Clinic

Use of the Word “Cure” in Oncology.

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Purpose: Use of the word “cure” in cancer care reflects a balance of physician and patient optimism, realism, medico-legal concerns, and even superstition. This study surveyed a group of oncology specialists regarding the frequency and determinants of using the word cure.

Methods: Oncology clinicians at the Dana-Farber Cancer Institute (n = 180) were invited to complete a survey regarding the word cure in cancer care. Participants completed a 19-question survey regarding how commonly their patients are cured, how often they use the word cure in their practice, and details about its use. Three case scenarios were presented to elicit participants’ views.

Results: Of the 117 participants (65%) who provided responses, 81% were hesitant to tell a patient that they are cured, and 63% would never tell a patient that they are cured. Only 7% felt that greater than 75% of their patients are, or will be, cured. The participating clinicians reported that only 34% of patients ask if they are cured. For 20-year survivors of testicular cancer, large-cell lymphoma, and estrogen receptor–positive breast cancer, 84%, 76%, and 48% of clinicians, respectively, believed that the patients were cured, and 35%, 43%, and 56% recommended annual oncology follow-up of the patients. Twenty-three percent of oncology clinicians believed that patients should never be discharged from the cancer center.

Conclusion: Oncology clinicians report that patients are hesitant to ask whether they are cured, and the clinicians are hesitant to tell patients they are cured. Annual oncology follow-up was frequently endorsed, even after 20 years in remission.

Source: JOP

Clinicians Should Listen to Their Guts When Treating Kids, Study Suggests

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When assessing children with acute illness, clinicians should not discount their “gut feeling” that something is seriously wrong, even if clinical examination suggests otherwise, according to a BMJ study.

Researchers recorded primary care physicians‘ overall clinical impression (based on history, observation, and exam) of children presenting with acute symptoms. They also recorded the physicians’ intuitive, or “gut,” feelings about illness severity.

Roughly 3400 children were clinically assessed as having a nonserious illness, six of whom were eventually admitted with a serious infection (most frequently, pneumonia or pyelonephritis). When clinicians had a gut feeling that something was wrong despite their assessment, the likelihood of serious illness increased 26-fold.

The authors conclude: “We suggest that having a gut feeling that something is wrong should make three things mandatory: the carrying out of a full and careful examination, seeking advice from more experienced clinicians (by referral if necessary), and providing the parent with carefully worded advice to act as a ‘safety net.'”

Source: BMJ

 

 

A More Creative Version of Counting Sheep to Get to Sleep .

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In a small study among college students with insomnia, focusing on personally engaging but nonarousing thoughts (e.g., song lyrics, recipes) instead of ruminations seemed to be more effective than standardized sleep hygiene.

In Journal Watch Psychiatry, Peter Roy-Byrne writes: “Clinicians, especially those in primary care, could offer this technique to their patients as a first-line intervention before prescribing hypnotic medications. The intervention seems to be a creative variant of the old ‘counting sheep’ method, but is more likely to be effective because it employs personalized cognitive scripts that are more appealing and easier to focus on.”

Source: Journal Watch Psychiatry

Fibrates and estimated glomerular filtration rate: observations from an outpatient clinic setting and clinical implications.

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Previous studies have demonstrated that fibrates have an effect on creatinine concentrations. The pattern of change with fibrates in estimated glomerular filtration rate (eGFR), widely used in clinical practice, has not been previously described.

Methods Data was retrospectively collected from 132 consecutive case notes of patients started on fibrates in a lipid clinic between 2002 and 2008. Pre- and post-fibrate creatinine concentrations were measured and eGFR measurements were obtained.

Results Of the 79 patients with both pre and post-treatment eGFR values <90 ml/min/1.73 m2, a significant mean eGFR reduction of 8.2 ml/min/1.73 m2 was noted. Of these patients, 50% demonstrated a reduction in eGFR >8 ml/min/1.73 m2, 25% demonstrated a reduction >16 ml/min/1.73 m2, and 10% demonstrated a reduction >21 ml/min/1.73 m2.

Conclusions The authors demonstrate a significant effect of fibrates on eGFR in clinical practice. Awareness of the pattern of eGFR change is important for decisions regarding the continued use of fibrate therapy and/or commonly co-prescribed diabetic drugs and renal specialist referrals.

Source: PMJ/BMJ