A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

https://www.jstor.org/stable/pdf/3765916.pdf

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.

Breast cancer patients with the same stage of disease can have markedly different treatment responses and overall outcome. The strongest predictors for metastases (for example, lymph node status and histological grade) fail to classify accurately breast tumours according to their clinical behaviour. Chemotherapy or hormonal therapy reduces the risk of distant metastases by approximately one-third; however, 70-80% of patients receiving this treatment would have survived without it. None of the signatures of breast cancer gene expression reported to date allow for patient-tailored therapy strategies. Here we used DNA microarray analysis on primary breast tumours of 117 young patients, and applied supervised classification to identify a gene expression signature strongly predictive of a short interval to distant metastases ('poor prognosis' signature) in patients without tumour cells in local lymph nodes at diagnosis (lymph node negative). In addition, we established a signature that identifies tumours of BRCA1 carriers. The poor prognosis signature consists of genes regulating cell cycle, invasion, metastasis and angiogenesis. This gene expression profile will outperform all currently used clinical parameters in predicting disease outcome. Our findings provide a strategy to select patients who would benefit from adjuvant therapy.

/pdf/gene-expression-profiling-predicts-clinical-outcome-of-5bu8dmnf6h.pdf

Gene expression profiling predicts clinical outcome of breast cancer

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

https://vascular.stanford.edu/content/dam/sm/vascular/documents/endovasc/guidelines/PIIS0741521406022968.pdf

Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)

Background A more accurate means of prognostication in breast cancer will improve the selection of patients for adjuvant systemic therapy. Methods Using microarray analysis to evaluate our previously established 70-gene prognosis profile, we classified a series of 295 consecutive patients with primary breast carcinomas as having a gene-expression signature associated with either a poor prognosis or a good prognosis. All patients had stage I or II breast cancer and were younger than 53 years old; 151 had lymph-node–negative disease, and 144 had lymph-node–positive disease. We evaluated the predictive power of the prognosis profile using univariable and multivariable statistical analyses. Results Among the 295 patients, 180 had a poor-prognosis signature and 115 had a good-prognosis signature, and the mean (±SE) overall 10-year survival rates were 54.6±4.4 percent and 94.5±2.6 percent, respectively. At 10 years, the probability of remaining free of distant metastases was 50.6±4.5 percent in the group with a...

/pdf/a-gene-expression-signature-as-a-predictor-of-survival-in-1f6irz2ok6.pdf

A Gene-Expression Signature as a Predictor of Survival in Breast Cancer

Education in palliative care for both undergraduates and graduates requires emphasis on special areas. Not only is it important to impart new knowledge and factual data, as for most other disciplines, it is in addition essential to focus on efficient communication, management of poor prognosis patients, and the involvement of a community-based team for optimal care. Education must also involve input from key paramedical staff who have crucial roles in patient care.

Education and Palliative Care: A Different Approach

0130 Initial adjuvant therapy with anastrozole - early- and late-event data from the arimidex, tamoxifen, alone or in combination (ATAC) trial in the hormone-responsive population

Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.

/pdf/an-rct-and-economic-evaluation-of-direct-versus-indirect-and-s3cnl94gtv.pdf

An rct and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment.

Results from many randomized trials of adjuvant breast cancer therapy have been presented in several overviews and at subsequent meetings. This manuscript reviews the current status of both chemo- and endocrine therapy and the prospects for combination therapy, as summarized at the NIH and St Gallen Consensus meetings. In conclusion, treatment selection should be based primarily on endocrine responsiveness; however, a collaborative approach involving the development of new agents and investigation of their optimal integration into therapy programs will ensure progress and improved patient care.

Choosing between endocrine therapy and chemotherapy - or is there a role for combination therapy?

Background: One third of breast cancers are now diagnosed in women aged 70 or over. With its high median age at study entry (64 years) the ATAC study (1) represents an opportunity to characterise tumour and treatment characteristics of a cohort of older women with early breast cancer. It also enables us to examine the effects co-morbidities and age on competing causes of mortality which could have a significant influence on adjuvant treatment decisions. Materials and Methods: Details of trial design, methods and outcome have been published in detail elsewhere (1). The current analysis was based on the 100-month median follow-up data in the safety population in the two monotherapy arms (anastrozole N=3092, tamoxifen N=3094). Baseline co-morbidities, tumour and treatment characteristics were comparedbetween those aged Results: 1662 patients (27%) were aged 70 or over at study entry. Women aged 70 or over had larger tumours compared with younger women (≥2cm: 56.8 vs. 67.6%, OR 0.63, [95%CI 0.56-0.71]). Older women were more likely to undergo mastectomy (OR 1.92 [95%CI 1.71-2.16]), less likely to receive radiotherapy (OR 0.49 [95%CI 0.44-0.55]), or chemotherapy (OR 0.24 [95%CI 0.18-0.29]). Women aged 70 or over had higher rates of co-morbidities irrespective of index used. Women aged 70 or over had an increased risk of recurrence compared with those less than 70: 20.2% vs. 18.7% (HR 1.21, [95%CI 1.09-1.38]), and an increased risk of death without recurrence: 17.9% vs. 5.2% (HR 4.03 [95%CI 3.39-4.78]). The risk of death without recurrence increased with increasing co-morbidity score: 5.8% vs. 14.4% vs. 21.7% for Satariano score 0, 1 and 2+ respectively (P Discussion: There are differences in tumour and treatment characteristics between older and younger patients which may explain the differences in risks of recurrence. Age and co-morbidities significantly influence the risks of death without recurrence. Formal assessment of co-morbidities should be incorporated into decisions regarding adjuvant therapies. 1. ATAC Trialists’ Group. Lancet Oncol 2008; 9: 45-53. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-13-03.

John F. Forbes

Papers

Education and Palliative Care: A Different Approach

0130 Initial adjuvant therapy with anastrozole - early- and late-event data from the arimidex, tamoxifen, alone or in combination (ATAC) trial in the hormone-responsive population

An rct and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment.

Choosing between endocrine therapy and chemotherapy - or is there a role for combination therapy?

Abstract P5-13-03: The Influences of Co-Morbidities and Age on Risk of Death without Recurrence: A Retrospective Analysis of the ATAC Trial