The American ‘Patterns of Care’ Study: A Model for the Assessment of the Quality of Patient Care in Radiation Oncology

There are well documented manpower and equipment deficiencies in the specialty of Radiation Oncology in Australia. These deficiencies persist despite numerous reports over the last decade detailing their existence. The Patterns of Care Study (PCS) from the United States of America (USA) is a unique, comprehensive review of Radiation Oncology services in that country. It has clearly demonstrated that substantial benefits not only in survival but also in reduced treatment morbidity accrue when a full range of modern techniques and equipment is used. The present paper is a review of the PCS: this study has immense implications for patient care in particular and cancer services in general, in Australia. There seems little point in continuing to fund cancer research in the hope of gains in survival rates while continuing to ignore the fact that gains of a similar magnitude can be obtained by the maximum use of current knowledge and the provision of modern equipment.     

The identification and treatment of motor/learning difficulties: parents''perceptions and the role of the therapist

The diagnostic experience of 31 children, assessed as having motor/learning difficulties, attending an occupational therapy department within a children's hospital, was investigated. The study demonstrates the difficulty of specific identification of perceptuomotor problems. Close examination of the children's individual diagnostic pathways revealed a high number of health-care professional contacts and the fact that frequently there were lengthy gaps between parental (and sometimes professional) suspicions and final confirmation. The children's diagnostic experiences prior to starting treatment were varied and involved, and no one single route was predominant. The rationale for occupational-therapy assessment and treatment of this disorder is described, and parental perceptions of its effect are discussed. The findings suggest that an important part of therapeutic intervention may be increasing children's self-confidence and reducing intra and extra family tensions. Fewer behavioural problems were reported once treatment had commenced. It was concluded that an important part of the therapist's role was to provide information and support for parents and to liaise with school teachers, in addition to treating the children themselves.     

Alterations in the blood coagulation system induced by bacterial endotoxins. II. In vitro

Bacterial endotoxins in vitro are capable of shortening the coagulation time of normal whole blood, native platelet-rich and platelet-poor plasma, and the blood of a hemophilic patient in silicone but not in glass. The point in the coagulation system at which the endotoxins act has not been found but the search has been narrowed by the demonstration that these materials act independently of leukocytes and red blood cells, and do not act as preformed thromboplastin or thrombin. The shortening of the coagulation time in vivo 4 hours after endotoxin injection is probably through a different mechanism than in vitro.     

Alterations in the blood coagulation system induced by bacterial endotoxin. I. In vivo (generalized Shwartzman reaction)

The intravenous injection of bacterial endotoxins alter the coagulation system of rabbits' blood in vivo. Twenty-four hours after the first injection the fibrinogen level rises to twice normal values. The second injection at this time causes a 30 to 40 per cent decrease in fibrinogen content in 4 hours. Twenty hours later it again rises to twice normal values. A marked decrease in whole blood coagulation times in silicone occurs 4 hours after both injections but rises to normal values 24 hours following each injection. The circulating platelets drop from average levels of 300,000/c.mm. to 150,000/c.mm. after the first injection. The platelets remain at this low level and decrease to less than 100,000 after the second injection. During this time no fibrinolytic or fibrinogenolytic activity can be detected. Also, there is no significant change in the one stage prothrombin times or antithrombin titres. The marked decrease in circulating fibrinogen at the time when intracapillary thrombi are formed suggests that the "hyaline" thrombi of the generalized Shwartzman reaction are composed, in part, of fibrin. There appears to be a relationship between the level of circulating fibrinogen at the time of injection of bacterial endotoxin and the extent of the thrombosis. The higher the preinjection fibrinogen level, the more extensive is the thrombosis. There is also a relationship between the amount of fibrinogen loss and the extent of thrombosis after the injection. The more extensive the thrombosis the greater is the postinjection decrease in circulating fibrinogen. A comparison between the response of the hemostatic mechanism to tissue thromboplastin and bacterial endotoxin indicates that the latter acts in a unique manner and not by way of a simple "thromboplastic" activity. From the hematological standpoint, "preparation" for the generalized Shwartzman reaction is accompanied by an increased circulating fibrinogen, leukocytosis, and thrombocytopenia.