PurposeA pneumatic tourniquet is commonly used in total knee arthroplasty (TKA) to improve surgical field visualisation but may result in quadriceps muscle ischaemia. We performed this study to analyse the effect of the tourniquet on recovery following TKA.Materials and MethodsA prospective randomised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain, swelling, blood loss, quadriceps function and outcome following TKA. Twenty patients with osteoarthritis of the knee were randomised to tourniquet or no tourniquet groups. Quadriceps function was assessed using surface electromyography (EMG) during active knee extension.ResultsThe no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group. There was no difference in Oxford knee score, range of motion, or thigh and knee swelling up to 12 months post-operatively. Quadriceps function, measured by surface EMG, was compromised for the first six months post-surgery by tourniquet use. The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet.ConclusionsWe believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet.

Patients had a complex array of symptoms and significant symptom burden, which was commonly the reason for treatment. Although chemotherapy improved symptoms in about half of the patients, many did not benefit and progressed rapidly. Our findings support research into the use of patient reported outcome measures to document symptoms, adverse events, and subjective benefit, both in clinical trials and in clinical practice, in this patient population. Our findings highlight the need to develop prognostic models to better select patients for treatment, and this is an aim of stage 2 of the GCIG Symptom Benefit Study.

Purpose. Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12-16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio.Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r ϭ 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r ϭ Ϫ0.43) and depression (r ϭ Ϫ0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49 -0.96; p ϭ .026). Conclusion. Trait hope and expectation of symptom benefit fromchemotherapyappeartobedistinctandindependentofthe aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefitfromchemotherapywasnotfulfilledweremorelikelytohave scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy. The Oncologist 2013;18:1221-1228 Implications for Practice: Many women with platinum resistant ovarian cancer decide to continue chemotherapy out of hope, even if their prognosis is very poor. They hope the chemotherapy will reduce the size of the cancer, give them more time, or reduce their symptoms. While most clinicians would agree that hope is a positive attribute, this study showed that if women's hopes were not fulfilled, they were more likely to become depressed. This suggests that clinicians should be careful to communicate in a way that encourages realistic hope, targeted toward achievable goals, as this may protect women from depression. INTRODUCTIONOvarian cancer is the leading cause of death in women with gynecological malignancies in the Western world. Most women present with advanced disease and following surgery receive platinum-based chemotherapy. Although many women initially respond to treatment, the majority will have relapse within 12 to 18 months [1]. Patients who have relapse within

This article documents the development of the MOST, a new PROM designed to assess patient-reported benefits and burden as end points in clinical trials of palliative chemotherapy for women with symptomatic ovarian cancer. The validity, reliability, and statistical efficiency of the MOST, relative to the best candidate scales of existing PROMs, will be assessed in the stage 2 of Gynecologic Cancer Intergroup Symptom Benefit Study.