Prevalence and correlates of posttreatment and anticipatory nausea and vomiting in cancer chemotherapy

Prevalance and correlates of posttreatment and anticipatory nausea and vomiting (NV) were examined in 149 cancer patients receiving chemotherapy at four treatment centres. Results of multiple regression analyses indicated that posttreatment NV was associated with treatment centre, diagnosis, drug toxicity, and frequency of antiemetic premedication. Anticipatory NV was found to be associated with age, treatment centre, drug toxicity and frequency of posttreatment NV. Eight predictor variables accounted for 49% of the variance in anticipatory NV. Variables showing significant unique effects included age, treatment centre, posttreatment NV and the age by posttreatment NV interaction. Results suggest the importance of examining environmental, psychosocial, and treatment-related variables that may differentiate treatment centres and strongly support the role of classical conditioning in the development of anticipatory NV.     

Relationship between drug company funding and outcomes of clinical psychiatric research

BACKGROUND: Pharmaceutical industry funding of psychiatric research has increased significantly in recent decades, raising the question of a relationship between pharmaceutical company funding of clinical psychiatric studies and the outcomes of those studies. This study examines this relationship. METHOD: Abstracts of articles from 1992 and 2002 in four peer-reviewed psychiatric journals were examined. Drug outcomes (n=542) for clinical studies were evaluated and then compared across sponsorship source. Outcome raters were blind to source of sponsorship. The percentage of these studies sponsored by drug companies in 2002 v. 1992 was also compared. In a secondary analysis, the contribution of a series of potentially mediating variables to the relationship between sponsorship source and study outcome was assessed via logistic regression. RESULTS: The percentage of studies sponsored by drug companies increased from 25% in 1992 to 57% in 2002. Favorable outcomes were significantly more common in studies sponsored by the drug manufacturer (78%) than in studies without industry sponsorship (48%) or sponsored by a competitor (28%). These relationships remained after controlling for the effects of journal, year, drug studied, time since FDA drug approval, diagnosis, sample size, and selected study design variables. CONCLUSIONS: These data indicate an association between pharmaceutical industry funding of clinical studies and positive outcomes of those studies. Further research is needed to elucidate the mechanisms underlying this relationship.     

Skin changes with aging and disease

Skin undergoes numerous macroscopic changes during the aging process. These alterations in the skin result from both intrinsic changes to the cells and connective tissue of the skin that are inherent with the chronologic aging of the individual and changes as a result of environmental insults to the organ, particularly ultraviolet irradiation. The combination of these factors produces a tissue which possesses quite different attributes compared with the skin of a young individual and which may result in characteristic lesions, both malignant and benign. Understanding these changes and the underlying mechanisms for them will help to treat older individuals in whom specific lesions develop as well as help to prevent the occurrence of these pathologic conditions.     

Treatment of high-grade squamous intraepithelial lesions: a 2- versus 3-step approach

OBJECTIVE: The purpose of this study was to determine whether colposcopically directed biopsy is a necessary step in the evaluation of patients with high-grade squamous intraepithelial lesions. STUDY DESIGN: A retrospective analysis was conducted of the correlation between the high-grade squamous intraepithelial lesion Papanicolaou test and the colposcopically directed biopsy and the correlation between the high-grade squamous intraepithelial lesion Papanicolaou test and the loop electrosurgical excisional procedure. RESULTS: Of 72 patients with high-grade squamous intraepithelial lesions on Papanicolaou test, 48 patients had a pathologic diagnosis on cervical biopsy of CIN II or greater, which provides a 67% correlation between the Papanicolaou test and the colposcopically directed biopsy. Fifty-six patients had a pathologic diagnosis on loop electrosurgical excisional procedure of CIN II or greater, which provides a 78% correlation between the Papanicolaou test and the loop electrosurgical excisional procedure. The median interval between the Papanicolaou test and the definitive treatment was significantly longer (P <.001) when colposcopically directed biopsy was performed before the loop electrosurgical excisional procedure. CONCLUSION: The colposcopically directed loop electrosurgical excisional procedure after a high-grade squamous intraepithelial lesion Papanicolaou test may reduce the time interval between diagnosis and treatment; furthermore, it offers equal correlation when compared with traditional treatment.     

Complexities in HIV consent in adolescents

A large proportion of people infected with the human immunodeficiency virus (HIV) are adolescents. Unfortunately, there is no uniform policy on minors' rights to consent to HIV testing and treatment. The process of obtaining consent is complex and depends on several factors, including individual state HIV laws and laws relating to a minor's capacity to consent to general health care. These issues are particularly relevant given the growth of HIV in this population. In this review, the complex laws of informed consent and confidentiality surrounding HIV disease in adolescents are reviewed. Familiarity with these laws by the clinician is essential to halting the HIV epidemic in adolescents and will be underscored.