Newer Agents in Colon Cancer: What’s Next?

Colorectal cancer (CRC) was the third leading cause of cancer deaths in the United States in 2012, and most patients eventually develop metastatic disease. The use of cytotoxic chemotherapy, the antiangiogenesis drug bevacizumab, and the anti-EGFR monoclonal antibodies cetuximab and panitumumab have led to an improvement in median OS for metastatic CRC. Despite this improvement in survival, few agents have activity against CRC. Between 2006 and 2012, the FDA approved no new agents for patients with metastatic CRC (mCRC). Recently, the FDA has approved aflibercept and regorafenib for use in the treatment of patients with mCRC, and several new agents are currently in development. This paper reviews the use of new agents and new uses for established agents in mCRC.     

Doctors' perceptions of why 360-degree feedback does (not) work: a qualitative study

Objectives Delivery of 360‐degree feedback is widely used in revalidation programmes. However, little has been done to systematically identify the variables that influence whether or not performance improvement is actually achieved after such assessments. This study aims to explore which factors represent incentives, or disincentives, for consultants to implement suggestions for improvement from 360‐degree feedback. Methods In 2007, 109 consultants in the Netherlands were assessed using 360‐degree feedback and portfolio learning. We carried out a qualitative study using semi‐structured interviews with 23 of these consultants, purposively sampled based on gender, hospital, work experience, specialty and views expressed in a previous questionnaire. A grounded theory approach was used to analyse the transcribed tape‐recordings. Results We identified four groups of factors that can influence consultants’ practice improvement after 360‐degree feedback: (i) contextual factors related to workload, lack of openness and social support, lack of commitment from hospital management, free‐market principles and public distrust; (ii) factors related to feedback; (iii) characteristics of the assessment system, such as facilitators and a portfolio to encourage reflection, concrete improvement goals and annual follow‐up interviews, and (iv) individual factors, such as self‐efficacy and motivation. Conclusions It appears that 360‐degree feedback can be a positive force for practice improvement provided certain conditions are met, such as that skilled facilitators are available to encourage reflection, concrete goals are set and follow‐up interviews are carried out. This study underscores the fact that hospitals and consultant groups should be aware of the existing lack of openness and absence of constructive feedback. Consultants indicated that sharing personal reflections with colleagues could improve the quality of collegial relationships and heighten the chance of real performance improvement.     

Rational emotive health therapy for the management of depressive symptoms among parents of children with intellectual and reading disabilities in English language

Background:There is little data in developing countries such as Nigeria with regard to the impact of caring for their children with intellectual and reading disability (IRD) on the quality of life of the parents and the risk of psychopathology.Objective:The main objective of the study was to assess the level of psychopathology, i.e., depression among parents of children with intellectual and reading disabilities.Methods:This was pretest/posttest control group design with 198 parents (99 fathers/99 mothers) of 100 children with the diagnosis of IRD. The measures used in this study for data collection was Beck Depression Inventory (BDI). Repeated measures analysis of variance (ANOVA) was employed for data analysis.Results:Result obtained showed a significant high proportion of depressive symptoms among parents of children with intellectual and reading disabilities at initial assessment. Furthermore, the REHT intervention resulted in a significant reduction in depression of parents in treatment group as compared to those in the control group.Conclusion:The presence of a child with intellectual and reading disabilities does not cause parents to become depressed but irrational beliefs about their children’s mental and reading deficiencies may contribute to unhealthy thinking and feelings about the future of their children. REHT is very effective in assisting depressed parents of children with intellectual and reading disabilities to think rationally about their children and work towards overcoming disability-related as well as behavior-related irrational beliefs. The mental health providers, therapists and counselors should apply the REHT in managing people with psychological distress especially parents of children with intellectual and reading disabilities who may have psychological diagnosis of depression.     

Environmental Pollution Levels of Lead and Zinc in Ishiagu and Uburu Communities of Ebonyi State, Nigeria

Water and soil samples from the area were therefore analyzed for their lead and zinc content. Computation of pollution statuses of lead and zinc revealed topsoil lead geoaccumulation indices of −0.143 and −0.069 and zinc geoaccumulation indices of 1.168 and 0.713 for Ishiagu and Uburu respectively. The pollution indices were determined to be 0.499 and 0.3564 for soil in Ishiagu and Uburu respectively and also 5.11 and 2.42 for water in Ishiagu and Uburu communities respectively. Water/soil concentration ratio were found to be 0.0018 and 0.0014 for lead in Ishiagu and Uburu respectively. On the other hand, the water/soil concentration ratio for zinc was computed to be 0.001 and 0.0008 for Ishiagu and Uburu respectively. These results seem to suggest that the pollution of the environment by these heavy metals in the areas were as a result of the water being contaminated by lead and zinc not necessarily their concentrations in the soil.     

Is there a business case for quality in The Netherlands? A critical analysis of the recent reforms of the health care system

Major reforms of the health insurance system and reimbursement systems for care providers are currently taking place in The Netherlands. These market-oriented health care reforms will transform the current central supply-driven system to a system of managed competition both among health care insurers and care providers. The reforms are not systematically linked to the discussions about quality of care and together with consumers who might be more interested in lower premiums; they offer almost no incentive for health care insurers and providers to steer on quality. Dutch policy makers should, therefore, be more explicit whether competition should take place on quality or price, and if the former is the case, additional incentives as part of the system reforms, are needed to create a business case for quality.     

Asymptomatic Plasmodium parasitaemia in pregnant Nigerian women: almost a decade after Roll Back Malaria

Malaria during pregnancy is a major cause of fetal and maternal morbidity and mortality. In malaria-endemic areas, the condition may remain asymptomatic but is still associated with complications. The objective of this study was to determine the prevalence of asymptomatic malaria parasitaemia and its relationship with various sociodemographic characteristics. The study was performed at three hospitals in Enugu, the centre of southeast Nigeria, during the rainy season between March 2006 and October 2007. Pregnant women attending the antenatal clinic at the index pregnancy were randomly selected and counseled, and peripheral blood samples were collected for malaria parasite and packed cell volume estimation. Age, parity, gestational age at booking, degree of anaemia and parasite density were recorded. Of 125 pregnant women tested, 73 had microscopic Plasmodium parasitaemia, giving a prevalence of 58.4%. Asymptomatic malaria parasitaemia was more common in primigravidae, in the second trimester and in the younger age group. Anaemia in pregnancy was prevalent (55.2%) and there was no significant difference in the density of parasitaemia in those with mild, moderate and severe anaemia. The prevalence of Plasmodium parasitaemia in pregnant Nigerian women is still very high nearly a decade after Roll Back Malaria. It is therefore pertinent to reappraise Roll Back Malaria strategies or to design a more effective programme for the prevention and treatment of malaria in pregnancy.     

Can Admission and Fasting Glucose Reliably Identify Undiagnosed Diabetes in Patients With Acute Coronary Syndrome?

OBJECTIVE—Our objectives were to determine the prevalence of previously undiagnosed abnormal glucose tolerance, i.e., diabetes and impaired glucose tolerance (IGT) in patients with acute coronary syndrome and to assess the utility of admission and fasting glucose in identifying diabetes in these patients.RESEARCH DESIGN AND METHODS—Glycemic status was characterized on the basis of admission plasma glucose (APG), fasting plasma glucose (FPG), and an oral glucose tolerance test (OGTT) in 140 patients admitted to the hospital with acute coronary syndrome, who were not known to have diabetes (mean ± SD age 67.3 ± 13.4 years; 79% men). OGTTs were performed on days 5–7 after admission.RESULTS—The prevalences of diabetes and IGT were 27 and 39%, respectively, according to OGTT criteria. Receiver operating characteristic curves showed that the area under the curve for diagnosing diabetes was 0.83 (P < 0.001) for FPG, 0.79 (P < 0.001) for APG, and 0.84 (P < 0.001) for FPG and APG applied in combination. A FPG cutoff ≥5.6 mmol/l (100 mg/dl) and/or APG ≥7.8 mmol/l (140 mg/dl) yielded a sensitivity of 89.5% and a positive predictive value of 43.6% for detecting diabetes.CONCLUSIONS—A high prevalence of abnormal glucose tolerance was seen in patients with acute coronary syndrome. The combination of FPG ≥5.6 mmol/l (100 mg/dl) and/or APG ≥7.8 mmol/l (140 mg/dl) was highly sensitive for identifying diabetes. Although weakly specific, this simple algorithm could offer a practical initial screening tool at the acute setting in the high-risk population with acute coronary syndrome.Diabetes is associated with increased cardiovascular risk. Individuals with diabetes have a greater mortality from acute myocardial infarction (AMI) than nondiabetic individuals (1). After an acute coronary event, hyperglycemia has been shown to be a predictor of immediate and long-term cardiovascular mortality (2). Although the prevalence of diabetes has continued to rise, diabetes remains undiagnosed in many patients. In recent years several studies have reported an increased prevalence of prior undiagnosed abnormal glucose tolerance, i.e., impaired glucose tolerance (IGT) and diabetes in patients with AMI (3–6). Furthermore, such newly diagnosed abnormalities of glucose metabolism have been shown to be associated with an excess long-term cardiovascular mortality (7). Thus, patients with acute coronary syndrome present an opportunity for targeted screening for diabetes and institution of effective management strategies aimed to improve cardiovascular outcome.The optimal strategy for identifying individuals with diabetes in the setting of an acute coronary syndrome is unclear, however. Although the oral glucose tolerance test (OGTT) is considered the gold standard for the diagnosis of diabetes, its utility is hampered by its cost, time-consuming protocol, and overall inconvenience compared with simple fasting or admission glucose measurements. Accordingly, clinicians in practice often adopt the more pragmatic approach of characterizing glycemic status on the basis of admission and fasting glucose values. The Joint British Societies’ 2005 clinical guidelines on prevention of cardiovascular disease recommended that a fasting glucose measurement can be done as an alternative to an OGTT in patients who have had an acute cardiovascular event (8). However, there is increasing evidence to suggest that use of fasting glucose measurements alone will miss a substantial proportion of patients with diabetes after an AMI (4). Studies specifically addressing this issue in the setting of the full spectrum of the acute coronary syndrome are limited. Likewise, the diagnostic utility of admission glucose measurements in patients with coronary events has received little attention even though hyperglycemia in this setting could potentially represent preexisting undiagnosed diabetes.Thus, it remains unresolved whether an OGTT is mandatory after an acute coronary syndrome or whether admission and fasting glucose could effectively identify patients with diabetes or at the least stratify individuals who will merit an OGTT. Our objective in this study was first to clarify the prevalence of unrecognized abnormal glucose tolerance in our own population of patients with acute coronary syndrome in South Wales, U.K. Second, we analyzed the performance of fasting and admission glucose measurements, applied individually or in combination, as markers of previously undiagnosed diabetes in patients with acute coronary syndrome.     

Concurrent outbreak of staphylococcal pneumonia with infectious bursal disease in broiler chickens

Concurrent outbreak of staphylococcal pneumonia with infectious bursal disease (IBD) occurred in 29-day-old broiler chickens. The outbreak started after a flock of 279 birds was decongested by moving 121 birds to another pen. The birds were depressed and weak before death and carcasses were cyanotic. At necropsy, the lungs were dark red, congested and consolidated; the bursa of Fabricius (BF) was enlarged; the liver was pale and the intestinal mucosa was hyperaemic. Histopathological examination of the lungs, BF and liver revealed fibrinopurulent pneumonia, purulent inflammation of the BF and hepatic lipidosis, respectively. Staphylococcus aureus was isolated from the teased tissue of the lungs. The mortality was 35.8% within 5?days of the outbreak. The circumstances of the outbreak suggested that immunosuppression due to stress associated with crowding and transferring of the birds from one pen to another and poor seroconversion to previous infectious bursal disease virus vaccination, favoured the clinical establishment of the bacterial and IBD viral infections.