Exogenous sources of pseudomonas aeruginosa in intensive care unit patients: implementation of infection control measures and follow-up with molecular typing.

BACKGROUND: In 1998, a study in the intensive care unit (ICU) of our institution suggested possible transmission of Pseudomonas aeruginosa from faucet to patient and from patient to patient. Infection-control measures were implemented to reduce the degree of P. aeruginosa colonization in faucets, to reduce the use of faucet water in certain patient care procedures, and to reduce the rate of transmission from patient to patient. OBJECTIVE: To evaluate the effect of the control measures instituted in 1999 to prevent P. aeruginosa infection and colonization in ICU patients. DESIGN: Prospective, molecular, epidemiological investigation. SETTING: A 870-bed, university-affiliated, tertiary care teaching hospital. METHODS: The investigation was performed in a manner identical to the 1998 investigation. ICU patients with a clinical specimen positive for P. aeruginosa were identified prospectively. Swab specimens from the inner part of the ICU faucets were obtained for the culture on 9 occasions between September 1997 and December 2000. All patients and environmental isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Compared with the 1998 study, in 2000 we found that the annual incidence of ICU patients colonized or infected with P. aeruginosa had decreased by half (26.6 patients per 1,000 admissions in 2000 vs 59.0 patients per 1,000 admissions in 1998), although the populations of patients were comparable. This decrease was the result of the decreased incidence of cases in which an isolate had a PFGE pattern identical to that of an isolate from a faucet (7.0 cases per 1,000 admissions in 2000, vs 23.6 per 1,000 admissions in 1998) or from another patient (6.5 cases per 1,000 admissions in 2000 vs 16.5 cases per 1,000 admissions in 1998), whereas the incidence of cases in which the isolate had a unique PFGE pattern remained nearly unchanged (13.1 cases per 1,000 admissions in 2000 vs 15.6 cases per 1,000 admissions in 1998). CONCLUSIONS: These results suggest that infection control measures were effective in decreasing the rate of P. aeruginosa colonization and infection in ICU patients, confirming that P. aeruginosa strains were of exogenous origin in a substantial proportion of patients during the preintervention period.     

Measuring individual quality of life in patients receiving radiation therapy: the SEIQoL-Questionnaire

Purpose

Quality of life (QoL) is one of the most important outcomes in cancer care. Although a number of instruments to measure health-related QoL (HRQoL) exist, there are few suitable instruments to measure individual QoL. The best established instrument is the Schedule for the Evaluation of Individual Quality of Life (SEIQoL). The disadvantage of this questionnaire is its use of semi-structured interviews, which are very time-consuming. The purpose of our study was to transform the SEIQoL into an economical instrument that can be used in clinical trials with large samples.

Methods

We developed the SEIQoL-Questionnaire (SEIQoL-Q) on the basis of the SEIQoL-Direct Weighting (SEIQoL-DW) by transforming the interview guide into a written questionnaire. Patients (N = 1,108) in all three phases of radiation treatment (first consultation, ongoing irradiation, and aftercare) were asked to complete the SEIQoL-Q and the European Organization for Research and Treatment of Cancer QLQ-C30.

Results

While the average HRQoL measured by the QLQ-C30 was 55.6, the average SEIQoL-Q index was 59.6. The most important life domain was “physical health,” followed by “emotional well-being” and “family.” Patients attributed the highest level of satisfaction to “home/housing,” followed by “family” and “partnership.” Male patients were shown to have a significantly better QoL than females. The SEIQoL-Q index correlates moderately with the QLQ-C30 functioning scale “global quality of life” [r = .42 (p < .001)].

Conclusions

According to our findings, the SEIQoL-Q appears to be a feasible and economical instrument for use in quantitative research among cancer patients in different stages of their disease.     

Gastrointestinal side effects and quality of life in patients receiving radiation therapy

A sample of 101 patients from four radiation oncology clinics participated in a study to describe the relative impact of gastrointestinal side effects of radiation therapy on the psychological and physical well-being dimensions of quality of life. Stepwise regression analysis showed that 44.2% of the variance in psychological well-being was accounted for by patient-reported gastrointestinal problems (21.5%), tension-anxiety (11.8%), other side effects of radiation (5.4%), and satisfaction with care (5.5%). A similar analysis revealed that 50.7% of the variance in physical well-being was accounted for by patient-reported fatigue (35.5%), gastrointestinal problems (8.8%), other side effects (4%), and willingness to comply (2.4%). Although treatment dose and field size directly impact on the severity of side effects, these results suggest that it is the perception of side effects as problems that impacts on psychological and physical well-being.     

Computed tomography after breast conserving carcinoma treatment: recognition of surgically induced lesions prior to radiation therapy

To introduce computed tomography for the detection of post-surgical intramammarian lesions, exposing risk factors for subsequent radiation therapy. 104 patients with breast cancer were treated. They previously underwent breast conserving carcinoma treatment and were subsequently irradiated. The techniques were planned individually based on a CTdata set. All the acquired slices were evaluated with regard to seromas, larger tissue defects or organized hematomas. Seromas and tissue defects are raising the rate of byeffects during radiation therapy and deteriorating the cosmetic results. Pretherapeutical CT allows the puncture of hidden seromas and the individual adaptation of the irradiation technique in order to avoid overdosage due to tissue defects. Therefore CT is valuable for all patients prior to radiation therapy.     

Resistance in directive sex therapy: recognition and management

Resistance, in the form of marital conflict, may play an important role in mediating therapeutic efficacy with sexually dysfunctional couples. The concept of resistance is introduced with a social learning framework, and relevant research on the interface betwaeen marital factors, sexual dysfunction and treatment outcome is reviewed. Clinical guidelines for the recognition and management of resistance due to relationship discord are presented with particular emphasis on the importance of nonspeccific treatment factors.     

Postvasectomy semen analysis: why patients don't follow-up.

Semen analysis following elective vasectomy is necessary to confirm that the procedure was successful. However, many patients fail to follow postoperative instructions to obtain semen analysis. One hundred forty-one patients who had undergone vasectomy at the Family Practice Center of the Medical College of Ohio were surveyed to assess reasons for a poor rate of follow-up after vasectomy. Only 26 percent of respondents had returned two or more semen samples following surgery. Forty-five percent had not returned any samples. The inconvenience and embarrassment of having to bring semen specimens to the laboratory were identified as factors that can affect patient adherence to instructions. Respondents who had not returned any semen specimens were more likely to answer that their spouse would not be very upset if the vasectomy failed and pregnancy resulted. Our survey results identify issues for improving patient care following vasectomy. These include patient education and postoperative protocols.     

Prospective study of K-cell activity in patients with malignant gynecologic tumors. Effect of radiation therapy

K cell activity was measured in the enzyme-like kinetic model of cytotoxicity against O, Rh (D) positive erythrocytes in 127 patients with carcinoma of the uterine cervix, 55 with carcinoma of the corpus uteri and 30 with malignant tumors of the ovary. The control groups included 62 healthy age matched women and 39 patients with benign tumor of the ovary. The cytotoxic activity was measured in a number of cases before any treatment and after irradiation and surgery in patients with cervical and endometrial cancer. The target cells were obtained from the same donor. ADCC activity of cervical and ovarian tumor patients enhanced depends on the stage of the disease. K cell activity of endometrial carcinoma patients was similar to the controls. ADCC activity of patients with carcinoma of the uterine cervix was increased, with carcinoma of the uterine corpus was indicated an increasing tendency following irradiation. There was connection with the dose of the irradiation and K cell activity. On the contrary, operation did not influence ADCC activity.     

In-flight radiation: counseling patients about risk.

BACKGROUND: At the high altitudes, which are the domain of commercial airliners, cosmic-ray exposure rates are hundreds of times greater than at ground level. If this radiation originated at a regulated industrial or medical facility, many frequent flyers would receive annual exposures in excess of the present legal limit applicable to members of the public. For pregnant travelers, the fetus is also at risk, with a sensitivity that varies during the course of pregnancy. METHODS: Health risks from in-flight radiation exposure are analyzed specifically to calculate the likelihood of cancer, birth defects, and genetic damage. A literature review was conducted from 1985 to 1998, using the key words "cosmic radiation," "aviation medicine," "radiation risk," and "in-flight radiation." RESULTS AND CONCLUSIONS: The analysis shows that for the passenger who travels only occasionally, the risks are extremely small. For business frequent flyers the risks are still small, but not negligible.     

甲状腺功能减退症的早期识别与防治

目的 提高甲状腺功能减退症临床早期诊断率并探讨早期防治措施及意义。方法 对９３例甲状腺功能减退症患从病程、病因、临床表现、辅助检查、疾病转归及误诊情况进行分析。结果 甲状腺功能减退症病因及临床表现繁杂，初诊误诊率高。结论 应重视本病特殊临床表现及早检查甲状腺功能，并予以合理替代治疗，是早期防治的关键。     

New technologies in radiation therapy: ensuring patient safety, radiation safety and regulatory issues in radiation oncology

New technologies such as intensity modulated and image guided radiation therapy, computer controlled linear accelerators, record and verify systems, electronic charts, and digital imaging have revolutionized radiation therapy over the past 10-15 y. Quality assurance (QA) as historically practiced and as recommended in reports such as American Association of Physicists in Medicine Task Groups 40 and 53 needs to be updated to address the increasing complexity and computerization of radiotherapy equipment, and the increased quantity of data defining a treatment plan and treatment delivery. While new technology has reduced the probability of many types of medical events, seeing new types of errors caused by improper use of new technology, communication failures between computers, corrupted or erroneous computer data files, and "software bugs" are now being seen. The increased use of computed tomography, magnetic resonance, and positron emission tomography imaging has become routine for many types of radiotherapy treatment planning, and QA for imaging modalities is beyond the expertise of most radiotherapy physicists. Errors in radiotherapy rarely result solely from hardware failures. More commonly they are a combination of computer and human errors. The increased use of radiosurgery, hypofractionation, more complex intensity modulated treatment plans, image guided radiation therapy, and increasing financial pressures to treat more patients in less time will continue to fuel this reliance on high technology and complex computer software. Clinical practitioners and regulatory agencies are beginning to realize that QA for new technologies is a major challenge and poses dangers different in nature than what are historically familiar.     

Reirradiation of spinal metastases with intensity-modulated radiation therapy: an analysis of 23 patients

This study aimed to evaluate the efficacy and safety of reirradiation with intensity-modulated radiation therapy (IMRT) for spinal metastases. We retrospectively analyzed 23 patients with spinal metastases who underwent IMRT reirradiation between December 2006 and July 2013. We evaluated the spinal radiation doses during the first and second radiation therapy courses, the interval between the courses, and the clinical outcomes after reirradiation, including skeletal-related events, local control rates (LCRs), overall survival (OS), and toxicities. The median time from the first irradiation to reirradiation was 13 months (range, 2–75 months). The median reirradiation dose delivered to 90% of the planning target volume was 24.5 Gy in 5 fractions (range, 14.7–50 Gy in 3–25 fractions). Nineteen patients experienced pain at reirradiation, and 15 of these attained pain relief. Two of the three patients with paresis in the upper or lower extremities upon initiation of reirradiation demonstrated improvement. Local progression was identified in four patients. The median time to local progression was 37 months. The 1- and 2-year LCRs after reirradiation were 88% and 75%, respectively. The 1- and 2-year OS rates after reirradiation were 45% and 20%, respectively, with a median OS of 12 months. No late toxicities occurred. In conclusion, spinal metastasis reirradiation using IMRT appears safe; pain relief and paresis improvement and/or prevention can be expected, along with a reduced risk of radiation-induced toxicity, especially in the spinal cord.