Publications

OBJECTIVES

The aim was to determine the safety and efficacy of gemcitabine plus cisplatin for patients with relapsed ovarian carcinoma and to compare ex vivo drug sensitivity profiles with clinical outcomes.

PATIENTS AND METHODS

Previously treated patients with ovarian carcinoma received cisplatin (30 mg/m(2)) plus gemcitabine (600-750 mg/m(2)) on Days 1 and 8 of each 21-day cycle. Seventeen of the 27 patients underwent ex vivo analyses for correlation with clinical response.

RESULTS

Of 27 patients, there were 7 (26%) complete and 12 (44%) partial responses, for an overall response rate of 70% (95% CI: 53-87%). Toxicities included neutropenia Grade III in 51.9%, Grade IV in 29.6%; anemia Grade III in 18.5 %; thrombocytopenia Grade III in 66.7 %, Grade IV in 29.6%; nausea and vomiting Grade III in 14.8 %; peripheral neuropathy Grade III in 3.7%; and alopecia Grade IV in 11.1% of patients. The median time to progression for objective responders was 7.9 months with a range of 2.1 to 13.2 months. There were no treatment-related deaths. Ex vivo results correlated with response, time to progression, and survival, remaining significant when adjusted for platin-resistance and number of prior therapies. Adjustment for platin-free interval decreased the significance but did not, in and of itself, predict significantly for progression-free survival.

CONCLUSIONS

Cisplatin plus gemcitabine is active for patients with relapsed ovarian cancer. Toxicities, primarily hematologic, are manageable with dose modifications. Responses observed in heavily pretreated and platin-resistant patients indicate activity in drug-refractory patients. The results of the ex vivo analyses correlate with clinical outcomes.

Randomized controlled trials (RCTs) are one of the best sources of evidence for the scientific practice of medicine. However, RCT findings are published only as text articles that are of limited machine understandability. The Trial Bank system captures information about the design, execution, and summary results of RCTs into a structured electronic knowledge base called RCT Bank.

The Systematic Review Bank (SysBank) is a structured knowledge base that captures information about the design, execution, and results of systematic reviews of randomized controlled trials (RCTs). The SysBank data model has been adapted from RCT Bank, a knowledge base of randomized trials, and refined using three published systematic reviews. SysBank links directly to the RCT Bank entries of studies included in the systematic review. SysBank builds upon RCT Bank to support computer-assisted evidence-based medicine.

BACKGROUND

Computer-based clinical decision support systems (CDSSs) vary greatly in design and function. A taxonomy for classifying CDSS structure and function would help efforts to describe and understand the variety of CDSSs in the literature, and to explore predictors of CDSS effectiveness and generalizability.

OBJECTIVE

To define and test a taxonomy for characterizing the contextual, technical, and workflow features of CDSSs.

METHODS

We retrieved and analyzed 150 English language articles published between 1975 and 2002 that described computer systems designed to assist physicians and/or patients with clinical decision making. We identified aspects of CDSS structure or function and iterated our taxonomy until additional article reviews did not result in any new descriptors or taxonomic modifications.

RESULTS

Our taxonomy comprises 95 descriptors along 24 descriptive axes. These axes are in 5 categories: Context, Knowledge and Data Source, Decision Support, Information Delivery, and Workflow. The axes had an average of 3.96 coded choices each. 75% of the descriptors had an inter-rater agreement kappa of greater than 0.6.

CONCLUSIONS

We have defined and tested a comprehensive, multi-faceted taxonomy of CDSSs that shows promising reliability for classifying CDSSs reported in the literature.

BACKGROUND

There is little ethnic diversity at the doctoral level among researchers in cancer control. The Minority Training Program in Cancer Control Research is designed to encourage underrepresented master's level health science students to pursue doctoral training and careers in research.

METHODS

Program components include an annual 5-day summer institute, internships, and doctoral incentive awards. Intention to pursue doctoral training is measured before and after participation. Doctoral applications and enrollment are tracked through annual surveys.

RESULTS

Seventy students participated during the first three years, 1999-2001. Intention to apply increased significantly for each class (year one, p %lt; 0.001; year two, p = 0.042; year three, p = 0.006). Thirty-one percent of participants have either enrolled in doctoral programs (n= 10) or report plans to apply in the next one to two years (n = 9). Over half of these students indicated that the MTPCCR had a positive influence on their plans.

CONCLUSIONS

A targeted training program encourages under-represented students to pursue doctoral degrees and thus has the potential to increase ethnic diversity in public health research.

With the introduction of combination antiretroviral therapy, changes in fat distribution and serum metabolites were reported. These included increased central fat ("buffalo hump," abdominal, and visceral); decreased peripheral fat (in the face, legs, and arms); increased levels of triglycerides, low-density lipoprotein and total cholesterol, glucose, and insulin; and low levels of high-density lipoprotein cholesterol. Many of these changes predict increased atherosclerosis. It has been proposed that these findings are part of a single syndrome, much like metabolic syndrome. Our data indicate that many of these changes are independent. Some changes are antiretroviral drug (but not necessarily class)-specific, some represent the restoration to health, and others are due to effects of the host response to human immunodeficiency virus itself.