Nutritional evaluation and dietetic care in cancer patients treated with radiotherapy: prospective study.

Ninety-three cancer patients about to undergo radiotherapy were studied. These patients were affected by cancer of the head and neck, breast cancer, and abdominopelvic cancer. They were randomly distributed into control and experimental groups. The patients from the control group were allowed to eat ad libitum, whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits. Data were collected the day before radiotherapy commenced and the day treatment ended. Anthropometric, analytical, and clinical parameters were determined. The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer.     

异种（猪）脱细胞真皮基质治疗深Ⅱ度烧伤患者血清中TNF-α水平的变化

目的研究应用异种（猪）脱细胞真皮基质（以下简称＂猪基质＂）治疗深Ⅱ度烧伤患者血清中TNF-α水平的变化。方法收集我院2006年8月～2007年10月住院应用猪基质治疗的深Ⅱ度烧伤患者44例,所有患者入院后经简单清创后全部应用猪基质将创面覆盖,分别于伤后第1、3、7、10d抽取其静脉血并行血清TNF-α水平的测定。结果患者伤后第3d血清TNF-α水平显著高于伤后第1d血清TNF-α水平（P〈0.01）,且高于伤后第10d血清TNF-α水平（P〈0.05）;同时伤后第7d血清TNF-α水平高于伤后第1d血清TNF-α水平（P〈0.05）。结论深Ⅱ度烧伤患者应用猪基质治疗后其血清TNF-α具有明显的变化规律,了解这一变化规律对于患者烧伤后应用猪基质治疗具有重要指导意义。     

Case report: hexachloroethane smoke inhalation: a rare cause of severe hepatic injuries

CONTEXT: We report on two patients, a 23-year-old man and a 24-year-old man, who had chemical pneumonitis and respiratory distress after inhaling hexachloroethane/zinc oxide (HC/ZnO) smoke during military training. CASE PRESENTATION: The patients had been healthy previously and denied any history of alcohol or drug abuse. Hematologic tests revealed leukocytosis with neutrophils predominant. The respiratory conditions of both patients improved after steroid therapy and oxygen support, but deterioration of liver function was found. The laboratory results showed that alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels were elevated about 1.5-fold the normal limits and that aspartate aminotransferase (AST) levels were marginally elevated. The elevation of liver aminotransferase started from day 1 and day 2 and peaked from day 18 to day 22. ALT/AST levels then returned to normal in 6 weeks. Common viral hepatitis was ruled out after serologic tests. Abdominal sonography and physical examination failed to show any specific findings. DISCUSSION: The hepatotoxic effect was attributed to inhalation of high-concentration HC/ZnO smoke in an enclosed area, where several hepatotoxicants, including ZnCl2, HC, and chlorinated vapors, could have been generated and mixed in the smoke. RELEVANCE TO CLINICAL PRACTICE: These case reports elaborate the hepatic effects that may occur in addition to pulmonary effects of HC/ZnO smoke.     

The island

A clinician's chance encounter on the subway, after a long day seeing patients, prompts reflections on the nature of our interactions with our patients and with others we come across in our lives. Random yet precise, these interactions create a string of opportunities to witness other people's lives as well as our own. Sitting next to a young girl and her mother, the author daydreams about the images that appear to be on the surface, and then suddenly glimpses another level of reality that redefines the stereotypes. Like strangers on a train, we accompany our patients, everyone with their own stories and histories, in a series of unique moments. Occasionally a door opens that lets us see things differently. If we are receptive to it, we may learn something not only about our patients but also about ourselves.     

Change in smoking behavior and long-term smoking abstinence among patients with stomach or head and neck cancer admitted to a cancer center

PURPOSE: This study was conducted to address change in smoking behavior of cancer patients when admitted to a cancer center, and elucidate factors associated with long-term smoking abstinence after discharge. METHODS: The subjects were 97 patients with stomach cancer and 93 with head and neck cancer (cancer in the oral cavity, pharynx and/or larynx that did not require total laryngectomy) who were current smokers at the time of first visit to a cancer center. In order to obtain detailed information on their smoking behavior, a self-administered questionnaire was mailed to each patient at least 18 months after the patient was discharged. Seventy-three percent (138/190) of the subjects returned the completed questionnaire by mail. RESULTS: The smoking cessation rates at five different time points, namely, 1) one day before admission, 2) the first day of admission, 3) the last day of admission, 4) one day after discharge, and 5) at the time the patient received the questionnaire, indicating long-term smoking abstinence after discharge, were 10.4%, 32.6%, 71.9%, 40.0% and 51.0%, respectively. Multivariate logistic regression analysis revealed that patients who had stopped smoking by the first day of admission had a significantly higher probability of long-term smoking abstinence than their counterparts who smoked up to the last day of admission. The patients who received doctors' and/or nurses' advice for smoking cessation at our medical center did not have significantly higher probability of long-term smoking abstinence than those who did not receive it. CONCLUSION: With patients suffering from stomach or head and neck cancer admitted to a cancer center, multivariate analysis indicated that smoking behavior in the pre-admission period influences long-term smoking abstinence after discharge.     

A pilot study of the activity patterns of five elderly persons after a housing adaptation

The importance of an accessible home environment for occupational performance has been emphasized in occupational therapy, but knowledge about how accessibility can affect a person's activity patterns is limited. The purpose of this study was to describe the activity patterns of five elderly persons aged between 70 and 84 years and their views about accessibility and usability of their homes before and after a housing adaptation. Two different questionnaires, 'Accessibility in My Home' and the 'Occupational Questionnaire' were used for data collection. Adaptations in the home included: removing thresholds, installing new taps in the bathroom and kitchen and broadening doorways. After the adaptations the five participants reported that they increased their outside activities, reduced naps during the day and slept better at night. The results showed that the participants performed more and new activities when their home environment had become accessible. Activities performed were also perceived as more important after the housing adaptation. There is a need to replicate the study with a larger sample. Further research is needed on the impact of home adaptations on the activity patterns of elderly people.     

Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit

Efforts to reduce infections acquired during a hospital stay through improvements in the quality of care have had measurable results in many hospital settings. In pediatric intensive care units, the right quality interventions can save lives and money. We found that improving practices of hand hygiene, oral care, and central-line catheter care reduced hospital-acquired infections and improved mortality rates among children admitted to a large pediatric intensive care unit in 2007-09. In addition, on average patients admitted after the quality interventions were fully implemented spent 2.3 fewer days in the hospital, their hospitalization cost $12,136 less, and mortality was 2.3 percentage points lower, compared to patients admitted before the interventions. The projected annual cost savings for the single pediatric intensive care unit studied was approximately $12 million. Given the modest expenses incurred for these improvements-which mainly consisted of posters for an educational campaign, a training "fair," roughly $21 per day for oral care kits, about $0.60 per day for chlorhexidine antiseptic patches, and hand sanitizers attached to the walls outside patients' rooms-this represents a significant return on investment. Used on a larger scale, these quality improvements could save lives and reduce costs for patients, hospitals, and payers around the country, provided that sustained efforts ensure compliance with new protocols and achieve long-lasting changes.     

神经外科气管切开患者口咽部细菌定植的临床研究

目的了解神经外科气管切开患者口咽部细菌定植及其耐药性研究。方法对2008年1月-2009年12月在医院神经外科气管切开的患者进行细菌学监测,于气管切开术后1、37、d采集咽拭子做细菌培养,收集每例患者临床及实验室资料,对结果进行统计学分析。结果 45例患者共培养出63株定植菌;术后1、37、d细菌定植者分别为1、7、15例,定植菌检出率分别为2.2%、15.6%、33.3%;定植菌以革兰阴性杆菌为主,亚胺培南对所用抗菌药物中最敏感。结论气管切开患者口咽部细菌定植需要进行监控,根据监测结果,采取缩短置管时间等干预措施,对控制气管切开患者细菌定植和呼吸道感染有重要意义。     

Relation of psychological distress after diagnosis of gastric cancer at a cancer screening center with psychological support from public health nurses and family members

PURPOSE: The objectives of this study were to examine the degree of psychological distress during the first 6 months after diagnosis of gastric cancer and investigate the relation to psychological support from public health nurses and family members. METHODS: One hundred and five patients with stomach, colorectal, or esophagus cancer were mailed a questionnaire. They were asked questions concerning the level of shock on the day of diagnosis, at 1-week after the diagnosis, and at 6 months post diagnosis. In addition, their physical and psychological status was assessed at the 6-month time point. They were also asked about perceived psychological support from public health nurses and family members. The relation between psychological distress and such psychological support was then assessed using multiple regression analyses. RESULTS: The levels of shock on the day of diagnosis and after 1-week were both significantly related to the psychological support from public health nurses. Physical and psychological status at 6 months post diagnosis was significantly related to the level of psychological support from the patient's family members. CONCLUSION: The study revealed that psychological support from public health nurses improves the level of patient psychological distress during the first 1 week after the cancer diagnosis. Psychological support from family members facilitates the physical and psychological adjustment at 6 months post diagnosis. The results indicate that psychological support is important just after cancer diagnosis and for longer term adjustment, pointing to a major role of health care professionals alleviating problems associated with cancer diagnosis.     

Characteristics of smokers and long-term changes in smoking behavior in consecutive patients with myocardial infarction

BACKGROUND: The prognosis of patients with estabLished coronary artery improves if smoking is stopped. Still, about half of patients who suffer a myocardial infarction continue smoking after that event. In order to predict to whom additional support should be offered, various baseline characteristics were compared with smoking status at short-term and long-term follow-up. METHODS: Demographics, medical history, presence of coronary risk factors, psychological determinants, and the clinical course were recorded in a group of 530 unselected consecutive patients who had been admitted with a myocardial infarction and were smoking. Patients who were smoking at admission, and who were alive at 4-year follow-up, were studied to relate smoking status and baseline characteristics. RESULTS: At 3 months, persistent smokers were younger than quitters, had shorter hospital stays, underwent revascularization procedures less often, smoked more cigarettes per day at baseline, and were more socially isolated. After 4 years, patients who stopped smoking had had a more serious myocardial infarction and had a lower displeasure score than those who continued smoking. Also, quitters received more support from their social environment. CONCLUSIONS: Although the majority of the patients try to stop smoking after a myocardial infarction, about half smokes after 4 years. In the future, special support should be offered to smokers who suffer myocardial infarction, especially to those whose psychosocial profiles are less favorable.     

Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge.

BACKGROUND: When a patient is admitted to a hospital, the need for information about the medications prescribed is an important issue. OBJECTIVES: Our aim was to assess whether electronic communication between the GP and the pharmacist provides better information regarding current medication when a patient is admitted to the hospital than paper-based communication. METHODS: A prospective study was carried out whereby on the day of admission and 10 days after discharge, three different data collectors independently asked the patient, the GP and the pharmacist details of the patient's current medication. Five GPs and a local pharmacy relying on electronic communication, and five GPs and a local pharmacy relying on paper-based communication were studied. RESULTS: A total of 139 patients were included on the first day of their admission, and 116 on the tenth day after discharge. Of the 275 drugs that the patient, the GP and/or the pharmacist reported on admission in the electronic group, 134 (49%) were reported by the patient, the GP and the pharmacist, and 79 (29%) were not reported by the patient. For the paper group, these figures were 340 drugs on admission, of which 107 (31%) were reported by the patient, the GP and the pharmacist, while 130 (38%) were not reported by the patient. CONCLUSIONS: We conclude that electronic communication between the GP and the community pharmacist results in a better agreement between them with respect to the current medication of the patient than paper-based communication. However, electronic communication does not suffice as a solution to obtain reliable information.     

How and why parents select profit-making day care programs: A study of two southeastern college communities

In this study, 86 parents whose children attended six profit-making day care centers rated as average or above-average in two southeastern college communities were interviewed to determine how and why they selected their children's day care programs. Our results indicated that these parents typically got initial information about day care through second-hand sources (e.g., theYellow Pages, over the phone, through friends and neighbors) and then visited one center—the one they ultimately enrolled their child in. Little information-seeking about day care by first-hand observations of several centers was reported. However, these parents said they selected their center because it (a) provided an educational program and (b) had a competent staff. Next most important on their list of reasons were that the center (c) was close to home, (d) charged relatively low fees, and (e) provided nutritious meals and snacks.     

Effect of posttraumatic serum thyroid hormone levels on severity and mortality of patients with severe traumatic brain injury

Traumatic brain injury (TBI) is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale (GCS) score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission.     

Alteration in skin composition of young rats fed liquid protein diet

The effects of liquid protein diet (LPD) on the collagen metabolism of developing skin tissue was examined in young rats fed a 20% liquid protein diet starting at day 23 after birth. Other rats were pair-fed, but with a 20% casein diet, and another group of rats were fed a 20% casein diet ad libitum. The LPD rats rapidly lost their hair, and they were smaller and weighed less than the pair-fed and ad libitum rats. None of the LPD-fed rats survived beyond day 53 of the study. Collagen contents of the skin continuously increased in all age groups, while hexosamine content decreased from day 23 to 35. From day 23 to 35, noncollagenous protein content in the ad libitum group decreased about 40% and in the LPD and pair-fed groups, about 50%; from day 35 to 48, the decrease was about 35% in the ad libitum group and only about 14% in both the LPD and pair-fed groups. The ratio of Type III to I collagen in the LPD group at days 35 and 48 was greater than that of the ad libitum group. Current observations suggest that LPD alters biochemical composition of the skin on young, growing rats.     

The role of risk and benefit perception in informed consent for surgery.

BACKGROUND: Informed consent relies on patients' ability to understand risk information. Evidence suggests that people may extract the gist of any risk information to make medical decisions. Existing evidence also suggests that there is an inverse relationship between the perception of risk and the perception of benefit. METHOD: Seventy-one patients on the waiting list for carotid endarterectomy (CEA) were surveyed regarding their understanding and recall of the risk and benefit to health of undergoing CEA. Patients were surveyed 1 month after their initial consultation, and a subgroup was surveyed again on the day before their operation. RESULTS: Patients' estimates of their baseline risk of stroke without surgery were significantly different from what they had been told by the surgeon. Patients' estimates of stroke risk due to surgery ranged from 0% to 65% (actual local risk 2%). Patients also had unreasonable expectations about the benefit of the operation for their health. Estimates of stroke risk correlated positively with the degree of expected benefit from the operation (r = 0.29, P = 0.05). When resurveyed the day before the operation, patients' perceptions of both risk and benefit had increased significantly. The risk perception data from some patients appeared to contradict some of the predictions of the fuzzy-trace theory. CONCLUSIONS: Most patients failed to understand the risks and benefits associated with CEA. Some patients' estimates of stroke risk were actually greater than the perceived potential benefit of surgery in terms of risk reduction. The data also suggested a positive correlation between the degree of perceived benefit and the degree of perceived risk.     

Estimating variability in the transmission of severe acute respiratory syndrome to household contacts in Hong Kong, China

The extensive data collection and contact tracing that occurred during the 2003 outbreak of severe acute respiratory syndrome (SARS) in Hong Kong, China, allowed the authors to examine how the probability of transmission varied from the date of symptom onset to the date of hospitalization for household contacts of SARS patients. Using a discrete-time likelihood model, the authors estimated the transmission probability per contact for each day following the onset of symptoms. The results suggested that there may be two peaks in the probability of SARS transmission, the first occurring around day 2 after symptom onset and the second occurring approximately 10 days after symptom onset. Index patients who were aged 60 years or older or whose lactate dehydrogenase level was elevated upon admission to the hospital (indicating higher viral loads) were more likely to transmit SARS to their contacts. There was little variation in the daily transmission probabilities before versus after the introduction of public health interventions on or around March 26, 2003. This study suggests that the probability of transmission of SARS is dependent upon characteristics of the index patients and does not simply reflect temporal variability in the viral load of SARS cases.     

Alternative pharmacotherapy. Patterns of patient use and family physician practice

BACKGROUND: The use of alternative pharmacotherapies is rapidly increasing. Many persons who use purchased or prepared alternative medications are also cared for by family physicians. We describe patient usage of alternative pharmacotherapies and examine how family physicians handle this in medical practice. METHODS: We recorded data from structured interviews of 178 patients in an academic family medicine practice in a midsized southern city. We then examined the medical records of each participant who reported using some form of alternative pharmacotherapy to determine whether there was discussion of this use with the physician. RESULTS: Approximately one third of the patients reported using some form of alternative pharmacotherapy for 1 year or less, learning about alternative medications mostly from the media, and being generally satisfied with the results. Eighty-four percent of the patients reported not having been asked by their physician about their use of these drugs on the day of their office visit, and more than half reported never having been asked about their use of them. Medical record reviews indicated that for the most part physicians did not document having discussed or making recommendations about the use of alternative pharmacotherapies at any point in their relationship with the patient. CONCLUSIONS: Since many of their patients are using alternative pharmacotherapies, family physicians are encouraged to learn more about what their patients use, to institute easy system-wide changes to facilitate discussion about this use with their patients, to document alternative drugs used, and to give recommendations regarding them.     

Indoor spraying with the pyrethroid insecticide lambda-cyhalothrin: effects on spraymen and inhabitants of sprayed houses

In March 1990 a study was carried out in the village of Kicheba, United Republic of Tanzania, in which the pyrethroid insecticide lambda-cyhalothrin was sprayed on all the internal surfaces of houses and other shelters at a coverage of about 25 mg of active ingredient per m2. Every day for 6 days, 12 spraymen and 3 squad-leaders were interviewed about symptoms of overexposure to the insecticide. Each sprayman used up to 62 g of lambda-cyhalothrin over 2.7-5.1 hours every day. All the spraymen complained at least once of symptoms that were related to exposure to lambda-cyhalothrin, the commonest being itching and burning of the face, and nose or throat irritation frequently accompanied by sneezing or coughing. Facial symptoms occurred on non-protected areas only. The symptoms were experienced at various times after the beginning of exposure and disappeared before the following morning. The number of subjects affected and the duration of their facial symptoms were proportional to the amount of compound sprayed. A sample of individuals was interviewed 1 day and 5-6 days after their houses had been sprayed. One woman, who entered her house 30 minutes after the end of spraying, complained of periorbicular itching, but this lasted only a few minutes. No other significant, insecticide-related adverse effect was reported by the inhabitants of the sprayed houses.     

Children's perceptions of their day care experiences

Results of a study focused on using a Day Care Center Toy and Interview Questionnaire to obtain information about preschool children's perceptions of their day care experiences are summarized. Fifty-eight preschool children from a variety of day care centers were interviewed about their liking for day care, selected problem situations, day care activities, and behaviors of their teachers. These children were able to express their thoughts and feelings about day care with the Day Care Center Toy and Interview Questionnaire through role playing, manipulation of objects, and verbal expression of concerns. Interscorer agreement in evaluating the interview data ranged from 92% to 100%. The Day Care Center Toy and Interview Questionnaire shows promise as a means of aiding early childhood educators in obtaining information about preschool children's perceptions of their day care experiences.