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With so many patients evacuated and arriving at other facilities for care after Hurricane Katrina, one of the first questions posed to health care providers was how to comply with the Health Insurance Portability and Accountability Act (HIPAA).
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In the midst of Hurricane Katrina, the Department of Health and Human Services (HHS) issued a special alert advising health care workers that were allowed to share protected patient information to provide necessary medical care.
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A man was diagnosed with a cancerous tumor in his left kidney. After determining that the diseased kidney needed to be removed, an embolization procedure was scheduled to minimize bleeding during the surgery.
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It is reasonably settled that from a legal and/or ethical viewpoint that a competent patient has the right to direct his or her own medical care in any scenario. However, when the patient who is receiving medical care is no longer legally competent or never was legally competent to undertake medical decisions, the legal and ethical waters become murky.
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One of the most challenging evaluations that an emergency department (ED) physician is asked to perform is the examination of a child with potential child abuse. The majority of ED physicians feel overwhelmed, and although they would like to perform the "ideal" history and physical examination, they find themselves feeling inadequate in these situations.
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This study defined the characteristics predicting response and EFS to rituximab. Prolonged treatment results in longer EFS at the cost of a longer reduction in B cell and IgM levels, but without additional clinical toxicity.
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In this large, randomized trial, the question of whether immediate postoperative radiation therapy for those prostate cancer patients treated by initial radical prostatectomy and found to have disease extending through the capsule (pT3) had added clinical benefit. Data with regard to local control and duration of biochemical (PSA) remission support the application of this approach. It will take additional time to be certain whether such intermediate positive outcomes translate to less metastatic disease and improved overall survival.
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In this retrospective review of patients with MDS reclassified according to the WHO, prognostic grouping using the WHO was found to have important prognostic value. Specifically, patients with RA and RARS fare significantly better than those with multi-lineage dysplasia (RCMD). Cytogenetics, independent of WHO classification, significantly influenced survival. The development of iron overloaded among low-risk patients was associated with worse outcome. This study points to the value of both the WHO classification system and cytogenetics for MDS.
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In a large, multicenter trial, the use of recombinant erythropoietin to maintain hemoglobin levels above anemic levels in chemotherapy treated patients with metastatic breast cancer, survival was reduced in those on the study drug. This trial, initially published in preliminary form 1 year ago is presented in more detail in this report. The question of optimal use of erythropoietic agents in the context of overall survival needs additional intense investigation.
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Breast cancer patients who receive neoadjuvant chemotherapy and achieve pathologic complete remission have a favorable outlook. However, some go on to develop recurrent disease. In this report, the experience at a single institution indicates that premenopausal patients with more advanced primary lesions and fewer axillary nodes resected are more likely to develop distant metastases.
