How to obtain the "perfect" plug

In order to obtain the "perfect" plug, distortion of the skin produced by the punch must be eliminated by reducing the pressure exerted. This can be accomplished by using a power-driven, exquisitely sharp punch and by proper saline infiltration. Other factors are also reviewed.     

New guidelines to evaluate the response to treatment "RECIST"

Response evaluation criteria in solid tumors (RECIST) guidelines proposes the simplification of response evaluation through the use of unidimensional measurements and the sum of the longest diameters for all target lesions. Data from collaborative studies, including more than 4,600 patients assessed for tumor response, support the simplification of response evaluation through the use of unidimensional measurements in stead of the conventional method using two measurements and the sum of the products. In this criteria, PR is at least a 30% decrease and PD is at least a 20% increase in the sum of the longest diameter of target lesions. In Japan, we will use this RECIST criteria for clinical studies of the new drug, because of international harmonization on new GCP. But, in this criteria, there are some problems in Japanese studies. One of them is that we cannot use the endoscopic findings for the evaluation of gastric cancer except for validation purposes, and one is that long NC (long SD) on breast cancer does not exist in this response criteria. We had discussed these problems at the 38th meeting of Japan Society of Clinical Oncology.     

The trustworthy person: from the law to the real practice

Since the 4th March 2002 law all hospital units should enable patients to designate a trustworthy person. The Institut Claudius Regaud Psycho-Social Oncology Unit has led an investigation into the understanding and the practical details use of this measure. The results demonstrate that the trustworthy person is well known. However its functions and responsibilities seem to be misunderstood. This raises the question of finding the most appropriate way of putting such a law into practice that would both suit and respect the patient's needs and wishes.     

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

There is sparse evidence on community practice patterns in treating women with breast cancer. This study compared care of women with breast cancer with evidence from meta-analyses and US National Comprehensive Cancer Network (NCCN) clinical guidelines. Records of 4395 women with breast cancer were abstracted from practices of 19 surgeon oncologists in six specialty practices in the Philadelphia region during 1995-1999. Patients were followed through December 2001. Low-frequency data were obtained on all patients. All other data were from a random sample of 464 women, minimum of 50 patients per practice. Actual care provided was compared to NCCN guidelines and results of meta-analyses. Fewer than half the women received treatments reflecting meta-analysis results or NCCN guidelines, by disease stage/TNM status. Adherence to either standard varied from 0% for LCIS to 87% for stages IIA or IIB node positive. There are multiple interactive reasons for low adherence to guidelines or meta-analyses results, including insufficient health system supports to clinicians, inadequate organisation and delivery systems and ineffective continuing medical education. The paucity of written information from patient records on physician/patient interactions limits the understanding of treatment decisions.     

Clinical practice in nursing, and "re establishment of daily routines"--the nurse's role in inter-professional collaboration

Clinical practice in adult nursing is given during the 4th year at the School of Health Sciences, Sapporo Medical University. In this paper, we report the achievements in this training on one theme. The theme chosen was the nursing of patients and support of their families particularly their caregivers, for whom re-establishment of daily routines was indispensable. A total of 51 students underwent this nursing practice at a neurological hospital on 26 occasions, over 3 years from 1996. We found that the students learned inter-professional collaboration in their relationships with other students, skilled nurses and other professionals in the hospital and other organizations. We also analyzed the nurses' roles learned through the inter-professional collaboration, which could be summarized as follows: 1. Understanding patients' and their families' living conditions and mental state, as affected by the patient's disease or disability. 2. Supporting the safe care at home of patients helping them to re-establish living routines. 3. Educating caregivers on how to attend to patients and develop better attendance skills. 4. Making sure the patients' and their families' living needs are reflected in the support system. 5. Providing nursing information for the coordination process of the support system, as well as respecting patients' and their families' individuality and lives as a whole.