Stereotactic body radiation therapy for primary liver tumors: An effective liver-directed therapy in the toolbox

The use of radiation for primary liver cancers has historically been limited because of the risk of radiation-induced liver disease. Treatment fields have become more conformal because of several technical advances, and this has allowed for dose escalation. Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is now able to safely treat liver tumors to ablative doses while sparing functional liver parenchyma by using highly conformal therapy. Several retrospective and small prospective studies have examined the use of SBRT for liver cancers; however, there is a lack of well-powered randomized studies to definitively guide management in these settings. Recent advances in systemic therapy for primary liver cancers have improved outcomes; however, the optimal selection criteria for SBRT as a local therapy remain unclear among other liver-directed options such as radiofrequency ablation, transarterial chemoembolization, and radioembolization.     

Characteristics and risk factors of bortezomib induced peripheral neuropathy: A systematic review of phase III trials

Bortezomib-induced peripheral neuropathy (BIPN) is a common toxicity associated with the treatment of multiple myeloma (MM), typically requiring dose reduction, delay, or cessation of treatment protocol. This systematic review aimed to investigate risk factors, trends, and variability associated with the development of BIPN. Searches were undertaken using Medline, PubMed, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Web of Science. Additional studies were identified by investigating authors' bibliographic references cited by original and review articles. Articles that reported on neuropathy in phase III randomised control trials involving bortezomib in any treatment arm for the treatment of MM were included in this review. A total of 43 full text articles met criteria, which examined 23 phase III trials (N = 8218). Overall incidence of neuropathy ranged from 8.4% to 80.5% (median = 37.8%) and severe neuropathy (grade 3-4) ranged from 1% to 33.2% (median = 8%). Similar reports of neuropathy of any grade and severe neuropathy were observed between the newly diagnosed and relapsed cohort. Bortezomib regimens with reduced dose intensity were associated with reduced neuropathy incidence. Increased cumulative dosing levels, intravenous compared with subcutaneous administration and combination therapy with thalidomide were associated with higher rates of BIPN. This analysis revealed that BIPN is a significant toxicity. More sensitive measures are required to capture the incidence and severity of BIPN. Better understanding of risk factors and reversibility profiles will minimise the number of cancer survivors living with residual treatment side effects.     

Discourses of professionalism: Metaphors,theory and practice

Professionalism is a contested concept and different discourses have differed by scope and epistemology. The theory of communicative action integrates epistemology (knowledge interests) with that of scope (lifeworld).

Aim: To pragmatically inform learning of professionalism.

Methods: apply the theory of communicative action to professionalism discourses.

Results: Previous professionalism discourses translated into four frames: technical; communicative; improvement, and critical. These can be viewed as four metaphors the scale; conversation; consensus conference, and protest. The theory of communicative action demonstrated that a critical frame was often lacking from discussions of professionalism and emphasized critiquing the assumptions made, the way power was utilized, and the ends to which actions were directed. Using these frameworks connected discourses on professionalism to other key medical discourses particularly quality improvement, patient centeredness, social justice, and the professional well-being.

Conclusion: The theory of communicative action adds value by introducing criteria for the evaluation of individual truth claims that expands the discussion beyond accuracy to include sincerity, ethics and coherence; and it emphasizes promoting free speech and the inclusion of diverse views and stakeholders. The theory of communicative action provides a coherent and useful framework for viewing professionalism that integrates with broader discussions about philosophy, truth claims, and post-modern society.     

Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility

Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.     

Exploring the DNA mixture deconvolution through simulation

ABSTRACT

If an unambiguous single-source DNA profile is obtained from a crime scene, then a potential person of interest can either match or not match the crime scene profile and the likelihood ratio for the single matching genotype can be easily computed. Mixed DNA profiles on the other hand are typically ambiguous and a vast number of different likelihood ratios can be obtained depending on the genotype of a potential person of interest that is compared with the mixture later. In the absence of a person of interest it can be unclear how suitable the profile is for discriminating between donors and non-donors. We introduce a simulation method to explore the range of likelihood ratios that is expected to be obtained when a non-donor or a true donor is compared with the mixed DNA profile. Sampling is conditional on the mixture deconvolution obtained using probabilistic genotyping. These simulations help to decide whether or not a (mixed) profile is suitable for comparison to a person of interest. Moreover, the methods can be used to determine whether a profile is suitable for upload to a database and whether or not potential rework could be advised.     

Error rates in proficiency testing in Australia

ABSTRACT

Recent criticism of forensic science has focused on the fundamental aspects of the science, including the lack of supporting empirical studies, validation, accreditation, limitations and error rates. Proficiency tests are an essential component of accreditation and can be used to evaluate laboratory performance and identify systematic issues within components of the service provision. In 2016 we reported on the results of an analysis of 3176 CTS proficiency tests undertaken between 2005 and 2015 by Australian government service providers. The data analysed represented 43 unique CTS test types and covered 21 disciplines. Here we present further data from 2016 to 2017 and compare these results with those obtained from the previous study. These combined results further demonstrate that errors exist even though practitioners know they are examining proficiency tests and the tests undergo a review process. This study illustrates the need to continue to monitor trends in proficiency test results and also further highlights the need for well-designed, relevant, blind error rate studies to determine the approximate error rates for casework.