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D H Cowan

Publications and source records attributed to D H Cowan.

At least 19 recordsLinked to original sources
PubMed1998

Commitment of a cancer organization to a program for training in communication skills.

An Ontario cancer agency started an initiative to improve and promote effective communications between health care providers and their patients, using a 4.5-hour workshop developed by the Bayer Institute for Health Care Communications. Each of the eight regional cancer centers in Ontario sent two people, one physician and one other health care professional, for training in delivery of the workshop. Subsequently, each center provided workshops for physicians, nurses, pharmacists, physicists, social workers, psychologists, radiotherapists, and secretarial staff. The ongoing workshops are multiprofessional in composition and interactive and participatory in design. Between September 1996 and September 1997, the workshops involved over 400 cancer care professionals. Their success has been attributed to the knowledge, skills, and enthusiasm of the trained pair of facilitators; the interactive and participatory nature of the workshop design; the multiprofessional participation; and the support of the board of directors and senior management and the administration of each cancer center.

Communication↗
PubMed1998

Progress of clinical oncology guidelines development using the Practice Guidelines Development Cycle: the role of practitioner feedback.

PURPOSE: To present an update on the development of oncology practice guidelines (PGs) using the Practice Guidelines Development Cycle (Cycle), and to present the results of surveys of oncologists on the first 10 guidelines from the Cancer Care Ontario Practice Guidelines Initiative. METHODS: Practitioners' opinions about guidelines in development were sought using a mail survey method with systematic follow-up. Practitioners were identified by cancer center representatives. Survey packages included evidence-based recommendations (EBRs) and a one-page, nine-item feedback questionnaire. Data were collected between February 1995 and February 1996. RESULTS: Nine hundred fourteen surveys that pertained to 10 guidelines were mailed to 423 practitioners in Ontario. Practitioners included 112 medical oncologists/hematologists, 34 radiation oncologists, 195 surgeons, and 82 practitioners from other medical specialities. One hundred practitioners were located in cancer centers and 323 had community-based practices. The overall response rate by practitioner was 72% and by survey questionnaire, 70%. For the five questionnaire items that assessed guideline quality, approval ratings ranged from 86% to 92%. For the 10 recommendations, 77% ( 63% to 82%) of respondents agreed that the EBR could be approved as a PG. Response and approval rates were consistent across medical specialities and locations of practice. CONCLUSION: The process of obtaining practitioner feedback in the development of PGs is both feasible and useful. The high response rates to the survey indicate that it is possible to obtain broad participation in evidence-based guidelines development throughout Ontario. The changes made to the EBRs in response to feedback suggest that practitioners' opinions can be valuable in shaping evidence-based guidelines.

Evidence-Based Medicine↗
PubMed1997

A strategy to improve communication between health care professionals and people living with cancer: II. Follow-up of a workshop on the teaching and assessment of communication skills in Canadian Medical Schools.

BACKGROUND AND METHODS: Follow-up questionnaires were sent to all Canadian medical schools in 1994 and 1996 in order to evaluate changes that had taken place in the teaching of physician-patient communication skills since recommendations were made by a national "Workshop on the Teaching and Assessment of Communication Skills in Canadian Medical Schools" in 1992. RESULTS AND CONCLUSIONS: Fifteen of 16 schools responded. All 15 reported major changes in the teaching of physician-patient communication over the preceding four years or planned changes in the very near future. However, barriers to improving the communications curriculum still existed. The most frequently cited barrier was the lack of trained faculty to teach communication skills; this was followed in frequency by poor coordination over the four years of medical school with lack of scheduled time in the clerkship years. There were identified needs to train faculty to teach communication skills and to extend formal teaching of the subject into the clerkship. Concurrent with these changes, the accreditation process for Canadian medical schools now requires the teaching and evaluation of communication skills.

Canada↗
PubMed1996

The Ontario Cancer Treatment Practice Guidelines Initiative.

The Ontario Cancer Treatment Practice Guidelines Initiative was established in 1993 to develop clinical practice guidelines for cancer treatment in Ontario, Canada. First, an organizational structure, consisting of a coordinating committee, a methods resource group, and disease site groups, was put in place. Central to the development of guidelines are the 10 provincial site groups, which use a methodologic framework, the practice guidelines development cycle, to formulate the guidelines. When a preliminary evidence-based recommendation is developed by a site group, it is sent out to a sample of community practitioners for input and is modified based on their feedback. The final product is the practice guideline. Further research is required to determine optimal dissemination strategies and evaluate the impact of these guidelines.

Evidence-Based Medicine↗
PubMed1994

Spontaneous remission of polycythemia vera: clinical and cell culture characteristics.

A 20-year-old woman presented with polycythemia vera and was treated with phlebotomy alone for eleven years, following which all clinical manifestations of the disease disappeared. The clinical remission with normal physical findings and normal peripheral blood counts has persisted for a further 11 years. Erythroid colony culture results have paralleled the clinical state. Initial bone marrow cultures revealed spontaneous growth of erythroid burst-forming units (BFU-E). Subsequent cultures of peripheral blood cells throughout most of the period of spontaneous clinical remission have revealed little or no spontaneous growth of BFU-E. This suggests a suppression of the abnormal stem cell clone during the period of remission.

Adult↗
PubMed1993

A strategy to improve communication between health care professionals and people living with cancer. I. Improvement of teaching and assessment of doctor-patient communication in Canadian medical schools.

A task force was established by the Canadian Cancer Society and the National Cancer Institute of Canada to make recommendations aimed at improving communication between health care professionals and people living with cancer. An annotated bibliography of the research literature on the subject was commissioned by the task force. This was followed by a research workshop. With this background, the task force organized a workshop on "The Teaching and Assessment of Communication Skills in Canadian Medical Schools." Participants included expert panelists; senior faculty from all Canadian medical schools; representatives from patient and ethnic groups, faculties of nursing and social work, the Canadian licensing and accrediting bodies, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada. A consensus statement regarding general principles, recommendations, and requirements for implementation of improved teaching and assessment of doctor-patient communication in Canadian medical schools was produced and circulated widely throughout Canada. The initial response to this initiative has been positive.

Canada↗
PubMed1992

Progress and survival factors in acute non lymphocytic leukemia. A 15 year analysis.

We analyzed a population of adults with acute non lymphocytic leukemia (ANLL) treated from 1972-1989 to identify prognostic factors and the influence of therapy over time. To 179 patients treated at Sunnybrook Medical Centre (SMC) were added 114 patients from published patient series from Princess Margaret Hospital (PMH) all treated during that period. All PMH and 98 SMC patients received one of three remission induction protocols: CAV (cyclophosphamide, cytosine arabinoside [ara-C], vincristine) 1973-1976 (n = 46); ACT (Adriamycin, ara-C +/- 6-thioguanine) 1976-1983 (n = 83); high dose ara-C and corticosteroids 1983-1987 (n = 83). The remainder either received supportive therapy only or minimally toxic therapy (e.g., low dose ara-C, 6-mercaptopurine) due to presenting complications such as advanced age, severe concurrent medical condition, or most recently at SMC only, mitoxanthrone and ara-C, and were excluded from analysis. Responses obtained at the two institutions were identical, no survival advantage of any particular protocol was seen. Overall median survival was 8.5 months for patients treated on protocol and 20 months for those entering complete remission. Patients treated with supportive or minimally toxic therapy (n = 76) had a median survival of less than two months. In multivariate analysis, the only important factors for survival were complete response to initial therapy; complete response to second induction therapy following either first relapse (n = 89) or lack of complete response to first therapy (n = 15); and normal cytogenetic analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Bioavailability of iron in oral ferrous sulfate preparations in healthy volunteers.

The bioavailability of iron in five ferrous sulfate preparations was studied in 10 healthy male volunteers. The preparations were an oral solution, two types of film-coated tablets and two types of enteric-coated tablets. Blood samples were drawn hourly from 8 am to 6 pm on the day before each study day to assess baseline serum iron concentrations and on the study day. Spectrophotometry was used to measure the serum iron concentrations. The area under the curve (AUC), the maximum concentration and the time to achieve the maximum concentration were compared by analysis of variance. The enteric-coated preparations resulted in AUCs less than 30% of the AUC for the oral solution. The two film-coated products produced AUCs essentially equivalent to that of the oral solution. We conclude that the bioavailability of iron in the enteric-coated preparations was low, relative to that of the film-coated products and the oral solution, and that these products should not be considered interchangeable.

Administration, Oral↗
PubMed1986

POEMS syndrome. Study of a patient with proteinuria, microangiopathic glomerulopathy, and renal enlargement.

We studied a patient with POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal [M]-protein, skin changes) who was also found to have renal enlargement and microangiopathic glomerulopathy. The latter finding is unusual in POEMS syndrome patients, and the associated symptoms can lead to confusion in diagnosis. We emphasize the importance of considering POEMS syndrome in the differential diagnosis of patients who have unexplained neuropathy, scleroderma-like skin changes, and/or monoclonal gammopathy.

Adult↗
PubMed1985

Low dose cytosine arabinoside in acute myeloid leukemia: remission is not due to differentiation induction.

A patient with acute nonlymphoblastic leukemia (FAB M4), showing a near tetraploid chromosome complement on his marrow cells, was treated with low dose cytosine arabinoside and achieved remission. During remission the near tetraploid marrow chromosome complement disappeared and reappeared upon relapse of leukemia. These findings are interpreted as evidence against differentiation induction in the leukemic cell line as a mechanism for remission of the disease in this patient.

Aged↗
PubMed1985

IgDK multiple myeloma presenting as unilateral proptosis.

A 72-year-old woman presented with painful proptosis of the right eye and a large destructive tumour of the middle cranial fossa. A diagnosis of IgDK multiple myeloma was made, based on histopathologic and immunologic studies of the biopsy. Biochemistry and bone marrow examination further confirmed the myeloma as IgDK type. The clinical, radiological, and pathological findings are presented. The patient was treated with radiotherapy with satisfactory results.

Aged↗