Eliciting remote data entry system requirements for the collection of cancer clinical trial data

Information regarding the clinical course of a patient in a clinical trial is critical for cancer research. Nurses and clinical research associates must locate data stored in many formats and transfer data to paper case report forms. These forms are associated with a unique protocol document that specifies the set of data to be collected. This paper-based process involves a series of abstractions that pose a significant potential for error. Remote data entry has been advocated to facilitate and streamline the collection of clinical trial data. A systematic process to elicit system requirements from end-users is described as an approach to integrate computer technology with cancer research. Nurses and clinical research associates, as end-users of remote data entry, can provide invaluable input into the requirements necessary to develop an efficient and practical system. By incorporating this input, remote data entry can offer a potential benefit for preserving data integrity.     

Mental health of British farmers

Aims: To estimate the prevalence of neurotic symptoms in a sample of British farmers, to investigate whether farming characteristics are associated with psychiatric morbidity, and to test the hypothesis that British farmers have a higher prevalence of depression and thoughts of life not worth living than the British household population.

Methods: A total of 425 farmers from Hereford, Norwich, and Preston completed the Revised Clinical Interview Schedule (CIS-R) by computer between March and July 1999. The comparison cohort consisted of 9830 private householders aged 16–64 from the Office of Population Censuses and Surveys National Psychiatric Morbidity Surveys of Great Britain carried out in 1993 in which the CIS-R was administered. All analyses used the commands developed specifically for survey data available in Stata version 6.0.

Results: Taking a threshold of an overall score of 12 or more on the CIS-R, only 6% of farmers reported clinically relevant psychiatric morbidity. Psychiatric morbidity was not significantly associated with farm type or size in this study. Farmers reported a lower prevalence of psychiatric morbidity than the general population but were more likely to report thinking that life is not worth living, particularly after the low prevalence of psychiatric morbidity had been taken into account (odds ratio 2.56, 95% CI 1.39 to 4.69). When restricting the comparison to only rural or semirural householders, this increased risk was even more pronounced (odds ratio 3.26, 95% CI 1.51 to 7.02).

Conclusions: The relation between depression and suicidal ideation seems to be quite different among farmers and the general population and warrants further investigation. We have shown it is possible to measure mental health systematically in a sample of British farmers. This study should be repeated in the aftermath of the foot and mouth crisis.

     

Breaking--bad news: women's experiences of fractures at midlife

OBJECTIVE: To gain understanding of the experiences and sequelae of fractures in women aged 40-65 years and to assess whether it is linked to overall bone health assessment. METHOD: A qualitative study using face-to-face indepth interviews. FINDINGS: Contrary to the common belief that fractures are benign, for middle-aged women, fractures have a significant impact on their well-being in both the short and long-term. Women report significant pain as well as an immediate need for help from family and professional caregivers. They experience interruptions to daily and leisure activities, employment, daily life and mobility. Only a minority of women and/or their family physicians initiated follow up to investigate bone health subsequent to the fracture. CONCLUSIONS: Bone health is often examined in the context of already established bone disease. This study suggests a need for a closer examination of fracture treatment in the context of preventive care, and early detection of osteoporosis.     

A simple modification of the glabellar flap in medial canthal reconstruction

PURPOSE: To highlight a simple modification of the traditional glabellar flap, which may improve the cosmetic results achieved with this flap by reducing the tendency for the eyebrows to be drawn together. METHODS: The modified surgical technique is described and used prospectively in 10 patients requiring medial canthal reconstruction with a glabellar flap. RESULTS: All patients were satisfied with the cosmetic and functional results. Photographs of one patient illustrate the preoperative and postoperative appearance of the eyebrows. CONCLUSIONS: This simple modification is recommended to avoid drawing the eyebrows together when using the glabellar flap.     

Developmental genetics of neuroblastoma.

Case reports of neuroblastoma revealed that some individuals are genetically predisposed and that this genetic predisposition may have other consequences. According to a mutation model, two classes of individuals could acquire neuroblastoma. One (prezygotic) was a rare class that carried a dominant gene imparting high risk of the tumor. The other (postzygotic) comprised all other individuals, each at low risk. The model related tumor incidence to germinal and somatic mutation rates and thereby carried implications for environmental modification of tumorigenesis and demographic variation in incidence. Case reports also revealed associations of neuroblastoma with congenital defects and a susceptibility to second tumors. Analogy with retinoblastoma and Wilms' tumor of the kidney suggested that these associations could result from action of a neuroblastoma gene or from chromosomal aberration. One known dominantly inherited condition, von Recklinghausen's disease, could dispose to neuroblastoma and create some associations. According to the two-mutation model, neuroblastoma may have been a single recessive gene disorder at the level of the cell. The phenomena of aganglionosis, neuroblastoma in situ, maturation of neuroblastoma to ganglioneuroma, and spontaneous regression suggested that such a neuroblastoma gene interfered with normal developmental processes. The specificities of this gene and of those for von Recklinghausen's disease and pheochromocytoma suggested that the functiof a membrane macromolecule.