Prostate cancer in Victoria in 1993: patterns of reported management

OBJECTIVE: To describe the management of newly diagnosed prostate cancer in 1993 during the early prostate specific antigen (PSA) era. DESIGN: Survey of medical practitioners involved in the management of a total sample of incident prostate cancer cases selected from a population-based cancer registry. The survey was conducted in 1996, and the sample was followed up until 1998, to obtain five-year survival data on all patients. SETTING: The State of Victoria, including both public and private health sectors. PATIENTS: All men who were newly diagnosed with prostate cancer in the six months January-June 1993. MAIN OUTCOME MEASURES: Reported management by method of diagnosis; staging investigations; and treatment by observation, hormonal therapy, radical radiotherapy or radical prostatectomy. RESULTS: 1048 of 1117 (94%) cases diagnosed were surveyed. Most of the men (858 [82%]) were older than 65 years: 117 (11%) cancers were detected by screening asymptomatic men, and a further 269 (26%) were found by testing of men with symptoms ("case-found"). The 259 (25%) men treated with definitive local therapies (prostatectomy and curative radiotherapy) were younger (< 75 years), and their disease was clinically more localised (clinical stage, T1-2) and they were often found by screening or case-finding. Men given hormonal therapy (407; 39%) or managed without treatment (373; 36%) tended to be older and more likely to have been diagnosed by transurethral resection of the prostate (TURP). The overall relative survival at five years was 86% and was decreased in men with cancers of higher histological grade or more advanced clinical stage, or who had higher PSA levels. CONCLUSIONS: Although a third of patients were detected by screening or case-finding early in the PSA era, definitive local therapies were used infrequently (25% of the total sample). Most received appropriate treatment.     

Reported management of lung cancer in Victoria in 1993: comparison with best practice. Anti-Cancer Council of Victoria Lung Cancer Study Group

OBJECTIVE: To determine recent patterns of management of lung cancer in Victoria in order to stimulate interest in the development of Australian consensus guidelines. DESIGN: A cross-sectional survey of doctors responsible for the care of an incident series of lung cancer patients in 1996-1997. PARTICIPANTS: 1054 people diagnosed with primary lung cancer in the State of Victoria between 1 January 1993 and 31 July 1993 and notified to the Victorian Cancer Registry. MAIN OUTCOME MEASURES: Method of diagnosis; tumour characteristics; factors affecting management plan; first-line and subsequent treatment; outcome; and patients' current status. RESULTS: Questionnaires were completed for 868 eligible patients (82%): 635 (73%) diagnosed with non-small-cell lung cancer, 124 (14%) diagnosed with small-cell lung cancer, and 109 (13%) with no histological diagnosis. Chest x-ray (814 patients; 94%) and computed tomography (CT) of the chest and abdomen (589 patients; 68%) were the most common investigations, and was the only diagnostic procedure in 48 patients (6%). Treatments were radiotherapy alone or in combination (385 patients; 44%), surgery alone or in combination (196 patients; 23%), chemotherapy alone or in combination (152 patients; 18%); 215 patients (25%) received no antitumour therapy. 243 patients (28%) were treated initially with curative intent. A further 399 (46%) were treated initially with palliative intent, and in 219 (55%) of these good symptom control was achieved. For 427 patients (49%) tumour size was not recorded. While 23% of non-small-cell patients had limited disease, only 8% were investigated with mediastinoscopy. Only four patients (13%) with limited-stage, small-cell lung cancer had combined-modality treatment. There was little use of adjuvant chemotherapy or neoadjuvant therapy. The five-year crude survival rate was 11%. CONCLUSIONS: The demographics of lung cancer in Victoria are similar to other population-based studies. Patterns of management are not uniform, and are inconsistent with current published guidelines.     

Post-caesarean septicaemia in Kandang Kerbau Hospital, Singapore, 1993-1995

We reviewed all documented cases of septicaemia following caesarean deliveries in Kandang Kerbau Hospital between 1st January 1993 to 31st December 1995. There were 22 cases of septicaemia among 8201 caesarean births, and hence the incidence is 2.7:1000. There were 45,412 deliveries, and the overall caesarean section rate was 18.1%. Among the 22 documented cases of septicaemia which came under this study, the most common clinical conditions found were endomyometritis (7 cases), urinary tract infection (6 cases), and wound infection (3 cases). One of the three cases with wound infection also had pneumonia. There was one patient who had mild transient myocarditis. We could not determine with certainty any site of infection in five patients. The most common bloodstream bacterial isolates was Staphylococcus aureus (16), while the uncommon ones were Acinetobacter baumanii (2), Escherichia coli (1), Klebsiella sp. (1), Staphylococcus epidermidis (1), Streptococcus Group F (1), Peptostreptococcus species and Veillonella species (1). There was no mortality and prompt, vigorous treatment had led to uneventful recovery in all the cases.     

Trends in allergies among children in a region of former East Germany between 1992-1993 and 1995-1996

A lower prevalence of asthma and allergies has been reported among children and adults living in the area of former East Germany compared with those living in West Germany. After German reunification in 1990, the East German population rapidly adopted a western lifestyle. Therefore, this study examined if the prevalence rates of allergic diseases, symptoms, and sensitisation and asthma have increased among East German children since German reunification. - Children aged 5 to 7 years living in the region of Sachsen-Anhalt, East Germany were examined in two cross-sectional studies during 1992-93 (n = 769, response rate 84.0%) and 1995-96 (n = 725, response rate 74.6%). Sensitisation was assessed by specific immunoglobulin E measurements against five common aeroallergens using the CAP-FEIA technique. After adjustment for sex, parental education, season of examination, day care attendance, breast feeding, environmental tobacco smoke exposure, cat dander exposure, and several indoor factors, an increase in the prevalence of self-reported, physician-diagnosed allergies (OR 1.44, 95% CI 1.01-2. 06), but not in allergic sensitisation (OR 0.85, 95% CI 0.62-1.16) was found. The only evidence of an increase in allergies of the self-reported increase in the prevalence of physician-diagnosed allergies is likely due to changes in physician diagnostic patterns and the heightened public awareness of allergic diseases. - In conclusion, there were no significant changes in the prevalence of asthma, allergic rhinitis, or self-reported symptoms of allergic diseases.     

1992—1995级诊断学教学调查

通过对四届毕业实习学生的问卷调查 ,发现一些与诊断学教学有关的问题 ,现对调查的状况提出几点思考。1　资料和分析1.1　对象临床医学专业 1992～ 1995级四个年级医学生331人 ,带教老师 62人。1.1.1　形式　问卷调查表 331份 ,回收 331份 (回收率 10 0 % )。1.1.2　调查内容　 (1)对诊断学理论课、见习课重视程度 ;(2 )由于招生规模不断扩大 ,见习课中 ,学生分组人数增加 ,普遍认为动手机会较少 ,医学生对见习课必要性认识及从见习课中收益 ;(3)动手操作机会 ;(4 )能否独立采集病史、完成体检及熟练程度 ;(5 )对理论课、见习课的要求和改进…     

The survival of extremely-low-birthweight infants in Victoria: 1982-1985

A population-based survey of mortality in extremely-low-birthweight (500- to 999-g) infants was carried out in Victoria for the years 1982 to 1985. No increase in the number of extremely-preterm births occurred during that time. The still-birth rate fell from 498 still births per 1000 births in 1982-1983 to 403 still births per 1000 births in 1984-1985. The neonatal mortality in 1982-1985 was 638 deaths per 1000 live births, with no significant decline from that of the 1978-1981 cohort. The small increase in neonatal survivors was not associated with any change in the postneonatal death rate. Delivery in a level-3 unit was associated with a significantly better outcome. Multiple births made a major contribution to the extremely-low-birthweight group of infants.     

Edmonton Regional Palliative Care Program: impact on patterns of terminal cancer care

The Edmonton Regional Palliative Care Program was established in July 1995 to measure the access of patients with terminal cancer to palliative care services, decrease the number of cancer-related deaths in acute care facilities and increase the participation of family physicians in the care of terminally ill patients. In this retrospective study the authors compared the pattern of care and site of deaths before establishment of the program (1992/93) and during its second year of operation (1996/97). Significantly more cancer-related deaths occurred in acute care facilities in 1992/93 than in 1996/97 (86% [1119/1304] v. 49% [633/1279]) (p < or = 0.001). The number of inpatient days decreased, from 24,566 in 1992/93 to 6960 in 1996/97. More cancer patients saw a palliative care consult team in 1996/97 than in 1992/93 (82% v. 22%). The shift from deaths in acute care facilities to palliative hospices suggests that the establishment of an integrated palliative care program has increased access of patients with terminal cancer to palliative care.     

Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study

OBJECTIVE: To investigate predictors of evidence-based surgical care in a population-based sample of patients with newly diagnosed colorectal cancer. DESIGN, PATIENTS AND SETTING: Prospective audit of all new patients with colorectal cancer reported to the New South Wales Central Cancer Registry between 1 February 2000 and 31 January 2001. MAIN OUTCOME MEASURES: Concordance with seven guidelines from the 1999 Australian evidence-based guidelines for colorectal cancer; predictors of guideline concordance; the mean proportion of relevant guidelines followed for individual patients. RESULTS: Questionnaires were received for 3095 patients (91.6%). Between 0 and 100% of relevant guidelines were followed for individual patients (median, 67%). Concordance with individual guidelines varied considerably. Patient age independently predicted non-concordance with guidelines for adjuvant therapy and preoperative radiotherapy. Adjuvant chemotherapy was more likely if a patient with node-positive colon cancer was treated in a metropolitan hospital or by a general surgeon. Surgeons with a high caseload or specialty in colorectal cancer were more likely to perform colonic pouch reconstruction, prescribe thromboembolism or antibiotic prophylaxis, and were less likely to refer patients with high-risk rectal cancer for adjuvant radiotherapy. Bowel preparation was less likely among older patients and in high-caseload hospitals. CONCLUSION: Effective strategies to fully implement national colorectal cancer guidelines are needed. In particular, increasing the use of appropriate adjuvant therapy should be a priority, especially among older people.     

Immunization rate comparison for Oklahoma Medicaid managed care population by age two: 1995-1998

Processes of care are used as one measure for the quality of care rendered by providers. One example is the immunization of children by the age of two. The Oklahoma Health Care Authority, with the Oklahoma Foundation for Medical Quality, has been tracking childhood immunization rates from 1995 through 1998. The rate calculated included the medical record data and the Oklahoma Statewide Immunization Information System (OSIIS) data set. The standards were based on Advisory Committee on Immunization Practices recommendations and Quality Assurance Reform Initiative standards. The rate of provision of documented immunizations in the Medicaid managed care population under the age of two has improved markedly from 1995 to 1998. The trend analysis suggests there might be areas for continued improvement in the provision of immunization to individuals in Oklahoma's Medicaid managed care population. Further, the OSIIS data is critical for maintaining a uniform data set for immunization information.     

荆州市精神病医院93、94、95三年空床原因调查分析

为探讨分析近年在院病人数逐年递减的原因，调阅近三年入院登记册及有关年份统计资料，统计分析相关数据．发现近三年入院病人数分别是十年前的1．2至1．4倍，但当年入、出院人数为负增长，其症结在于平均住院天数逐年下降，分别为十年前的2／3至1／2；每年三月入院病人数最多（占同年10％以上）．认为除外宏观因素，医院可以在一切以病人为中心的前提下，改善医疗质量和服务质量，可以合理延长病人的留院时间；据各月入院病人数的多少，有侧重地安排医疗、科研、教学等各项工作．     

结直肠癌2042例临床病理特点及预后回归分析

目的 探讨广东地区结直肠癌的临床病理特点和影响预后的因素.方法 总结中山大学附属第一医院1995-2007年经病理确诊的2042例结直肠癌的临床资料,分析其临床特点和预后情况.结果 2042例患者的中位年龄为59岁,好发年龄为50～70岁.男女比例为1.4:1.直肠是最常见部位,占46.2%,其次为乙状结肠,占22.0%.年龄<40岁患者黏液癌占16.7%,而低分化癌占33.5%,比例明显高于40岁以上患者.根据TNM分期,Ⅰ期占5.8%,Ⅱ期占42.9%,Ⅲ期占31.0%,Ⅳ期占20.3%.结直肠癌总体生存率1年为92.3%,3年为73.9%,5年为65.1%,10年为57.5%.年龄、大体分型、分化程度、TNM分期和手术方式是影响结直肠癌患者生存的独立危险因素,辅助化疗是保护因素.1995-2001年(第Ⅰ阶段)与2002-2007年(第Ⅱ阶段)比较,第Ⅱ阶段中使用吻合器、直肠癌行Dixon手术和化疗的比例增高,第Ⅱ阶段1、3、5年生存率分别为93.4%、78.0%、73.2%,明显高于第Ⅰ阶段(90.6%、69.2%、58.8%).结论 年龄、大体分型、分化程度、TNM分期、手术方式和辅助化疗是影响结直肠癌患者生存的重要因素.