Factors influencing University of Papua New Guinea medical imaging science students considering rural radiography careers.

INTRODUCTION: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. METHODS: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. RESULTS: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. CONCLUSION: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional non-digital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study.

A review of mammographic image quality in Papua New Guinea.

INTRODUCTION: To report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation system (IES); and to benchmark the image quality against BreastScreen Australia (BSA) National Accreditation Standards (NAS). METHODS: A retrospective image quality analysis of the de-identified mammograms of 102 women imaged at the Port Moresby General Hospital (PMGH) was undertaken using the PGMI IES. Each craniocaudal (CC) and mediolateral oblique (MLO) image was assigned a grade and the reasons for the grade recorded. Age was recorded in years. Simple frequency analysis was undertaken and comparison with BSA NAS 2.4 was made. RESULTS: Women were aged between 25 and 74 years. There were 111 CC views and 109 MLO views. The most frequent individual grade for the CC view was G (83.8%) and for the MLO view M (72.48%); and for a routine series (four images), P and G combined (14.8%). Non-visualisation of the IMA (28%), nipple not in profile (26%) and short length of pectoral muscle (12%) were the most cited reasons for assigning an M grade. CONCLUSION: The reported image quality is not commensurate with that required by BSA (P and G > 50%) and while common positioning errors can be rectified through education and training, it is also important to recognise the complex challenges faced by PNG radiographers in obtaining mammographic images that extend beyond education and training and reflect the emerging nature of the modality as well as wider health, economic and other issues. This work raises the need for national standards, dedicated equipment, and radiographer education to best serve the women of PNG.

Correlation of the BI-RADS assessment categories of Papua New Guinean women with mammographic parenchymal patterns, age and diagnosis.

INTRODUCTION: Women with increased breast density are at increased risk of breast cancer. The aim of this research is to evidence for the first time the mammographic breast findings of Papua New Guinean (PNG) women and the relationship between Breast Imaging-Reporting and Data System (BI-RADS) assessment, mammographic parenchymal patterns (MPPs) and age. METHODS: A retrospective analysis of 1357 mammograms of women imaged at the Pacific International Hospital (PIH) from August 2006 to July 2010 was undertaken. Mammographic findings were categorised using the BI-RADS Atlas® 5th Edition. MPPs were recorded for each woman using the Tabár Pattern I-V classification system. Age was recorded in years. Statistical analysis was by descriptive analysis and Kruskal-Wallis with Dunn's post-test and Spearman's rho correlation for inferential analysis. RESULTS: True pathological findings (benign and malignant); BI-RADS 2-5 were noted in 111 women (8.2%); 1242 (91.5%) were negative. BI-RADS categories for malignancy were reported in 16 (88.9%) of women aged 30 to 60 years. The lower risk Tabár Type I, II and III MPPs were associated with 94.4% (n = 17) of malignancies. Linear correlations between variables were weak and not statistically significant: age and Tabár pattern r = 0.031, P = 0.0261; age and BI-RADS r = 0.018, P = 0.517; Tabár pattern and BI-RADS r = 0.020, P = 0.459 (n = 1357). CONCLUSION: There was no correlation demonstrated between BI-RADS category, age and MPP. Importantly, there was no correlation demonstrated between BI-RADS categories 4 and 5 for breast malignancy and high-risk Tabár Type IV and V MPPs. The results of this study again reflect that the incidence of breast cancer in PNG cannot be explained by breast density and suggest that any formalised screening program in PNG has a target age group aimed at women younger than that of Western screening programs.

Full-field digital mammography: the '30% rule' and influences on visualisation of the pectoralis major muscle on the craniocaudal view of the breast.

INTRODUCTION: To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the breast. METHODS: A retrospective review of 2688 paired full-field digital mammography (FFDM) CC view mammograms of women attending BreastScreen NSW between August and October 2015 was undertaken. PMM visualisation and measurements of PMM width and length, compressed breast thickness, the posterior nipple line (PNL) and age were recorded. Statistical analysis was performed using descriptive and inferential statistics to investigate associations between key breast measurements, age and PMM visualisation. RESULTS: PMM visualisation was reported in 10.4% of images unilaterally (one breast, left or right only), 14.1% bilaterally (both left and right breasts) and 24.5% overall (unilateral and bilateral combined). There was little or no correlations between PMM length or width and age, breast compressed thickness or PNL. Multiple logistic regression analysis found that up to 15% of the variance in visualisation of the PMM was accounted for by the predictors overall. While some predictors provided a statistically significant contribution to the model, the contribution was small and the odds ratio for all predictors approximated 1. CONCLUSION: This research could not replicate the '30% rule', and visualisation of the PMM was determined not to be influenced by the variables investigated. The significance of the 'rule' itself must be challenged where the vast majority of images (70-85%) do not comply, and there is no requirement for repeat imaging if the 'rule' is not met. Further research should be undertaken to validate this study including analysis of diagnostic images for comparison.

Current practice in mammographic imaging of the augmented breast in Australia.

AIM: This study seeks to document the imaging series used in contemporary Australian practice for imaging the augmented breast, with a secondary focus on differences in practice and opinion between BreastScreen Australia and diagnostic imaging services. METHODS: A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and was assessable during December 2017 and January 2018. The questionnaire investigated: years of experience, facility type and location, image acquisition systems, appointment times, patients imaged per week, technique and imaging series used, use of limited compression views, rationale for variation in imaging series and the use of ultrasound. Descriptive statistics were produced for all variables with chi-squared tests used for comparisons between categorical variables. RESULTS: The most frequently used series was the eight-image Eklund ID technique 64% and 59% (submuscular) and 68% and 58% (subglandular) for BSA and diagnostic services, respectively. Eighteen different combinations of projections were reported with eight combinations common to both subglandular and submuscular imaging. The majority of participants attributed imaging series preferences to dose reduction and radiologist preference. CONCLUSION: This research has demonstrated varied approaches to the routine imaging of women with breast implants and identified the need for the establishment of dedicated evidence-based imaging protocols to ensure that regardless of which setting a woman attends that they receive standardised imaging with minimal dose and maximum breast coverage. This is a reassurance that is not applicable to current practice.

Antimicrobial susceptibility of clinical isolates of Campylobacter jejuni from New South Wales, Australia.

OBJECTIVES: The aim of this study was to investigate the prevalence of resistance to commonly used antimicrobials in Campylobacter jejuni isolates from clinical faecal samples in New South Wales (NSW), Australia. METHODS: A total of 117 C. jejuni isolates from human faecal samples from regional and metropolitan NSW were examined for antimicrobial resistance. RESULTS: Of the 117 isolates tested, 15.4% were resistant to ampicillin, 5.1% to tetracycline and 13.7% to ciprofloxacin. Most of the isolates were susceptible to erythromycin, except for three that showed intermediate resistance. Furthermore, 9.4% of isolates were resistant (or intermediate-resistant) to more than one antimicrobial agent. Isolates that were resistant to ampicillin and tetracycline harboured the blaOXA-61 and tet(O) genes, respectively. A mutation in the gyrA gene, resulting in the T86I substitution, was identified in the majority of ciprofloxacin-resistant isolates. CONCLUSION: The data obtained in the current study demonstrate that the majority of C. jejuni isolates evaluated were susceptible to one or more antimicrobials tested. Apart from three isolates that demonstrated intermediate resistance, all of the isolates were susceptible to erythromycin, which is the drug of choice for treating Campylobacter infections.

Prevalence of Campylobacter spp. in diarrhoea samples from patients in New South Wales, Australia.

Campylobacteriosis is a leading cause of bacterial foodborne disease in many industrialized countries including Australia. New South Wales (NSW) is the most populous state in Australia yet the lack of any Campylobacter species surveillance programs has led to a knowledge gap in the importance of these pathogens as causes of diarrhoea. The data collected in this study demonstrated a need for such programs. In this study, 400 human clinical fecal samples were collected from two NSW locations, Western Sydney and Wagga Wagga, and tested for the presence of Campylobacter spp. Patients were clustered by location, age and gender to assess Campylobacter spp. prevalence within these groups between the two regions. The frequency of Campylobacter spp. was higher in males compared to females in the age groups 0-4 and 5-14 years; 6.4% and 1.0%, and 8.2% and none, respectively. A second peak was noted in elderly adults compared with those in younger age groups. Based on the findings of the quantitative PCR analysis it was estimated that the age-adjusted prevalence of Campylobacter spp. associated diarrhoea was 159 cases per 100,000 persons. [Int Microbiol 2016; 19(1):33-37].

Prevalence of Campylobacter spp. in diarrhoea samples from patients in New South Wales, Australia

Campylobacteriosis is a leading cause of bacterial foodborne disease in many industrialized countries including Australia. New South Wales (NSW) is the most populous state in Australia yet the lack of any Campylobacter species surveillance programs has led to a knowledge gap in the importance of these pathogens as causes of diarrhoea. The data collected in this study demonstrated a need for such programs. In this study, 400 human clinical fecal samples were collected from two NSW locations, Western Sydney and Wagga Wagga, and tested for the presence of Campylobacter spp. Patients were clustered by location, age and gender to assess Campylobacter spp. prevalence within these groups between the two regions. The frequency of Campylobacter spp. was higher in males compared to females in the age groups 0-4 and 5-14 years; 6.4% and 1.0%, and 8.2% and none, respectively (P < 0.05). A second peak was noted in elderly adults compared with those in younger age groups. Based on the findings of the quantitative PCR analysis it was estimated that the age-adjusted prevalence of Campylobacter spp. associated diarrhoea was 159 cases per 100,000 persons (AU)

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Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines?

BACKGROUND: A common procedure within intensive care units (ICUs) is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy. Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice. OBJECTIVE: To examine the suctioning practices of registered nurses (RNs) and registered respiratory therapists (RRTs) in six hospital ICUs in Ontario, with special attention devoted to the use of NSI. METHODS: A 24-question, self-administered survey was distributed to 180 participants (90 RNs and 90 RRTs) working in the ICU of six hospitals in Ontario. The survey addressed individual suctioning practices within the ICU. RESULTS: The survey response rate was 96%. There were many similarities between the RRT and RN groups, with both reporting high use of NSI. Both groups observed side effects following NSI with suctioning including decreased oxygen saturation, patient agitation and increased volume of secretions. A significant number of participants from both the RN and RRT groups were unaware of the existence of suctioning and/or NSI protocols in the ICU. Some respondents reported that they routinely suctioned mechanically ventilated patients rather than as required. CONCLUSION: RNs and RRTs continue to practice NSI despite evidence-based practice guidelines suggesting that this therapy may be detrimental to patients. Increased awareness of best practices with respect to endotracheal tube suction generally, and NSI specifically, should be the focus of professional education in both groups of ICU staff.

HISTORIQUE: À l'unité de soins intensifs (USI), on aspire souvent les sécrétions respiratoires des patients intubés ou trachéostomisés. Des études antérieures ont démontré une importante variation des pratiques d'aspiration, et même si les données actuelles n'appuient pas le rinçage systématique par solution physiologique normale (SPN), les données empiriques révèlent que leur utilisation serait courante. OBJECTIF: Examiner les pratiques d'aspiration des infirmières et des inhalothérapeutes à l'USI de six hôpitaux de l'Ontario et s'attarder particulièrement à l'utilisation de la SPN. MÉTHODOLOGIE: Les chercheurs ont distribué un sondage auto-administré de 24 questions à 180 participants (90 infirmières et 90 inalhothérapeutes) qui travaillaient à l'USI de six hôpitaux de l'Ontario. Ce sondage traitait des pratiques d'aspiration individuelles à l'USI. RÉSULTATS: Le taux de réponse au sondage s'élevait à 96 %. Les groupes d'infirmières et d'inhalothérapeutes présentaient surtout des similarités, tous deux déclarant une forte utilisation du SPN. Les deux groupes observaient des effets secondaires après l'administration du SPN, l'aspiration entraînant une diminution de la saturation en oxygène, une agitation des patients et une augmentation du volume de sécrétions. Bon nombre des participants des deux groupes ne connaissaient pas de protocoles d'aspiration ou d'utilisation de la SPN à l'USI. Certains répondants précisaient qu'ils procédaient à l'aspiration systématique des patients sous ventilation mécanique plutôt que d'attendre les besoins. CONCLUSION: Les infirmières et les inhalothérapeutes continuent d'administrer un SPN malgré les directives cliniques fondées sur des données probantes indiquant qu'elle peut être néfaste au patient. La formation professionnelle de ces deux groupes d'employés de l'USI devrait s'attarder sur les pratiques exemplaires en matière d'aspiration des sondes trachéales en général et de l'administration de SPN en particulier.

An experience of the introduction of a blood bank automation system (Ortho AutoVue Innova) in a regional acute hospital.

This paper reports on an evaluation of the introduction of a blood bank automation system (Ortho AutoVue(®) Innova) in a hospital blood bank by considering the performance and workflow as compared with manual methods. The turnaround time was found to be 45% faster than the manual method. The concordance rate was found to be 100% for both ABO/Rh(D) typing and antibody screening in both of the systems and there was no significant difference in detection sensitivity for clinically significant antibodies. The Ortho AutoVue(®) Innova automated blood banking system streamlined the routine pre-transfusion testing in hospital blood bank with high throughput, equivalent sensitivity and reliability as compared with conventional manual method.

Obesity and Healthcare Avoidance: A Systematic Review.

This review addresses the issue of health care avoidance and obesity. English language journal articles published between 1990 and 2012 that addressed the review question; "is being overweight or obese an unrecognized factor in healthcare avoidance?" were located using major databases. A modified JADAD scoring system was then used to assess papers. Ten papers were identified which directly addressed the review question. A positive relationship exists between obesity and healthcare avoidance. The major contributory factors were being female, have a diagnosed mental health problem and perceived or actual bias and discrimination by health professionals. The review also highlights the importance of the relationship between healthcare professionals and their patients, and the physical environment in which interactions occur as these may contribute to avoidance behaviors. Concern about obesity is rising and while there has been much discussion about strategies to reduce obesity this review highlights the need for thinking more broadly about the way in which overweight and obese individuals interact with preventative health strategies.

Use of complementary and alternative medical therapies (CAM) by patients attending a regional comprehensive cancer care centre.

BACKGROUND: This study determined the prevalence, types, and attitudes towards complementary and alternative medicines (CAMs) and therapies in cancer patients actively undergoing conventional cancer treatment at a regional cancer centre. METHODS: Data were collected using a self-administered questionnaire provided to adult cancer patients attending a comprehensive cancer care centre in regional Australia over a 3-month period. RESULTS: A participation rate of 89% was recorded over the 3-month period with 285 of 320 cancer patients providing completed data. Mean age was 64 years and slightly more females responded (56%). CAM types used by patients were classified according to US National Centre for Complementary and Alternative Medicine (NCCAM) domains. Overall prevalence of CAM use was 49% (140/285). The NCCAM domains of biologically-based treatments (mainly herbal and vitamin/mineral supplements) and manipulative/body-based methods (chiropractic and massage) were the most popular. Most patients (61%) who used CAM prior to cancer diagnosis continued complementary practices afterwards, and 33% of participants became first-time CAM users only after diagnosis. CAM use appeared to be associated with high patient acceptance and satisfaction which was not related to either cancer diagnosis or prognosis. Patients who used CAM were mainly willing to disclose (77%) this practice to their conventional health care providers. CONCLUSIONS: CAM use is prevalent in regional Australia. Collaborative integration of some CAM practices into conventional cancer care pathways (a process known as integrative oncology) is likely to have substantial patient support.

Therapeutic options for chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review.

BACKGROUND: Chronic inflammatory demyelinating polyradiculoneuropathy is a rare acquired immune-mediated progressive or relapsing disorder causing peripheral neuropathic disease of duration more than two months. Many individuals with chronic inflammatory demyelinating polyradiculoneuropathy fail to make a long-term recovery with current treatment regimes. The aim of this study was to prospectively review the literature to determine the effectiveness of therapies for chronic inflammatory demyelinating polyradiculoneuropathy. METHODS: Articles published from January 1990 to December 2012 were searched for studies to treat adults with chronic inflammatory demyelinating polyradiculoneuropathy. Peer-reviewed full-text articles published in English were included. RESULTS: Nine placebo-controlled double-blinded randomised trials were reviewed to treat subjects with chronic inflammatory demyelinating polyradiculoneuropathy exhibiting various degrees of effectiveness. The most effect treatments were; three randomised controlled trials using intravenous immunoglobulin, a study comparing pulsed dexamethasone and short term prednisolone and rituximab all showed promising results and were well tolerated. CONCLUSION: IVIg and corticosteroids remain first line treatments for CIDP. Therapies using monoclonal antibodies, such as Rituximab and Natalizumab offer the most promise for treatment of Chronic inflammatory demyelinating polyradiculoneuropathy however they also need further research, as does the use of stem cell therapy for treating Chronic inflammatory demyelinating polyradiculoneuropathy. Large randomised controlled trials and better patient selection are required to address responsiveness of CIDP patients to conventional treatments to elucidate mechanisms of action and future directions for therapeutic improvement.

Detection of Campylobacter in human faecal samples in Fiji.

INTRODUCTION: Data on campylobacteriosis in developed countries are well documented; in contrast, few studies on campylobacteriosis have been conducted in developing countries. This study was undertaken to test for Campylobacter in human faecal samples sent to the two major pathology laboratories in Fiji. METHODS: A total of 408 diarrhoeal faecal samples were collected from the two major hospital pathology laboratories in Central Fiji (Suva) and Western Fiji (Lautoka) between December 2012 and February 2013 and from June to July 2013. Samples were analysed for the presence of Campylobacter using polymerase chain reaction (PCR) based methods. RESULTS: Campylobacter was detected in 241/408 (59.1%) of samples tested using PCR. Samples from children aged less than five accounted for 21.6% of positive cases. DISCUSSION: Campylobacter was detected in 59.1% of diarrhoeal samples collected from the two main laboratories in Fiji. A high proportion of children under five years with Campylobacter has been reported in other countries and could be due to parents being more likely to seek medical attention. Further studies are required to confirm the species of Campylobacter that are predominantly associated with gastroenteritis in Fiji.

Detection of Campylobacter in human faecal samples in Fiji

Introduction:Data on campylobacteriosis in developed countries are well documented; in contrast, few studies on campylobacteriosis have been conducted in developing countries. This study was undertaken to test for Campylobacter in human faecal samples sent to the two major pathology laboratories in Fiji. Methods:A total of 408 diarrhoeal faecal samples were collected from the two major hospital pathology laboratories in Central Fiji (Suva) and Western Fiji (Lautoka) between December 2012 and February 2013 and from June to July 2013. Samples were analysed for the presence of Campylobacter using polymerase chain reaction (PCR) based methods. Results:Campylobacter was detected in 241/408 (59.1%) of samples tested using PCR. Samples from children aged less than five accounted for 21.6% of positive cases. Discussion:Campylobacter was detected in 59.1% of diarrhoeal samples collected from the two main laboratories in Fiji. A high proportion of children under five years with Campylobacter has been reported in other countries and could be due to parents being more likely to seek medical attention. Further studies are required to confirm the species of Campylobacter that are predominantly associated with gastroenteritis in Fiji.

Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials.

INTRODUCTION: The dose-volume effect of radiation therapy on breast tissue is poorly understood. We estimate NTCP parameters for breast fibrosis after external beam radiotherapy. MATERIALS AND METHODS: We pooled individual patient data of 5856 patients from 2 trials including whole breast irradiation followed with or without a boost. A two-compartment dose volume histogram model was used with boost volume as the first compartment and the remaining breast volume as second compartment. Results from START-pilot trial (n=1410) were used to test the predicted models. RESULTS: 26.8% patients in the Cambridge trial (5 years) and 20.7% patients in the EORTC trial (10 years) developed moderate-severe breast fibrosis. The best fit NTCP parameters were BEUD3(50)=136.4 Gy, γ50=0.9 and n=0.011 for the Niemierko model and BEUD3(50)=132 Gy, m=0.35 and n=0.012 for the Lyman Kutcher Burman model. The observed rates of fibrosis in the START-pilot trial agreed well with the predicted rates. CONCLUSIONS: This large multi-centre pooled study suggests that the effect of volume parameter is small and the maximum RT dose is the most important parameter to influence breast fibrosis. A small value of volume parameter 'n' does not fit with the hypothesis that breast tissue is a parallel organ. However, this may reflect limitations in our current scoring system of fibrosis.

Cellular consequences of the expression of Alzheimer's disease-causing presenilin 1 mutations in human neuroblastoma (SH-SY5Y) cells.

Mutations in the presenilin 1 (PS1) gene lead to early-onset Alzheimer's disease with the S170F mutation causing the earliest reported age of onset. Expression of this, and other PS1 mutations, in SH-SY5Y cells resulted in significant loss of cellular viability compared to control cells. Basal Ca2+ concentrations in PS1 mutants were never lower than controls and prolonged incubation in Ca2+ -free solutions did not deplete Ca2+ stores, demonstrating there was no difference in Ca2+ leak from endoplasmic reticulum (ER) stores in PS1 mutants. Peak muscarine-evoked rises of [Ca2+]i were variable, but the integrals were not significantly different, suggesting, while kinetics of Ca2+ store release might be affected in PS1 mutants, store size was similar. However, when Ca2+ -ATPase activity was irreversibly inhibited with thapsigargin, the S170F and ΔE9 cells showed larger capacitative calcium entry indicating a direct effect on Ca2+ influx pathways. There was no significant effect of any of the mutations on mitochondrial respiration. Amyloid ß(Aß(1-40)) secretion was reduced, and Aß(1-42) secretion increased in the S170F cells resulting in a very large increase in the Aß42/40 ratio. This, rather than any potential disruption of ER Ca2+ stores, is likely to explain the extreme pathology of this mutant.

The prevalence and experience of Australian naturopaths and Western herbalists working within community pharmacies.

BACKGROUND: Naturopaths and Western herbal medicine (WHM) practitioners were surveyed to identify their extent, experience and roles within the community pharmacy setting and to explore their attitudes to integration of complementary medicine (CM) practitioners within the pharmacy setting. METHOD: Practising naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations. RESULTS: 479 practitioners participated. 24% of respondents (n=111) reported they had worked in community pharmacy, three-quarters for less than 5 years. Whilst in this role 74% conducted specialist CMs sales, 62% short customer consultations, 52% long consultations in a private room and 51% staff education. This was generally described as a positive learning experience and many appreciated the opportunity to utilise their specialist knowledge in the service of both customers and pharmacy staff. 14% (n=15) did not enjoy the experience of working in pharmacy at all and suggested pharmacist attitude largely influenced whether the experience was positive or not. Few practitioners were satisfied with the remuneration received. 44% of the total sample provided comment on the issue of integration into pharmacy, with the main concern being the perceived incommensurate paradigms of practice between pharmacy and naturopathy. Of the total sample, 38% reported that they would consider working as a practitioner in retail pharmacy in future. CONCLUSIONS: The level of integration of CM into pharmacy is extending beyond the mere stocking of supplements. Naturopaths and Western Herbalists are becoming utilised in pharmacies.

Evaluation of implanted gold seeds for breast radiotherapy planning and on treatment verification: a feasibility study on behalf of the IMPORT trialists.

BACKGROUND AND PURPOSE: We describe a feasibility study testing the use of gold seeds for the identification of post-operative tumour bed after breast conservation surgery (BCS). MATERIALS AND METHODS: Fifty-three patients undergoing BCS for invasive cancer were recruited. Successful use was defined as all six seeds correctly positioned around the tumour bed during BCS, unique identification of all implanted seeds on CT planning scan and ≥ 3 seeds uniquely identified at verification to give couch displacement co-ordinates in 10/15 fractions. Planning target volume (PTV) margin size for four correction strategies were calculated from these data. Variability in tumour bed contouring was investigated with five radiation oncologists outlining five CT datasets. RESULTS: Success in inserting gold seeds, identifying them at CT planning and using them for on-treatment verification was recorded in 45/51 (88%), 37/38 (97%) and 42/43 (98%) of patients, respectively. The clinicians unfamiliar with CT breast planning consistently contoured larger volumes than those already trained. Margin size ranged from 10.1 to 1.4mm depending on correction strategy. CONCLUSION: It is feasible to implant tumour bed gold seeds during BCS. Whilst taking longer to insert than surgical clips, they have the advantage of visibility for outlining and verification regardless of the ionising radiation beam quality. Appropriate correction strategies enable margins of the order of 5mm as required by the IMPORT trials however, tackling clinician variability in contouring is important.

Antimicrobial and antioxidant activities of traditional Thai herbal remedies for aphthous ulcers.

Four medicinal plants (Quercus infectoria, Kaempferia galanga, Coptis chinensis and Glycyrrhiza uralensis) as well as one traditional Thai treatment for aphthous ulcers based on these four plants were tested for antimicrobial activity. MIC values for a range of bacteria and Candida albicans were determined, with both type strains and clinical isolates being used. Antioxidant activity was determined using the ABTS radical scavenging assay. Among the four plants, Q. infectoria showed antimicrobial activity against Staphylococcus aureus with an MIC of 0.41 mg/mL, while C. chinensis showed antifungal activity against C. albicans with an MIC of 6.25 mg/mL. Activity was also shown against a range of other organisms including Salmonella typhi, Serratia marcescens, Vibrio cholerae, Vibrio parahaemolyticus, Pseudomonas aeruginosa and Enterococcus faecalis. The antimicrobial activity of the traditional aphthous ulcer preparation (a powder) was comparable to that for the individual plant extracts, however, incorporation of the powder into a gel formulation resulted in the loss of almost all activity. All extracts, with the exception of K. galanga, also showed good antioxidant activity. This study supports the traditional use of these plants and suggests that they may also be useful in the treatment of other infections.