapsing-remitting MS (ES=-1.4, mean difference=13.4s, P<.01).

Mediating Effects of Frailty Indicators on the Risk of Sepsis After Cancer

BACKGROUND

Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race.

METHODS

We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race.

RESULTS

Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P < .01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P < .01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race.

CONCLUSION

Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.

A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort

BACKGROUND

Hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to patients with no cancer history. We compared the risk of sepsis between cancer survivors and no cancer history participants, and examined whether race was an effect modifier.

METHODS

We performed a prospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer, excluding non-melanoma skin cancer. We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We performed Cox proportional hazard models to examine the risk of sepsis after cancer (adjusted for sociodemographics, health behaviors, and comorbidities), and stratified by race.

RESULTS

Among 29,693 eligible participants, 2959 (9.97%) were cancer survivors, and 26,734 (90.03%) were no cancer history participants. Among 1393 sepsis events, the risk of sepsis was higher for cancer survivors (adjusted HR: 2.61, 95% CI: 2.29-2.98) when compared to no cancer history participants. Risk of sepsis after cancer survivorship was similar for Black and White participants (p value for race and cancer interaction = 0.63).

CONCLUSION

In this prospective cohort of community-dwelling adults we observed that cancer survivors had more than a 2.5-fold increased risk of sepsis. Public health efforts should attempt to mitigate sepsis risk by awareness and appropriate treatment (e.g., antibiotic administration) to cancer survivors with suspected infection regardless of the number of years since cancer remission.

Predictors of Time to Nursing Home Placement in White and African American Individuals With Dementia

Objective: This study examined the influence of racial group identification on nursing home placement (NHP) for individuals with dementia before and after adjusting for the possible mediating effects of the caregiving context as defined by stressprocess variables in 215 caregiver/care recipient dyads. Method: Demographics, problem behaviors, self-care impairment, and caregiver appraisal, social support, psychological well-being, and coping were used to prospectively predict Time to NHP. Results: Race was a significant predictor of NHP with African American care recipients placed significantly slower than White care recipients. Race remained a significant predictor of Time to NHP after controlling for other variables that showed independent association with Time to NHP and stress-process variables. Discussion: Findings suggest that stress-process variables are critical factors in Time to NHP; however, these variables do not explain fully the difference in Time to NHP seen in White and African American care recipients.

Obesity and mortality: are the risks declining? Evidence from multiple prospective studies in the United States

We evaluated whether the obesity-associated years of life lost (YLL) have decreased over calendar time. We implemented a meta-analysis including only studies with two or more serial body mass index (BMI) assessments at different calendar years. For each BMI category (normal weight: BMI 18.5 to <25 [reference]; overweight: BMI 25 to <30; grade 1 obesity: BMI 30 to <35; and grade 2-3 obesity: BMI ≥ 35), we estimated the YLL change between 1970 and 1990. Because of low sample sizes for African-American, results are reported on Caucasian. Among men aged ≤60 years YLL for grade 1 obesity increased by 0.72 years (P < 0.001) and by 1.02 years (P = 0.01) for grade 2-3 obesity. For men aged >60, YLL for grade 1 obesity decreased by 1.02 years (P < 0.001) and increased by 0.63 years for grade 2-3 obesity (P = 0.63). Among women aged ≤60, YLL for grade 1 obesity decreased by 4.21 years (P < 0.001) and by 4.97 years (P < 0.001) for grade 2-3 obesity. In women aged >60, YLL for grade 1 obesity decreased by 3.98 years (P < 0.001) and by 2.64 years (P = 0.001) for grade 2-3 obesity. Grade 1 obesity's association with decreased longevity has reduced for older Caucasian men. For Caucasian women, there is evidence of a decline in the obesity YLL association across all ages.

Factors affecting tobacco use among middle school students in Saudi Arabia

A rapid rise in the number of tobacco users in Saudi Arabia has occurred in the past decade, particularly among the youth. This study identified socio-cultural determinants of tobacco use and explored possible approaches to prevent adolescents' tobacco use in Saudi Arabia. A cross-sectional survey was administered using a self-administered questionnaire for collecting information on risk and protective factors for tobacco use among middle school students. School selection was stratified by region, gender, and type (public or private). Of 1,186 7-9th grade students, 1,019 questionnaires were analyzed. Risk factors affecting tobacco use included all important others' perceptions; mother, sister, friend, teacher and important person's tobacco use; pressure to use tobacco from brother, sister, friend and important persons; easy access to tobacco and frequent skipping of classes. Protective factors for tobacco use included family's perception; friend, teacher and important person's tobacco use; parents' help; support from family, friends, and teachers; accessibility to tobacco; school performance and family income, father's education, and district of residence. The findings of this study show clear gender differences in social influences and attitudes towards tobacco use. Religious beliefs and access to tobacco products were significantly associated with attitudes towards tobacco use and future intention of use. Developing and implementing effective gender specific school-based tobacco prevention programs, strict reinforcement of tobacco control policies, and a focus on the overall social context of tobacco use are crucial for developing successful long-term tobacco prevention programs for adolescents.

Safety-net facilities and hospitalization rates of chronic obstructive pulmonary disease: a cross-sectional analysis of the 2007 Texas Health Care Information Council inpatient data

Purpose

Geographic disparities in hospitalization rates for chronic obstructive pulmonary disease (COPD) have been observed in Texas. However, little is known about the sources of these variations. The purpose of this manuscript is to further explore the geographic disparity of COPD hospitalization rates in Texas by examining county-level factors affecting access to care.

Patients and methods

The study is a cross-sectional analysis of the 2007 Texas Health Care Information Council, Texas, demographer population projections and the 2009 Area Resource File (ARF). The unit of analysis was county-specific hospitalization rate, calculated as the number of discharges of county residents divided by county-level population estimates. Indicators of access to care included: type of safety-net facility and number of pulmonary specialists in a county. Safety-net facilities of interest were federally qualified health centers (FQHCs) and rural health clinics (RHCs).

Results

There was a significant difference (P < 0.05) in hospitalization rates according to health center presence. Counties with only FQHCs had the lowest COPD hospitalization rate (132 per 100,000 observations), and counties with only RHCs had the highest hospitalization rate (229 per 100,000 observations). The presence of a pulmonary specialist was associated with a significant decrease (25%) in hospitalization rates among counties with only FQHCs.

Conclusion

In Texas, counties with only FQHCs were associated with lower COPD hospitalization rates. The presence of a RHC alone may be insufficient to decrease hospitalizations from COPD. There are a number of factors that may contribute to these variations in hospitalization rates, such as racial/ethnic distribution, types and quality of services provided, and the level of rurality, which creates greater distances to care and lower concentration of hospitals and pulmonary specialists.

Geographic disparity in COPD hospitalization rates among the Texas population

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality caused by cigarette smoking and other environmental exposures. While variation in exposures may affect COPD morbidity and mortality, little is known about geographic variation, a surrogate of exposures. The objective of this manuscript is to explore the geographic variation in COPD hospitalization rates among the Texas population in 2006.

METHODS

The study population consisted of all Texas residents with COPD hospitalizations in the 2006 Texas Health Care Information Council (THCIC) data. County population estimates stratified by race, age, and gender were linked to THCIC data to calculate county level COPD hospitalization rates per 100,000 admissions. The data were merged with Urban Influence Codes by county, and metropolitan status was determined by United States Department of Agriculture (USDA) criteria. Variation in COPD hospitalization rates were analyzed using Poisson Regression.

RESULTS

Overall, non Hispanic (NH) Whites had the highest rate of hospitalization, followed by NH Blacks (rate ratio=0.42) and Hispanics (RR=0.17), the 65+ age category had the highest rates of hospitalization. In the metropolitan counties COPD hospitalization rates were lower than non-metropolitan counties, however in metropolitan counties the rates of hospitalization were significantly higher (p<0.0001) in females compared to males. The rates were significantly higher in males in public health regions 10 and 11, which are predominantly non-metropolitan counties.

CONCLUSIONS

In Texas there is substantial geographic variation in hospitalization rates associated with gender and race/ethnicity. Other factors that may contribute to the variation and require further investigation include differences in smoking and exposure to other environmental risk factors, access to primary care, medical practice patterns, and coding practices.

Declining financial capacity in mild cognitive impairment: A 1-year longitudinal study

OBJECTIVE

To investigate 1-year change in financial capacity in relation to conversion from amnestic mild cognitive impairment (MCI) to dementia.

METHODS

Seventy-six cognitively healthy older controls, 25 patients with amnestic MCI who converted to Alzheimer-type dementia during the study period (MCI converters), and 62 patients with MCI who did not convert to dementia (MCI nonconverters) were administered the Financial Capacity Instrument (FCI) at baseline and 1-year follow-up. Performance on the FCI domain and global scores was compared within and between groups using multivariate repeated-measures analyses.

RESULTS

At baseline, controls performed better than MCI converters and nonconverters on almost all FCI domains and on both FCI total scores. MCI converters performed below nonconverters on domains of financial concepts, cash transactions, bank statement management, and bill payment and on both FCI total scores. At 1-year follow-up, MCI converters showed significantly greater decline than controls and MCI nonconverters for the domain of checkbook management and for both FCI total scores. The domain of bank statement management showed a strong trend. For both the checkbook and bank statement domains, MCI converters showed declines in procedural skills, such as calculating the correct balance in a checkbook register, but not in conceptual understanding of a checkbook or a bank statement.

CONCLUSIONS

Declining financial skills are detectable in patients with mild cognitive impairment (MCI) in the year before their conversion to Alzheimer disease. Clinicians should proactively monitor patients with MCI for declining financial skills and advise patients and families about appropriate interventions.

Clinical interview assessment of financial capacity in older adults with mild cognitive impairment and Alzheimer's disease

OBJECTIVES

To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) using a clinician interview approach.

DESIGN

Cross-sectional.

SETTING

Tertiary care medical center.

PARTICIPANTS

Healthy older adults (n=75) and patients with amnestic MCI (n=58), mild AD (n=97), and moderate AD (n=31).

MEASUREMENTS

The investigators and five study physicians developed a conceptually based, semistructured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity.

RESULTS

Study physicians made more than 11,000 capacity judgments across the study sample (N=261). Very good interrater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95% of physician judgments for older controls were rated as capable, compared with 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD.

CONCLUSION

Physicians and other clinicians can reliably evaluate financial capacity in cognitively impaired older adults using a relatively brief, semistructured clinical interview. Patients with MCI have mild impairment in financial capacity, those with mild AD have emerging global impairment, and those with moderate AD have advanced global impairment. Patients with MCI and their families should proactively engage in financial and legal planning, given these patients' risk of developing AD and accelerated loss of financial abilities.

Medical decision-making capacity in cognitively impaired Parkinson's disease patients without dementia

Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision-making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD-CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD-CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD-CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment.

Bayesian analyses of multiple epistatic QTL models for body weight and body composition in mice

To comprehensively investigate the genetic architecture of growth and obesity, we performed Bayesian analyses of multiple epistatic quantitative trait locus (QTL) models for body weights at five ages (12 days, 3, 6, 9 and 12 weeks) and body composition traits (weights of two fat pads and five organs) in mice produced from a cross of the F1 between M16i (selected for rapid growth rate) and CAST/Ei (wild-derived strain of small and lean mice) back to M16i. Bayesian model selection revealed a temporally regulated network of multiple QTL for body weight, involving both strong main effects and epistatic effects. No QTL had strong support for both early and late growth, although overlapping combinations of main and epistatic effects were observed at adjacent ages. Most main effects and epistatic interactions had an opposite effect on early and late growth. The contribution of epistasis was more pronounced for body weights at older ages. Body composition traits were also influenced by an interacting network of multiple QTLs. Several main and epistatic effects were shared by the body composition and body weight traits, suggesting that pleiotropy plays an important role in growth and obesity.

Role of a CYP17 polymorphism in the regulation of circulating dehydroepiandrosterone sulfate levels in women with polycystic ovary syndrome

We studied 259 consecutive unselected white patients with the polycystic ovary syndrome (PCOS) and 161 matched controls for a common polymorphism of CYP17, the gene encoding for P450c17alpha, and did not observe an important modulatory effect of this variant on circulating DHEAS. It does not appear that this common variant of CYP17, a T to C substitution in the 5' promoter region, plays a significant role in the adrenal androgen excess of PCOS.

An endogastric capsule for measuring tumor markers in gastric juice: an evaluation of the safety and efficacy of a new diagnostic tool

BACKGROUND

In gastric juice, high levels of the carcinoembryonic antigen (CEA) and the carbohydrate antigen 19-9 (CA 19-9) have been found to correlate with precancerous lesions and gastric cancer. So far, sampling of gastric juice has required upper endoscopy. In place of this invasive procedure, we investigated a new tool for the quantitation of tumor markers in gastric juice.

MATERIALS AND METHODS

The study population consisted of healthy controls and consecutive subjects with suspected gastric cancer or dyspepsia/epigastric distress. Patients were asked to swallow a small gelatine capsule (14 mm in length and 5 mm in diameter) containing a pierced plastic cover and surrounding a piece of absorbent paper. The capsule was left in the gastric cavity for 60 min to allow saturation of the absorbent paper with gastric juice. A 45-50 cm length of nylon thread connected to the inner capsule was used to remove the device from the gastric cavity. After processing the absorbent paper for radioimmunoassay, CEA and CA 19-9 levels were correlated to the findings of upper endoscopy and biopsies of gastric mucosa or suspected lesions.

RESULTS

The endogastric capsule did not cause any side-effects and 62 participants were fully compliant to the procedure. Assessable gastric juice samples were taken from 23 patients with gastric cancer, 15 patients with intestinal metaplasia or dysplasia, 12 patients with gastritis and 12 controls without gastric diseases. In the 12 samples of gastric juice from control patients, mean values of CEA and CA 19-9 were 1.1 +/- 0.9 ng/ml and 16 +/- 7.5 ng/ml, respectively. The mean levels of both markers were found to increase according to the severity of gastric lesions and in patients with cancer, mean CEA and CA 19-9 levels were 513 +/- 627 ng/ml and 545 +/- 510 ng/ml, respectively. Patients with precancerous lesions and cancer showed higher levels of CEA and CA 19-9 than patients with normal findings or gastritis (P <0.001).

CONCLUSIONS

The endogastric capsule is a simple, non-invasive tool for the measurement of CEA and CA 19-9 levels in gastric juice. These values may discriminate between normal or minor pathologic changes and precancerous lesions or carcinomas. Further investigations are warranted, since this may represent a new method for gastric cancer screening.

Autonomy development in adolescents with insulin dependent diabetes mellitus

This descriptive study investigated autonomy development among young adolescents with insulin-dependent diabetes mellitus (IDDM); assessed relationships among behavioral, cognitive, and emotional autonomy; and determined the relationships between these types of autonomy and metabolic control. Developmental and family theory provided the framework for this study. This investigation suggested that the pattern of autonomy for adolescents with IDDM is congruent with that of adolescents without chronic illness. The three autonomy types are conceptually distinct and one aspect of emotional autonomy was related to poorer metabolic control. Daughters and adolescents in one-parent families scored higher on this component.

Improved reduction in pain in chronic pancreatitis with combined intraoperative celiac axis plexus block and lateral pancreaticojejunostomy

PURPOSE:Severe abdominal pain secondary to chronic pancreatitis is often multifactorial in origin. Lateral pancreaticojejunostomy (LPJ) is currently the accepted surgical treatment of choice when the main pancreatic duct is dilated. Chemical ablation of the celiac plexus for the treatment of intractable pain in chronic pancreatitis has been used without clear benefit. The aim of this study is to compare treatment outcomes of 2 groups of patients with the diagnosis of chronic pancreatitis and intractable abdominal pain (LPJ alone versus LPJ with intraoperative alcohol celiac ablation).Between 1994 and 1997, 34 patients underwent LPJ to control intractable pain secondary to chronic pancreatitis. These patients were divided into 2 groups, group 1 was LPJ only (16 patients) and group 2 was LPJ and intraoperative celiac ablation with 50% absolute alcohol (18 patients). Preoperative diagnosis and treatment criteria were similar for both groups. The clinical characteristics and outcome of both groups were retrospectively analyzed. Fisher exact test was used for statistical analysis.Demographic characteristics were similar in both groups. Pain control at short- and long-term follow-up was significantly improved in group 2 compared with group 1 (p < 0.035).Intraoperative celiac ablation in addition to LPJ appears to have a better response than does LPJ alone. Even though the number of patients is small, these results provide a basis for pursuing a prospective, randomized study to definitively answer this question.

The perception of optimal profile in African Americans versus white Americans as assessed by orthodontists and the lay public

This study was designed to assess the perceived optimal profiles of African Americans versus white Americans. A survey was conducted using profile silhouettes of 30 African American and 30 white patients, ranging in age from 7 to 17 years. Twenty white orthodontists, 18 African American orthodontists, 20 white laypersons, and 20 African American laypersons evaluated the profiles. The preference of each rater for each of the 60 profiles was scored on an attached visual analog scale. Eighteen cephalometric variables were measured for each profile, and statistical analyses were performed on the profiles that had a mean rating of 60 or greater from an analog scale of 0 to 100. The results show the following 6 cephalometric variables were significant: Z-angle, skeletal convexity at A-point, upper lip prominence, lower lip prominence, nasomental angle, and mentolabial sulcus. All raters preferred the African American sample to have a greater profile convexity than they preferred for the white sample. The raters preferred the African American sample with upper and lower lips that were more prominent compared with the white sample. However, only the choice of the African American orthodontists for the African American sample was significantly different for this parameter. The white orthodontists gave the highest mean scores for the profile chosen, whereas the African American laypersons gave the lowest scores.

Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease

OBJECTIVES

To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians.

DESIGN

Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency.

SETTING

A university medical center.

PARTICIPANTS

Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center.

MEASUREMENTS

The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression.

RESULTS

As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04).

CONCLUSIONS

Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.

Factors associated with patients' participation in rehabilitation services: a comparative injury analysis 12 months post-discharge

PURPOSE

To determine key characteristics or factors associated with rehabilitation participation during the first year following discharge for persons with either traumatic brain injury (TBI), spinal cord injury (SCI), intra-articular fracture (IAF), or burn injury (BURNS).

METHOD

Medical records and longitudinal survey [telephone questionnaire] data were collected for persons in the four injury groups and analyzed using hierarchical logistic regression procedures for each domain of factors.

RESULTS

The only significant predictors with odds ratios greater than one were those for vocational rehabilitation participation. TBI patients lacking private insurance were 2.6 times more likely to participate in vocational rehabilitation; older SCI and TBI patients are about twice as likely to participate in vocational rehabilitation; and finally those with IAF or BURNS who are married at 12 months post discharge are 11.5 and 4.4 times respectively more likely to participate in vocational rehabilitation.

CONCLUSION

Those lacking valuable socio-economic resources, such as private insurance (for TBI) and social support systems provided by marriage (for BURNS and IAF patients) are much more likely to be referred to vocational rehabilitation. This is true for older SCI and TBI patients as well. Lacking such resources, patients may be viewed by referral agents as less likely to benefit from in or outpatient rehabilitation.

Error behaviors associated with loss of competency in Alzheimer's disease

OBJECTIVE

To investigate qualitative behavioral changes associated with declining medical decision-making capacity (competency) in patients with AD.

BACKGROUND

Qualitative measures can yield clinical information about functional changes in neurologic disease not available through quantitative measures.

METHODS

Normal older controls (n = 21) and patients with mild and moderate probable AD (n = 72) were compared using a standardized competency measure and neuropsychological measures. A system of 16 qualitative error scores representing conceptual domains of language, executive dysfunction, affective dysfunction, and compensatory responses was used to analyze errors produced on the competency measure. Patterns of errors were examined across groups. Relationships between error behaviors and competency performance were determined, and neurocognitive correlates of specific error behaviors were identified.

RESULTS

AD patients demonstrated more miscomprehension, factual confusion, intrusions, incoherent responses, nonresponsive answers, loss of task, and delegation than controls. Errors in the executive domain (loss of task, nonresponsive answer, and loss of detachment) were key predictors of declining competency performance by AD patients. Neuropsychological analyses in the AD group generally confirmed the conceptual domain assignments of the qualitative scores.

CONCLUSIONS

Loss of task, nonresponsive answers, and loss of detachment were key behavioral changes associated with declining competency of AD patients and with neurocognitive measures of executive dysfunction. These findings support the growing linkage between executive dysfunction and competency loss.

The Role of Pancreaticoduodenectomy in the Treatment of Severe Chronic Pancreatitis

Chronic pancreatitis remains a debilitating disease with few definitive options for treatment. The purpose of this study was to evaluate the benefit of pancreaticoduodenectomy in the treatment of chronic pancreatitis. The results were evaluated by standard descriptive statistics. In a retrospective study, we reviewed the patients at a single institution undergoing pancreaticoduodenectomy between 1994 and 1997 for complications of chronic pancreatitis. Patients were evaluated for preoperative indication for surgery and perioperative morbidity and mortality, as well as long-term results. Thirty-two patients underwent pancreaticoduodenectomy for chronic pancreatitis; 56 per cent (18) underwent pylorus-preserving and 44 per cent (14) underwent classic pancreaticoduodenectomy. The mean age of these patients was 56 ± 14.7 years (range, 23–79). All patients underwent preoperative CT scan and endoscopic retrograde cholangiopancreatography. The preoperative indication for surgery in 81 per cent (26) of these patients was intractable pain in the setting of a nondilated pancreatic duct. The other 19 per cent were treated for biliary/pancreatic duct stricture and pancreatic head fibrosis (mass suspicious of malignancy). Fifty-three per cent of the patients had a history of previous abdominal surgery. There were no perioperative deaths. The mean postoperative stay was 12.2 ± 7.4 days. The postoperative morbidity rate was 31 per cent (10), consisting of 25 per cent with delayed gastric emptying, 3 per cent with pneumonia, and 3 per cent with wound infections. There was no occurrence of pancreatic fistulas. With a mean follow-up of 40 months (range, 10–52 months), 85 per cent reported a significant improvement in pain with 71 per cent being pain free and not requiring narcotics. Twenty per cent developed new-onset diabetes. The overall event survival rate at 5 years was 97 per cent. Thus, in a selected group of patients with severe chronic pancreatitis, resection of the head of the pancreas achieved relief of symptoms and was a safe and effective treatment for chronic pancreatitis.

The role of pancreaticoduodenectomy in the treatment of severe chronic pancreatitis

Chronic pancreatitis remains a debilitating disease with few definitive options for treatment. The purpose of this study was to evaluate the benefit of pancreaticoduodenectomy in the treatment of chronic pancreatitis. The results were evaluated by standard descriptive statistics. In a retrospective study, we reviewed the patients at a single institution undergoing pancreaticoduodenectomy between 1994 and 1997 for complications of chronic pancreatitis. Patients were evaluated for preoperative indication for surgery and perioperative morbidity and mortality, as well as long-term results. Thirty-two patients underwent pancreaticoduodenectomy for chronic pancreatitis; 56 per cent (18) underwent pylorus-preserving and 44 per cent (14) underwent classic pancreaticoduodenectomy. The mean age of these patients was 56+/-14.7 years (range, 23-79). All patients underwent preoperative CT scan and endoscopic retrograde cholangiopancreatography. The preoperative indication for surgery in 81 per cent (26) of these patients was intractable pain in the setting of a nondilated pancreatic duct. The other 19 per cent were treated for biliary/pancreatic duct stricture and pancreatic head fibrosis (mass suspicious of malignancy). Fifty-three per cent of the patients had a history of previous abdominal surgery. There were no perioperative deaths. The mean postoperative stay was 12.2+/-7.4 days. The postoperative morbidity rate was 31 per cent (10), consisting of 25 per cent with delayed gastric emptying, 3 per cent with pneumonia, and 3 per cent with wound infections. There was no occurrence of pancreatic fistulas. With a mean follow-up of 40 months (range, 10-52 months), 85 per cent reported a significant improvement in pain with 71 per cent being pain free and not requiring narcotics. Twenty per cent developed new-onset diabetes. The overall event survival rate at 5 years was 97 per cent. Thus, in a selected group of patients with severe chronic pancreatitis, resection of the head of the pancreas achieved relief of symptoms and was a safe and effective treatment for chronic pancreatitis.

Is the capacity for lymph node-mediated distant dissemination the same for all nodal groups in malignant melanoma?

This study addresses two hypotheses: (1) that the inherent potential of melanoma metastatic to regional nodal groups for lymph-mediated distant dissemination may not be the same for all nodal groups; and (2) that the risk of distant metastases in patients with clinically involved nodal metastases is higher than in patients with clinically occult nodal metastases. It involved a retrospective chart review of patients with histologically involved axillary or inguinal nodes treated at Roswell Park Cancer Institute (RPCI) (244 patients) or at the participating institutes from the Intergroup Surgical Trial (IST) (108 patients). The distant recurrence rates of 623 melanomas with axillary or inguinal drainage from the IST data were also reviewed. In the RPCI data there was a significant difference in the overall and disease-free survival (P=0.0001) between patients with microscopic versus palpable involvement of the regional nodes in the axilla, while no such difference was observed for patients with groin metastases (P=0.30 and 0.36, respectively). The same trend was noted in the IST data. In the latter data the distant recurrence rate for melanomas drained via the axilla was significantly higher (P=0.026) than for those drained by the groin. In conclusion, lymph-mediated distant dissemination may be more aggressive from the axilla than from the groin in melanoma.

An evaluation of the prevalence of latex sensitivity among atopic and non-atopic intensive care workers

BACKGROUND

Exposure to latex is known to cause an array of symptoms, including pruritus, dermatitis, erythema, and urticaria. Workers at elevated risk for latex exposure include health care personnel whose repeated patient contact or surgical work require extensive use of latex gloves. This study evaluated the prevalence of latex allergies in atopic and non-atopic intensive care workers and sought to determine the impact of risk factors such as frequency of glove use and hand washing on latex sensitization.

METHODS

We evaluated the prevalence of latex sensitivity in 122 intensive care unit (ICU) workers using a questionnaire and skin prick test. Atopy and latex sensitivity were determined by skin prick test using a battery of common inhalant allergens and an extract prepared from the gloves used in the ICU. Frequency of glove use and hand washing were determined by questionnaire.

RESULTS AND CONCLUSIONS

Forty ICU workers (32.8%) were considered atopic by having at least one positive response to the inhalant allergens. Atopic ICU workers were more likely to have positive latex skin test than non-atopic ICU workers (atopic vs. non-atopic workers: p < 0.001, odds ratio = 14.2). Frequency of current glove use or hand washing frequency were not significant predictors of a positive response to latex; however, a positive history of atopic eczema and family history of allergies, as determined by questionnaire were significant predictors of a positive response to latex antigens.

Long-term follow-up of three randomized trials comparing idarubicin and daunorubicin as induction therapies for patients with untreated acute myeloid leukemia

BACKGROUND

Most clinical trials for acute leukemia have reported results after 2-3 years of follow-up. Comparisons between the original data and longer-term follow-up data may be of interest, particularly with regard to promising new therapies.

METHODS

In 1996, survival data were updated from three prospective, randomized comparisons of idarubicin and daunorubicin that began in 1984 and 1985. These were trials of the Memorial Sloan-Kettering Cancer Center (MSKCC), the U.S. Multicenter Study Group, and the Southeastern Cancer Study Group (SEG). The original results of these trials were reported in 1991 and 1992.

RESULTS

The original results of the SEG trial demonstrated no significant difference between idarubicin and daunorubicin. The updated survival analysis showed similar results. The MSKCC trial revealed a significant advantage of idarubicin compared with daunorubicin in both the original and the updated analyses. The U.S. Multicenter trial found a significant difference favoring idarubicin in the original analysis, but the difference was not significant in the updated analysis.

CONCLUSIONS

It is essential that the median length of follow-up be clearly stated in any clinical trial. When the results obtained with a particularly promising new drug or procedure are presented early in the course of study (within 1-2 years), the investigators should strongly consider a repeat evaluation after an additional 3-5 years of follow-up.

Consistency of physician judgments of capacity to consent in mild Alzheimer's disease

OBJECTIVE

To investigate the agreement of physician judgments of capacity to consent to treatment for normal and demented older adults.

DESIGN

Subjects were individually administered a standardized consent capacity interview. Physicians viewed videotapes of these interviews and made judgments of capacity to consent to treatment.

SETTING

University medical center.

PARTICIPANTS

Subjects assessed for competency (N = 45) were 16 normal older controls and 29 patients with mild Alzheimer's disease (AD). Five medical center physicians with experience assessing the competency of dementia patients were recruited from the specialties of geriatric psychiatry, geriatric medicine, and neurology.

MEASUREMENTS

Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Study physicians blinded to subject diagnosis individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent. Agreement of physician judgments was evaluated using percentage agreement, kappa, and logistic regression.

RESULTS

Competency judgements of physicians showed high agreement for controls but low agreement for AD patients. Physicians as a group achieved 98% judgment agreement for the controls but only 56% judgment agreement for the mild AD patients. The physician group kappa for controls was 1.00 (P < .0001) and differed significantly (P < .0001) from the physician group kappa of .14 (P = .44) for AD patients, indicative of a real difference in the ability of the study physicians to judge consistently competency across the two groups. Similarly, logistic regression analysis showed significant variability in physician judgements for the AD group (chi 2 = 63.8, P < .0001) but not for the control group (chi 2 = 4.1, P = 1.00). Within the Ad group, pairwise analyses revealed significant judgment disagreement (P < .01) for seven of the 10 physician pairs.

Association between visual reaction time and batting, fielding, and earned run averages among players of the Southern Baseball League

BACKGROUND

This study was performed to investigate the relationship between vision reaction time (VRT) and batting, fielding, and pitching skill in baseball.

METHODS

A vision screening of 213 professional baseball players in the Southern Baseball League was performed, and the visual reaction times of these players were determined. Official Southern Baseball League statistics were consulted to obtain the players' batting average, fielding average, and earned run average.

RESULTS

The mean visual reaction time for all players was 239 msec. There was no significant association between mean VRT and age or race. The mean VRT for dominant eyes was not significantly different from the mean VRT for nondominant eyes. For the 92 players who batted at least 100 times, an association was found between mean VRT and batting average (p = 0.017). For the 168 fielders in the league playing at least 20 games, no statistically significant association was found between mean VRT and fielding average. Similarly, no association was found between mean VRT and earned run average for the B8 pitchers who had participated in more than 20 games.

CONCLUSIONS

An association was found between visual reaction time and batting skill in baseball. No association was found between visual reaction time and fielding or pitching skill.

Association between eye and hand dominance and hitting, fielding and pitching skill among players of the Southern Baseball League

BACKGROUND

The relationship between eye dominance and batting skill in baseball has been investigated, but conflicting results have been obtained. In addition, little attention has been given to the relationship, if any, between eye dominance and fielding and pitching skill.

METHODS

A vision screening of 215 professional baseball players in the Southern Baseball League was performed and the eye dominance of these players was determined by a sighting test. Handedness for batting, fielding, and pitching was determined by history.

RESULTS

The screening revealed that 66 percent of players were right-eye dominant and that, of 92 players who met the criteria established to qualify for the league batting championship, 60 percent had matched dominance of eye and hand. When official league batting averages were obtained for these 92 players, it was found that there was no statistically significant difference between batters with matched dominance (.278 mean batting average). For the 149 fielders in the league, no statistically significant differences based on eye dominance were found for fielding average (.893 matched dominance, .864 crossed dominance); for the 89 pitchers, a similar result was obtained. Pitchers were also evaluated with respect to eye dominance and earned run average, but no significant difference was found (3.91 matched dominance, 4.03 crossed dominance).

CONCLUSIONS

Results indicate that there is no association between eye dominance, and hitting, fielding, or pitching skill in baseball.

Adjuvant therapy for clinical localized prostate cancer treated with surgery or irradiation

OBJECTIVE

Because of efficacy demonstrated with chemotherapy in patients with metastatic disease, the National Prostate Cancer Project in 1978 initiated two protocols evaluating adjuvant therapy following surgery (Protocol 900) and irradiation (Protocol 1000) for patients with localized disease at high risk for relapse.

METHODS

All patients underwent staging pelvic lymph node dissection. Following definitive treatment, patients were randomized to either cyclophosphamide 1 g/m2 intravenously every 3 weeks for 2 years, estramustine phosphate 600 mg/m2 orally daily for 2 years or to observation only. Accession closed in 1985 and included 184 patients in Protocol 900 (170 evaluable) and 253 in Protocol 1000 (233 evaluable).

RESULTS

Nodal involvement was identified in 198 patients (49% of total): 29% in Protocol 900 and 63% in protocol 1000. Median progression-free survival (PFS) and survival have been greater for patients in Protocol 900 regardless of adjuvant, reflecting their lower pathologic stage. Median PFS is significantly greater for patients in Protocol 1000 receiving estramustine (52.2 months) compared to cyclophosphamide (35.0 months). Median PFS for patients with nodal involvement in Protocol 1000 receiving estramustine is increased (43.5 months) compared to no treatment (21.5 months). Patients with limited nodal involvement in Protocol 1000 have a longer median PFS (45.6 months) compared to patients with extensive disease (23.6 months). But in the latter group patients receiving estramustine experienced a significantly longer median PFS (43.5 months) compared to cyclophosphamide (29.1 months) or no adjuvant (13.5 months). Increased PFS with estramustine adjuvant was also noted in stage C patients (only Protocol 900) and in those with high-grade (grade 3) tumors (both protocols).

CONCLUSIONS

With now over 10 years mean follow-up for this series of patients, we conclude that adjuvant estramustine is beneficial for prostate cancer patients receiving definitive irradiation. This benefit is particularly noted in those patients with extensive nodal involvement (N+, D-1).

Evaluation of adjuvant estramustine phosphate, cyclophosphamide, and observation only for node-positive patients following radical prostatectomy and definitive irradiation. Investigators of the National Prostate Cancer Project

In 1978 the National Prostate Cancer Project launched two protocols evaluating adjuvant therapy following surgery (Protocol 900) or irradiation (Protocol 1,000) for clinically localized prostate cancer. All patients underwent staging pelvic lymphadenectomy. Following definitive treatment, patients were randomized to either cyclophosphamide 1 gram/m2-IV every 3 weeks for 2 years, estramustine phosphate 600 mg/m2-po daily for up to 2 years, or to observation only. Patient accession closed in 1985 and includes 184 to Protocol 900 (170 evaluable) and 253 to Protocol 1,000 (233 evaluable). Lymph node involvement was identified in 198 patients (49% of total), 29% in Protocol 900, 63% in Protocol 1,000. Median progression-free survival (PFS) for patients with nodal involvement in Protocol 1,000 receiving estramustine phosphate adjuvant was longer (37.3 mo) compared to cyclophosphamide (30.9 mo) and to no treatment (20.9 mo). Median PFS for patients with limited nodal disease in Protocol 1,000 was longer (39.9 mo), regardless of adjuvant, compared to extensive nodal disease (20.7 mo). However for patients with extensive nodal involvement, those receiving adjuvant estramustine phosphate experienced a significantly longer median PFS (32.8 mo) compared to adjuvant cyclophosphamide (22.7 mo) and no adjuvant (12.9 mo). We conclude that adjuvant estramustine phosphate is of benefit in prostate cancer patients with extensive pelvic node involvement receiving irradiation as definitive treatment.

Breast cancer early detection: differences between African American and white women's health beliefs and detection practices

PURPOSE/OBJECTIVES

To identify differences in African American and white women's health beliefs and practices regarding early detection of breast cancer.

DESIGN AND SETTING

Descriptive survey of educators employed by one public school system in one southern state.

SAMPLE

One hundred seventeen African American and 157 white female professional educators.

METHODS

Subjects completed a survey questionnaire consisting of investigator-developed items and an adapted version of Champion's Health Belief Model Scales.

MAIN OUTCOME MEASURES

Reported frequency of use of mammography, clinical breast examination (CBE), and breast self-examination (BSE); health beliefs about these procedures.

FINDINGS

No significant difference in frequency of use of mammography and CBE was found between the two groups. The difference for BSE frequency approached significance (p = 0.058); African American women had performed BSE significantly more times (p = 0.028) than white women during the preceding 12 months. White women had a significantly higher mean score (p = 0.002) for barriers to mammography. The difference between the two groups for barriers to CBE and control with CBE reached the 0.05 level of significance; in both cases, white women had the higher mean score. No significant difference was found in mean scores for beliefs about BSE.

CONCLUSIONS

The contribution of health beliefs about breast cancer, mammography, CBE, and BSE to frequency of use of these procedures by race remains unclear.

IMPLICATIONS

Efforts to inform women of the need to adopt an early breast cancer detection program should continue. Additional studies are needed to validate present study findings and to expand the knowledge base for healthcare providers.

Combination chemotherapy with or without thoracic radiotherapy in limited-stage small-cell lung cancer: a randomized trial of the Southeastern Cancer Study Group

PURPOSE

The primary objective of this randomized prospective study was to compare the survival of limited-stage small-cell lung cancer (SCLC) patients treated with chemotherapy alone or chemotherapy plus thoracic radiotherapy (TRT). A secondary objective was to determine the effect of consolidation chemotherapy on survival.

PATIENTS AND METHODS

This multiinstitutional phase III study included 386 patients with limited-stage SCLC. All patients received cyclophosphamide 1,000 mg/m2, doxorubicin 40 mg/m2, and vincristine 1 mg/m2 (CAV) every 3 weeks for six cycles. Irradiated patients received 30 Gy in 10 fractions during weeks 1 and 2 of chemotherapy. Fifteen Gy in five fractions was administered during week 7 (total dose, 45 Gy). Following CAV, responding patients were randomized to receive two cycles of consolidation chemotherapy (cisplatin 20 mg/m2/d for 4 days plus etoposide 100 mg/m2/d for 4 days) or observation.

RESULTS

Complete (46% and 38%; P = .14) and overall response rates (67% and 64%; P = .58) were not statistically significantly different. Although not significantly different, median (14.4 v 12.8 months) and 2-year survival (33% v 23.5%) rates favored the irradiated patients. Grade 4 hematologic toxicity was greater in irradiated patients (60% and 39%; P < .001). Patients given consolidation chemotherapy experienced superior median (21.1 v 13.2 months; P = .028) and 2-year survival (44% v 26%; P = .028) rates.

CONCLUSION

The concurrent use of TRT and CAV chemotherapy as administered in this study failed to improve the survival of limited-stage SCLC patients compared with CAV alone. Life-threatening hematologic toxicities were more frequent with combined-modality therapy. The survival of limited-stage patients treated with CAV (with or without TRT) was improved with two cycles of cisplatin and etoposide consolidation therapy. Whether similar survival results could be achieved with cisplatin and etoposide alone requires additional study.