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PubMed1992

Crohn's disease among ethnic groups in a large health maintenance organization.

The epidemiology of Crohn's disease (CD) was investigated among ethnic groups in a 2-million-member health maintenance organization. Between 1982 and 1988 there were 909 hospitalizations for CD. Annual hospitalizations per 100,000 were much lower for Hispanics (0.6) than those for whites (10.2) and blacks (10.2), and rates were higher among women (8.3) than men (6.0) (P less than 0.001). Bimodal age distributions were found for both sexes with peaks identified in the 20-29-year and greater than or equal to 60-year age groups. Annual age-adjusted hospitalizations per 100,000 decreased from 1982 (8.3) through 1988 (5.4) (P less than 0.05). A mail survey and medical records were used to collect data from the 169 CD patients who were identified at two sites within the organization. Prevalence rates per 100,000 for Hispanics (4.1) and Asians (5.6) were much lower than those for whites (43.6), blacks (29.8), and "others" (8.4). The distribution of age at diagnosis was bimodal, and the average age at diagnosis was 36 years. Patients reported an average of 3.7 outpatient visits and 13.3 days lost from work per year. Current cigarette smokers reported significantly more days troubled by symptoms during a one-month period (15.4 days) than nonsmokers (5.0 days) (P less than 0.001).

Adolescent↗
PubMed2000

[Quality of dispensation of prescription medication from the patients' point of view].

A cross-sectional survey investigated quality relevant aspects of the most common distribution channels (pharmacies, self-dispensing physicians) for prescription drugs in Switzerland. A self-administered questionnaire focusing on consumers' behaviour, perception and priorities regarding the process of dispensation of prescriptive medication was mailed to a random sample of 3000 patients, aged 18 years or older, with regular intake of prescriptive medication. Chi-square analysis was performed on 1058 responses. 60% of the respondents received their medication mainly or exclusively from pharmacies and 40% from self-dispensing physicians. In German-speaking Switzerland 53% of participants received their prescription drugs exclusively or mainly from self-dispensing physicians, compared to only 10% in the French-speaking area (p = 0.00). This distribution confirms the existing differences in regulation of self-dispensation in these regions. Most of the patients took 2-4 prescriptive drugs a day. The French Swiss received slightly more prescriptive medication than the German Swiss (p = 0.05). 45% of the participants, especially women and people using a pharmacy, reported additional, usually occasional over-the-counter medication. Provision of technical information (41%), friendliness (19%), and the availability of drugs (19%) were valued most important when receiving prescription drugs and 96% of the participants were satisfied with the service. In consequence, the participants were strongly bound to their source of drug supply. Some 80% received instructions for use there. However, only half were informed about the purpose of the medication, drugs' side effects, or possible drug interactions. Physicians provided such information more often than pharmacy staff. This observation may be attributable to the double role played by the self-dispensers, who provide medical care and at the same time hand out the drug. In conclusion, patients' satisfaction is achieved equally by both medication channels. However, there is a need to improve counselling to ensure excellence in the supply of drugs.

Adult↗
PubMed1999

DSHEA's third-party literature exemption; mail order sales, direct marketing, and Internet use.

This article examines ways in which marketers of dietary supplements can make use of the "third-party literature" section of the Dietary Supplement Health and Education Act of 1994 (DSHEA). This provision permits persons or entities, other than manufacturers or distributors, to distribute to consumers certain publications in connection with the sale of particular supplements. These publications may include statements about the therapeutic benefits of such products without subjecting the products to regulation by the Food and Drug Administration (FDA) as unapproved new drugs. Specifically, this article addresses the following: Can a dietary supplement manufacturer or distributor send third-party literature about a dietary supplement to a customer in a mail order sales transaction? Can third-party literature be disseminated by mail with dietary supplement catalogues only? Can third-party literature be disseminated by sales representatives engaged in direct marketing of dietary supplements? Can third-party literature appear on the Internet? The answer appears to be affirmative in each of these situations.

Dietary Supplements↗
PubMed1999

Management of diabetic retinopathy by Australian optometrists. Working Group on Evaluation of NHMRC Retinopathy Guideline Distribution. National Health and Medical Research Council.

PURPOSE: To describe current practices related to the management of diabetic retinopathy by Australian optometrists. SETTING AND METHODS: A two-page self-administered questionnaire was mailed to a random sample of 504 Australian optometrists. The survey included questions about the practice (such as size and location); current practice with regard to management of patients with diabetic retinopathy; barriers to use of dilating drops; and a number of patient scenarios related to screening, follow-up and treatment of diabetic retinopathy. RESULTS: Completed questionnaires were returned by 407 of the 473 eligible optometrists (86%). They had been practising optometry between 1 and 50 years (median 14). Of the 243 optometrists who provided details about the location of their practices, 145 (37%) had at least one of their practices in a rural area. The estimated percentage of patients with diagnosed diabetes ranged from 0.5 to 40% (median = 5.0%). Three-hundred and twenty-two optometrists (79%) reported that they would often or almost always ask new patients over the age of 40 whether they have diabetes. The majority of optometrists (n = 387, 95%) would often or almost always ask their new patients with diabetes about their control of blood glucose levels and the majority of optometrists (n = 330, 81%) would often or almost always tell their patients with diabetes about the importance of strict glucose control in delaying retinopathy. The most common barrier to dilated ophthalmoscopy was patients not wanting to be dilated, with 38.1% of optometrists reporting this to be a moderate or major barrier. The next most common barrier was fear of precipitating angle closure glaucoma; 17.1% of optometrists reported this to be a moderate or major barrier CONCLUSION: The National Health and Medical Research Council (NHMRC) guidelines for the management of diabetic retinopathy are timely in relation to the expressed desire of Australian optometrists to learn more about management of diabetic retinopathy These data will be used prospectively to assess changes in management of patients with diabetic retinopathy as a result of the release of the NHMRC guidelines.

Australia↗
PubMed2000

Use of hormone replacement therapy to reduce the risk of osteopenia in adolescent girls with anorexia nervosa.

PURPOSE: To assess how commonly hormone replacement therapy (HRT) and other measures are prescribed for the treatment of osteopenia in children and adolescents with anorexia nervosa (AN). METHODS: A self-administered questionnaire was distributed and completed by allopathic and osteopathic physician members of the Society for Adolescent Medicine at its 1998 annual meeting. The questionnaire was also mailed and E-mailed between March 1998 and February 1999. Descriptive statistics included percentages and measures of central tendency. RESULTS: The questionnaire was completed by 394 of the 1029 physicians surveyed (38.3%). Of the 268 respondents who treated patients with AN under the age of 18 years, 77.6% prescribed HRT. The decision to prescribe HRT was influenced by patient's age but not by bone mineral status. Among those who prescribed HRT, additional therapies included increased caloric intake (89.4%), weight gain (82.2%), increased calcium intake (84.1%), a change in exercise patterns (59.1%), and vitamin D supplementation (37.0%). Only 59 (22.0%) did not use HRT as a treatment modality. One-third of nonprescribers cited the lack of evidence of efficacy of HRT in preventing osteopenia. More recent medical graduates were less likely to prescribe HRT. CONCLUSIONS: This survey suggests that practitioners caring for adolescent females with AN commonly prescribe HRT for the treatment of osteopenia despite the paucity of evidence demonstrating that it effectively prevents or reverses bone loss associated with this disorder.

Adolescent↗
PubMed2002

Information and communication technology among undergraduate dental students in Finland.

Use of information and communication technology (ICT) is rapidly increasing in medical and dental education. The aim of the present study was to determine the knowledge, skills and opinions of dental undergraduate students regarding ICT and to analyze possible shifts in the acquisition of these resources. For these purposes a survey of all undergraduate dental students at the University of Oulu, Finland, was conducted during the spring term 2000. All the students in the 5 years of study (n = 140) were asked to answer a questionnaire presented during a lecture or demonstration. An overall response rate of 95% was achieved. The frequencies and percentage distributions of the items were analyzed separately for each year (1-5). All the students in the faculty are provided with personal e-mail addresses at the beginning of their studies and special emphasis has been laid on the utilization of their ICT knowledge and skills. An overwhelming majority of the students, more than 95%, judged themselves to have good or satisfactory skills in word processing, but only a slight majority considered that they could manage some advanced operating system functions. Use of ICT services was high, as about 60% of the students used e-mail and one-third WWW services daily. Literature retrieval was widely employed, so that almost 80% of the students had used literature databases (including Ovid Medline and collections of electronic full-text articles), which were introduced and provided by the Medical Library when the students were in their second year. More than 50% had received educational material in electronic form often or sometimes, and almost 80% had communicated by e-mail with a faculty teacher. A clear trend (P < 0.05) was found for the younger students to use ICT services in general and for educational purposes more often than the older ones. In conclusion, e-mail and WWW have been widely adopted for both private and educational purposes by dental students in Finland and are employed together with WWW-based medical and dental publication databases. The younger students have more interest in ICT and better skills, which presents a challenge for dental education in the future.

Computer Literacy↗
PubMed1984

Nonresponse bias and early versus all responders in mail and telephone surveys.

Mail and telephone survey methods, with or without follow-up by other methods, are cost-effective alternatives to the conventional home interview approach. However, it has long been thought that they are especially susceptible to nonresponse bias. The study addressed this issue in the context of parallel mail and telephone health surveys carried out in Montreal. The mail strategy among 1,555 adults achieved 68.5% response and follow-up by telephone and home interview increased response to 80.9%. Respondents were adequately representative of the entire sample with respect to socioeconomic status, number of adults in household, and ethnic distribution. The 68.5% initial stage respondents were similar to all respondents on the above variables as well as on age, sex, education and reported health status. Odds ratios of smoking and respiratory symptoms hardly differed between initial stage and all respondents. The telephone survey among 1,595 adults achieved 72.7% response and follow-up by mail and personal interview increased response to 88.2%. Comparisons between respondents and the entire sample and between initial stage respondents and all respondents gave similar results to those found in the mail strategy, although there was some change in a symptom-smoking odds ratio from the initial stage respondents to all respondents. In both survey strategies, there was no evidence of substantial nonresponse bias and estimates of morbidity and health care would not have differed much if the fieldwork had stopped at the initial mail or telephone stage.

Adolescent↗
PubMed2006

Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients.

OBJECTIVES: To characterize the perceived utilization of sedative, analgesic, and neuromuscular blocking agents, the use of sedation scales, algorithms, and daily sedative interruption in mechanically ventilated adults, and to define clinical factors that influence these practices. DESIGN: Cross-sectional mail survey. PARTICIPANTS: Canadian critical care practitioners. MEASUREMENTS AND MAIN RESULTS: A total of 273 of 448 eligible physicians (60%) responded. Respondents were well distributed with regard to age, years of practice, specialist certification, size of intensive care unit and hospital, and location of practice. Twenty-nine percent responded that a protocol/care pathway/guideline for the use of sedatives or analgesics is currently in use in their intensive care unit. Daily interruption of continuous infusions of sedatives or analgesics is practiced by 40% of intensivists. A sedation scoring system is used by 49% of respondents. Of these, 67% use the Ramsay scale, 10% use the Sedation-Agitation Scale, 9% use the Glasgow Coma Scale, and 8% use the Motor Activity Assessment Scale. Only 3.7% of intensivists use a delirium scoring system in their intensive care units. Only 22% of respondents currently have a protocol for the use of neuromuscular blocking agents in their intensive care unit, and 84% of respondents use peripheral nerve stimulation for monitoring. In patients receiving neuromuscular blocking agents for >24 hrs, 63.7% of respondents discontinue the neuromuscular blocking agent daily. Intensivists working in university-affiliated hospitals are more likely to employ a sedation protocol and scale (p < .0001), as are intensivists working in larger intensive care units (>or=15 beds, p < .01). Intensivists with anesthesiology training (and no formal critical care training) are more likely to use a protocol and sedation scale, and critical care-trained intensivists are more likely to use daily interruption. Younger physicians (<40 yrs) are more likely to practice daily interruption (p = .0092). CONCLUSIONS: There is significant variation in critical care sedation, analgesia, and neuromuscular blockade practice. Given the potential effect of practices regarding these medications on patient outcome, future research and educational efforts related to evidence-based protocols for the use of these agents in mechanically ventilated patients might be worthwhile.

Adult↗
PubMed2005

International employment in clinical practice: influencing factors for the dental hygienist.

PURPOSE: To assess demographics, job characteristics, geographical regions, resources and commitment, which influence dental hygienists seeking international clinical practice employment opportunities. METHODS: Questionnaires were mailed to a convenience sample of members of the Dental Hygienists' Association of the City of New York. Statistical analyses were conducted and frequency distributions and relationships between variables were calculated. RESULTS: Seventy-two percent of respondents reported that they are or may be interested in working overseas. Italy and Spain (67%) were the regions of most interest. Salary (65%) was cited as the most influencing factor in selection, whereas non-compliance with the equivalency to Occupational Safety and Health Administration standards (74%) was the most frequently perceived barrier. Multiple language fluency was statistically significant (0.003) regarding interest in overseas employment. CONCLUSION: Policy makers, employers and educators need to be aware of these findings should recruitment be a possibility to render urgently needed oral hygiene care in regions where there is a perceived shortage of dental hygienists.

Adult↗
PubMed2002

Practice activity trends among Australian private general dental practitioners: 1983-84 to 1998-99.

AIM: To investigate time trends in practice activity. DESIGN: Four cross-sectional surveys across a 15 year period. SETTING: Australian private general practice. PARTICIPANTS: A random sample of dentists. METHODS: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998. MAIN OUTCOME MEASURES: Hours per year worked, patient visits per hour and patient visits per year. RESULTS: The number of patient visits per year declined across the period, related to parallel decreases in the number of patient visits per hour (ANOVA; P<0.05), while there was no significant difference during the period in the number of hours per year devoted to work. The interaction of dentist sex by time of survey indicated that while numbers of patient visits per year had remained stable for female dentists, there was a trend for the higher number of patient visits per year among male dentists at the beginning of the survey period to decline over time. CONCLUSIONS: Male dentists had higher levels of practice activity compared with female dentists, but a decline in the number of patient visits per year reflected a convergence of male practice patterns towards that of female dentists.

Adult↗
PubMed2003

Service provision trends among Australian private general dental practitioners: 1983/84 to 1998/99.

AIM: To investigate time trends in service provision. DESIGN: Four cross-sectional surveys across a 15-year period. SETTING: Australian private general practice. PARTICIPANTS: A random sample of dentists. METHODS: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998. MAIN OUTCOME MEASURES: Services per visit, annual services per dentist, annual services per patient. RESULTS: Total services per visit increased over the study period from 1.78 to 2.14 (Poisson regression; p < 0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased over the period from 3.47 to 5.22 (OLS regression; p < 0.05), reflecting both the increased service rate per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more endodontic and crown and bridge services. The pattern of annual care received per patient also included more endodontic and crown and bridge services but differed from the dentist pattern through increased service rates over the study period in areas such as restorative, diagnostic and preventive. CONCLUSIONS: While dentists are providing a similar number of services annually, the content of their workload has changed to include less emphasis on removal and replacement of teeth and more effort on maintenance and retention of natural dentitions.

Adult↗
PubMed1997

The effect of a monetary incentive in increasing the return rate of a survey to family physicians.

The barrage of requests family physicians receive to complete mail surveys often results in physicians who are unwilling, or unable due to time constraints, to complete each survey they receive. Thus, to obtain an acceptable response rate, state-of-the-art mail survey techniques must be used. This article reports the results of the use of a modest ($1) monetary incentive to increase a survey response rate. A random sample of 600 American Academy of Family Physicians members were mailed a survey of firearm safety counseling; half received a $1 incentive whereas the remaining half served as a control group. The response rate in the incentive group was 63% compared to 45% in the control group [chi 2 (1, N = 251) = 16.0, p < .001]. Further, the use of the incentive appears to be more cost-effective than a third follow-up (postcard reminder) mailing.

Chi-Square Distribution↗
PubMed2005

Conducting accelerometer-based activity assessments in field-based research.

PURPOSE: The purpose of this review is to address important methodological issues related to conducting accelerometer-based assessments of physical activity in free-living individuals. METHODS: We review the extant scientific literature for empirical information related to the following issues: product selection, number of accelerometers needed, placement of accelerometers, epoch length, and days of monitoring required to estimate habitual physical activity. We also discuss the various options related to distributing and collecting monitors and strategies to enhance compliance with the monitoring protocol. RESULTS: No definitive evidence exists currently to indicate that one make and model of accelerometer is more valid and reliable than another. Selection of accelerometer therefore remains primarily an issue of practicality, technical support, and comparability with other studies. Studies employing multiple accelerometers to estimate energy expenditure report only marginal improvements in explanatory power. Accelerometers are best placed on hip or the lower back. Although the issue of epoch length has not been studied in adults, the use of count cut points based on 1-min time intervals maybe inappropriate in children and may result in underestimation of physical activity. Among adults, 3-5 d of monitoring is required to reliably estimate habitual physical activity. Among children and adolescents, the number of monitoring days required ranges from 4 to 9 d, making it difficult to draw a definitive conclusion for this population. Face-to-face distribution and collection of accelerometers is probably the best option in field-based research, but delivery and return by express carrier or registered mail is a viable option. CONCLUSION: Accelerometer-based activity assessments requires careful planning and the use of appropriate strategies to increase compliance.

Acceleration↗
PubMed2003

GI complications after lung transplantation in patients with cystic fibrosis.

STUDY OBJECTIVE: Lung transplantation is now available for patients with cystic fibrosis (CF) and end-stage lung disease. While pulmonary graft function is often considered the major priority following transplantation, the nonpulmonary complications of this systemic disease also continue. We examined the GI complications in a cohort of patients who underwent transplantation. DESIGN: This was a retrospective study of all patients with CF who underwent transplantation between March 1988 and December 1998 in Toronto. Medical records were reviewed, and a short questionnaire was mailed to patients who were alive as of December 1998. RESULTS: There were 80 bilateral lung transplants performed in 75 patients. The questionnaire was distributed to 43 patients, of whom 27 patients (63%) responded. Pancreatic insufficiency requiring enzyme intake was evident in 72 of 75 patients (96%) at the time of surgery. Of three pancreatic-sufficient patients (4%), pancreatic insufficiency was diagnosed in two patients later. Biliary cirrhosis was diagnosed in three patients prior to transplantation. Distal intestinal obstruction syndrome (DIOS) was recorded for 15 patients (20%). Ten patients had a single episode, of which eight episodes occurred early in the postoperative period. Five patients had recurrent episodes. All were medically treated, except for two patients who underwent surgery. Other complications included cholecystitis (n = 3), mucocele of the appendix (n = 1), peptic ulcer disease (n = 3), and colonic carcinoma (n = 1). CONCLUSION: GI complications after lung transplantation are common in patients with CF, and attention should be paid to the risk for DIOS in the early postoperative period. Prevention and early medical treatment are important in order to avoid acute surgery. Close collaboration with the CF clinic, in order to diagnose and treat CF-related complications, is recommended.

Adult↗
PubMedDate not supplied

[Presence of MIR-elements in the complete nucleotide sequence of human chromosome 22].

The location of mammalian interspersed repeats (MIRs) and their density have been determined in the complete nucleotide sequence of human chromosome 22. The approach developed by us has allowed detection of 9675 MIRs at a statistically significant level, which by 15% exceeds the MIR number revealed by all previous approaches. It has been demonstrated that a considerable amount of MIRs missed by the algorithms applied earlier occurs in known DNA sequences of the human genome. The study of the MIR density revealed substantial irregularity of their distribution along the chromosome. The data on the MIRs thus found and the computer program searching for diverged sequences are available by E-mail: katrin2@mail.ru or katrin22@mtu-net.ru.

Algorithms↗
PubMed2003

The Harstad Injury Prevention Study. A decade of community-based traffic injury prevention with emphasis on children. Postal dissemination of local injury data can be effective.

OBJECTIVES: To evaluate the outcome of a community-based program for reducing traffic injury rates with special focus on children and to assess the impact of a Traffic Injury Report (TIR) in terms of awareness and attitudes about safety issues. SETTING: The Norwegian cities Harstad (23 000) and Trondheim (140 000), during ten years. METHODS: The outcome was evaluated using hospital-based injury recording. Sustainability of the prevention program was promoted by disseminating information on the community's traffic injury profile. Reports containing information about traffic injuries were distributed quarterly to all Harstad households, containing victim stories and statistics on medical data and the location of the accidents. The impact of the reports was evaluated, using a questionnaire mailed to persons 18-80 years old. RESULTS: From the first two years (mean rate 116.1/10,000 person years), to last two years, a significant 59% [confidence interval (CI): 42% to 71%] reduction of traffic injury rates was observed for Harstad children. Overall rates for all ages decreased 37% [CI:47% to 24%] in Harstad increased by 3% [CI:-4% to 10%] in Trondheim (reference city). Significantly higher scores were found in Harstad compared to Trondheim concerning the awareness of, and positive attitudes towards, safety issues (e.g. alcohol and driving, speeding and children's safety in traffic). 56.0% of respondents in Harstad reported having acquired information, or good advice, about traffic safety from the reports. CONCLUSIONS: Traffic injuries in children can be prevented by community-based interventions. Distributing written information may enhance the program's sustainability.

Accident Prevention↗
PubMed2007

Identifying students with self-report of asthma and respiratory symptoms in an urban, high school setting.

Strategies for identifying urban youth with asthma have not been described for high school settings. African-American high school students are rarely included in asthma studies, despite a high risk of asthma mortality when compared to other age and race groups. Identification and follow-up of children with uncontrolled respiratory symptoms are necessary to reduce the burden of asthma morbidity and mortality, especially in underserved areas. We describe a process used to identify high school students who could benefit from intervention based on self-report of asthma and/or respiratory symptoms, and the costs associated with symptom-identification. Letters announcing a survey were mailed to parents of 9th-11th graders by an authorized vendor managing student data for the school district. Scan sheets with student identifiers were distributed to English teachers at participating schools who administered the survey during a scheduled class. Forms were completed by 5,967 of the 7,446 students assigned an English class (80% response). Although prevalence of lifetime asthma was 15.8%, about 11% of students met program criteria for enrollment through report of an asthma diagnosis and recent symptoms, medication use, or health care utilization. Another 9.2% met criteria by reported symptoms only. Cost of symptom-identification was $5.23/student or $32.29/program-eligible student. There is a need for school-based asthma programs targeting urban adolescents, and program initiation will likely require identification of students with uncontrolled symptoms. The approach described was successfully implemented with a relatively high response rate. Itemized expenses are presented to facilitate modifications to reduce costs. This information may benefit providers, researchers, or administrators targeting similar populations.

Absenteeism↗
PubMed2005

Practice patterns of SGO members for stage IIIA endometrial cancer.

OBJECTIVE: The purpose of surgical staging is to better determine prognosis and treatment. The International Federation of Gynecology and Obstetrics (FIGO) stage IIIA endometrial cancer is a heterogenous disease, and adjuvant therapy is not well-defined. The aim of this study was to survey the Society of Gynecologic Oncologists (SGO) members and fellows about their approach to the treatment of patients with stage IIIA endometrial cancer. METHODS: All 850 members of the SGO were mailed surveys that asked how they would manage various case scenarios of stage IIIA endometrial cancer. Data were collected using an Internet survey database. Frequency distributions were determined, and nonparametric tests were performed. RESULTS: Fifty-three percent of SGO members and fellows responded. For the treatment of stage IIIA disease with malignant cytology only, adjuvant therapy was recommended 46%, 62%, and 98% of the time for women with grades 1, 2, and UPSC, respectively. Sixty-six percent of respondents would not remove malignant cytology from the current staging criteria. Ninety-nine percent of respondents recommended adjuvant therapy for patients with adnexal or serosal involvement. Eighty-six percent indicated that a hysteroscopy for diagnosis would not alter their treatment recommendations. CONCLUSIONS: While most gynecologic oncologists in our survey recommend adjuvant therapy for stage IIIA endometrial carcinoma, our results showed that patients with malignant cytology only would receive different treatments than patients with adenxal or serosal involvement. Histology and grade of the tumor are predictors of therapy recommendations over malignant cytology. Most respondents agreed that patients with malignant cytology should remain in stage IIIA.

Carcinoma, Endometrioid↗