Hypofractionated radiotherapy and adjuvant chemotherapy do not increase radiation-induced dermatitis in breast cancer patients.

PURPOSE: Radiation-induced dermatitis is a common side effect of breast irradiation, with hypofractionation being a well-known risk factor. In the context of the widespread adoption of hypofractionated breast radiotherapy, we evaluated the effect of hypofractionated radiotherapy on the incidence of skin toxicity in patients receiving adjuvant chemotherapy. PATIENTS AND METHODS: We retrospectively reviewed the records of patients with breast cancer treated from 2004 to 2006 at a single institution. Patients undergoing lumpectomy with or without adjuvant chemotherapy followed by hypofractionated radiotherapy consisting of 42.4 Gy in 16 fractions were included in the study. Using cosmetic and skin toxicity scales, all patients were evaluated weekly during treatment and at scheduled follow-up visits with the radiation oncologist. RESULTS: During the study period, 162 patients underwent radiotherapy, and 30% of those (n = 48) received chemotherapy. Radiotherapy boost to the tumour bed was more common in the chemotherapy group [n = 20 (42%)] than in the radiotherapy-alone group [n = 30 (26%)]. We observed no statistically significant difference between the groups with regard to acute skin toxicity of grade 3 or higher (2.1% in the chemotherapy group vs. 4.4% in the radiation-alone group, p = 0.67) or of grades 1-2 toxicity (62.5% vs. 51.7% respectively, p = 0.23). There was also no significant difference in late grade 3 or higher skin toxicity between the groups (2.1% vs. 0% respectively, p = 0.30) or in grades 1-2 toxicity (20.8% vs. 25.5% respectively, p = 0.69). Similarly, excellent or good cosmetic result scores were similar in both groups (p = 0.80) CONCLUSIONS: In our single-institution review, we observed no adverse effects of chemotherapy in combination with hypofractionated whole-breast irradiation. Further investigations are necessary to better elucidate the effects of chemotherapy on skin toxicity in the context of hypofractionated irradiation.

How clean is clean? Proposed methods for hospital cleaning assessment.

SUMMARY: Reducing infection rates in hospitals depends on a variety of factors, including environmental measures. Although microbiological standards have been proposed for surface hygiene in hospitals, standard methods for environmental sampling have not been discussed. The aim of this study was to assess the effectiveness of cleaning/disinfection in critical care units using the wipe-rinse method to detect an indicator organism and dipslides to quantitatively determine the microbial load. Frequent-hand-touch surfaces from clinical and non-clinical areas were microbiologically surveyed, targeting both meticillin-susceptible (MSSA) and meticillin-resistant (MRSA) Staphylococcus aureus. A subset of the surfaces targeted was sampled quantitatively to determine the total aerobic count. MRSA was isolated from 9 (6.9%) and MSSA was isolated from 15 (11.5%) of the 130 samples collected. Seven of 81 (8.6%) samples collected from non-clinical areas grew MRSA, compared with two (4.1%) from 49 samples collected from clinical areas. Of 116 sites screened for the total aerobic count, 9 (7.7%) showed >5 cfu/cm(2) microbial growth. Bed frames, telephones and computer keyboards were among the surfaces that yielded a high total viable count. There was no direct correlation between the findings of total aerobic count and MRSA isolation. We suggest, however, that combining both standards will give a more effective method of assessing the efficacy of cleaning/disinfection strategy. Further work is required to evaluate and refine these standards in order to assess the frequency of cleaning required for a particular area, or for changing the protocol or materials used.

Differential aspects of consultation-liaison psychiatry in a Saudi hospital. II: knowledge and attitudes of physicians and patients

To assess the attitude and knowledge of physicians and patients towards psychiatry, we asked 115 referring doctors and 188 referred patients to complete questionnaires. We examined the results along with the referral rates to try to identify factors that may affect a consultation-liaison psychiatry service. Generally, knowledge was poor and attitudes towards psychiatry negative in both groups. This negatively influenced the referral rates and reflected the lack of integration of psychiatry and medicine at the training level. This is an indication that psychiatrists need to work in collaboration with hospital doctors to integrate psychiatry into medicine at all levels and emphasizes the priority of education of hospital staff, patients and the community in consultation-liaison psychiatry

Differential aspects of consultation-liaison psychiatry in a Saudi hospital. I: referral pattern and clinical indices

Consultation-liaison psychiatry has emerged as an important sub-specialty in the general hospital setting during recent years as a result of psychiatric acute wards moving into these hospitals. This has inspired the need for better structured research to establish its relevance and effectiveness. We, therefore, carried out a prospective cohort study at King Fahad General Hospital. We report the interaction of sociodemographic, clinical and diagnostic factors, time lag of referral and diagnostic ability of referring physicians. A total of 206 patients were referred over a period of 6 months. Sensitivity and specificity of the diagnostic skills of the referring doctors were found to be generally poor, particularly for anxiety

Heavy metals in urban soils of central Jordan: should we worry about their environmental risks?

Forty soil samples collected from central Jordan were analyzed by atomic absorption spectrophotometry for Pb, Cd, Zn, Cr, and Hg. The samples were also investigated for mineralogy using X-ray, electron, and optical microscopes. Sequential extraction procedures were used to predict the percentages of the Pb, Zn, Cd, and Cr present in each of the soil geochemical phases. The clay mineral assemblage encountered in the analyzed samples is composed of kaolinite, smectite, illite, and illite/smectite mixed-layer. The nonclay minerals of the sand-sized fraction are composed mainly of quartz and calcite as major minerals with pyroxene, biotite, and feldspars as minor minerals. The enrichment factors of the measured heavy metals Pb, Cd, Zn, Cr, and Hg in the clay fraction (<2 microm) of the collected samples are 3.1, 16.6, 1.5, 0.9, and 4.5, respectively. According to the index of geoaccumulation, the soils of the study area are considered to be moderately contaminated with respect to Cd, uncontaminated to moderately contaminated with respect to Pb, Hg, and Zn, and uncontaminated with respect to Cr. The measured metals correlated positively with the determined physicochemical factors such as pH, clay content, organic matter content, and carbonate content. The relatively high concentrations of Cd, Pb, and Hg in the soils of the study area are related to anthropogenic sources such as cement industry, fertilizers, and vehicle exhausts. It was found that Pb, Zn, and Cr are associated mainly with the residual phases and are relatively immobile. On the other hand Cd is enriched in the carbonate phase of the analyzed soil samples. It is possible to suggest the sequence of mobility for Pb, Zn, Cd, and Cr in the analyzed soil samples as the following: Cd>>Pb>Cr>Zn.

The psychosocial needs of cancer patients: findings from an observational study.

The objectives of this study were to identify the prevalence of psychosocial need, and the contributory factors to need, among cancer patients, using a descriptive cross-sectional questionnaire survey of adult cancer patients. The participants were 1,000 patients from four hospitals in the north west of England with the following characteristics: tumour type (breast, colorectal, lymphoma, lung), being 1 month from a 'critical moment' in the cancer journey (i.e. (i) diagnosis, (ii) end of first treatment, (iii) recurrence, (iv) move from active treatment to palliative care), and aged over 18 years. The main outcome measure was a psychosocial needs inventory comprising seven needs categories (48 need items). A sample of 402 was achieved (40% response rate). Psychosocial needs relating to the need categories 'health professionals', 'information' and 'support networks' are commonly expressed and strongly felt by cancer patients. Needs relating to 'identity', 'emotional and spiritual' issues and 'practical' issues are less commonly expressed but are also strongly felt. Particular needs are related to tumour type, illness 'critical moment', age, gender, health status, socioeconomic and other social factors. This information should increase awareness among cancer care professionals about a range of psychosocial needs and may help them target particular patient groups for particular support interventions.

Geographical epidemiology of residence of patients with motor neuron disease in Lancashire and south Cumbria.

OBJECTIVES: To seek objective evidence for geographical clustering of places of residence of patients with motor neuron disease (MND). METHODS: A complete residential history from birth to onset of disease was obtained from a cohort of 130 patients with MND from Lancashire and south Cumbria presenting to the Department of Neurology in Preston between 1 January 1989 and 31 December 1993. These data were compared with population based reference data from the 1991 UK Census. RESULTS: Some areal units showed a greater, others a lesser, number of MND patient residences than expected. The results suggest that the background population incidence of MND is relatively low and that the overall incidence figures previously quoted have been skewed upwards by areas in which the incidence of MND is relatively increased. These findings were further tested by Poisson modelling. The Poisson model provided a poor fit for the data at postcode district and sector levels confirming that patients with MND were significantly more likely to have lived in some areas than others after allowing for variation in population of the different areal units and for variation in duration of residence. CONCLUSIONS: These findings reinforce the results of previous work, much of which has been qualitative rather than quantitative. The results presented here suggest a low background incidence of MND in the context of generally quoted overall incidence figures. This low background incidence is, however, skewed upwards by some areal units with a relatively high incidence, thus achieving overall incidence rates comparable with generally quoted figures. We conclude that there is prima facie evidence of spatial patterns in the distribution of places of residence of patients with MND. Further examination of occupational and environmental factors in the lives of the patients with MND is required to obtain a better understanding of the importance of these findings.

Secondary posterior chamber intraocular lens implantation in children.

BACKGROUND: Primary intraocular lens (IOL) implantation after cataract aspiration is a widely accepted means of correcting pediatric aphakia. However, little is available in the literature on secondary IOL implantation in children. We present our experience over the past 6 years. METHODS: The charts of 57 aphakic children (61 eyes) who underwent secondary posterior chamber IOL implantation between January 1989 and April 1996 were reviewed. In general, these children were either intolerant of or noncompliant with their contact lenses. An attempt was made to correlate visual outcome with patient variables. Evaluation of the ciliary sulcus structure was made in selected patients by ultrasonographic biomicroscopy to reveal any changes resulting from the presence of the IOL haptic in the sulcus. RESULTS: The age range at the time of surgery was 2 to 16 years (mean 8 y). Mean follow-up was 14 months (range 6 to 48 months). Forty-two percent of the patients had a best-corrected visual acuity of 20/40 or better and 78% saw better than 20/80. Posterior capsular opacification occurred in 10 eyes, 8 of which required neodymium:yttrium-aluminum-garnet laser capsulotomy. No major complications occurred. Ciliary sulcus evaluation by biomicroscopy did not reveal any significant ciliary body or scleral erosion. No changes were noted when the implanted sulcus was compared with the normal contralateral side. CONCLUSION: Although follow-up was short, this review suggests that secondary posterior chamber IOL implantation is a safe alternative when other methods of correcting pediatric aphakia fail.

Migration of elderly people to join existing households: some evidence from the 1991 Household Sample of Anonymised Records.

"In this paper the extent to which migration of the elderly is linked to changing family living situations [in Great Britain] is explored.... [The authors] estimate the number of older people making moves of this type, and...identify their age, sex, and marital status, and their relationship to the household they have joined. It is also possible to say something about the households which these people are joining, in terms of tenure and house type, and to describe the distribution of distances moved."

Obsessive compulsive disorder.

Clinical features of obsessive compulsive disorder (OCD) were found to be similar in various cultures. However, there was no report about phenomenology of this disorder from Moslem or Arab cultures. This study is a review of 45 cases who presented as a psychiatric clinic at a general university hospital in Saudi Arabia. The findings were found to be similar to those reported in Western studies with regard to age of onset, level of functioning, type of onset, course, and co-morbidity. Religious obsessions and compulsions were found to be the most common clinical features. Findings are explained in cultural terms.

The seasonality of mania: Preliminary findings.

The relationship between climatic variables and monthly manic admissions to a teaching hospital in Riyadh, Saudi Arabia was examined over a six-year period. The results indicate a weak but significant correlation between monthly admission rates of mania and day length, humidity, air pressure, and temperature. The correlation did not seem, however, to be strong enough to indicate a seasonal trend. Also, current month climatic variablesare better correlated than previous months. The prevalence of sunshine throughout the year may explain the low correlation with mania admissions unlike reports from other countries.

A statistical study of factors influencing outpatient service in health districts.

This paper describes a statistical study within NHS health districts, using routinely available data, of the supply of outpatient services, the demands made on these services and the resulting balance of supply and demand. Indicators of supply have been investigated which aim to reflect the resources available within a district for outpatient services and indicators of demand have been studied which link to the number of general practitioners who are considered likely to make use of the services provided. Some preliminary analysis is attempted of relationships between the observed balance of supply and demand and the predictions based on the statistical models developed.