The impact of socio-economic status on melanoma clinical trial participation: an observational cohort study from Australia.

Low socio-economic status (SES) is reported to be a barrier to participation in cancer clinical trials due to out-of-pocket costs associated with trial participation, logistical barriers to attend screening services in different diagnostic and treatment centers, and associated cultural or linguistic barriers. One study of clinical trial participation in the ocular melanoma population, reported somewhat different results, whereby people of an older age (≥60 years), lower education level, and those with non-managerial jobs were more likely to participate in a clinical trial, than their younger, more educated counterparts. The aim of the present study was to determine whether SES was associated with participation in clinical trials for people with cutaneous melanoma

The impact of socio-economic status on melanoma clinical trial participation: an observational cohort study from Australia.

Low socio-economic status (SES) is reported to be a barrier to participation in cancer clinical trials due to out-of-pocket costs associated with trial participation, logistical barriers to attend screening services in different diagnostic and treatment centers, and associated cultural or linguistic barriers. One study of clinical trial participation in the ocular melanoma population, reported somewhat different results, whereby people of an older age (≥60 years), lower education level, and those with non-managerial jobs were more likely to participate in a clinical trial, than their younger, more educated counterparts. The aim of the present study was to determine whether SES was associated with participation in clinical trials for people with cutaneous melanoma

Patients' perspectives of long-term follow-up for localised cutaneous melanoma

Background Little is known about the value of long-term follow-up for localised cutaneous melanoma from the patients' perspective. This study aimed to explore the benefits and potential downsides of follow-up; feelings about changes to frequency of follow-up, and patient-centred recommendations for improving follow-up care. Methods Qualitative analysis of 29 in-depth interviews conducted with Australian patients undergoing long-term follow-up after surgical treatment of stage I/II melanoma. Results Patient-perceived benefits of follow-up included reassurance, early detection of new melanomas and non-melanoma skin cancers, education about skin self-examination, the opportunity to ask questions, and reinforcement of ‘sunsafe’ behaviours. Downsides included anxiety leading up to and during follow-up visits; inconvenience of travel to attend visits; and lost work time. Patients varied in their engagement with skin self-examination, and their views on multiple skin excisions, but highly valued access to specialists for unscheduled visits. Most patients felt their follow-up intervals could be extended to 12 months if recommended by their clinician. Conclusion The benefits and potential downsides of follow-up should be discussed with patients when deciding on a melanoma follow-up plan to achieve a balance between inducing additional patient anxiety and providing reassurance. Follow-up intervals of 12 months appear to be acceptable to patients

Primary cutaneous melanoma of the breast: A case report

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Primary cutaneous melanoma of the breast is a very rare tumour, accounting for < 5 % of all malignant melanomas. Case presentation: A young lady was seen in the breast clinic for a skin lesion in the right breast. Clinical examination and investigations confirmed a diagnosis of a primary cutaneous melanoma of the breast. The lesion was excised and the patient made good recovery. She has shown no signs of local recurrence and is under regular follow-up in the dermatology clinic. Conclusion: This case is educational as it shows that the treatment of breast cutaneous melanoma is similar to that for any skin parts with surgery remaining the main therapeutic option. It also shows that mastectomy is unnecessary as it does not improve the results obtained by wide local excision of melanoma. Background Primary cutaneous melanoma rarely affects the breast, accounting for less than 5 % of all malignant melanomas

Daily Changes of Resting Metabolic Rate in Elite Rugby Union Players

Introduction: Preparation for competitive contact sport has been extensively researched. There are, however, limited data to guide players as to how the demands of their sport affect the energy requirements of recovery. We aimed to provide novel data on changes in resting metabolic rate (RMR) in contact sport athletes and relate these to the physical demands of training and competition. Methods: Twenty-two elite professional Premiership Rugby Union players were recruited to the study. Indirect calorimetry (Vyntus CPX canopy; CareFusion) was used to measure RMR each morning of the competitive game week, in a fasted, rested state. External loads for training and game play were monitored and recorded using global positioning systems (Catapult Innovations, Australia), whereas internal loads were tracked using rate of perceived exertion scales. Collisions were reviewed and recorded by expert video analysts for contacts in general play (breakdown and tackle area) or the set piece (scrum or maul). Results: There were significant (P = 0.005) mean increases in RMR of approximately 231 kcal the morning after (game day [GD] + 1) and 3 d after the game (GD + 3), compared with the day before the game (GD − 1). The players were exposed to internal and external loads during the training week comparable to that of a match day; however, despite the equivocal loads between training and game play, there were no significant increases in RMR after training. Conclusion: The collisions experienced in rugby match play are likely to be responsible for the significant increases in RMR at GD + 1 and GD + 3. Consequently, the measurement of RMR via indirect calorimetry may provide a novel noninvasive measure of the effects of collisions. This study provides a novel insight to the energy requirements of recovering from contact sport

Adjunct primer for the use of national comprehensive cancer network guidelines for the surgical management of cutaneous malignant melanoma patients

Recently, a Surveillance Epidemiology and End Results (SEER) survey of melanoma patterns of care by the Mayo Clinic, Scottsdale showed remarkable deviations from best practice patterns throughout the country. The study, which analyzed the SEER records of 35,126 stage I to III cutaneous malignant melanoma patients treated from 2004 to 2006, showed that adherence to National Comprehensive Cancer Network (NCCN) therapeutic resection margins occurred in less than 36% of patients. Similarly, considerable variation in the quality of melanoma care in the United States when assessed using 26 quality indicators drawn by a panel of melanoma experts was independently reported. These observations underscore the significant lack of adherence to published best practice patterns reflected by the NCCN guidelines. The untoward effects of these variations in practice pattern can have an inordinate impact on the survival of melanoma patients in whom long term outcomes are affected by the adequacy of surgical management. Thin malignant melanoma is curable; however, thick or node positive melanoma is often incurable. This outcome is determined not only by the stage at presentation but by the use of best practice patterns as reflected in current NCCN cutaneous melanoma practice guidelines

"Fuel for the Damage Induced": Untargeted Metabolomics in Elite Rugby Union Match Play.

The metabolic perturbations caused by competitive rugby are not well characterized. Our aim is to utilize untargeted metabolomics to develop appropriate interventions, based on the metabolic fluctuations that occur in response to this collision-based team sport. Seven members of an English Premiership rugby squad consented to provide blood, urine, and saliva samples daily, over a competitive week including gameday (GD), with physical demands and dietary intake also recorded. Sample collection, processing and statistical analysis were performed in accordance with best practice set out by the metabolomics standards initiative employing 700 MHz NMR spectroscopy. Univariate and multivariate statistical analysis were employed to reveal the acute energy needs of this high intensity sport are met via glycolysis, the TCA cycle and gluconeogenesis. The recovery period after cessation of match play and prior to training recommencing sees a re-entry to gluconeogenesis, coupled with markers of oxidative stress, structural protein degradation, and reduced fatty acid metabolism. This novel insight leads us to propose that effective recovery from muscle damaging collisions is dependent upon the availability of glucose. An adjustment in the periodisation of carbohydrate to increase GD+1 provision may prevent the oxidation of amino acids which may also be crucial to allay markers of structural tissue degradation. Should we expand the 'Fuel for the work required' paradigm in collision-based team sports to include 'Fuel for the damage induced'

A survey of statistics in three UK general practice journal

Background Many medical specialities have reviewed the statistical content of their journals. To our knowledge this has not been done in general practice. Given the main role of a general practitioner as a diagnostician we thought it would be of interest to see whether the statistical methods reported reflect the diagnostic process. Methods Hand search of three UK journals of general practice namely the British Medical Journal (general practice section), British Journal of General Practice and Family Practice over a one-year period (1 January to 31 December 2000). Results A wide variety of statistical techniques were used. The most common methods included t-tests and Chi-squared tests. There were few articles reporting likelihood ratios and other useful diagnostic methods. There was evidence that the journals with the more thorough statistical review process reported a more complex and wider variety of statistical techniques. Conclusions The BMJ had a wider range and greater diversity of statistical methods than the other two journals. However, in all three journals there was a dearth of papers reflecting the diagnostic process. Across all three journals there were relatively few papers describing randomised controlled trials thus recognising the difficulty of implementing this design in general practice