Medical practitioners’ educational competence about oral and oropharyngeal carcinoma: a systematic review and meta-analysis

Medical practitioners’ (MP) role is pivotal in primary prevention, early diagnosis, prompt referral and effective management of oral and oropharyngeal carcinomas (OC/OPC), which raises the importance of their effective OC/OPC education at all levels of medical education. The purpose of this systematic review was to summarise the available scientific evidence about their educational competence in dealing with OC/OPC. We made a systematic search of papers in the English language in MEDLINE, Scopus, Cochrane Library CENTRAL and CINAHL databases from their inception until December 2018. Overall, 23 cross-sectional and three interventional studies have been selected for the systematic review and 18 of these were included in the meta-analyses. Excluding tobacco use (synthesised estimate of 95% of respondents identified tobacco as an OC/OPC risk factor, 95% CI of synthesised estimate 92% to 97%) and alcohol consumption (65%, 95%CI 52% to 77%), less than half of MP (approximately) were knowledgeable about important OC/OPC risk factors including human papilloma virus (42%, 95% CI 30% to 54%), poor diet (34%, 95% CI 17% to 54%), and advancing age (45%, 95% CI 21% to 70%). There was a low to moderate level of awareness among MP regarding common precancerous oral lesions involving leukoplakia (56%, 95% CI 32% to 79%), erythroplakia (30%, 95% CI 8% to 58%), and oral lichen planus (13%, 95% CI 0 to 41%). Moderate knowledge was also recorded about frequent sites of OC development involving the tongue (48%, 95% CI 33% to 64%) and floor of the mouth (37%, 95% CI 19% to 57%). Most MP enquired about tobacco use (86%, 95% CI 74% to 96%), and alcohol consumption (73%, 95% CI 47% to 94%) during history taking, and expressed willingness to be given supplementary OC/OPC education (78%, 95% CI 54% to 96%), as well. With regard to the incidence of intraoral screening, 27% of MP (95% CI 12% to 46%) make an intraoral examination as a routine. Interestingly, studies from each continent yielded significantly different outcomes to some research questions in the review. From the MP’s perspective, clinical time restrictions and deficiencies in organised training were recognised as the main barriers towards their OC/OPC educational competence. The findings of this systematic review indicated the existence of deficiencies in knowledge and misconceptions, neglected preventive responsibilities, and associated barriers towards OC/OPC. A need for improved OC/OPC training at all levels of medical education is required to increase competence worldwide.     

Of stewardship,motherhood and apple pie

Antibiotic stewardship is universally agreed to be desirable, but optimal models for stewardship remain uncertain. UK stewardship targets the particular antibiotic families—cephalosporins and fluoroquinolones—blamed for the selection of Clostridium-difficile-associated disease. To balance this there have been dramatic increases in the use of penicillin–β-lactamase inhibitor combinations. By channelling selection pressure in this way, we hazard destroying the utility of these antibiotic classes in turn, as happened with gonorrhoea where penicillins, fluoroquinolones and cefixime were sequentially lost as therapies. Strikingly, in context, almost all carbapenemase-producers are highly resistant to penicillin–β-lactamase inhibitor combinations, which may select for them. There is an urgent need to explore an alternative stewardship model, seeking to limit total antibiotic use but to maintain heterogeneity in what is used, avoiding concentrated selection pressure. There is also a great need to improve and accelerate diagnostics for infection and resistance, reducing or removing the need for protracted empirical treatment with broad-spectrum agents.     

均相酶免技术与治疗药物监测

均相酶免疫技术是一种基于液相均相竞争性反应体系的免疫测定技术,目前,基于该技术建立的药物浓度测定方法以其独特优势已成功应用于临床治疗药物和兴奋剂等小分子以及蛋白质等大分子的检测,但大多依靠进口试剂。本文对均相酶免疫技术的研究现状、技术原理、技术优点进行了综述,重点介绍了该技术在治疗药物监测方面的临床应用以及需要注意的问题,并对该技术的应用前景进行了展望。该技术具有检测速度快、特异性强、自动化程度高等优点,但面临进口试剂价格昂贵、运送周期长等问题,因此我国对该技术的自主研发平台及试剂需求显得尤为迫切。     

腋下小切口在胸外科手术中的应用体会(附26例报告)

目的 介绍腋下小切口的手术方法，探讨其在胸外科手术中的适应症。方法 回顾性分析26例患者经腋下小切口开胸手术的治疗情况。结果 26例经腋下小切口手术的患者，术后伤口疼痛轻微，恢复快，无其他并发症。结论 腋下小切口开胸手术治疗自发性气胸、肺周围疾患及部分纵隔病变，具有创伤小、暴露良好等优点，值得推广。     

DHA复合物诱导人胃癌细胞SGC-7901凋亡的实验研究

[目的]研究DHA复合物抗肿瘤作用机理。[方法]以人胃癌细胞SGC-7901为模型,利用吖啶橙染色,荧光显微镜观察人胃癌细胞SGC-7901经DHA复合物治疗前后的形态,研究DHA复合物诱导人胃癌细胞SGC-7901的凋亡作用。[结果]实验发现:经DHA复合物治疗后,人胃癌细胞SGC-7901细胞核出现明显的凋亡核形态。[结论]DHA复合物具有明显诱导人胃癌细胞SGC-7901发生凋亡的作用。     

Health-related quality of life and cognitive failures in patients with lower-grade gliomas treated with radiotherapy

PurposePatients with lower grade (grade 2 and 3) glioma (LGG) frequently experience prolonged clinical course after multimodal therapy (including surgery, radiotherapy (RT), and chemotherapy). There is therefore significant concern about the potential long-term impact of the disease and treatments on quality of life (QOL) and cognitive functioning. In this context, we evaluated health related QOL and cognitive failures in LGG patients previously treated in our RT department.Patients and methodsAdult LGG patients previously treated with RT were prospectively included. Patients were evaluated based on standardized questionnaires [i.e., EORTC QLQ-C30, EORTC QLQ-BN20, and cognitive failures questionnaire (CFQ)].ResultsForty-eight patients were included. Median time elapsed since the end of RT was 59.5 months (range: 4–297). Based on EORTC QLQ-C30 and QLQ-BN20, the most prevalent HRQOL issues were impaired cognitive functioning (50% of the patients), impaired emotional functioning (47.9%), financial difficulties (43.7%), fatigue (43.7%), future uncertainty (39.6%), and impaired physical functioning (35.4%). Based on the CFQ, 35.4% of the patients showed increased tendency to cognitive failures.ConclusionPatients with LGG frequently experience impairments in HRQOL and cognitive failures after treatment (including RT). Further efforts are therefore warranted to improve the QOL and cognitive outcome of these patients.     

CT-scan contouring technique allows for direct and reliable measurements of the cochlear duct length: implication in cochlear implantation with straight electrode-arrays

European Archives of Oto-Rhino-Laryngology - The advent of hybrid electro-acoustic implants requires precise positioning of the electrode-array (EA) within the cochlea. The cochlea size, that is,...     

Pathologic childhood aerophagia]

« Air swallowing » described as being part of functional gastrointestinal disorders in “Rome criteria” in 1999 is often misdiagnosed, particularly in non-mentally deficient children.AimsTo recognize « air swallowing » child and to describe any progress according to the treatment.Population and methodsThis retrospective study reports 13 cases of children without mental deficiency or neuromuscular disease. Clinical elements and precise histories are detailed and we have contacted consulting doctors or families for news.ResultsTen boys and 3 girls, from 2,5 years to 10 years old, were referred for long lasting pain or abdominal distension. Numerous laboratory investigations were always normal. Diagnosis relied upon the observation of air swallowing and X-Rays views of gastric distension. Air swallowing was observed 7 times, 9 children had twitches and 3 language troubles. In 10 cases, X-rays showed gastric and colic distension. Three children have Chilaïditi syndrome. Favourable results followed in 12 cases after an average of 28 months of treatment. One case was lost for follow-up. Treatment was long, often disappointing and required the intervention of a psychiatrist, a paediatrician and (temporarily) a speech therapist.ConclusionPathological childhood aerophagia is often underdiagnosed and deserves to be better known by paediatricians, psychiatrists and surgeons. A late diagnosis leads to many negative results and causes anxiety. An early diagnosis should lead to a multidisciplinary care.