Because of the different nature and treatment requirements for depression subtypes, PR may be applicable to a limited range of depressed patients, particularly those who do not exhibit Anhedonia.

Although the higher proportion of women in faculties and schools of pharmacy is apparent to pharmacy students, we were interested in evaluating students' understanding of the implications of a largely female workforce, both for individuals entering the profession and for the profession itself. ABSTRACTBackground: Women have historically been attracted to pharmacy because it is widely perceived as a profession that offers them an opportunity to combine a professional career with a family. Women now make up the majority of practising pharmacists in Canada, yet the literature demonstrates disparities such as gender segregation and underrepresentation of women in senior positions. This study was intended to identify the attitudes and beliefs of pharmacy students about women's issues in pharmacy and raise awareness of these issues.

Centers that perform stem cell transplants have patient selection criteria for treatment, typically including patient performance status, acceptable cardiopulmonary function, normal renal function, absence of active infection, and underlying disease likely to respond to treatment. Despite these selection criteria, transplant-related morbidity and mortality are high, particularly in allogeneic transplants. We sought to find a method to better predict outcome after SCT. The Charlson Comorbidity Index (CCI) is a tool to assess comorbidities and outcome in a varitety of diseases, but its utility in SCT is unclear. This retrospective study used chart review from 187 procedures (109 autologous and 78 allogeneic; 43 myeloablative and 35 non-myeloablative) performed between 2002 and 2004 to assign CCI scores. Transplant outcomes, including 100-day and 1-year survival and transplant related toxicity, were grouped according to CCI and analyzed using regression analysis, T-test, Fisher Exact and ANOVA. Median age at transplant was 55 years for autologous and 48 years for allogeneic (41 years for myeloablative and 55 years for non-myeloablative). The CCI was not predictive of survival or toxicity in autologous transplant patients. In allogeneic transplants, the CCI was predictive of only long-term survival when a score of zero was compared to all other scores, but was not clinically useful since 76% of patients had a CCI score of zero and values over one had similar outcomes. We thus sought a better tool to predict outcomes and modified the CCI using clinical parameters that were anticipated to impact outcome. These included pre-transplant lab values (AST, ALT, creatinine and bilirubin), scores for prior organ dysfunction (CNS, cardiovascular, diabetes, lung, liver and kidney), pulmonary function, alcohol use and smoking history. This new SCT Comorbidity Index, SCI, was used to evaluate outcomes using the same methodology. The modification of the original CCI expanded the range of comorbidities to 27 from the 19 medical conditions assessed in the original CCI. By this expansion, a new maximum score of 38 was created with an individual patient high SCI score of 8. The autologous and allogeneic SCT populations had comparable comorbidity scores, while non-myeloablative patients had higher comorbidity scores, on average, than myeloablative. For short term 100-day survival, the SCI proved to be a better predictor than the original CCI only in autologous SCTs (99% survival with SCI scores of 0 or 1 vs. 83% survival with other SCI scores p=0.004). Long-term survival 100 days to 1 year was opposite of anticipated in autologous SCTs (67% survival with SCI score of 0 vs. 91% survival with other SCI scores p=0.007) but appeared to be predictive in allogenic transplants (87% survival with SCI score 0–2 vs. 50% for higher SCI scores p=.002). The SCI did not predict long-term survival in the non-myeloablative allogeneic SCT subset of patients. In addition, neither index predicted overall toxicity (d0 to d30), and neither predicted grade III–IV toxicity (d0 to d30) in any patient population. Thus neither the Charlson Comorbidity Index nor a modified index was found to be a helpful in the consistent prediction of stem cell transplant outcomes. This likely reflects the selection criteria used for determining candidacy that limits the degree of comorbidity.

Quality of life for stem cell transplant patients hinges partly on expectations of health outcomes. This study was designed to determine how information provided to patients before stem cell transplant was used in their decision making process and their coping with diagnosis, therapy and complications. Anonymous questionnaires were sent to 127 patients transplanted 2001 through 2004. Patients indicated the resources they used (transplant physicians, transplant coordinator, ancillary staff, and former patients; referring physicians; audiotapes of the information session; national organization booklets; and websites) and ranked these resources by helpfulness in learning about the transplant process, as well as in coping with their diagnosis. Responses were obtained from 69 patients (54%) representing 30 allogeneic and 39 autologous procedures. Of the patients questioned, 96% believe they were well informed about their disease and transplant process. The first information session with the physician was recorded and was scored as the most important for understanding the disease and transplant process, followed by the information session with the transplant coordinator. These sources were also ranked as the two most helpful in coping with dianosis, treatment and complications. Booklets from national organizations, such as the Leukemia and Lymphoma Society and National Cancer Institute, were used by 46% of the patients and were scored slightly more important than meetings with former patients, but less important than discussions with the referring oncologist. Websites, including our own website, were used by only 30% of the patients and were not regarded as highly important. The value of tape recording the information session with the physician was analyzed in more depth. Of the 62 patients who had received a usable recording, 84% considered the tape useful. Fifteen percent of the patients did not listen to the audiotape, 29% listened once, 38% listened twice, and 18% listened three or more times. In addition to the patients, spouses (73%), children (38%), parents (21%), friends (19%) and other health-care providers (6%) listened to the audiotapes. Eighty-eight percent of the patients studied felt they received most or all of the information they needed, while the remaining 12% wished they had received more. Time spent with transplant physicians and coordinators explaining the rationale, process, risks and benefits of the transplant procedure is a pivital part of the information gathering process. Web-based information was relatively unimportant for the patients studied, however, demographics such as age, education level adn financial resources play a part in the process of retreiving information. The audiotape was also recognized as an important, and frequently referred to, source of information provided to our patients. This suggests that patient-specific human interactions between patients, physicians and coordinators could never be completely replaced by written information from pamphlets or websites. The role of recording the information session, therefore, deserves further attention in a prospective study.