6025 Background: Assessing symptoms of treatment toxicity is standard practice during routine care and clinical trials. Currently, clinicians gather symptom information via complex and often inefficient mechanisms. There is growing interest in patient reported outcomes, but it remains unknown if patients can be engaged to report their own symptoms during chemotherapy, or whether practitioners will view this information as reliable towards management decisions or regulatory reporting. Methods: The NCI’s Common Terminology Criteria for Adverse Events (CTCAE) schema for 7 common symptoms was adapted into a web-based patient-reporting system, accessible from computers in outpatient clinics and from home computers. 80 outpatients with gynecologic malignancies beginning standard chemotherapy regimens were enrolled. During an 8-week observation period, participants were encouraged to login and report symptoms at each follow-up visit, or alternatively to access the system from home. Severe toxicities entered into the system (grade 3–4) triggered emails to the primary clinical team. Results: All 80 patients completed an initial login. At each subsequent appointment, most enrollees (80–85%) reported symptoms using the online system, with a mean of 3 visits per patient (range 1–6). 68/80 (85%) logged in at more than two-thirds of appointments. 60/80 (75%) logged in at least once from home, with a mean of 9 logins among home users versus 3 among non-home users. Utilization was associated with prior Internet experience (p=0.002) but not with age, cancer type, ECOG score, income, or education level. Forty-two severe toxicities entered from home prompted 7 telephone interventions and 3 new clinic visits. 96% of patients found the system useful, easy to use, and would recommend it to others. 8/9 (89%) of participating clinicians felt STAR reports reflected patients’ clinical status, and based clinical decisions on these data. Conclusion: Patients are capable of reporting symptoms experienced during chemotherapy via the web, and clinicians view these as a potentially valuable source of toxicity data. Assessment in the clinical trial setting and comparison of patient versus clinician symptom reporting will be performed in a separate study. No significant financial relationships to disclose.
A 40-year-old man with chronic myeloid leukemia presented to the hospital with recurrent dyspnea and hypoxemic respiratory failure. He presented from his outpatient transplant infectious diseases appointment with dyspnea, cough, worsening hypoxemia, acute kidney injury, and somnolence after discharge from the hospital 2 weeks prior with a similar presentation. During the previous hospital stay, he underwent bronchoscopy and alveolar lavage with negative infectious workup. He was prescribed caspofungin, amphotericin, and continued posaconazole for prior probable invasive fungal infection (elevated blood BD-glucan and pulmonary nodules). Antibiotics included previous meropenem for esophageal nocardiosis, cefepime and azithromycin during admission, and now ceftriaxone for nocardiosis in the outpatient setting for convenience of home infusion. He was prescribed diuretics for presumed volume overload. Despite home diuretics, antimicrobials, and supplemental oxygen, he re-presented with worsening symptoms.
the writers were engaged in a study of bird populations in northern Maine in conjunction with investigations to determine the effectiveness o! the breeding bird population as a controlling agent of the spruce budworm.Chorisloneura fumiferana.The field work was started in 1949 and the current project was a continuation.The entomological phase of the study during both seasons was conducted under the supervisleu of Philip B. Dowden and V. M. Carolin of the Bureau of Entomobgy and Plant Quarantine; the initial bird population study was made oy John W. Aldrich and Robert E. Stewart of the Fish and Wildlife Service (See page 471 of this issue of 'The Auk').Many data were accumulated concerning bird population dynamics during the initial study.To compare the res,Its of the two seasons and to present other significant facts, additional data are presented here.The study was conducted in the same 40 acre tract of spruce-fir forest that was established as the experime,tal area during 1949.Balsam fir, Abies balsamea, and black spruce.Picea mariana, were the predominant trees in the area and ranged from 40 to 60 feet in height.The vegetation complex was somewhat varied due to selective cutting in several small sections of the forest.This resulted in a rather dense undergrowth of conifers.Where the canopy was unbroken very little understory was present.The arec was crossed by a state highway.An attempt was again made to eliminate, or to reduce drastically, the bird populations on the experimental area which was then closely studied to determine any difference in the numbers of budworms.Stomachs of most of the birds collected were preserved, and an analysis of their contents was made by Robert T. Mitchell of the U. S. Fish and Wildlife Service.Prior to the collecting period a series of bird censuses was conducted to determine the breeding bird population of the area.The spotmapping method (Aud.Field Notes, 4 (2): 185-187, 1950) was utilized for this phase of the work.A total of 28 censuses involving 45 man-hours was taken from June 6 to June 13, inclusive.Most of the trips were made between 6:00 a.m. and 10:30 a.m. with the exception
The objective of this study was to analyze retrospective populations with recurrent ovarian cancer to assess differences in CA-125 patterns during chemotherapy. The populations included all patients treated between January 1994 and January 2004, who received liposomal doxorubicin and topotecan, and all patients treated between July 1997 and June 2001, who received carboplatin. Prognostic variables were abstracted from the medical records. Eighty-nine patients received liposomal doxorubicin and topotecan therapy and 21 received carboplatin; of these, 59 (liposomal doxorubicin), 60 (topotecan), and 17 (carboplatin) patients had evaluable CA-125 patterns. Patients given liposomal doxorubicin were more likely to have received only one or two cycles of therapy (37/89 [42%]) than patients receiving either carboplatin (5/21 [24%]) or topotecan (20/89[22%]). In cycle 1, CA-125 increases in patients were carboplatin, 4/17 (24%); liposomal doxorubicin, 41/59 (69%); and topotecan, 11/60 (18%). In cycle 2, CA-125 increases were carboplatin, 2/16 (13%); liposomal doxorubicin, 19/37 (51%); and topotecan, 9/50 (18%). In cycle 3, CA-125 increases were carboplatin, 0/12 (0%); liposomal doxorubicin, 7/23 (30%); and topotecan, 6/38 (16%). Of patients having any CA-125 decrease and given two or more cycles, fewer declines were seen in those given liposomal doxorubicin precycle 2 (18/35[51%]) than in those given carboplatin (13/16[81%]) or topotecan (49/56[88%]). The most prominent delay in CA-125 decline was in patients given liposomal doxorubicin compared with those given topotecan or carboplatin. In the entire population, only 3 of 107 (2.8%) patients demonstrated first CA-125 decline precycle 4. Discontinuation of therapy solely on the basis of early CA-125 increase (precycle 3), particularly with liposomal doxorubicin chemotherapy, may exclude some patients who will benefit from continued therapy.
Albinism in thirteen-lined ground squirrels, Citellus tridecemlineatus, is not rare. On the golf courses in Urbana, Illinois, and Tulsa, Oklahoma, albino squirrels have reportedly been seen for a number of years. Undoubtedly at other places, albino ground squirrels have been seen, but their occurrence apparently has not been reported in the literature. It is not albinism in Citellus tridecemlineatus that we are primarily interested in recording here, but the unusual condition in such an albino wherein the typical pattern of stripes and spots is retained even though the animal lacks all pigmentation. Figure I shows this striped albino alongside a normally-pigmented squirrel. Except for a few small light spots lacking in the head region, the pattern, but not the color, in the albino is typical of that of the normal squirrel.
During a 13-day period in mid-June and an 11-day period in late July and early August, we had an opportunity to collect amphibians and reptiles in the vicinity of Sonoyta, Sonora. The June visit to the area was made by Smith, his wife, and daughter; the July-August visit, by Hensley and Smith. Upon arrival in Sonoyta the first time, it was our good fortune to discover that a new black-top highway had just been completed between Sonoyta and San Luis, some 128 miles to the west by northwest. The eastern portion of the new road is the old Camino del Diablo which formerly entered Arizona a few miles west of Sonoyta. The new highway parallels the International Border on the Mexican side all the way to the Colorado River, thus making accessible by road the northwestern corner of the state of Sonora.
