Medicine and Health Sciences Commons^™

Incontinence Surgery In The Older Woman, V. Sharp, Catherine Bradley, K. Kreder

Catherine S. Bradley

PURPOSE OF REVIEW: To review recently published studies on stress urinary incontinence surgery outcomes in older women. RECENT FINDINGS: Five prospective and two retrospective studies were identified that reported tension-free vaginal tape (n = 6), colposuspension (n = 1) and cadaveric fascia transvaginal sling (n = 1) procedure results. In each study, 21-175 older women were included, with mean ages ranging from 71 to 83 years; most studies included younger comparison groups. Mean follow-ups ranged from 3 to 30 months. Subjective stress urinary incontinence 'cure/improvement' rates after surgery were significantly lower in older women when compared with younger women in …

Predictors Of Success And Satisfaction Of Nonsurgical Therapy For Stress Urinary Incontinence, J. Schaffer, C. Nager, F. Xiang, D. Borello-France, Catherine Bradley, J. Wu, E. Mueller, P. Norton, M. Paraiso, H. Zyczynski, H. Richter

Catherine S. Bradley

OBJECTIVE: To identify factors that may predict success and satisfaction in women undergoing nonsurgical therapy for stress urinary incontinence. METHODS: Baseline demographic and clinical characteristics of women participating in a multicenter randomized trial of pessary, behavioral, or combined therapy for stress urinary incontinence were evaluated for potential predictors of success and satisfaction. Success and satisfaction outcomes were assessed at 3 months and included the Patient Global Impression of Improvement, stress incontinence subscale of the Pelvic Floor Distress Inventory, and Patient Satisfaction Questionnaire. Logistic regression was performed to identify predictors, adjusting for treatment and other important clinical covariates. Adjusted odds ratios …

Risk Factors For Painful Bladder Syndrome In Women Seeking Gynecologic Care, Colleen Kennedy, Catherine Bradley, R. Galask, I. Nygaard

Catherine S. Bradley

The aim of this cross-sectional study was to report risk factors for painful bladder syndrome in women. We surveyed 645 women presenting for care to general gynecology clinics and a vulvar specialty clinic using a standardized questionnaire and validated outcome measures. We used two definitions for painful bladder syndrome, based on the O'Leary-Sant interstitial cystitis symptom and problem indices. Of those women surveyed, 29.5% met broader criteria and 8.5% met more restrictive criteria for painful bladder syndrome. After adjusting for confounders, bladder pain was significantly associated with current smoking, irritable bowel syndrome, and a generalized pain disorder. Tobacco use, the …

Natural History Of Pelvic Organ Prolapse In Postmenopausal Women, Catherine Bradley, M. Zimmerman, Y. Qi, I. Nygaard

Catherine S. Bradley

OBJECTIVE: To describe the natural history of pelvic organ prolapse and risk factors for changes in vaginal descent in older women. METHODS: This 4-year prospective observational study included 259 postmenopausal women with a uterus enrolled at one Women's Health Initiative clinical site who completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations. We calculated 1-year and 3-year incidence and resolution risks for prolapse (defined as maximal vaginal descent to or beyond the hymen) and estimated progression and regression rates (1 cm or greater and 2 cm or greater changes in maximal vaginal descent) and risk factors. RESULTS: Mean …

The "Costs" Of Urinary Incontinence For Women, L. Subak, J. Brown, S. Kraus, L. Brubaker, F. Lin, H. Richter, Catherine Bradley, D. Grady

Catherine S. Bradley

OBJECTIVE: To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. METHODS: In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. RESULTS: Mean age was 56 +/- …

Vaginal Descent And Pelvic Floor Symptoms In Postmenopausal Women: A Longitudinal Study, Catherine Bradley, M. Zimmerman, Q. Wang, I. Nygaard

Catherine S. Bradley

OBJECTIVE: To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women. METHODS: This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized …

Preservation Of Immune Function In Cervical Cancer Patients During Chemoradiation Using A Novel Integrative Approach., Susan Lutgendorf, Elizabeth Mullen-Houser, Daniel Russell, Koen De Geest, Geraldine Jacobson, Laura Hart, David Bender, Barrie Anderson, Thomas Buekers, Michael Goodheart, Michael Antoni, Anil Sood, David Lubaroff

David P Bender

Patients receiving chemoradiation for cervical cancer are at risk for distress, chemoradiation-related side-effects, and immunosuppression. This prospective randomized clinical trial examined effects of a complementary therapy, Healing Touch (HT), versus relaxation training (RT) and usual care (UC) for (1) supporting cellular immunity, (2) improving mood and quality of life (QOL), and (3) reducing treatment-associated toxicities and treatment delay in cervical cancer patients receiving chemoradiation. Sixty women with stages IB1 to IVA cervical cancer were randomly assigned to receive UC or 4 ×/weekly individual sessions of either HT or RT immediately following radiation during their 6-week chemoradiation treatment. Patients completed psychosocial …

A Phase Ii Evaluation Of Tirapazamine Plus Cisplatin In The Treatment Of Recurrent Platinum-Sensitive Ovarian Or Primary Peritoneal Cancer: A Gynecologic Oncology Group Study., Allan Covens, John Blessing, David Bender, Robert Mannel, Mark Morgan

David P Bender

OBJECTIVES: To estimate the anti-tumor activity, nature and degree of toxicity of tirapazamine in combination with cisplatin in patients with recurrent platinum-sensitive ovarian or primary peritoneal cancers.

METHODS: Eligible consenting patients had to have recurrent epithelial ovarian or primary peritoneal carcinoma with measurable disease. Patients were not allowed to have received any additional cytotoxic chemotherapy for management of recurrent or persistent disease, including re-treatment with initial chemotherapy regimens. Patients must have been platinum-sensitive, meaning a treatment-free interval of >6 months after response to a platinum-based regimen. The RECIST criteria were used for parameters of response. Tirapazamine was administered at a …

Diurnal Cortisol Dysregulation, Functional Disability, And Depression In Women With Ovarian Cancer., Aliza Weinrib, Sandra Sephton, Koen De Geest, Frank Penedo, David Bender, Bridget Zimmerman, Clemens Kirschbaum, Anil Sood, David Lubaroff, Susan Lutgendorf

David P Bender

BACKGROUND: Multiple alterations in circadian rhythms have been observed in cancer patients, including the diurnal rhythm of the adrenal hormone cortisol. Diurnal cortisol alterations have been associated with cancer-related physiological processes as well as psychological stress. Here we investigate alterations in diurnal cortisol rhythm in ovarian cancer patients, and potential links with depression, life stress, and functional disability.

METHODS: Women (n = 177) with suspected ovarian cancer completed questionnaires and collected salivary cortisol 3× daily for 3 consecutive days before surgery. One hundred women were subsequently diagnosed with ovarian cancer and 77 with benign disease. In addition, healthy women (n …

Sleep Disturbance, Cytokines, And Fatigue In Women With Ovarian Cancer., Lauren Clevenger, Andrew Schrepf, Desire Christensen, Koen De Geest, David Bender, Amina Ahmed, Michael Goodheart, Frank Penedo, David Lubaroff, Anil Sood, Susan Lutgendorf

David P Bender

Pro-inflammatory cytokines, such as interleukin-6 (IL-6), have been implicated in the underlying processes contributing to sleep regulation and fatigue. Despite evidence for sleep difficulties, fatigue, and elevations in IL-6 among women with ovarian cancer, the association between these symptoms and IL-6 has not been investigated. To address this knowledge gap, we examined relationships between sleep disturbance, fatigue, and plasma IL-6 in 136 women with ovarian cancer prior to surgery. These relationships were also examined in 63 of these women who were disease-free and not receiving chemotherapy one year post-diagnosis. At both time-points, higher levels of IL-6 were significantly associated with …

Social Isolation Is Associated With Elevated Tumor Norepinephrine In Ovarian Carcinoma Patients., Susan Lutgendorf, Koen De Geest, Laila Dahmoush, Donna Farley, Frank Penedo, David Bender, Michael Goodheart, Thomas Buekers, Luis Mendez, Gina Krueger, Lauren Clevenger, David Lubaroff, Anil Sood, Steve Cole

David P Bender

Noradrenergic pathways have been implicated in growth and progression of ovarian cancer. Intratumoral norepinephrine (NE) has been shown to increase with stress in an animal cancer model, but little is known regarding how tumor NE varies with disease stage and with biobehavioral factors in ovarian cancer patients. This study examined relationships between pre-surgical measures of social support, depressed mood, perceived stress, anxiety, tumor histology and tumor catecholamine (NE and epinephrine [E]) levels among 68 ovarian cancer patients. We also examined whether associations observed between biobehavioral measures and tumor catecholamines extended to other compartments. Higher NE levels were found in advanced …

A Single-Institution Evaluation Of Factors Important In Fallopian Tube Carcinoma Recurrence And Survival., Alireza Shamshirsaz, Thomas Buekers, Koen De Geest, David Bender, Gideon Zamba, Michael Goodheart

David P Bender

OBJECTIVE: The aim of this study was to identify prognostic factors and markers that influence clinical outcomes in patients with primary fallopian tube carcinoma at a single tertiary health care center. These prognostic factors may be of clinical importance and can subsequently be included in future clinical trials. MATERIALS AND METHODS: A retrospective review of our Tumor Registry and Gynecologic Oncology database was conducted to include any patients with a diagnosis of fallopian tube carcinoma between the years 1994 and 2005. We identified clinicopathological data to evaluate factors important in recurrence, disease-specific and overall survival. Kaplan-Meier curves were generated, and …

Social Influences On Clinical Outcomes Of Patients With Ovarian Cancer, Susan Lutgendorf, Koen De Geest, David Bender, Amina Ahmed, Michael Goodheart, Laila Dahmoush, M. Zimmerman, Frank Penedo

David P Bender

PURPOSE Previous research has demonstrated relationships of social support with disease-related biomarkers in patients with ovarian cancer. However, the clinical relevance of these findings to patient outcomes has not been established. This prospective study examined how social support relates to long-term survival among consecutive patients with ovarian cancer. We focused on two types of social support: social attachment, a type of emotional social support reflecting connections with others, and instrumental social support reflecting the availability of tangible assistance. PATIENTS AND METHODS Patients were prospectively recruited during a presurgical clinic visit and completed surveys before surgery. One hundred sixty-eight patients with …

Serum Ca 125 Is An Independent Prognostic Factor In Cervical Adenocarcinoma, David Bender, J. Sorosky, R. Buller, A. Sood

David P Bender

OBJECTIVE: The purpose of this study was to determine the prognostic significance of a pretreatment serum CA 125 value in patients who were diagnosed with adenocarcinoma of the cervix. STUDY DESIGN: All patients who were diagnosed with adenocarcinoma or adenosquamous carcinoma of the cervix and treated definitively between 1986 and 1998 were eligible. The relationship between pretreatment serum CA 125 values and various clinical factors was evaluated. RESULTS: Seventy-three patients had pretreatment CA 125 drawn, with values that ranged from 5 to 683 U/mL and all patients were included in this study. A CA 125 value of >or=30 U/mL was …

A Phase Ii Study Of Vorinostat In The Treatment Of Persistent Or Recurrent Epithelial Ovarian Or Primary Peritoneal Carcinoma: A Gynecologic Oncology Group Study, S. Modesitt, M. Sill, J. Hoffman, David Bender

David P Bender

PURPOSE: This multi-institutional phase II trial assessed the activity and toxicity of a new histone deacetylase inhibitor, vorinostat (suberoylanilide hydroxamic acid--SAHA) in patients with recurrent or persistent epithelial ovarian or primary peritoneal carcinoma. PATIENTS AND METHODS: Women with recurrent or persistent epithelial ovarian or primary peritoneal carcinoma who were platinum-resistant/refractory (progression-free interval <12 months since platinum) were eligible for trial entry if they had measurable disease, a good performance status, and good overall organ function. Women were treated with a 400 mg daily oral dose of vorinostat and continued on treatment until disease progression or unacceptable toxicity. The primary endpoints …

Efficacy Of A Vitamin/Nutriceutical Formulation For Moderate To Late Alzheimer’S Disease: A Placebo-Controlled Pilot Study, Ruth Remington, A Chan, Thomas Shea

Ruth Remington

Recent studies demonstrated efficacy of a vitamin/ nutriceutical formulation (folate, vitamin B12, alpha-tocopherol, S-adenosyl methionine, N-acetyl cysteine, and acetyl-L-carnitine) for mild to moderate Alzheimer's disease. Herein, we tested the efficacy of this formulation in a small cohort of 12 institutionalized patients diagnosed with moderate-stage to later-stage Alzheimer's disease. Participants were randomly separated into treatment of placebo groups. Participants receiving the formulation demonstrated a clinically significant delay in decline in the Dementia Rating Scale and clock-drawing test as compared to those receiving placebo. Institutional caregivers reported approximately 30% improvement in the Neuropyschiatric Inventory and maintenance of performance in the Alzheimer's Disease …

Dehydration Reduction In The Community Dwelling Older Adult: Perspectives Of Community Health Care Providers, Lisa Abdallah, Ruth Remington, S Houde, L Zhan, Karen Melillo

Ruth Remington

Dehydration is a common problem among older adults and can negatively affect their health. This crosssectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participantsidentify dehydration as a problem affecting older adults, and 94% noted …

Interpreting Laboratory Values In The Rehabilitation Setting, Jane Flanagan, Karen Melillo, Lisa Abdallah, Ruth Remington

Ruth Remington

Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health …

Apple Juice Improved Non-Cognitive Symptoms In Moderate- To Late-Stage Alzheimer’S Disease In An Open-Label Pilot Study, Ruth Remington, A Chan, A Lepore, E Kotlya, Thomas Shea

Ruth Remington

Preclinical studies demonstrate that apple juice exerts multiple beneficial effects including reduction of central nervous system oxidative damage, suppression of Alzheimer's disease (AD) hallmarks, improved cognitive performance, and organized synaptic signaling. Herein, we initiated an open-label clinical trial in which 21 institutionalized individuals with moderate-to-severe AD consumed 2 4-oz glasses of apple juice daily for 1 month. Participants demonstrated no change in the Dementia Rating Scale, and institutional caregivers reported no change in Alzheimer's Disease Cooperative Study (ADCS)-Activities of Daily Living (ADL) in this brief study. However, caregivers reported an approximate 27% (P < .01) improvement in behavioral and psychotic symptoms associated with dementia as quantified by the Neuropsychiatric Inventory, with the largest changes in anxiety, agitation, and delusion. This pilot study suggests that apple juice may be a useful supplement, perhaps to augment pharmacological approaches, for attenuating the decline in mood that accompanies progression of AD, which may also reduce caregiver burden.

A Vitamin/Nutriceutical Formulation Improves Memory And Cognitive Performance In Community-Dwelling Adults Without Dementia, A Chan, Ruth Remington, E Kotlya, A Lepore, J Zemianek, Thomas Shea

Ruth Remington

Adults of both genders without dementia consumed a nutriceutical formulation ("NF," consisting of folic acid, B12, Vitamin E, S-adenosylmethionine, N-acetyl cysteine and Acetyl-L-carnitine), previously shown to improve cognitive performance in Alzheimer's disease, or placebo. Participants receiving NF but not placebo improved statistically and clinically in the California Verbal Learning Test II and the Trail-Making Test. Both groups improved further during a 3-month open-label extension. Additional individuals displayed identical improvement during a separate 6-month open-label trial. Performance declined to baseline following withdrawal of NF, and statistically improved when participants resumed taking NF. Additional participants receiving NF but not placebo demonstrated improvement …

Managing Problem Behaviors Associated With Dementia, Ruth Remington, Lisa Abdallah, Karen Melillo, Jane Flanagan

Ruth Remington

The older adult with dementia who exhibits problem behaviors is likely to be experiencing physical or psychological distress. Both can negatively affect the health, rehabilitation and quality of life for the older adult. Managing problem behaviors can challenge the skills of the most experienced nurse. Being able to identify the origins of these behaviors can help caregivers respond in a way that will achieve behavioral management and preserve the dignity of the older adult. This article presents some practical measures to assist nurses with minimizing the negative effects of dementia-associated problem behaviors in older adults.

The Clock-Drawing Test: Time For A Change?, A Chan, Ruth Remington, J Paskavitz, Thomas Shea

Ruth Remington

Clock-drawing tests are simple and rapid screening devices for dementia. It was observed that individuals (" . . .make the clock read 12:45") or an analog prompt (" . . .quarter to 1"), whereas individuals >70 years of age showed improved performance with an analog prompt. The digital prompt has routinely been used to force participants to recode the prompt via conceptualization. Differential scoring across a range of ages has likely derived from the advent and increase of digital clocks with the younger segment of the population. This implies the need for as-yet undetermined alteration in the nature of prompts …

Endocrine Cancer Risks For Women During The Perimenopause And Beyond., Kimberly Leslie, N. Kumar

Kimberly K. Leslie

Cancer and its link to reproductive hormones is an area of intense concern for our patients and has been the subject of much speculation. But if estrogen causes breast cancer, for example, most women would eventually develop the disease. We know this is not the case! Actually, estrogen and progesterone have been linked to a decrease as well as an increase in cancer, depending upon the type of tumor under investigation. The purpose of this manuscript is to review the data supporting those relationships.

Cadherins, Catenins And Cell Cycle Regulators: Impact On Survival In A Gynecologic Oncology Group Phase Ii Endometrial Cancer Trial, M. Singh, K. Darcy, W. Brady, R. Clubwala, Z. Weber, J. Rittenbach, A. Akalin, C. Whitney, R. Zaino, N. Ramirez, Kimberly Leslie

Kimberly K. Leslie

OBJECTIVE: We evaluated the clinical relevance of catenins, cadherins and cell cycle regulators in stage IV or recurrent endometrial carcinoma in a multi-center phase II trial (GOG protocol #119). METHODS: Tissue microarrays of metastatic or recurrent (n=42) tumor were developed and immunohistochemistry was performed. Average expression (percent staining x intensity) was assessed in tumor epithelium ((E)) and stroma ((S)) and categorized into tertiles (T1, T2, T3) for E-cadherin(E), N-cadherin(E), alpha-catenin(E), beta-catenin(E), gamma-catenin(E), p120-catenin(E) and Ki-67(E); as negative, below median or above median for p16(E), p27(E) and CD44(S); or as negative or positive for p53(E), Ki-67(S) and APC(S) (adenomatous polyposis coli). …

A Phase Ii Evaluation Of Lapatinib In The Treatment Of Persistent Or Recurrent Epithelial Ovarian Or Primary Peritoneal Carcinoma: A Gynecologic Oncology Group Study, A. Garcia, M. Sill, H. Lankes, A. Godwin, R. Mannel, D. Armstrong, R. Carolla, M. Liepman, N. Spirtos, E. Fischer, Kimberly Leslie

Kimberly K. Leslie

OBJECTIVE: Activation and dimerization of the ERBB family play a role in the pathogenesis and progression of ovarian cancer. We conducted a phase II trial to evaluate the activity and tolerability of lapatinib in patients with recurrent or persistent epithelial ovarian cancer (EOC) and to explore the clinical value of expression levels of epidermal growth factor receptors (EGFR), phosphorylated EGFR, HER-2/neu, and Ki-67, and the presence of EGFR mutations. METHODS: Eligible patients had recurrent or persistent EOC or primary peritoneal carcinoma, measurable disease, and up to 2 prior chemotherapy regimens for recurrent disease. Patients were treated with lapatinib 1500 mg/day. …

Effect Of Tamoxifen On Endometrial Histology, Hormone Receptors, And Cervical Cytology: A Prospective Study With Follow-Up, Kimberly Leslie, S. Walter, K. Torkko, J. Stephens, C. Thompson, M. Singh

Kimberly K. Leslie

OBJECTIVES: Our major hypothesis for these studies was that tamoxifen's varied effects on the endometrium might be due in part to differences in effect on estrogen and progesterone receptors [ER, progesterone receptor isoform A (PRA), and progesterone receptor isoform B (PRB)]. We aimed to evaluate the changes in histology in serial endometrial biopsies (Em bx), Papanicolaou smears (Pap smears), and endometrial ultrasounds as well as changes in the expression of ER, PRA, and PRB in response to tamoxifen. We propose that understanding and correlating the dynamics of receptor expression with histologic and cytologic changes will help us better understand the …

Phase Ii Trial Of Bevacizumab In Recurrent Or Persistent Endometrial Cancer: A Gynecologic Oncology Group Study, C. Aghajanian, M. Sill, K. Darcy, B. Greer, D. Mcmeekin, P. Rose, J. Rotmensch, M. Barnes, P. Hanjani, Kimberly Leslie

Kimberly K. Leslie

PURPOSE: Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor-A (VEGF-A), has clinical activity in multiple tumor types. We conducted a phase II trial to assess the activity and tolerability of single-agent bevacizumab in recurrent or persistent endometrial cancer (EMC). PATIENTS AND METHODS: Eligible patients had persistent or recurrent EMC after receiving one to two prior cytotoxic regimens, measurable disease, and Gynecologic Oncology Group performance status of

Gpr30: A Novel Indicator Of Poor Survival For Endometrial Carcinoma, H. Smith, Kimberly Leslie, M. Singh, C. Qualls, C. Revankar, N. Joste, E. Prossnitz

Kimberly K. Leslie

OBJECTIVE: This study was undertaken to evaluate the relationship between GPR30, classical steroidal receptor expression, and clinical outcome in patients with endometrial carcinoma. STUDY DESIGN: Immunohistochemistry was used to investigate the expression of GPR30, estrogen, progesterone, epidermal growth factor receptors and Ki-67 in 47 consecutive consenting patients with endometrial carcinoma diagnosed between 1997 and 2001. Results were correlated with clinical and pathologic predictors of adverse outcome and survival. RESULTS: GPR30 correlated positively with epidermal growth factor receptor (P = .005), but negatively with progesterone (P = .05) receptor expression. GPR30 overexpression occurred more frequently in tumors with deep myometrial invasion, …

Endometrial Cancer, Kimberly Leslie, K. W. Thiel, Michael Goodheart, Koen De Geest, Y. Jia, S. Yang

Kimberly K. Leslie

Despite the questions and barriers, the incorporation of molecular therapy into treatment regimens in endometrial cancer is an exciting area of investigation with the potential to improve outcomes. Outside of the development of a reliable screening test for endometrial cancer, converting the disease to a chronic state and improving progression-free survival is our best hope to reverse the concerning trend of decreasing 5-year survival for this disease.

Dietary Glycemic Index And Glycemic Load Among Indigenous And Non-Indigenous Children Aged 10-12 Years, Jimmy Chun Yu Louie, Josephine Gwynn, Nicole Turner, Janine Cochrane, John Wiggers, Victoria Flood

Jimmy Chun Yu Louie

No abstract provided.