The number of unintentional marijuana poisonings in children rose markedly in Colorado after medical marijuana was decriminalized in 2009, with visits to one emergency department climbing from zero to 2.4% of all poisoning cases in just 2 years, according to a report published online May 27 in JAMA Pediatrics.

The toxic effects in these children were more serious than those typically reported for marijuana exposures in the past, most likely because tetrahydrocannabinol concentrations are higher in today’s medical marijuana products than in the plant parts involved in most previous exposures. So now, even when the amount ingested is small, it still produces significant adverse effects in the pediatric population, including respiratory insufficiency requiring care in the pediatric intensive care unit (PICU), said Dr. George Sam Wang of Rocky Mountain Poison and Drug Center, Denver, and his associates.

©ron hilton/iStockphoto.com

In addition, medical marijuana is sold in a variety of forms that are more palatable to children than plant parts are, such as baked goods, soft drinks, and candies. So more children are attracted to eating the drug now, and they likely eat larger amounts than in the past.

"Physicians, especially in states that have decriminalized medical marijuana, need to be cognizant of the potential for marijuana exposures and be familiar with the symptoms of marijuana ingestion," the investigators said.

After Colorado decriminalized medical marijuana, both the number of dispensaries and the number of patients authorized to use the drug increased rapidly. As of 2010, more than 300 such dispensaries were licensed in Denver alone, "roughly twice the number of the city’s public schools," Dr. Wang and his colleagues noted.

They performed the first U.S. study to asses the impact of this legislation on pediatric poisonings: a retrospective cohort study at a tertiary children’s hospital that had approximately 65,000 annual visits to its emergency department. The researchers focused on children under age 12 who were evaluated for possible toxic exposures, comparing the 790 patients seen from 2005 to Sept. 30, 2009, before legalization with the 588 seen from Oct. 1, 2009, to the end of 2011 after medical marijuana was legalized.

There were no cases of marijuana poisoning during the first time period, compared with 14 in the second time period. The proportion of such visits in relation to all pediatric ED visits for toxic exposures thus rose from 0% to 2.4% after the drug was decriminalized.

Children as young as 8 months of age were exposed to marijuana. Most presented with central nervous system (CNS) effects such as lethargy or somnolence, and some displayed rigidity, ataxia, hypoxia, or respiratory insufficiency, the researchers reported (JAMA Ped. 2013 May 27 [doi: 10.1001/jamapediatrics.2013.140]).

Only two patients were known to have been exposed to marijuana on arrival at the ED; they underwent a urine toxicology screen. The rest underwent extensive workups to determine the cause of their symptoms, which included urine toxicology screens; blood work; CT and x-ray imaging of the head, spine, and abdomen; and lumbar punctures.

Only one patient, a 13-year-old girl with minimal symptoms, was discharged after being assessed. The rest were observed in the ED (5) or admitted for hospitalization (8), including 2 children who required admission to the PICU.

This 93% rate of hospitalization reinforces the hypothesis that current marijuana exposures induce more serious effects than past exposures did, because historically only 1.3% of marijuana poisoning cases required hospitalization, Dr. Wang and his associates said.

Eight of these 14 (57%) marijuana exposures were from food products that incorporated the drug. "Currently, there are no regulations on storing medical marijuana products in child-resistant containers, including labels with warnings or precautions, or providing counseling on safe storage practices," the investigators said.

As is the case with many accidental pediatric exposures to other medications, the source of the medical marijuana in several of the cases in this study was the child’s grandparent.

Dr. Wang and his colleagues added that proponents of legalizing marijuana often claim that it is "safer" than alcohol. However, only two patients under age 12 were evaluated for alcohol exposure at this ED since 2009. One, an 11-year-old, intentionally drank alcohol and only required observation for intoxication; the other, a 2-year-old who accidentally drank a household product containing ethanol, was discharged after failing to develop any symptoms.

In comparison, the symptoms, invasive assessments, and hospitalizations described in this study can hardly be considered "safer." These findings clearly demonstrate that "the consequences of marijuana exposure in children should be part of the ongoing debate on legalizing marijuana," the researchers said.

Seventeen states and Washington, D.C., have passed laws to decriminalize medical marijuana at the state level, even though marijuana is a schedule I drug under the Controlled Substances Act. "In November 2012, Colorado and Washington [State] passed amendments legalizing the recreational use of marijuana," Dr. Wang and his associates said.

No financial conflicts of interest were reported.

The number of unintentional marijuana poisonings in children rose markedly in Colorado after medical marijuana was decriminalized in 2009, with visits to one emergency department climbing from zero to 2.4% of all poisoning cases in just 2 years, according to a report published online May 27 in JAMA Pediatrics.

The toxic effects in these children were more serious than those typically reported for marijuana exposures in the past, most likely because tetrahydrocannabinol concentrations are higher in today’s medical marijuana products than in the plant parts involved in most previous exposures. So now, even when the amount ingested is small, it still produces significant adverse effects in the pediatric population, including respiratory insufficiency requiring care in the pediatric intensive care unit (PICU), said Dr. George Sam Wang of Rocky Mountain Poison and Drug Center, Denver, and his associates.

©ron hilton/iStockphoto.com

In addition, medical marijuana is sold in a variety of forms that are more palatable to children than plant parts are, such as baked goods, soft drinks, and candies. So more children are attracted to eating the drug now, and they likely eat larger amounts than in the past.

"Physicians, especially in states that have decriminalized medical marijuana, need to be cognizant of the potential for marijuana exposures and be familiar with the symptoms of marijuana ingestion," the investigators said.

After Colorado decriminalized medical marijuana, both the number of dispensaries and the number of patients authorized to use the drug increased rapidly. As of 2010, more than 300 such dispensaries were licensed in Denver alone, "roughly twice the number of the city’s public schools," Dr. Wang and his colleagues noted.

They performed the first U.S. study to asses the impact of this legislation on pediatric poisonings: a retrospective cohort study at a tertiary children’s hospital that had approximately 65,000 annual visits to its emergency department. The researchers focused on children under age 12 who were evaluated for possible toxic exposures, comparing the 790 patients seen from 2005 to Sept. 30, 2009, before legalization with the 588 seen from Oct. 1, 2009, to the end of 2011 after medical marijuana was legalized.

There were no cases of marijuana poisoning during the first time period, compared with 14 in the second time period. The proportion of such visits in relation to all pediatric ED visits for toxic exposures thus rose from 0% to 2.4% after the drug was decriminalized.

Children as young as 8 months of age were exposed to marijuana. Most presented with central nervous system (CNS) effects such as lethargy or somnolence, and some displayed rigidity, ataxia, hypoxia, or respiratory insufficiency, the researchers reported (JAMA Ped. 2013 May 27 [doi: 10.1001/jamapediatrics.2013.140]).

Only two patients were known to have been exposed to marijuana on arrival at the ED; they underwent a urine toxicology screen. The rest underwent extensive workups to determine the cause of their symptoms, which included urine toxicology screens; blood work; CT and x-ray imaging of the head, spine, and abdomen; and lumbar punctures.

Only one patient, a 13-year-old girl with minimal symptoms, was discharged after being assessed. The rest were observed in the ED (5) or admitted for hospitalization (8), including 2 children who required admission to the PICU.

This 93% rate of hospitalization reinforces the hypothesis that current marijuana exposures induce more serious effects than past exposures did, because historically only 1.3% of marijuana poisoning cases required hospitalization, Dr. Wang and his associates said.

Eight of these 14 (57%) marijuana exposures were from food products that incorporated the drug. "Currently, there are no regulations on storing medical marijuana products in child-resistant containers, including labels with warnings or precautions, or providing counseling on safe storage practices," the investigators said.

As is the case with many accidental pediatric exposures to other medications, the source of the medical marijuana in several of the cases in this study was the child’s grandparent.

Dr. Wang and his colleagues added that proponents of legalizing marijuana often claim that it is "safer" than alcohol. However, only two patients under age 12 were evaluated for alcohol exposure at this ED since 2009. One, an 11-year-old, intentionally drank alcohol and only required observation for intoxication; the other, a 2-year-old who accidentally drank a household product containing ethanol, was discharged after failing to develop any symptoms.

In comparison, the symptoms, invasive assessments, and hospitalizations described in this study can hardly be considered "safer." These findings clearly demonstrate that "the consequences of marijuana exposure in children should be part of the ongoing debate on legalizing marijuana," the researchers said.

Seventeen states and Washington, D.C., have passed laws to decriminalize medical marijuana at the state level, even though marijuana is a schedule I drug under the Controlled Substances Act. "In November 2012, Colorado and Washington [State] passed amendments legalizing the recreational use of marijuana," Dr. Wang and his associates said.

No financial conflicts of interest were reported.

The number of unintentional marijuana poisonings in children rose markedly in Colorado after medical marijuana was decriminalized in 2009, with visits to one emergency department climbing from zero to 2.4% of all poisoning cases in just 2 years, according to a report published online May 27 in JAMA Pediatrics.

The toxic effects in these children were more serious than those typically reported for marijuana exposures in the past, most likely because tetrahydrocannabinol concentrations are higher in today’s medical marijuana products than in the plant parts involved in most previous exposures. So now, even when the amount ingested is small, it still produces significant adverse effects in the pediatric population, including respiratory insufficiency requiring care in the pediatric intensive care unit (PICU), said Dr. George Sam Wang of Rocky Mountain Poison and Drug Center, Denver, and his associates.

©ron hilton/iStockphoto.com

In addition, medical marijuana is sold in a variety of forms that are more palatable to children than plant parts are, such as baked goods, soft drinks, and candies. So more children are attracted to eating the drug now, and they likely eat larger amounts than in the past.

"Physicians, especially in states that have decriminalized medical marijuana, need to be cognizant of the potential for marijuana exposures and be familiar with the symptoms of marijuana ingestion," the investigators said.

After Colorado decriminalized medical marijuana, both the number of dispensaries and the number of patients authorized to use the drug increased rapidly. As of 2010, more than 300 such dispensaries were licensed in Denver alone, "roughly twice the number of the city’s public schools," Dr. Wang and his colleagues noted.

They performed the first U.S. study to asses the impact of this legislation on pediatric poisonings: a retrospective cohort study at a tertiary children’s hospital that had approximately 65,000 annual visits to its emergency department. The researchers focused on children under age 12 who were evaluated for possible toxic exposures, comparing the 790 patients seen from 2005 to Sept. 30, 2009, before legalization with the 588 seen from Oct. 1, 2009, to the end of 2011 after medical marijuana was legalized.

There were no cases of marijuana poisoning during the first time period, compared with 14 in the second time period. The proportion of such visits in relation to all pediatric ED visits for toxic exposures thus rose from 0% to 2.4% after the drug was decriminalized.

Children as young as 8 months of age were exposed to marijuana. Most presented with central nervous system (CNS) effects such as lethargy or somnolence, and some displayed rigidity, ataxia, hypoxia, or respiratory insufficiency, the researchers reported (JAMA Ped. 2013 May 27 [doi: 10.1001/jamapediatrics.2013.140]).

Only two patients were known to have been exposed to marijuana on arrival at the ED; they underwent a urine toxicology screen. The rest underwent extensive workups to determine the cause of their symptoms, which included urine toxicology screens; blood work; CT and x-ray imaging of the head, spine, and abdomen; and lumbar punctures.

Only one patient, a 13-year-old girl with minimal symptoms, was discharged after being assessed. The rest were observed in the ED (5) or admitted for hospitalization (8), including 2 children who required admission to the PICU.

This 93% rate of hospitalization reinforces the hypothesis that current marijuana exposures induce more serious effects than past exposures did, because historically only 1.3% of marijuana poisoning cases required hospitalization, Dr. Wang and his associates said.

Eight of these 14 (57%) marijuana exposures were from food products that incorporated the drug. "Currently, there are no regulations on storing medical marijuana products in child-resistant containers, including labels with warnings or precautions, or providing counseling on safe storage practices," the investigators said.

As is the case with many accidental pediatric exposures to other medications, the source of the medical marijuana in several of the cases in this study was the child’s grandparent.

Dr. Wang and his colleagues added that proponents of legalizing marijuana often claim that it is "safer" than alcohol. However, only two patients under age 12 were evaluated for alcohol exposure at this ED since 2009. One, an 11-year-old, intentionally drank alcohol and only required observation for intoxication; the other, a 2-year-old who accidentally drank a household product containing ethanol, was discharged after failing to develop any symptoms.

In comparison, the symptoms, invasive assessments, and hospitalizations described in this study can hardly be considered "safer." These findings clearly demonstrate that "the consequences of marijuana exposure in children should be part of the ongoing debate on legalizing marijuana," the researchers said.

Seventeen states and Washington, D.C., have passed laws to decriminalize medical marijuana at the state level, even though marijuana is a schedule I drug under the Controlled Substances Act. "In November 2012, Colorado and Washington [State] passed amendments legalizing the recreational use of marijuana," Dr. Wang and his associates said.

No financial conflicts of interest were reported.

Sometimes those in helping roles could use some help, too. Caring for people who are suffering can cause a form of burnout known as “compassion fatigue.” After a while, it’s quite possible to become disillusioned and numb.

“Hospitalists can be affected as easily as any other physician in the hospital setting,” says Patricia Smith, founder of the Compassion Fatigue Awareness Project, the educational arm of Healthy Caregiving LLC in Mountain View, Calif. “This can be due to long hours, overload of patients, new procedures, and processes that are mandatory in healthcare reform, issues among hospital colleagues, poor leadership, and the types of violence and trauma they are experiencing, especially if a hospitalist is in the ED as a first responder.”

When signs of compassion fatigue appear to overwhelm a colleague, offer a shoulder to lean on and accept the legitimacy of the individual’s feelings. Health professionals often are “not valued for the caregiving work we do, and we are not validated for who we are,” Smith says. “To provide this level of support to each other is the best thing we can do.”

Healthcare workers who succumb to compassion fatigue often experience too much empathy and perform their jobs with unwavering devotion.

Self-neglect is common and makes them more susceptible to compassion fatigue, says Dennis Portnoy, a licensed psychotherapist in San Francisco and author of “Overextended and Undernourished: A Self-Care Guide for People in Helping Roles.”

Hospital-based educational sessions on compassion fatigue can be beneficial. “Helpers are often predisposed to being more attentive to the needs of others than they are at caring for their own needs,” he says. “Many helpers understand the importance of self-care intellectually, but this knowledge doesn’t lead to taking better care of themselves.”

Hospitalists might be reluctant to seek emotional support from colleagues, family, and friends. Support is essential in the prevention of and recovery from compassion fatigue. It’s also important to establish firm boundaries, Portnoy says. He suggests providers cultivate a healthy detachment from traumatic events while being empathetically engaged with people in distress.

To allow for detachment, job duties ideally should consist of more than direct patient care, says Katherine C. Chretien, MD, FACP, chief of the hospitalist section and clerkship director at Washington, D.C.’s Veterans Affairs Medical Center. As one of seven hospitalists in the group, she avoids scheduling anyone for longer than two consecutive weeks of attending on wards.

“At the end of one of those blocks, I am emotionally exhausted and need a break from that,” Dr. Chretien says. That’s when physicians should spend time on administrative and research tasks or quality improvement (QI) projects before resuming patient care.

Striking a balance between work and leisure also promotes resilience. “We have to care for ourselves first in order to care for others,” says Dr. Chretien, 38, founder and editor of the Mothers in Medicine blog, launched in 2008. She’s married to a physician, and they have three children, ages, 7, 5, and 2.

Listen to Dr. Chretien discuss the importance of fair schedules, work-life balance, and support systems

Dr. Chretien, who is an associate professor of medicine at George Washington University, recommends that hospitalists open up about their experiences—both good and bad—with peers. “We have regular meetings where we have an agenda to talk about our division issues,” she says. “But also, it’s an open forum to share whatever is on your mind.”

Despite the difficult challenges that arise, “there are moments when you’re so glad you’re a physician,” Dr. Chretien says. “You see the humanity in what we do.” TH

Susan Kreimer is a freelance writer in New York.

Sometimes those in helping roles could use some help, too. Caring for people who are suffering can cause a form of burnout known as “compassion fatigue.” After a while, it’s quite possible to become disillusioned and numb.

“Hospitalists can be affected as easily as any other physician in the hospital setting,” says Patricia Smith, founder of the Compassion Fatigue Awareness Project, the educational arm of Healthy Caregiving LLC in Mountain View, Calif. “This can be due to long hours, overload of patients, new procedures, and processes that are mandatory in healthcare reform, issues among hospital colleagues, poor leadership, and the types of violence and trauma they are experiencing, especially if a hospitalist is in the ED as a first responder.”

When signs of compassion fatigue appear to overwhelm a colleague, offer a shoulder to lean on and accept the legitimacy of the individual’s feelings. Health professionals often are “not valued for the caregiving work we do, and we are not validated for who we are,” Smith says. “To provide this level of support to each other is the best thing we can do.”

Healthcare workers who succumb to compassion fatigue often experience too much empathy and perform their jobs with unwavering devotion.

Self-neglect is common and makes them more susceptible to compassion fatigue, says Dennis Portnoy, a licensed psychotherapist in San Francisco and author of “Overextended and Undernourished: A Self-Care Guide for People in Helping Roles.”

Hospital-based educational sessions on compassion fatigue can be beneficial. “Helpers are often predisposed to being more attentive to the needs of others than they are at caring for their own needs,” he says. “Many helpers understand the importance of self-care intellectually, but this knowledge doesn’t lead to taking better care of themselves.”

Hospitalists might be reluctant to seek emotional support from colleagues, family, and friends. Support is essential in the prevention of and recovery from compassion fatigue. It’s also important to establish firm boundaries, Portnoy says. He suggests providers cultivate a healthy detachment from traumatic events while being empathetically engaged with people in distress.

To allow for detachment, job duties ideally should consist of more than direct patient care, says Katherine C. Chretien, MD, FACP, chief of the hospitalist section and clerkship director at Washington, D.C.’s Veterans Affairs Medical Center. As one of seven hospitalists in the group, she avoids scheduling anyone for longer than two consecutive weeks of attending on wards.

“At the end of one of those blocks, I am emotionally exhausted and need a break from that,” Dr. Chretien says. That’s when physicians should spend time on administrative and research tasks or quality improvement (QI) projects before resuming patient care.

Striking a balance between work and leisure also promotes resilience. “We have to care for ourselves first in order to care for others,” says Dr. Chretien, 38, founder and editor of the Mothers in Medicine blog, launched in 2008. She’s married to a physician, and they have three children, ages, 7, 5, and 2.

Listen to Dr. Chretien discuss the importance of fair schedules, work-life balance, and support systems

Dr. Chretien, who is an associate professor of medicine at George Washington University, recommends that hospitalists open up about their experiences—both good and bad—with peers. “We have regular meetings where we have an agenda to talk about our division issues,” she says. “But also, it’s an open forum to share whatever is on your mind.”

Despite the difficult challenges that arise, “there are moments when you’re so glad you’re a physician,” Dr. Chretien says. “You see the humanity in what we do.” TH

Susan Kreimer is a freelance writer in New York.

Sometimes those in helping roles could use some help, too. Caring for people who are suffering can cause a form of burnout known as “compassion fatigue.” After a while, it’s quite possible to become disillusioned and numb.

“Hospitalists can be affected as easily as any other physician in the hospital setting,” says Patricia Smith, founder of the Compassion Fatigue Awareness Project, the educational arm of Healthy Caregiving LLC in Mountain View, Calif. “This can be due to long hours, overload of patients, new procedures, and processes that are mandatory in healthcare reform, issues among hospital colleagues, poor leadership, and the types of violence and trauma they are experiencing, especially if a hospitalist is in the ED as a first responder.”

When signs of compassion fatigue appear to overwhelm a colleague, offer a shoulder to lean on and accept the legitimacy of the individual’s feelings. Health professionals often are “not valued for the caregiving work we do, and we are not validated for who we are,” Smith says. “To provide this level of support to each other is the best thing we can do.”

Healthcare workers who succumb to compassion fatigue often experience too much empathy and perform their jobs with unwavering devotion.

Self-neglect is common and makes them more susceptible to compassion fatigue, says Dennis Portnoy, a licensed psychotherapist in San Francisco and author of “Overextended and Undernourished: A Self-Care Guide for People in Helping Roles.”

Hospital-based educational sessions on compassion fatigue can be beneficial. “Helpers are often predisposed to being more attentive to the needs of others than they are at caring for their own needs,” he says. “Many helpers understand the importance of self-care intellectually, but this knowledge doesn’t lead to taking better care of themselves.”

Hospitalists might be reluctant to seek emotional support from colleagues, family, and friends. Support is essential in the prevention of and recovery from compassion fatigue. It’s also important to establish firm boundaries, Portnoy says. He suggests providers cultivate a healthy detachment from traumatic events while being empathetically engaged with people in distress.

To allow for detachment, job duties ideally should consist of more than direct patient care, says Katherine C. Chretien, MD, FACP, chief of the hospitalist section and clerkship director at Washington, D.C.’s Veterans Affairs Medical Center. As one of seven hospitalists in the group, she avoids scheduling anyone for longer than two consecutive weeks of attending on wards.

“At the end of one of those blocks, I am emotionally exhausted and need a break from that,” Dr. Chretien says. That’s when physicians should spend time on administrative and research tasks or quality improvement (QI) projects before resuming patient care.

Striking a balance between work and leisure also promotes resilience. “We have to care for ourselves first in order to care for others,” says Dr. Chretien, 38, founder and editor of the Mothers in Medicine blog, launched in 2008. She’s married to a physician, and they have three children, ages, 7, 5, and 2.

Listen to Dr. Chretien discuss the importance of fair schedules, work-life balance, and support systems

Dr. Chretien, who is an associate professor of medicine at George Washington University, recommends that hospitalists open up about their experiences—both good and bad—with peers. “We have regular meetings where we have an agenda to talk about our division issues,” she says. “But also, it’s an open forum to share whatever is on your mind.”

Despite the difficult challenges that arise, “there are moments when you’re so glad you’re a physician,” Dr. Chretien says. “You see the humanity in what we do.” TH

Susan Kreimer is a freelance writer in New York.

WASHINGTON – Nearly half of teens reported texting while driving at least once in the past 30 days, according to two analyses of survey data from the Centers for Disease Control and Prevention.

And state laws banning texting while driving are having little impact among teen drivers, researchers cautioned.

Physicians "need to discuss this with license-eligible teens, and they need to [help ensure], too, that parents are not [setting an example] by texting while driving," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York in New Hyde Park, who presented an analysis of the CDC survey data at the annual meeting of the Pediatric Academic Societies.

©lisafx/iStockphoto.com

Motor vehicle accidents are the leading cause of death among teenagers, and many experts believe that texting while driving is more dangerous for all drivers than driving while intoxicated. One previous study of adult drivers found that the act of texting while driving raises the risk of a crash 23-fold.

The CDC conducts its national Youth Risk Behavior Surveillance System survey every 2 years to monitor six types of health risk behaviors that contribute to the leading causes of death, disability, and social problems among U.S. youths.

For the first time, the 2011 survey included a question about texting while driving: "During the past 30 days, on how many days did you text or e-mail while driving a car or other vehicle?" Of the nationally representative sample of high school students, approximately 8,500 students responded to the question.

Researchers performed two separate analyses of the CDC survey data – one conducted by CDC officials and published in June in Pediatrics, and another presented by Dr. Adesman at the meeting.

According to the CDC analysis, approximately 45% of respondents reported texting while driving during the 30 days before the survey, and more than one in four of these teens (12% of the total) said they do so everyday. The prevalence of any texting while driving increased with age, from 33% for 16-year-olds to 58% for students aged 18 and older.

Male students also were more likely to report texting while driving (46%) than female students (42%), reported Emily O’Malley Olsen and her associates at the CDC (Pediatrics 2013 [doi:10.1542/peds.2012-3462]).

The analyses also demonstrated that students who text while driving are more likely to engage in several other high-risk behaviors.

Students who engaged in texting while driving were 5.33 times more likely to drive when they had been drinking alcohol than students who did not engage in texting while driving. They were also more likely to not always wear their seatbelts and to ride with a driver who had been drinking alcohol. The prevalence of each risky motor-vehicle behavior increased as the frequency of texting while driving increased.

Dr. Adesman’s study assessed a broader range of high-risk behaviors – not only driving-related behaviors – in examining the association of other behaviors with texting while driving. He and his coinvestigators found that teens who texted while driving were significantly more likely to drink and drive, frequently consume alcohol, use indoor tanning devices, and have unprotected sex.

They also examined the effectiveness of state laws. Teens living in a state with a law that prohibits texting while driving were only slightly less likely to report the practice than teens living in a state without such a law.

"State laws banning texting while driving are not effective," Dr. Adesman said in an interview after the meeting. "The most likely effective intervention would be for parents, with their teens’ consent, to download applications that turn off the texting function while the car is in motion. We have some of this technology available today, and more should be developed."

Physicians can also suggest that teens pledge – in official agreements or "contracts" with their parents – not to text while driving, he said.

The two studies used different criteria for their samples. While the CDC analysis looked at all students 16 years of age and older, Dr. Adesman and his coinvestigators limited their sample to teens who, in their states, were eligible to drive with a full or unrestricted license. The two analyses’ main findings on the prevalence of texting while driving were similar, however, with 49% of males and 45% of females reportedly engaging in the practice.

The new data build on several previous studies that show high rates of texting while driving among teens. In an Insurance Institute for Highway Safety telephone survey in 2010 of approximately 1,200 drivers across the United States, 13% of drivers of all ages, and 43% of drivers aged 18-24 years, reported texting while driving.

The investigators of both studies reported that they had no relevant financial disclosures.

WASHINGTON – Nearly half of teens reported texting while driving at least once in the past 30 days, according to two analyses of survey data from the Centers for Disease Control and Prevention.

And state laws banning texting while driving are having little impact among teen drivers, researchers cautioned.

Physicians "need to discuss this with license-eligible teens, and they need to [help ensure], too, that parents are not [setting an example] by texting while driving," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York in New Hyde Park, who presented an analysis of the CDC survey data at the annual meeting of the Pediatric Academic Societies.

©lisafx/iStockphoto.com

Motor vehicle accidents are the leading cause of death among teenagers, and many experts believe that texting while driving is more dangerous for all drivers than driving while intoxicated. One previous study of adult drivers found that the act of texting while driving raises the risk of a crash 23-fold.

The CDC conducts its national Youth Risk Behavior Surveillance System survey every 2 years to monitor six types of health risk behaviors that contribute to the leading causes of death, disability, and social problems among U.S. youths.

For the first time, the 2011 survey included a question about texting while driving: "During the past 30 days, on how many days did you text or e-mail while driving a car or other vehicle?" Of the nationally representative sample of high school students, approximately 8,500 students responded to the question.

Researchers performed two separate analyses of the CDC survey data – one conducted by CDC officials and published in June in Pediatrics, and another presented by Dr. Adesman at the meeting.

According to the CDC analysis, approximately 45% of respondents reported texting while driving during the 30 days before the survey, and more than one in four of these teens (12% of the total) said they do so everyday. The prevalence of any texting while driving increased with age, from 33% for 16-year-olds to 58% for students aged 18 and older.

Male students also were more likely to report texting while driving (46%) than female students (42%), reported Emily O’Malley Olsen and her associates at the CDC (Pediatrics 2013 [doi:10.1542/peds.2012-3462]).

The analyses also demonstrated that students who text while driving are more likely to engage in several other high-risk behaviors.

Students who engaged in texting while driving were 5.33 times more likely to drive when they had been drinking alcohol than students who did not engage in texting while driving. They were also more likely to not always wear their seatbelts and to ride with a driver who had been drinking alcohol. The prevalence of each risky motor-vehicle behavior increased as the frequency of texting while driving increased.

Dr. Adesman’s study assessed a broader range of high-risk behaviors – not only driving-related behaviors – in examining the association of other behaviors with texting while driving. He and his coinvestigators found that teens who texted while driving were significantly more likely to drink and drive, frequently consume alcohol, use indoor tanning devices, and have unprotected sex.

They also examined the effectiveness of state laws. Teens living in a state with a law that prohibits texting while driving were only slightly less likely to report the practice than teens living in a state without such a law.

"State laws banning texting while driving are not effective," Dr. Adesman said in an interview after the meeting. "The most likely effective intervention would be for parents, with their teens’ consent, to download applications that turn off the texting function while the car is in motion. We have some of this technology available today, and more should be developed."

Physicians can also suggest that teens pledge – in official agreements or "contracts" with their parents – not to text while driving, he said.

The two studies used different criteria for their samples. While the CDC analysis looked at all students 16 years of age and older, Dr. Adesman and his coinvestigators limited their sample to teens who, in their states, were eligible to drive with a full or unrestricted license. The two analyses’ main findings on the prevalence of texting while driving were similar, however, with 49% of males and 45% of females reportedly engaging in the practice.

The new data build on several previous studies that show high rates of texting while driving among teens. In an Insurance Institute for Highway Safety telephone survey in 2010 of approximately 1,200 drivers across the United States, 13% of drivers of all ages, and 43% of drivers aged 18-24 years, reported texting while driving.

The investigators of both studies reported that they had no relevant financial disclosures.

WASHINGTON – Nearly half of teens reported texting while driving at least once in the past 30 days, according to two analyses of survey data from the Centers for Disease Control and Prevention.

And state laws banning texting while driving are having little impact among teen drivers, researchers cautioned.

Physicians "need to discuss this with license-eligible teens, and they need to [help ensure], too, that parents are not [setting an example] by texting while driving," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York in New Hyde Park, who presented an analysis of the CDC survey data at the annual meeting of the Pediatric Academic Societies.

©lisafx/iStockphoto.com

Motor vehicle accidents are the leading cause of death among teenagers, and many experts believe that texting while driving is more dangerous for all drivers than driving while intoxicated. One previous study of adult drivers found that the act of texting while driving raises the risk of a crash 23-fold.

The CDC conducts its national Youth Risk Behavior Surveillance System survey every 2 years to monitor six types of health risk behaviors that contribute to the leading causes of death, disability, and social problems among U.S. youths.

For the first time, the 2011 survey included a question about texting while driving: "During the past 30 days, on how many days did you text or e-mail while driving a car or other vehicle?" Of the nationally representative sample of high school students, approximately 8,500 students responded to the question.

Researchers performed two separate analyses of the CDC survey data – one conducted by CDC officials and published in June in Pediatrics, and another presented by Dr. Adesman at the meeting.

According to the CDC analysis, approximately 45% of respondents reported texting while driving during the 30 days before the survey, and more than one in four of these teens (12% of the total) said they do so everyday. The prevalence of any texting while driving increased with age, from 33% for 16-year-olds to 58% for students aged 18 and older.

Male students also were more likely to report texting while driving (46%) than female students (42%), reported Emily O’Malley Olsen and her associates at the CDC (Pediatrics 2013 [doi:10.1542/peds.2012-3462]).

The analyses also demonstrated that students who text while driving are more likely to engage in several other high-risk behaviors.

Students who engaged in texting while driving were 5.33 times more likely to drive when they had been drinking alcohol than students who did not engage in texting while driving. They were also more likely to not always wear their seatbelts and to ride with a driver who had been drinking alcohol. The prevalence of each risky motor-vehicle behavior increased as the frequency of texting while driving increased.

Dr. Adesman’s study assessed a broader range of high-risk behaviors – not only driving-related behaviors – in examining the association of other behaviors with texting while driving. He and his coinvestigators found that teens who texted while driving were significantly more likely to drink and drive, frequently consume alcohol, use indoor tanning devices, and have unprotected sex.

They also examined the effectiveness of state laws. Teens living in a state with a law that prohibits texting while driving were only slightly less likely to report the practice than teens living in a state without such a law.

"State laws banning texting while driving are not effective," Dr. Adesman said in an interview after the meeting. "The most likely effective intervention would be for parents, with their teens’ consent, to download applications that turn off the texting function while the car is in motion. We have some of this technology available today, and more should be developed."

Physicians can also suggest that teens pledge – in official agreements or "contracts" with their parents – not to text while driving, he said.

The two studies used different criteria for their samples. While the CDC analysis looked at all students 16 years of age and older, Dr. Adesman and his coinvestigators limited their sample to teens who, in their states, were eligible to drive with a full or unrestricted license. The two analyses’ main findings on the prevalence of texting while driving were similar, however, with 49% of males and 45% of females reportedly engaging in the practice.

The new data build on several previous studies that show high rates of texting while driving among teens. In an Insurance Institute for Highway Safety telephone survey in 2010 of approximately 1,200 drivers across the United States, 13% of drivers of all ages, and 43% of drivers aged 18-24 years, reported texting while driving.

The investigators of both studies reported that they had no relevant financial disclosures.

Gastrointestinal mucosal toxicity is extremely common following cytotoxic therapies. The alimentary mucosa is particularly susceptible to injury and dysfunction, leading to many debilitating complications. Despite much research, there is currently no single noninvasive biomarker to detect gut injury. Several biomarkers have been investigated in the context of gastrointestinal diseases, which may prove useful in the oncology arena. Identification of a biomarker that is easy to obtain and measure and that accurately identifies mucosal damage would allow for improved patient diagnosis of toxicities and for personalized treatment regimens. In this review, we highlight the effectiveness of urine and breath tests as potential clinically effective biomarkers, with significant focus placed on the emerging role of the carbon-13 sucrose breath test (13C SBT). The 13C SBT provides a simple, noninvasive, and integrated measure of gut function. The 13C SBT also has the potential to monitor gut function in the setting of cytotoxic therapy–induced mucositis, or in the assessment of the efficacy of antimucositis agents.

*For a PDF of the full article, click on the link to the left of this introduction.

Gastrointestinal mucosal toxicity is extremely common following cytotoxic therapies. The alimentary mucosa is particularly susceptible to injury and dysfunction, leading to many debilitating complications. Despite much research, there is currently no single noninvasive biomarker to detect gut injury. Several biomarkers have been investigated in the context of gastrointestinal diseases, which may prove useful in the oncology arena. Identification of a biomarker that is easy to obtain and measure and that accurately identifies mucosal damage would allow for improved patient diagnosis of toxicities and for personalized treatment regimens. In this review, we highlight the effectiveness of urine and breath tests as potential clinically effective biomarkers, with significant focus placed on the emerging role of the carbon-13 sucrose breath test (13C SBT). The 13C SBT provides a simple, noninvasive, and integrated measure of gut function. The 13C SBT also has the potential to monitor gut function in the setting of cytotoxic therapy–induced mucositis, or in the assessment of the efficacy of antimucositis agents.

*For a PDF of the full article, click on the link to the left of this introduction.

Gastrointestinal mucosal toxicity is extremely common following cytotoxic therapies. The alimentary mucosa is particularly susceptible to injury and dysfunction, leading to many debilitating complications. Despite much research, there is currently no single noninvasive biomarker to detect gut injury. Several biomarkers have been investigated in the context of gastrointestinal diseases, which may prove useful in the oncology arena. Identification of a biomarker that is easy to obtain and measure and that accurately identifies mucosal damage would allow for improved patient diagnosis of toxicities and for personalized treatment regimens. In this review, we highlight the effectiveness of urine and breath tests as potential clinically effective biomarkers, with significant focus placed on the emerging role of the carbon-13 sucrose breath test (13C SBT). The 13C SBT provides a simple, noninvasive, and integrated measure of gut function. The 13C SBT also has the potential to monitor gut function in the setting of cytotoxic therapy–induced mucositis, or in the assessment of the efficacy of antimucositis agents.

*For a PDF of the full article, click on the link to the left of this introduction.

Most patients with esophageal cancer are diagnosed with locoregionally advanced disease at presentation, with an overall 5-year survival rate of 19%.¹ Clinical trials have failed to specify the optimal treatment regimen; however, a multimodal approach to therapy is considered the standard of care for patients with locoregionally advanced disease.² Most often, patients are treated with chemoradiotherapy with or without subsequent esophagectomy. Curative-intent interventions for advanced esophageal cancer are necessarily aggressive and may be associated with significant morbidity and even treatment-related mortality. Appropriate selection of patients for intervention is necessary so that those who are most likely to benefit can initiate curative-intent therapy, whereas those who are unlikely to benefit from intervention may be appropriately initiated on less toxic palliative-intent treatment. The use of positron emission tomography (PET) in esophageal cancer staging has improved the ability to detect distant disease at diagnosis,^3-7 an important factor in determining the appropriate treatment regimen and prognosis…

To read the full article, click on the PDF icon at the top of this introduction.

Most patients with esophageal cancer are diagnosed with locoregionally advanced disease at presentation, with an overall 5-year survival rate of 19%.¹ Clinical trials have failed to specify the optimal treatment regimen; however, a multimodal approach to therapy is considered the standard of care for patients with locoregionally advanced disease.² Most often, patients are treated with chemoradiotherapy with or without subsequent esophagectomy. Curative-intent interventions for advanced esophageal cancer are necessarily aggressive and may be associated with significant morbidity and even treatment-related mortality. Appropriate selection of patients for intervention is necessary so that those who are most likely to benefit can initiate curative-intent therapy, whereas those who are unlikely to benefit from intervention may be appropriately initiated on less toxic palliative-intent treatment. The use of positron emission tomography (PET) in esophageal cancer staging has improved the ability to detect distant disease at diagnosis,^3-7 an important factor in determining the appropriate treatment regimen and prognosis…

To read the full article, click on the PDF icon at the top of this introduction.

Most patients with esophageal cancer are diagnosed with locoregionally advanced disease at presentation, with an overall 5-year survival rate of 19%.¹ Clinical trials have failed to specify the optimal treatment regimen; however, a multimodal approach to therapy is considered the standard of care for patients with locoregionally advanced disease.² Most often, patients are treated with chemoradiotherapy with or without subsequent esophagectomy. Curative-intent interventions for advanced esophageal cancer are necessarily aggressive and may be associated with significant morbidity and even treatment-related mortality. Appropriate selection of patients for intervention is necessary so that those who are most likely to benefit can initiate curative-intent therapy, whereas those who are unlikely to benefit from intervention may be appropriately initiated on less toxic palliative-intent treatment. The use of positron emission tomography (PET) in esophageal cancer staging has improved the ability to detect distant disease at diagnosis,^3-7 an important factor in determining the appropriate treatment regimen and prognosis…

To read the full article, click on the PDF icon at the top of this introduction.

ORLANDO – Both 12- and 24-week regimens of an investigational interferon-free therapy for hepatitis C were associated with high sustained virological response rates at 12 weeks post treatment in a phase II study of patients with hepatitis C virus genotype 1 who had baseline characteristics associated with poor response to interferon-based therapies.

The findings of this subgroup analysis of the randomized, open-label, multicenter Aviator trial demonstrate that the high response rates recently reported for the entire cohort also apply to patients with older age, black race, Hispanic/Latino ethnicity, interleukin (IL)-28B non-cc genotype, and higher body mass index (BMI), Dr. Frederick Nunes reported at the annual Digestive Disease Week.

The Aviator trial assessed the safety and efficacy of various dosing regimens and combinations of three AbbVie investigational direct-acting antivirals (DAAs) with or without ribavirin, including the potent hepatitis C virus (HCV) protease inhibitor ABT-450 dosed with 100 mg of ritonavir (ABT-450/r, dosed at 100 or 150 mg daily), the NS5A inhibitor ABT-267 (25 mg daily), and the non-nucleoside NS5B inhibitor ABT-333 (400 mg twice daily). A total of 247 patients were included in the subanalysis, Dr. Nunes reported at the meeting.

The regimen that included all three investigational drugs and ribavirin, known as 3 DAA/RBV, was associated with sustained virological response rates of 99% and 93% at 12 weeks in treatment-naive patients and previous peg-interferon/ribavirin (peg-IFN/RBV) null responders, respectively, said Dr. Nunes, who is clinical associate professor of medicine in the University of Pennsylvania Health System, and section chief of gastroenterology at Pennsylvania Hospital, Philadelphia.

In the current analysis, high sustained virological response rates at 12 weeks (SVR12) were also achieved in the 247 patients with chronic HCV genotype 1, including 159 treatment-naive and 88 previous peg-IFN/RBV null responders, who were assigned to 12 or 24 weeks of 3 DAA/RBV. The virological response rates were 99% and 93% for the treatment-naive 12- and 24-week groups, respectively, and 93% and 98% for the null responder 12- and 24-week groups.

The high responses occurred regardless of treatment duration, age, race, ethnicity, BMI, Homeostatic Model of Assessment–Insulin Resistance (HOMA-IR), IL-28B host genotype, or baseline viral load. The rates did not differ significantly on any comparison made in treatment-naive patients or previous null responders, he said.

In the treatment-naive patients, no breakthroughs occurred, although 1% of those in the 12-week treatment arm relapsed, and 3% of the 24-week treatment group relapsed.

In the null responder group, no relapses occurred, but breakthroughs occurred in 7% of those in the 12-week treatment arm, and in 2% of the 24-week treatment arm, he said.

Treatment was safe and generally well tolerated. Four patients discontinued treatment due to drug-related adverse events, most commonly fatigue (in 32.7% and 23.9% of treatment-naive and null responders, respectively) and headache (31.4% and 30.7%, respectively).

One patient had a serious adverse event (arthralgia) considered to be possibly related to the study drug regimen.

Because ribavirin was included in the treatment regimens, it is impossible to tease out whether the adverse events were associated with that drug or with the investigational DAAs, Dr. Nunes noted.

Patients included in the study were noncirrhotic adults aged 18-70 years with a BMI between 18 and 38 kg/m², and HCV genotype 1.

"The overall efficacy was excellent irrespective of the baseline grouping. So black race, Hispanic/Latino ethnicity, age greater than 50, BMI over 30, male gender, HOMA-IR greater than 3, IL-28B non-cc genotype, and viral load greater than 7 logs all had very high SVR12 response rates," Dr. Nunes said.

The safety and efficacy of this interferon-free 3 DAA/RBV therapy will be further explored in phase III studies, he said.

Dr. Nunes has received grant or research support from Merck, Abbott Laboratories, and Roche Pharma AG.

ORLANDO – Both 12- and 24-week regimens of an investigational interferon-free therapy for hepatitis C were associated with high sustained virological response rates at 12 weeks post treatment in a phase II study of patients with hepatitis C virus genotype 1 who had baseline characteristics associated with poor response to interferon-based therapies.

The findings of this subgroup analysis of the randomized, open-label, multicenter Aviator trial demonstrate that the high response rates recently reported for the entire cohort also apply to patients with older age, black race, Hispanic/Latino ethnicity, interleukin (IL)-28B non-cc genotype, and higher body mass index (BMI), Dr. Frederick Nunes reported at the annual Digestive Disease Week.

The Aviator trial assessed the safety and efficacy of various dosing regimens and combinations of three AbbVie investigational direct-acting antivirals (DAAs) with or without ribavirin, including the potent hepatitis C virus (HCV) protease inhibitor ABT-450 dosed with 100 mg of ritonavir (ABT-450/r, dosed at 100 or 150 mg daily), the NS5A inhibitor ABT-267 (25 mg daily), and the non-nucleoside NS5B inhibitor ABT-333 (400 mg twice daily). A total of 247 patients were included in the subanalysis, Dr. Nunes reported at the meeting.

The regimen that included all three investigational drugs and ribavirin, known as 3 DAA/RBV, was associated with sustained virological response rates of 99% and 93% at 12 weeks in treatment-naive patients and previous peg-interferon/ribavirin (peg-IFN/RBV) null responders, respectively, said Dr. Nunes, who is clinical associate professor of medicine in the University of Pennsylvania Health System, and section chief of gastroenterology at Pennsylvania Hospital, Philadelphia.

In the current analysis, high sustained virological response rates at 12 weeks (SVR12) were also achieved in the 247 patients with chronic HCV genotype 1, including 159 treatment-naive and 88 previous peg-IFN/RBV null responders, who were assigned to 12 or 24 weeks of 3 DAA/RBV. The virological response rates were 99% and 93% for the treatment-naive 12- and 24-week groups, respectively, and 93% and 98% for the null responder 12- and 24-week groups.

The high responses occurred regardless of treatment duration, age, race, ethnicity, BMI, Homeostatic Model of Assessment–Insulin Resistance (HOMA-IR), IL-28B host genotype, or baseline viral load. The rates did not differ significantly on any comparison made in treatment-naive patients or previous null responders, he said.

In the treatment-naive patients, no breakthroughs occurred, although 1% of those in the 12-week treatment arm relapsed, and 3% of the 24-week treatment group relapsed.

In the null responder group, no relapses occurred, but breakthroughs occurred in 7% of those in the 12-week treatment arm, and in 2% of the 24-week treatment arm, he said.

Treatment was safe and generally well tolerated. Four patients discontinued treatment due to drug-related adverse events, most commonly fatigue (in 32.7% and 23.9% of treatment-naive and null responders, respectively) and headache (31.4% and 30.7%, respectively).

One patient had a serious adverse event (arthralgia) considered to be possibly related to the study drug regimen.

Because ribavirin was included in the treatment regimens, it is impossible to tease out whether the adverse events were associated with that drug or with the investigational DAAs, Dr. Nunes noted.

Patients included in the study were noncirrhotic adults aged 18-70 years with a BMI between 18 and 38 kg/m², and HCV genotype 1.

"The overall efficacy was excellent irrespective of the baseline grouping. So black race, Hispanic/Latino ethnicity, age greater than 50, BMI over 30, male gender, HOMA-IR greater than 3, IL-28B non-cc genotype, and viral load greater than 7 logs all had very high SVR12 response rates," Dr. Nunes said.

The safety and efficacy of this interferon-free 3 DAA/RBV therapy will be further explored in phase III studies, he said.

Dr. Nunes has received grant or research support from Merck, Abbott Laboratories, and Roche Pharma AG.

ORLANDO – Both 12- and 24-week regimens of an investigational interferon-free therapy for hepatitis C were associated with high sustained virological response rates at 12 weeks post treatment in a phase II study of patients with hepatitis C virus genotype 1 who had baseline characteristics associated with poor response to interferon-based therapies.

The findings of this subgroup analysis of the randomized, open-label, multicenter Aviator trial demonstrate that the high response rates recently reported for the entire cohort also apply to patients with older age, black race, Hispanic/Latino ethnicity, interleukin (IL)-28B non-cc genotype, and higher body mass index (BMI), Dr. Frederick Nunes reported at the annual Digestive Disease Week.

The Aviator trial assessed the safety and efficacy of various dosing regimens and combinations of three AbbVie investigational direct-acting antivirals (DAAs) with or without ribavirin, including the potent hepatitis C virus (HCV) protease inhibitor ABT-450 dosed with 100 mg of ritonavir (ABT-450/r, dosed at 100 or 150 mg daily), the NS5A inhibitor ABT-267 (25 mg daily), and the non-nucleoside NS5B inhibitor ABT-333 (400 mg twice daily). A total of 247 patients were included in the subanalysis, Dr. Nunes reported at the meeting.

The regimen that included all three investigational drugs and ribavirin, known as 3 DAA/RBV, was associated with sustained virological response rates of 99% and 93% at 12 weeks in treatment-naive patients and previous peg-interferon/ribavirin (peg-IFN/RBV) null responders, respectively, said Dr. Nunes, who is clinical associate professor of medicine in the University of Pennsylvania Health System, and section chief of gastroenterology at Pennsylvania Hospital, Philadelphia.

In the current analysis, high sustained virological response rates at 12 weeks (SVR12) were also achieved in the 247 patients with chronic HCV genotype 1, including 159 treatment-naive and 88 previous peg-IFN/RBV null responders, who were assigned to 12 or 24 weeks of 3 DAA/RBV. The virological response rates were 99% and 93% for the treatment-naive 12- and 24-week groups, respectively, and 93% and 98% for the null responder 12- and 24-week groups.

The high responses occurred regardless of treatment duration, age, race, ethnicity, BMI, Homeostatic Model of Assessment–Insulin Resistance (HOMA-IR), IL-28B host genotype, or baseline viral load. The rates did not differ significantly on any comparison made in treatment-naive patients or previous null responders, he said.

In the treatment-naive patients, no breakthroughs occurred, although 1% of those in the 12-week treatment arm relapsed, and 3% of the 24-week treatment group relapsed.

In the null responder group, no relapses occurred, but breakthroughs occurred in 7% of those in the 12-week treatment arm, and in 2% of the 24-week treatment arm, he said.

Treatment was safe and generally well tolerated. Four patients discontinued treatment due to drug-related adverse events, most commonly fatigue (in 32.7% and 23.9% of treatment-naive and null responders, respectively) and headache (31.4% and 30.7%, respectively).

One patient had a serious adverse event (arthralgia) considered to be possibly related to the study drug regimen.

Because ribavirin was included in the treatment regimens, it is impossible to tease out whether the adverse events were associated with that drug or with the investigational DAAs, Dr. Nunes noted.

Patients included in the study were noncirrhotic adults aged 18-70 years with a BMI between 18 and 38 kg/m², and HCV genotype 1.

"The overall efficacy was excellent irrespective of the baseline grouping. So black race, Hispanic/Latino ethnicity, age greater than 50, BMI over 30, male gender, HOMA-IR greater than 3, IL-28B non-cc genotype, and viral load greater than 7 logs all had very high SVR12 response rates," Dr. Nunes said.

The safety and efficacy of this interferon-free 3 DAA/RBV therapy will be further explored in phase III studies, he said.

Dr. Nunes has received grant or research support from Merck, Abbott Laboratories, and Roche Pharma AG.

ABSTRACT

Oncologists frequently face the difficult task of estimating prognosis in patients with incurable malignancies. Their prediction of prognosis informs decision-making ranging from recommendations of cancer treatments to hospice enrollment. Unfortunately, physicians’ estimates of prognosis are often inaccurate and overly optimistic. Further, physicians often fail to disclose their prognosis estimates, despite patient wishes to the contrary. Several studies have examined patient factors that might improve physicians’ prognostic accuracy, including performance status, clinical symptoms and laboratory values. Prognostic models have been developed and validated but, to date, none are able to provide accurate estimates throughout the spectrum of advanced illness. This review examines tools utilized to predict life expectancy for patients with advanced, incurable cancer.

*For a PDF of the full article, click on the link to the left of this introduction.

ABSTRACT

Oncologists frequently face the difficult task of estimating prognosis in patients with incurable malignancies. Their prediction of prognosis informs decision-making ranging from recommendations of cancer treatments to hospice enrollment. Unfortunately, physicians’ estimates of prognosis are often inaccurate and overly optimistic. Further, physicians often fail to disclose their prognosis estimates, despite patient wishes to the contrary. Several studies have examined patient factors that might improve physicians’ prognostic accuracy, including performance status, clinical symptoms and laboratory values. Prognostic models have been developed and validated but, to date, none are able to provide accurate estimates throughout the spectrum of advanced illness. This review examines tools utilized to predict life expectancy for patients with advanced, incurable cancer.

*For a PDF of the full article, click on the link to the left of this introduction.

ABSTRACT

Oncologists frequently face the difficult task of estimating prognosis in patients with incurable malignancies. Their prediction of prognosis informs decision-making ranging from recommendations of cancer treatments to hospice enrollment. Unfortunately, physicians’ estimates of prognosis are often inaccurate and overly optimistic. Further, physicians often fail to disclose their prognosis estimates, despite patient wishes to the contrary. Several studies have examined patient factors that might improve physicians’ prognostic accuracy, including performance status, clinical symptoms and laboratory values. Prognostic models have been developed and validated but, to date, none are able to provide accurate estimates throughout the spectrum of advanced illness. This review examines tools utilized to predict life expectancy for patients with advanced, incurable cancer.

*For a PDF of the full article, click on the link to the left of this introduction.

Background The role of radiotherapy in palliation is well recognized. Analyzing referrals from an inpatient palliative care unit to the radiation oncology service may help in planning palliative care services and educational programs.

Objective To determine the pattern and rate of referrals from a PCU to the RO service at a tertiary oncology facility in Saudi Arabia.

Methods Referrals from the PCU to the RO service were prospectively identified over the period beginning November 27, 2007 and ending March 9, 2011. The appropriateness of referrals was determined by 2 radiation oncologists.

Results Of the 635 cancer admissions to the PCU, 25 (3.9%) referrals to RO were made, and 32 sites were irradiated. All patients had a poor performance status (ECOG 3). The most common areas irradiated were vertebrae (40.6%), pelvis (18.7%) and other bony structures (28.1%). Pain control was the most frequent reason for referral (87.5%). Only one referral was regarded by the RO service as inappropriate, indicating that 96% of the referrals were appropriate. The mean time lapse between referral and starting radiation was 4 3.6 days. A total of 75% of the patients died in the PCU within a median of 30 days post radiotherapy.

Conclusion The small minority of patients in the PCU referred for radiotherapy were deemed appropriate referrals by the radiation oncologists despite their poor performance status and limited time remaining. When planning a PCU with similar admission criteria, the availability of a radiotherapy facility in close proximity may not be a priority.

Click on the PDF icon at the top of this introduction to read the full article.

Background The role of radiotherapy in palliation is well recognized. Analyzing referrals from an inpatient palliative care unit to the radiation oncology service may help in planning palliative care services and educational programs.

Objective To determine the pattern and rate of referrals from a PCU to the RO service at a tertiary oncology facility in Saudi Arabia.

Methods Referrals from the PCU to the RO service were prospectively identified over the period beginning November 27, 2007 and ending March 9, 2011. The appropriateness of referrals was determined by 2 radiation oncologists.

Results Of the 635 cancer admissions to the PCU, 25 (3.9%) referrals to RO were made, and 32 sites were irradiated. All patients had a poor performance status (ECOG 3). The most common areas irradiated were vertebrae (40.6%), pelvis (18.7%) and other bony structures (28.1%). Pain control was the most frequent reason for referral (87.5%). Only one referral was regarded by the RO service as inappropriate, indicating that 96% of the referrals were appropriate. The mean time lapse between referral and starting radiation was 4 3.6 days. A total of 75% of the patients died in the PCU within a median of 30 days post radiotherapy.

Conclusion The small minority of patients in the PCU referred for radiotherapy were deemed appropriate referrals by the radiation oncologists despite their poor performance status and limited time remaining. When planning a PCU with similar admission criteria, the availability of a radiotherapy facility in close proximity may not be a priority.

Click on the PDF icon at the top of this introduction to read the full article.

Background The role of radiotherapy in palliation is well recognized. Analyzing referrals from an inpatient palliative care unit to the radiation oncology service may help in planning palliative care services and educational programs.

Objective To determine the pattern and rate of referrals from a PCU to the RO service at a tertiary oncology facility in Saudi Arabia.

Methods Referrals from the PCU to the RO service were prospectively identified over the period beginning November 27, 2007 and ending March 9, 2011. The appropriateness of referrals was determined by 2 radiation oncologists.

Results Of the 635 cancer admissions to the PCU, 25 (3.9%) referrals to RO were made, and 32 sites were irradiated. All patients had a poor performance status (ECOG 3). The most common areas irradiated were vertebrae (40.6%), pelvis (18.7%) and other bony structures (28.1%). Pain control was the most frequent reason for referral (87.5%). Only one referral was regarded by the RO service as inappropriate, indicating that 96% of the referrals were appropriate. The mean time lapse between referral and starting radiation was 4 3.6 days. A total of 75% of the patients died in the PCU within a median of 30 days post radiotherapy.

Conclusion The small minority of patients in the PCU referred for radiotherapy were deemed appropriate referrals by the radiation oncologists despite their poor performance status and limited time remaining. When planning a PCU with similar admission criteria, the availability of a radiotherapy facility in close proximity may not be a priority.

Click on the PDF icon at the top of this introduction to read the full article.

Blood for transfusion

Canada is lifting the lifetime ban on blood donations from men who have sex with men (MSM).

The country’s new policy will allow MSM to donate blood if they have remained celibate for 5 years. The policy is set to take effect July 22.

Health Canada approved this change based on a request from Canadian Blood Services and Héma-Québec submitted last December. 

The lifetime ban on MSM blood donation was insituted in the 1980s after thousands of Canadians were infected with HIV through blood transfusions.

In the US, the lifetime ban is still in place. But the UK, Australia, and other countries have adopted policies alowing MSM to donate if they have refrained from sexual activity for a certain period of time.

Supporters of the lifetime ban on MSM have said such a policy helps ensure a safe blood supply. But critics have said banning MSM is discriminatory, and the policy lacks scientific evidence to support it.

“We recognize that many people will feel that this change does not go far enough, but, given the history of the blood system in Canada, we see this as a first and prudent step forward on this policy,” said Dana Devine, Vice President of Medical, Scientific, and Research Affairs at Canadian Blood Services.

“It’s the right thing to do, and we are committed to regular review of this policy as additional data emerge and new technologies are implemented.”

Under the new policy, potential male blood donors will be asked whether they have had sex with a man in the past 5 years rather than “even once, since 1977,” which is how the policy has read until now.

Canadian Blood Services has been pursuing data to inform a policy change on MSM for several years. In September 2011, the organization’s board of directors passed a motion committing to re-examine this policy, with a view to reduce the lifetime exclusion to no less than 5 years and no longer than 10 years.

After conducting risk analyses and consulting with scientific experts, as well as patient and community groups, Canadian Blood Services and Héma-Québec submitted a policy request to Health Canada in December 2012.

Health Canada approved the policy change with the stipulation that blood operators must closely monitor and report the potential impacts of this change in terms of transmissible disease rates back to the regulator.

Blood for transfusion

Canada is lifting the lifetime ban on blood donations from men who have sex with men (MSM).

The country’s new policy will allow MSM to donate blood if they have remained celibate for 5 years. The policy is set to take effect July 22.

Health Canada approved this change based on a request from Canadian Blood Services and Héma-Québec submitted last December. 

The lifetime ban on MSM blood donation was insituted in the 1980s after thousands of Canadians were infected with HIV through blood transfusions.

In the US, the lifetime ban is still in place. But the UK, Australia, and other countries have adopted policies alowing MSM to donate if they have refrained from sexual activity for a certain period of time.

Supporters of the lifetime ban on MSM have said such a policy helps ensure a safe blood supply. But critics have said banning MSM is discriminatory, and the policy lacks scientific evidence to support it.

“We recognize that many people will feel that this change does not go far enough, but, given the history of the blood system in Canada, we see this as a first and prudent step forward on this policy,” said Dana Devine, Vice President of Medical, Scientific, and Research Affairs at Canadian Blood Services.

“It’s the right thing to do, and we are committed to regular review of this policy as additional data emerge and new technologies are implemented.”

Under the new policy, potential male blood donors will be asked whether they have had sex with a man in the past 5 years rather than “even once, since 1977,” which is how the policy has read until now.

Canadian Blood Services has been pursuing data to inform a policy change on MSM for several years. In September 2011, the organization’s board of directors passed a motion committing to re-examine this policy, with a view to reduce the lifetime exclusion to no less than 5 years and no longer than 10 years.

After conducting risk analyses and consulting with scientific experts, as well as patient and community groups, Canadian Blood Services and Héma-Québec submitted a policy request to Health Canada in December 2012.

Health Canada approved the policy change with the stipulation that blood operators must closely monitor and report the potential impacts of this change in terms of transmissible disease rates back to the regulator.

Blood for transfusion

Canada is lifting the lifetime ban on blood donations from men who have sex with men (MSM).

The country’s new policy will allow MSM to donate blood if they have remained celibate for 5 years. The policy is set to take effect July 22.

Health Canada approved this change based on a request from Canadian Blood Services and Héma-Québec submitted last December. 

The lifetime ban on MSM blood donation was insituted in the 1980s after thousands of Canadians were infected with HIV through blood transfusions.

In the US, the lifetime ban is still in place. But the UK, Australia, and other countries have adopted policies alowing MSM to donate if they have refrained from sexual activity for a certain period of time.

Supporters of the lifetime ban on MSM have said such a policy helps ensure a safe blood supply. But critics have said banning MSM is discriminatory, and the policy lacks scientific evidence to support it.

“We recognize that many people will feel that this change does not go far enough, but, given the history of the blood system in Canada, we see this as a first and prudent step forward on this policy,” said Dana Devine, Vice President of Medical, Scientific, and Research Affairs at Canadian Blood Services.

“It’s the right thing to do, and we are committed to regular review of this policy as additional data emerge and new technologies are implemented.”

Under the new policy, potential male blood donors will be asked whether they have had sex with a man in the past 5 years rather than “even once, since 1977,” which is how the policy has read until now.

Canadian Blood Services has been pursuing data to inform a policy change on MSM for several years. In September 2011, the organization’s board of directors passed a motion committing to re-examine this policy, with a view to reduce the lifetime exclusion to no less than 5 years and no longer than 10 years.

After conducting risk analyses and consulting with scientific experts, as well as patient and community groups, Canadian Blood Services and Héma-Québec submitted a policy request to Health Canada in December 2012.

Health Canada approved the policy change with the stipulation that blood operators must closely monitor and report the potential impacts of this change in terms of transmissible disease rates back to the regulator.