K.S. Virgo

Cisapride for Constipation in Spinal Cord Injured Patients: A Preliminary Report

Chronic constipation in patients with spinal cord injury (SCI) has significant impact on quality of life. To measure baseline clinical functioning, colonic transit time and anorectal manometry and the effect of cisapride on these clinical and physiological parameters, we studied 12 SCI patients. Patients initially received baseline clinical scoring, measurement of colonic transit time and anorectal manometry. Patients then received cisapride 20 mg orally three times each day. After one and three months of cisapride therapy, all measurements were repeated. The mean duration cisapride treatment was 5.2 months. Six of 12 (50 percent) reported that symptoms of constipation improved. No patient had worsening of symptoms. Prior to cisapride treatment, 23 percent of patients passed colonic transit markers by day five and 57 percent by day seven; baseline anal manometry revealed variable resting and squeeze pressures. After treatment, 33 percent of patients passed their colonic transit markers by day five and 71 percent by day seven. Six of 12 (50 percent) demonstrated a 10 percent or more increase in resting anal canal pressures. We conclude that about 50 percent of SCI patients have subjective improvement in constipation after cisapride therapy. Cisapride appears to improve both colonic and anorectal function.

How practice patterns in colon cancer patient follow-up are affected by surgeon age.

BACKGROUND Strategies for the follow-up of colon cancer patients after potentially curative treatment are known to vary widely. The optimal regimen remains unknown. We investigated whether the date of completion of formal surgical training affects choice of surveillance strategy. METHODS The 1070 members of the Society of Surgical Oncology (SSO) and the 1663 members of the American Society of Colon and Rectal Surgeons (ASCRS) were surveyed using a detailed questionnaire to measure how these surgical experts deal with colon cancer follow-up. Subjects were asked how they use nine specific follow-up modalities during years 1-5 following primary treatment for patients with colon cancer (TNM Stages I-III). Repeated-measures analysis of variance was used to compare practice patterns by TNM stage and year post-surgery, as well as by the year in which the surgeons formal surgery training was completed. RESULTS Evaluable responses were received from 349 SSO members (33%) and 646 ASCRS members (39%). Few significant differences in follow-up practices were noted by training period, but follow-up for most of the nine modalities was highly correlated with TNM stage and year post-surgery, as expected. CONCLUSIONS This analysis indicates that the post-treatment surveillance practice patterns of surgeons caring for patients with colon cancer do not vary substantially with practitioner age. The data provide credible evidence that postgraduate education is effective in homogenizing practitioner behaviour.

Evaluation of an electronic message strip to recruit smokers to a smoking cessation program

Knowledge of outcome is essential when analyzing effectiveness of educational programs. Although quantitative data can be analyzed more rigorously than other forms of data, quantitation of behavioral processes is often difficult. To promote our smoking-cessation program we designed a method that relies on electronic message strips and a dedicated telephone line capable of providing quantitative outcome information. This approach appears quite versatile and shows that the electronic message strip is a surprisingly ineffective method of enlisting subjects into a smoking-cessation program in our hospital.

Colorectal cancer patient follow-up following surgery with curative intent

3645 Background: Surgery is the mainstay of treatment for colorectal cancer. In western industrial societies most patients are treated with curative intent and enter some type of follow-up regimen. Surgeons often follow their own patients after colorectal cancer surgery but the optimum surveillance strategy has not been defined. There are no active adequately powered trials dealing with this topic originating in North America, as far as we are aware, but one based in Milan, Italy, is open (Gruppo Italiano di Lavoro per la Diagnosi Anticipata - GILDA). METHODS After primary curative-intent treatment, stratification, and randomization at GILDA headquarters, colon cancer patients are followed according to a more intensive or less intensive surveillance regimen. Rectal cancer patients are also followed according to a more intensive or less intensive regimen; these arms are similar to the arms for colon cancer patients but focus more on local-regional recurrence. To ensure adequate statistical power, the target number of patients is 1,500. Health-related quality of life and cost-effectiveness measures are incorporated in the trial. RESULTS The trial opened in 1998; 940 patients from 41 centers had been enrolled as of November 2003. The trial opened to North American centers in 2002. The mean duration of follow-up was 13 months as of November 2003. Sixty-six relapses, 31 deaths, and 5 second primary cancers had been documented in the two more intensive follow-up arms; 52 relapses, 21 deaths, and 9 second primary cancers had been observed in the two less intensive arms as of November 2003. CONCLUSIONS This trial should provide the first evidence based on an adequately powered randomized trial to determine the optimal follow-up strategy for colorectal cancer patients. The authors will provide information packets at the meeting for individuals and institutions interested in participating in this trial. No significant financial relationships to disclose.