This document discusses guidelines in Canada around elective C-sections and bone mineral density testing. It summarizes that:
1) Obstetricians in Canada are still advocating that vaginal delivery poses lower risks than C-sections for most women and may need to reinforce this message.
2) The Society of Obstetricians and Gynecologists of Canada has not decided to support elective C-sections and is still considering its position on this issue.
3) New standards have been developed in Canada for bone mineral density testing in premenopausal women, men, and children to help ensure appropriate use and interpretation of these tests.
Communicating hope and truth: A presentation for health care professionalsbkling
This document discusses improving cancer communication between doctors and patients. It begins with some cancer epidemiology statistics in the US. The main points are:
- The language used in oncology, such as "war on cancer", can imply meanings that increase patient anxiety and imply blame.
- Terms like "early detection" and "screening saves lives" may give patients a false sense of prevention or cure.
- Doctors should acknowledge patient emotions, use plain language, present information in bite-sized chunks, and encourage participation in decision making.
- When discussing risks, benefits, and the future, doctors should address patient concerns directly and not minimize their experiences. The goal is to provide trust and hope while still being honest.
SHARE Presentation: New Developments in the Medical Treatment of Breast Cance...bkling
Dr. Cliff Hudis on the latest information on new breast cancer treatments. Dr. Hudis is Chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
SHARE Presentation: Maximizing Treatment Options -- What to Know When Conside...bkling
Current and former clinical trial participants discuss decision-making from a patient's perspective. What factors should you consider when choosing a clinical trial? What are the potential benefits of participating? What misconceptions might discourage people from seeking clinical trials? When is it best not to participate? Panelists include women living with metastatic breast and ovarian cancers.
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
SNCH was selected based on its clinical excellence, quality care and clinical quality and patient safety awards for women's health services. Becker's Hospital Review is a bimonthly magazine published by ASC Communications located in Chicago, IL.
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
Dr. Stephanie Blank and Dr. Melissa Frey update us on the latest developments in ovarian cancer research and treatment from the annual conference of the Society of Gynecologic Oncology. Dr. Blank is a gynecologic oncologist at Perlmutter Cancer Center at NYU Langone Medical Center and an associate professor at NYU School of Medicine. Dr. Frey is a Gynecological Oncology Fellow at NYU Langone Medical Center.
Finding a Clinical Trial That's Right for Youbkling
Elly Cohen, PhD, Program Director of BreastCancerTrials.org, works closely with breast cancer organizations that promote patient awareness of clinical trials as a routine option for care. In this webinar, Elly walked listeners through the steps involved in finding clinical trials that are specific to their diagnosis.
Communicating hope and truth: A presentation for health care professionalsbkling
This document discusses improving cancer communication between doctors and patients. It begins with some cancer epidemiology statistics in the US. The main points are:
- The language used in oncology, such as "war on cancer", can imply meanings that increase patient anxiety and imply blame.
- Terms like "early detection" and "screening saves lives" may give patients a false sense of prevention or cure.
- Doctors should acknowledge patient emotions, use plain language, present information in bite-sized chunks, and encourage participation in decision making.
- When discussing risks, benefits, and the future, doctors should address patient concerns directly and not minimize their experiences. The goal is to provide trust and hope while still being honest.
SHARE Presentation: New Developments in the Medical Treatment of Breast Cance...bkling
Dr. Cliff Hudis on the latest information on new breast cancer treatments. Dr. Hudis is Chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
SHARE Presentation: Maximizing Treatment Options -- What to Know When Conside...bkling
Current and former clinical trial participants discuss decision-making from a patient's perspective. What factors should you consider when choosing a clinical trial? What are the potential benefits of participating? What misconceptions might discourage people from seeking clinical trials? When is it best not to participate? Panelists include women living with metastatic breast and ovarian cancers.
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
SNCH was selected based on its clinical excellence, quality care and clinical quality and patient safety awards for women's health services. Becker's Hospital Review is a bimonthly magazine published by ASC Communications located in Chicago, IL.
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
Dr. Stephanie Blank and Dr. Melissa Frey update us on the latest developments in ovarian cancer research and treatment from the annual conference of the Society of Gynecologic Oncology. Dr. Blank is a gynecologic oncologist at Perlmutter Cancer Center at NYU Langone Medical Center and an associate professor at NYU School of Medicine. Dr. Frey is a Gynecological Oncology Fellow at NYU Langone Medical Center.
Finding a Clinical Trial That's Right for Youbkling
Elly Cohen, PhD, Program Director of BreastCancerTrials.org, works closely with breast cancer organizations that promote patient awareness of clinical trials as a routine option for care. In this webinar, Elly walked listeners through the steps involved in finding clinical trials that are specific to their diagnosis.
Precision Prevention: Let's Avoid Exacerbating Cancer DisparitiesGraham Colditz
The document discusses how a focus on precision medicine could exacerbate health disparities if certain populations are not adequately represented in research. It emphasizes the importance of continuing research on established cancer prevention strategies like screening and vaccination to ensure equitable access. The speaker argues researchers should avoid creating new disparities through an overly narrow focus on "incremental precision" and should consider individual variability in genes, environment, lifestyle and socioeconomic factors when developing prevention approaches.
This document provides a curriculum vitae for Dr. Jeffrey S. Gerdes that includes his contact information, occupational history as a chiropractor since 2010, education including a Doctorate of Chiropractic from Palmer College of Chiropractic in 2008, licensure information, selected postgraduate education and certifications in areas related to chiropractic and neurology, and publications.
Three key points from the document are:
1. Chemotherapy-induced hair loss occurs in approximately 65% of patients undergoing chemotherapy. Hair loss is one of the most traumatic aspects of chemotherapy for many patients.
2. Scalp cooling has been shown to be the most effective method for reducing chemotherapy-induced alopecia according to several clinical studies. One hospital in Northern California currently offers cold caps.
3. The document reviews 5 studies on scalp cooling that range from randomized controlled trials to qualitative studies. The studies show that scalp cooling significantly reduces the risk of chemotherapy-induced alopecia for most chemotherapy regimens.
This document outlines the process from diagnosis to follow-up care for ovarian cancer. It begins with an introduction and disclosure section. It then covers the diagnosis process, including symptoms, imaging, biopsy and surgery. Treatment options like surgery, chemotherapy, targeted therapy and clinical trials are discussed. The roles of the treatment team members are defined. Follow-up care including exams, imaging and survivorship are also summarized. Resources and questions from patients are addressed. Key terminology around histology, grade, stage and tumor markers is explained.
This document discusses the need for ethically responsible choice architecture in prostate cancer treatment decision making. It notes that while patients are assumed to make autonomous decisions, evidence shows that for prostate cancer many men may not be properly informed of their options, especially active surveillance. Decision making can be influenced by biases and heuristics that favor immediate intervention over active surveillance. The document advocates for clinicians to engage in choice architecture that encourages men to seriously consider the harms of immediate intervention and benefits of active surveillance when deciding on treatment. This could be done through framing options, appealing to social norms, and using patient narratives. The goal is to raise awareness of active surveillance as an appropriate option for eligible men.
Senology Newsletter - November 6, 2012Senology.org
This document is a newsletter from the International Senologic and Oncologic Scientific Community (ISOSC) that provides information on recent publications in oncology and breast cancer research, upcoming conferences, and summaries of expert discussions on cancer treatment. It lists several new peer-reviewed articles on topics like HER2-positive breast cancer treatment and screening techniques. It also announces upcoming breast cancer and oncology conferences worldwide and provides summaries of expert workshops on treating cancers like breast cancer, kidney cancer, prostate cancer, and leukemia.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
Disclaimer: These slides belong to Dr. Jeanne Carter and cannot be reproduced without her explicit consent.
Presented July 10, 2016 at the Ovarian Cancer National Conference in Washington, DC
This curriculum vitae summarizes Jeffrey S. Gerdes' professional experience and education. It lists that he has been the chiropractor and clinical director of Carolina ChiroCare and Rehab Inc. in Raleigh, NC since 2010. It also notes that he received his doctorate of chiropractic from Palmer College of Chiropractic Florida in 2008. The CV provides details on his licensure, certifications, and extensive postgraduate education, including courses on MRI interpretation, neurological emergencies, and assessing medical fitness to return to work.
This study proposes implementing a nutrition education program in Poudre School District that incorporates gardening and cooking lessons. The study analyzes the program's feasibility based on student interest, teacher acceptance, health impact, and financial impact. Student interest was high based on participation in similar programs. However, teacher acceptance was mixed - while teachers supported nutrition education, they felt unable to implement interactive programs due to preparation time requirements. The health impact was inconclusive as long-term studies have not been done, but short-term studies found improved nutrition knowledge and healthier food choices. The financial feasibility would depend on fitting costs such as staff and supplies within the school district's budget.
The document summarizes preliminary results from a study exploring perceptions of cervical cancer and medical research among Chinese and Vietnamese women in Philadelphia. Freelisting interviews were conducted in English, Mandarin, and Vietnamese to understand how the topics are constructed as cultural domains. Initial findings show diversity of cervical cancer knowledge but little specific understanding of research processes, and themes of fear, physical impacts, treatment urgency and ambiguity around research purposes.
Topic-Driven Round Table on Low Grade Serous Ovarian Cancerbkling
A discussion about low grade serous ovarian cancer with Dr. Amanda Nickles Fader, Director of Kelly Gynecologic Oncology Service, Johns Hopkins Hospital. This type of ovarian cancer behaves differently and is treated differently than other ovarian cancers. Join the conversation to learn more and ask an expert your questions.
This document discusses fertility preservation options for pediatric and young adult cancer patients. It finds that cancer treatments can impair development and cause infertility through damage to the ovaries, uterus, testes or hypothalamic-pituitary axis. Pelvic radiation over 2 Gy, alkylating chemotherapy, and hematopoietic stem cell transplantation carry higher risks. The standard options for fertility preservation are embryo and sperm cryopreservation, though oocyte and ovarian tissue cryopreservation are gaining acceptance. No options exist yet for prepubertal boys, though experimental testicular tissue cryopreservation is available at some centers. All at-risk patients should discuss potential infertility with oncologists before starting treatment.
New post-chemotherapy maintenance treatment options for ovarian cancer have emerged in recent years. Dr. Maurie Markman explains and takes questions on maintenance therapies for ovarian cancer in our 4th annual Joan Sommer Educational Program.
DCIS Topic-Driven Round Table: Decision-Making and Treatment Choicesbkling
Facilitator Deb Hackenberry is joined by Cecilia Hammond, Senior Medical Science Liaison at Genomic Health, to discuss better decision-making and your treatment choices with DCIS.
Precision Prevention: Let's Avoid Exacerbating Cancer DisparitiesGraham Colditz
The document discusses how a focus on precision medicine could exacerbate health disparities if certain populations are not adequately represented in research. It emphasizes the importance of continuing research on established cancer prevention strategies like screening and vaccination to ensure equitable access. The speaker argues researchers should avoid creating new disparities through an overly narrow focus on "incremental precision" and should consider individual variability in genes, environment, lifestyle and socioeconomic factors when developing prevention approaches.
This document provides a curriculum vitae for Dr. Jeffrey S. Gerdes that includes his contact information, occupational history as a chiropractor since 2010, education including a Doctorate of Chiropractic from Palmer College of Chiropractic in 2008, licensure information, selected postgraduate education and certifications in areas related to chiropractic and neurology, and publications.
Three key points from the document are:
1. Chemotherapy-induced hair loss occurs in approximately 65% of patients undergoing chemotherapy. Hair loss is one of the most traumatic aspects of chemotherapy for many patients.
2. Scalp cooling has been shown to be the most effective method for reducing chemotherapy-induced alopecia according to several clinical studies. One hospital in Northern California currently offers cold caps.
3. The document reviews 5 studies on scalp cooling that range from randomized controlled trials to qualitative studies. The studies show that scalp cooling significantly reduces the risk of chemotherapy-induced alopecia for most chemotherapy regimens.
This document outlines the process from diagnosis to follow-up care for ovarian cancer. It begins with an introduction and disclosure section. It then covers the diagnosis process, including symptoms, imaging, biopsy and surgery. Treatment options like surgery, chemotherapy, targeted therapy and clinical trials are discussed. The roles of the treatment team members are defined. Follow-up care including exams, imaging and survivorship are also summarized. Resources and questions from patients are addressed. Key terminology around histology, grade, stage and tumor markers is explained.
This document discusses the need for ethically responsible choice architecture in prostate cancer treatment decision making. It notes that while patients are assumed to make autonomous decisions, evidence shows that for prostate cancer many men may not be properly informed of their options, especially active surveillance. Decision making can be influenced by biases and heuristics that favor immediate intervention over active surveillance. The document advocates for clinicians to engage in choice architecture that encourages men to seriously consider the harms of immediate intervention and benefits of active surveillance when deciding on treatment. This could be done through framing options, appealing to social norms, and using patient narratives. The goal is to raise awareness of active surveillance as an appropriate option for eligible men.
Senology Newsletter - November 6, 2012Senology.org
This document is a newsletter from the International Senologic and Oncologic Scientific Community (ISOSC) that provides information on recent publications in oncology and breast cancer research, upcoming conferences, and summaries of expert discussions on cancer treatment. It lists several new peer-reviewed articles on topics like HER2-positive breast cancer treatment and screening techniques. It also announces upcoming breast cancer and oncology conferences worldwide and provides summaries of expert workshops on treating cancers like breast cancer, kidney cancer, prostate cancer, and leukemia.
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
Disclaimer: These slides belong to Dr. Jeanne Carter and cannot be reproduced without her explicit consent.
Presented July 10, 2016 at the Ovarian Cancer National Conference in Washington, DC
This curriculum vitae summarizes Jeffrey S. Gerdes' professional experience and education. It lists that he has been the chiropractor and clinical director of Carolina ChiroCare and Rehab Inc. in Raleigh, NC since 2010. It also notes that he received his doctorate of chiropractic from Palmer College of Chiropractic Florida in 2008. The CV provides details on his licensure, certifications, and extensive postgraduate education, including courses on MRI interpretation, neurological emergencies, and assessing medical fitness to return to work.
This study proposes implementing a nutrition education program in Poudre School District that incorporates gardening and cooking lessons. The study analyzes the program's feasibility based on student interest, teacher acceptance, health impact, and financial impact. Student interest was high based on participation in similar programs. However, teacher acceptance was mixed - while teachers supported nutrition education, they felt unable to implement interactive programs due to preparation time requirements. The health impact was inconclusive as long-term studies have not been done, but short-term studies found improved nutrition knowledge and healthier food choices. The financial feasibility would depend on fitting costs such as staff and supplies within the school district's budget.
The document summarizes preliminary results from a study exploring perceptions of cervical cancer and medical research among Chinese and Vietnamese women in Philadelphia. Freelisting interviews were conducted in English, Mandarin, and Vietnamese to understand how the topics are constructed as cultural domains. Initial findings show diversity of cervical cancer knowledge but little specific understanding of research processes, and themes of fear, physical impacts, treatment urgency and ambiguity around research purposes.
Topic-Driven Round Table on Low Grade Serous Ovarian Cancerbkling
A discussion about low grade serous ovarian cancer with Dr. Amanda Nickles Fader, Director of Kelly Gynecologic Oncology Service, Johns Hopkins Hospital. This type of ovarian cancer behaves differently and is treated differently than other ovarian cancers. Join the conversation to learn more and ask an expert your questions.
This document discusses fertility preservation options for pediatric and young adult cancer patients. It finds that cancer treatments can impair development and cause infertility through damage to the ovaries, uterus, testes or hypothalamic-pituitary axis. Pelvic radiation over 2 Gy, alkylating chemotherapy, and hematopoietic stem cell transplantation carry higher risks. The standard options for fertility preservation are embryo and sperm cryopreservation, though oocyte and ovarian tissue cryopreservation are gaining acceptance. No options exist yet for prepubertal boys, though experimental testicular tissue cryopreservation is available at some centers. All at-risk patients should discuss potential infertility with oncologists before starting treatment.
New post-chemotherapy maintenance treatment options for ovarian cancer have emerged in recent years. Dr. Maurie Markman explains and takes questions on maintenance therapies for ovarian cancer in our 4th annual Joan Sommer Educational Program.
DCIS Topic-Driven Round Table: Decision-Making and Treatment Choicesbkling
Facilitator Deb Hackenberry is joined by Cecilia Hammond, Senior Medical Science Liaison at Genomic Health, to discuss better decision-making and your treatment choices with DCIS.
This document provides instructions for using the Academic Search Complete database to search for scholarly articles on the topic of video games and violence and children or adolescents. It outlines how to access the database from the library homepage, find Academic Search Complete, perform an advanced search on the specified topic while limiting results to scholarly journals from the past 5 years. It then notes that 63 results were found and provides additional instructions for limiting results by publication.
The article discusses a new blood-based screening test for colon cancer that was recently approved by the FDA. However, experts have raised concerns about the test because it has not been shown to improve mortality rates compared to other screening methods. The test may be more effective at detecting advanced cancers rather than improving outcomes. While the test could increase screening rates by addressing challenges with current methods, doctors need more evidence that it actually reduces colon cancer deaths before widely incorporating it into practice.
My talk to University of Wisconsin event, "Science Writing in Age of Denial"Gary Schwitzer
This is an amended version to reduce file size to allow it to fit on SlideShare.
My main theme was news coverage of screening tests that emphasized only benefits while denying/ignoring/minimizing evidence of potential harms.
Detecting Distress in Gynecologic Cancer Patients Worksheet.docxstudywriters
1) A study assessed distress levels in 62 gynecologic cancer patients using the Distress Thermometer and Problem List. 66% of patients scored 4 or higher on the Distress Thermometer, indicating follow up was needed. The top reported problems were nervousness, worry, fears, fatigue, and sleep problems.
2) Staff perceptions of using distress screening tools were also examined through interviews. While screening helped identify patient needs, staff noted high levels of distress required referral to appropriate services.
3) Both quantitative and qualitative data provided insight into the prevalence and types of distress experienced by gynecologic cancer patients, as well as challenges in implementing distress screening in a clinical setting.
The document discusses controversies surrounding breast cancer screening guidelines. It summarizes criticisms of screening mammography from the US Preventive Services Task Force and Swiss Medical Board, including concerns about overdiagnosis and limited survival benefits. It also reviews controversial studies that have influenced guidelines, such as ones finding mammography has low sensitivity especially for dense breasts and limited benefits from screening women in their 40s. Guidelines recommending less frequent screening are criticized for failing to account for tumor growth rates. Overall, the document examines ongoing debates around breast cancer screening recommendations.
Lessons to improve our reporting on evidence - analysis of 1,600 stories over...Gary Schwitzer
This document summarizes lessons from analyzing 1,600 health news stories over 6 years. It finds that most stories fail to adequately discuss costs, quantify benefits and harms, evaluate evidence quality, and compare new options to existing ones. There is also a tendency to emphasize benefits and minimize harms. Screening stories in particular are often one-sided and promote false certainty. Overall, health journalism could be improved by providing more balanced and evidence-based reporting.
Consumer-centered journalism that promotes patient-centered care could help address issues with how medical news currently impacts health behaviors. Research shows news coverage can influence information-seeking and health actions, yet most coverage fails to fully explain the evidence, costs, risks, and alternatives. By providing more balanced and complete information, consumer-centered journalism could help the public make more informed healthcare decisions that align with their own values and priorities. This may be especially important as new technologies and screening tests are introduced, to avoid harms from unnecessary or poorly-informed actions.
Clinical research is essential to improving cancer treatment results. It offers patients access to state-of-the-art therapies through clinical trials when standard treatments may not be available or adequate. Latin America represents an important region for clinical research due to its large patient populations and qualified investigators. However, barriers like bureaucratic hurdles can stall development. Addressing discrepancies in cancer care globally through strategies like screening programs and vaccination could help reduce the growing cancer burden in developing areas.
The early symptoms of ovarian cancer are easily missed and often confused with gastrointestinal issues like bloating, constipation, and pelvic pain. There are no reliable screening tests for ovarian cancer detection. Risk factors include family history, never using birth control pills, and having fewer or no children. While ovarian cancer can be deadly, treatments have improved and many women now live longer with the disease. It is important for women with symptoms or risk factors to see a gynecological oncologist for evaluation and care.
This document summarizes challenges in providing preventive care services to older adults in the United States. Fewer than half of those aged 65 and older are up-to-date on recommended preventive services like immunizations and cancer screenings. While some goals have been met, like mammogram rates, the US still falls short of goals for vaccinating older adults against herpes zoster and pneumococcal disease. Barriers include a healthcare system focused on sickness rather than prevention, time constraints in medical visits, lack of awareness among patients and doctors of available preventive services like annual visits and weight loss counseling, and off-putting topics like colon cancer screening that require more discussion.
This study examined trends in preoperative pulmonary function testing (PFT) in Ontario, Canada before and after 2006 American College of Physicians guidelines. The study found that preoperative PFT rates decreased over the study period and following the 2006 guidelines, while non-operative PFT rates remained stable. By 2013, preoperative PFTs were performed in fewer than 8% of patients with risk factors for pulmonary complications. The decreasing preoperative PFT rates contrast with increases in other perioperative interventions like anesthesia consultations and stress testing.
Cancer treatment during pregnancy not unsafeOther Mother
A new study of over 100 children who were exposed to cancer treatment during their mother's pregnancy in the last two trimesters showed that the children had normal cognitive and cardiac function. The study found no difference in cardiac or cognitive development between children exposed to cancer treatment in utero and a control group. This suggests that termination of pregnancy or early preterm delivery is not necessarily warranted to enable a pregnant woman to receive cancer treatment, as exposure during the later stages of pregnancy appears to pose no additional risks to the child's development.
This document summarizes a workshop on preventing first cesarean deliveries. Key points discussed include:
- Over 1/3 of births in the US are by cesarean delivery, and the rate of repeat cesareans after an initial one is over 90%.
- Factors contributing to the first cesarean rate that were examined include obstetric indications, labor management practices like inductions and definitions of failed progress, and non-medical factors.
- Recommendations include allowing adequate time for labor induction and each stage of labor before declaring failure, and facilitating training in operative vaginal delivery to prevent some cesareans.
Covering Cancer News - Lessons from HealthNewsReview.orgGary Schwitzer
This is 1 of 2 presentations I made at the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 7, 2011
Applying and Sharing Evidence Discussion.docxwrite22
This document discusses implementing routine distress screening for gynecologic cancer patients using the Distress Thermometer and Problem List. A study found that 66% of patients screened had moderate to high distress levels. The top problems identified were nervousness, worry, fatigue and sleep issues. Healthcare providers saw benefits for patients in validating their concerns and opening discussion. They also felt it enhanced holistic care. However, finding time for screening in busy clinics was challenging.
This multi-year study analyzed end-of-life discussions at a cancer center over four years. On average, 113 patients expired each year, with 60 expiring seven or more days after admission. Lung cancer was the most common cause of death. While palliative care consultations occurred for only 25.5% of patients on average, the study found no correlations between variables like timing of discussions, location, attendance, and palliative care involvement. Without interventions between years, the study could not measure performance improvement directly. Future research would require implementing interventions to gauge their impact over multiple years.
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What Men Told Us: Prostate Cancer Survey Results, Oct. 1, 2020
Medical post csection 04
1. By KAREN RICHARDSON
OTTAWA – For patients inquiring
about C-sections, ob/gyns may
need to reinforce the message
that for most women vaginal de-
livery poses a lower risk, said Dr.
Jan Christilaw, a past-president of
the Society of Obstetricians and
Gynecologists of Canada (SOGC).
Some confusion was created
by the “Elective C-sections gain-
ing acceptance” commentary in
the March 2 Canadian Medical
Association Journal (CMAJ).
It said Canadian experts will
be releasing guidelines similar to
those of the American College of
Obstetricians and Gynecologists,
which support the permissibility
of elective cesarean delivery in a
normal pregnancy, after adequate
informed consent. But the ethics
committee of the SOGC has, to
date, made no decision to support
elective C-sections, according to a
recent media advisory from the
society. It will release its position
statement in late spring.
Nevertheless, the CMAJ com-
mentary attracted an outpouring
of media headlines that C-sec-
tions will be available “on de-
mand” for Canadians without the
presence of a medical indication.
Dr. Mary Hannah, principal in-
vestigator of the Term Breech
Trial published in 2000 that found
C-section best for breech, au-
thored a different article in the
March 2 CMAJ about elective ce-
sarean section. She is director of
the Maternal, Infant and Repro-
ductive Health Research Unit at
the University of Toronto.
In addressing the quandary
now faced by Canadian physi-
cians if a woman without an ac-
cepted medical indication re-
quests delivery by C-section, the
article by Dr. Hannah suggests
the request should be supported
if, after a thorough discussion
about the risks and benefits, a
woman continues to perceive the
benefits outweigh the risks.
In her article, Dr. Hannah ac-
knowledged there is higher ma-
ternal mortality associated with
C-section birth, as well as a
longer recovery time and opera-
tive complications with C-section.
“But the highest mortality is
associated with emergency ce-
sarean, which is not something
done electively, but happens be-
cause planned vaginal birth
failed,” said Dr. Hannah in an in-
terview with the Medical Post.
“It is reasonable in some situa-
tions to respond positively to a
woman’s request (for a C-section),
if the woman understands the
pros and cons.” she said.
But it is speculative to draw
conclusions about the risks and
benefits of C-sections from the
CMAJ commentary, which re-
ferred to the women in the Term
Breech Trial who were at higher
risk for C-sections than the gen-
eral population, said Dr. Christi-
law, a clinical professor of obstet-
rics and gynecology at the Uni-
versity of British Columbia in
Vancouver, and an obstetrician-
gynecologist in White Rock, B.C.
Canadian ob/gyns will want to
carefully consider a patient’s re-
quest for a cesarean section with-
out medical indication, she
added.
“Often the primary motivator
is fear of pain and labour . . .
However, they may not be aware
of postoperative pain that can oc-
cur up to six weeks after surgery,
as well as the risks associated
with surgery itself, such as a
higher risk of thromboembolic
complications and complications
with future pregnancies.”
While the society is deliberat-
ing on this topic, Dr. Hannah said
the delay of a committee opinion
from the society could be an op-
portunity for physicians in
Canada to influence the develop-
ment of the society’s recommen-
dations.
6 THE MEDICAL POST NEWS March 16, 2004
WARRANTY
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restricted by Section 19 of the
Canadian Income Tax Act.”
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returns can claim the
advertising costs of this
publication as a business expense.”
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Medical Post (ISSN 0025-7435)
MEDICAL ADVISORY BOARD
MEDICAL CONSULTANT:
Dr. Cornelia Baines
CENTRAL:
Dr. Paul Caldwell, Cobourg, Ont.
(family medicine)
Dr. Michael Clarfield, Toronto
(sports medicine)
Dr. Michael Evans, Toronto,
(family medicine)
Dr. Charles Godfrey, Toronto
(rehabilitation)
Dr. Philip F. Hall, Winnipeg
(maternal and fetal medicine)
Dr. Brian Hands, Toronto
(otolaryngology/professional voice)
Dr. Julie McIntyre, Toronto
(family medicine)
Dr. Keith Meloff, Etobicoke (neurology)
Dr. Mano Murty, Ottawa
(family medicine)
Dr. Morton Rapp, Toronto (psychiatry)
Dr. Chandrakant Shah, Toronto
(public health)
Dr. Irvin Wolkoff, Toronto (psychiatry)
EAST COAST:
Dr. George Burden, Elmsdale, N.S.
(family medicine)
Dr. Ian Cameron, Halifax
(family medicine)
Dr. Michael Cussen, Newport, N.S.
(community medicine)
Dr. Peter Fraser, Oromocto, N.B.
(family medicine)
Dr. James Goodwin, Yarmouth, N.S.
(ob/gyn)
Dr. Joni Guptill, Woodstock, N.B.
(family medicine)
Dr. Richard Hall, Halifax
(clinical pharmacology)
Dr. Dana Hanson, Fredericton, N.B.
(dermatology)
Dr. Lara Hazelton, Halifax (psychiatry)
Dr. Shelagh Leahey, Yarmouth, N.S.
(family medicine)
Dr. Allan MacDonald, Halifax
(general surgery)
Dr. Jennifer Szerb, Dartmouth, N.S.
(family medicine)
Dr. Douglas Tweel, Charlottetown
(family medicine)
WEST COAST:
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Dr. Arun Garg, New Westminister, B.C.
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Dr. Barbara Kane, Prince George, B.C.
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Dr. Patricia Mark, Lantzville, B.C.
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Dr. John O’Brien-Bell, Surrey
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Dr. Erik Paterson, Creston, B.C.
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Dr. Janet Friesen, Surrey, B.C.
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Dr. Peter Steele, Whitehorse
(family medicine)
By KAREN RICHARDSON
HAMILTON – The Canadian
panel of the International Society
of Densitometry has developed
standards for the appropriate use
of bone mineral density testing
(BMD) in premenopausal women,
men and children.
“There needed to be a docu-
ment to give some guidance and
ensure that practice right across
Canada is of good quality,” said
lead author Dr. Aliya Khan, chair-
woman of the panel.
The standards—which define
the minimum level of acceptable
performance in Canada for as-
sessment of BMD—were devel-
oped in conjunction with the Os-
teoporosis Society of Canada and
international colleagues.
“Unfortunately, we’re seeing a
lot of variation in practice,”
added Dr. Khan, an associate clin-
ical professor of medicine in the
divisions of endocrinology and
geriatrics at McMaster University
in Hamilton, Ont.
She said the guidelines ad-
dress who to test and how to in-
terpret tests in men, pre-
menopausal women and chil-
dren—a grey area where stan-
dards have not yet been estab-
lished. “We’re seeing a lot of poor
quality practice in those specific
areas—inappropriate testing, in-
terpretation and management.”
Young women
There is a trend to overtreat-
ment of osteoporosis because of
the emphasis placed on treating
postmenopausal women. As a
consequence, many healthy,
young women are being inappro-
priately labelled as having osteo-
porosis, said Dr. Khan.
“We’ve seen a knee-jerk reac-
tion. The T-score comes back, it’s
low . . . and the patient is stuck on
bisphosphonates.”
Dr. Khan said clinicians need
to remember that some women
may simply have a genetic
makeup for low bone density. “We
need to find out if this bone den-
sity is normal for this person or if
it is a pathological problem . . .
We don’t give short women hor-
mones to reach the average
height, for instance.”
Dr. Khan recommends clini-
cians keep in mind there are vari-
ations. “Fifteen per cent of
healthy young women between
the ages of 30 and 40 have a T-
score of minus 1, which doesn’t
necessarily mean osteopenia.”
The T-score is the number of
standard deviations that a pa-
tient’s bone density is above or
below the young adult
mean value (a value of
-1 or higher is normal).
Dr. Khan said in fact
the Z-score, not the T-
score, should be used
premenopausally and
should not be weight-
adjusted. (The Z-score
is the number of stan-
dard deviations that a
patient’s bone density
is above or below the
mean age-matched ref-
erence value.)
“It is also important to make
sure the scan was valid, and if the
patient was positioned properly
as this will affect the results .”
The new guidelines outline
four scenarios for premenopausal
women who should be tested.
These include women who have
been on prednisone therapy,
those who have had premature
ovarian failure, those who have
diseases/conditions associated
with bone loss and those who
have had fragility fractures.
Children’s diagnosis
Children are also being over-
diagnosed with osteoporosis, said
Dr. Khan. She said T-scores are of-
ten inappropriately used in chil-
dren, who should be matched to
their age peers, not to the healthy,
adult population.
The panel also
identified how to in-
terpret bone density
testing in children.
“It’s very important to
children that the bone
density test be inter-
preted in the clinical
context of the height
and weight and the
growth of the child. If
the child is at the fifth
percentile for height
and weight and they’re
small for their age and their
weight is also appropriately small
for their age, their bone density is
not going to be normal.”
The new guidelines recom-
mend children only be tested if
they have been on long-term glu-
cocorticoid therapy, if they have
chronic illness, prolonged immo-
bilization or low-trauma, recur-
rent fractures.
The Canadian standards also
outline indications for testing in
men, which include conditions as-
sociated with bone loss such as
hypogonadism or hyperparathy-
roidism. Testing is recommended
also for men over age 65 years,
men on glucocorticoid or pred-
nisone therapy, those who’ve had
vertebral fractures and those who
have X-ray evidence of ostopenia.
Bone mineral density tests now standardized
Elective C-sections
may not be optional
Dr. Aliya Khan
Ob/gyns in Canada
still advocating for
vaginal deliveries
where possible
The SOGC is still considering guidelines for elective C-sections.