Intraoperative Pleural Lavage in Esophageal Carcinoma

Background: Cytological examination of intraoperative pleural or peritoneal lavage specimens is useful for predicting outcomes for patients with various carcinomas. There have been few reports regarding cytological examination of pleural lavage fluid in esophageal carcinoma.Methods: Intraoperative pleural lavage fluid was collected before and after esophagectomy and was examined by Papanicolaou and Giemsa staining for 78 patients with esophageal carcinoma.Results: Although epithelial cells were found for 29 patients, only blood cells were detected for 48. The remaining one patient exhibited no cells in the specimen. For 4 of 78 (5.2%) patients, tumor cells were detected in the pleural lavage fluid after esophagectomy. Three of these four patients had T4 tumors.Conclusions: Positive cytological findings for pleural lavage fluid, using Papanicolaou and Giemsa staining, is correlated with regrowth of residual tumor and poor prognosis in esophageal carcinoma.     

Dissemination of research findings to alcohol and other drug practitioners

This article provides an overview of the literature in the area of research dissemination, and suggests ways of increasing communication between researchers and clinicians. It then describes a dissemination project based at the Centre for Education and Information on Drugs and Alcohol (CEIDA) which was designed to convey the results of a major research project in the alcohol and other drug area to practitioners in New South Wales. The article includes the development, implementation and evaluation of the project. The format employed—an intensive workshop conducted in different locations—was found to be a useful strategy, particularly when used to promote a large research project of clinical significance and when used in conjunction with other dissemination strategies.     

Disseminating educational innovations in health care practice: Training versus social networks

Improvements and innovation in health service organization and delivery have become more and more important due to the gap between knowledge and practice, rising costs, medical errors, and the organization of health care systems. Since training and education is widely used to convey and distribute innovative initiatives, we examined the effect that following an intensive Teach-the-Teacher training had on the dissemination of a new structured competency-based feedback technique of assessing clinical competencies among medical specialists in the Netherlands. We compared this with the effect of the structure of the social network of medical specialists, specifically the network tie strength (strong ties versus weak ties).     

Spinal intramedullary metastasis of medulloblastoma at initial diagnosis

Case report Spinal magnetic resonance imaging of a 4-year-old boy with medulloblastoma at the initial presentation showed intramedullary lesion without enhancement effect and slight cord swelling from C-5 to T-1. After complete response to the initial therapy, this lesion recurred and slowly expanded. Cervical ¹¹C-methionine-positron emission tomography could establish the diagnosis of intramedullary metastasis.Conclusion Spinal intramedullary metastasis of medulloblastoma at initial diagnosis is extremely rare, but must be considered.     

Training with tarantulas: A randomized feasibility and acceptability study using experiential learning to enhance exposure therapy training

BackgroundAlthough exposure is a key evidence-based intervention for anxiety, it is infrequently used in clinical settings. This study employed a novel training strategy, experiential learning, to improve exposure implementation. This study aimed to assess the feasibility and acceptability of experiential training and preliminary training effectiveness.MethodsParticipants were 28 therapists who were randomized to (a) training-as-usual or (b) experiential training (training-as-usual plus a one-session treatment for fear of spiders). Workshops lasted one day and were followed by three months of weekly consultation.ResultsExperiential training was viewed as feasible and acceptable. Participants, including those who were fearful of spiders, had a positive response to the training and reported it to be useful. There was a significant increase in the number of exposures used by therapists receiving experiential training compared to training-as-usual at 1-month follow-up.ConclusionsA one-day training resulted in significant improvements in knowledge, attitudes toward exposure, and self-efficacy in using exposure. Preliminary findings suggest that experiential training resulted in greater use of exposure post-training compared to training-as-usual. Results provide evidence for the feasibility and acceptability of experiential training as a strategy to increase the use of evidence-based interventions.     

De-identification of clinical notes in French: towards a protocol for reference corpus development

BackgroundTo facilitate research applying Natural Language Processing to clinical documents, tools and resources are needed for the automatic de-identification of Electronic Health Records.ObjectiveThis study investigates methods for developing a high-quality reference corpus for the de-identification of clinical documents in French.MethodsA corpus comprising a variety of clinical document types covering several medical specialties was pre-processed with two automatic de-identification systems from the MEDINA suite of tools: a rule-based system and a system using Conditional Random Fields (CRF). The pre-annotated documents were revised by two human annotators trained to mark ten categories of Protected Health Information (PHI). The human annotators worked independently and were blind to the system that produced the pre-annotations they were revising. The best pre-annotation system was applied to another random selection of 100 documents. After revision by one annotator, this set was used to train a statistical de-identification system.ResultsTwo gold standard sets of 100 documents were created based on the consensus of two human revisions of the automatic pre-annotations. The annotation experiment showed that (i) automatic pre-annotation obtained with the rule-based system performed better (F = 0.813) than the CRF system (F = 0.519), (ii) the human annotators spent more time revising the pre-annotations obtained with the rule-based system (from 102 to 160 minutes for 50 documents), compared to the CRF system (from 93 to 142 minutes for 50 documents), (iii) the quality of human annotation is higher when pre-annotations are obtained with the rule-based system (F-measure ranging from 0.970 to 0.987), compared to the CRF system (F-measure ranging from 0.914 to 0.981). Finally, only 20 documents from the training set were needed for the statistical system to outperform the pre-annotation systems that were trained on corpora from a medical speciality and hospital different from those in the reference corpus developed herein.ConclusionWe find that better pre-annotations increase the quality of the reference corpus but require more revision time. A statistical de-identification method outperforms our rule-based system when as little as 20 custom training documents are available.     

亚抑菌浓度头孢西丁对耐药质粒接合转移的影响

目的 探讨亚抑菌浓度头孢西丁对耐药质粒接合转移的影响,研究病原菌耐药性播散的产生机制.方法 采用聚合酶链反应(PCR)分析临床分离的63株产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌株SHV型β-内酰胺酶编码基因.质粒接合转移试验采用肉汤接合法.研究不同亚抑菌浓度头孢西丁(0、1、0.5、0.25、0.125μg/mL)和不同作用时间(2、4、6、8、10、12 h)下临床产ESBLs肺炎克雷伯菌株供体菌与受体菌大肠埃希菌C600接合转移频率的变化.结果 63株临床分离的产ESBLs肺炎克雷伯菌株有41株扩增出SHV型基因,阳性率为65.1%.随着亚抑菌浓度头孢西丁作用时间的增加,接合转移频率随之增加.在相同作用时间下,头孢西丁浓度为0.125 μg/mL作用下的接合转移频率高于其他亚抑菌浓度的作用.结论 不同亚抑菌浓度头孢西丁能影响耐药质粒的转移.临床使用抗生素时,应考虑到给药间歇期间亚抑菌浓度的变化,及时调整治疗方案,防止细菌耐药性的播散.     

THE EUROPEAN BASIC CORE CURRICULUM FOR NEPHROLOGY NURSING THE PROCESS OF WRITING,PUBLISHING AND DISSEMINATING

In August 2002 the European Basic Core Curriculum (BCC) for Nephrology Nursing was published on the EDTNA/ERCA homepage. At the EDTNA/ERCA annual conference in The Hague in September 2002, it was presented to the delegates as an oral presentation and a poster presentation. Publicity flyers were translated into seven languages and distributed to delegates. This paper will describe the aims of the BCC, the process of writing and publishing, the use of the BCC in nursing schools and the measures that have already been taken in implementation and dissemination.     

Thymic carcinoma with dissemination: a retrospective analysis of ten patients

OBJECTIVE: Thymic carcinoma is a rare mediastinal neoplasm with frequent pleural or pericardial dissemination. We retrospectively studied ten such cases and analyzed factors that influenced the survival of the patients. METHODS: Ten thymic carcinoma patients with dissemination have been treated since 1987. The clinical and pathological data were retrospectively reviewed. RESULTS: Pretreatment tumor biopsy was performed and demonstrated squamous cell carcinomas in nine and small cell carcinoma in one. In six of ten patients pleural or pericardial dissemination was clinically evident (cT4). These patients were basically regarded as inoperable and treated with chemotherapy and/or radiotherapy. Four other patients were diagnosed as cT3 preoperatively but were found to have dissemination at the time of thoracotomy. They underwent total resection of the thymic tumor and all visible pleural dissemination but without pericardial dissemination. Radiotherapy was performed pre-or postoperatively with or without chemotherapy. The 5-year survival rate in all patients was 42.0%. The patients with Masaoka stage IVa showed significantly better prognosis than the patients with stage IVb (MST, 69.7 months vs. 14.5 months; 5-year survival rate, 64.3% vs. 0%) (P = 0.03). The patients with cT3 disease showed significantly better prognosis (P = 0.016) than the patients with cT4 disease (MST, 69.7 months vs. 14.5 months; 5-year survival rate, 100% vs. 16.7%). CONCLUSIONS: Among thymic carcinoma patients with pleural or pericardial dissemination, there seem to be some patients who show good prognosis. These candidates are patients who underwent subtotal resection with disseminations that were identified only at the operation and without hematogenous or lymphogenous metastasis.