Objectives: Pediatric Early Warning Scores (PEWS) are an easy-to-use diagnostic tool for patient evaluation. The goal of this study was to determine if using PEWS in our pediatric emergency department (PED) at the time of admission to the hospital was associated with a decrease in the number of emergency response calls within 6 hours of admission.Methods: A retrospective chart review of 6 months before (May 2013-October 2013) and after (December 2013-May 2014) initiation of PEWS upon inpatient admission from our urban, tertiary care PED was conducted to determine the number of patients who had emergency response calls within 6 hours of admission. Results:The percentage of patients admitted from the PED who required an emergency response call within 6 hours of admission dropped from 1.77% in the 6 months before assigning PEWS to 0.79% in the 6 months after, a 55% reduction (P = 0.0070). Conclusions:Assigning PEWS to patients being admitted to our hospital from the PED was associated with a reduced number of emergency response calls in the period immediately after admission.

Background: Combination chemotherapies of platinum compounds with alkylating agents have been the standard treatment for patients with advanced ovarian carcinoma over the last decades. The recent development of taxans has added a group of new promising agents; however, long-term results are not yet available. Platin derivates have proven to be an indispensable part in combination chemotherapies for ovarian carcinoma. The dose intensity of cisplatin is, however, still a matter of debate. We report on the long-term results of a prospective randomized trial comparing two dosages of cisplatin combined with treosulfan in patients with advanced epithelial ovarian cancer. Patients and Methods: Between 1988 and 1995, 125 patients with ovarian cancer (FIGO stage II–IV) were randomized to receive 4 cycles (28-day intervals) of either cisplatin 100 mg/m² (high dose, HD) or 50 mg/m² (low dose, LD) in combination with 5 g/m² treosulfan after primary cytoreductive surgery. Postoperative residual tumor was absent in 39 patients (HD: 16; LD: 23), < 2 cm in 61 patients (HD: 36; LD: 25) and > 2 cm in 25 patients (HD: 13; LD: 12). 65 and 60 patients received HD and LD cisplatin, respectively. Second-look surgery was optional. Results:The overall response rate was 70.0% (HD: 70.9%; LD: 68.9%). Pathological complete response (CR) was seen in 45 patients (37.5%), clinical CR in 23 patients (19.2%), partial response (PR) in 16 patients (13.3%), stable disease (SD) in 2 patients, and progression of disease (PD) in 34 patients (28.3%). 5 patients were not assessable for response. Overall median survival was 25.6 (HD: 26.9, LD: 25.2) months. The overall disease-free survival for responders was 19.6 and 24.7 months (HD and LD, respectively). HD chemotherapy did not result in any significant survival benefit in completely resected patients: HD: 39.8 months versus LD: 49.5 months. In suboptimally debulked patients (residual tumor < 2 cm), median survival was 24.1 months (HD) versus 22.6 months (LD). In patients with residual tumors > 2 cm median survival was 14.6 months (HD) versus 15.5 months (LD). Significantly less side effects were seen in the LD group: anemia (p = 0.008); nephrotoxicity (p = 0.014); alopecia (p = 0.017). Conclusions: Our data suggest that LD cisplatin-based chemotherapy is as effective as HD chemotherapy in patients with advanced epithelial ovarian cancer, but is far less toxic.

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