Do psychiatric inpatients know their rights? A re-audit on information given to inpatients at a London mental health trust about their rights and admission to hospital

This re-audit assessed whether wards at South West London and St Georges' mental health trust (SWLSTG) met agreed standards regarding informing inpatients about their legal status in hospital and rights, following an initial audit in 2009. Three general adult wards were re-audited, and other general and specialist wards (addictions, eating disorders, deaf services and obsessive compulsive disorder) were added. One hundred and five people (61 informal, 44 detained under the Mental Health Act 1983, revised 2007) on 10 wards were interviewed using an agreed proforma. The re-audit of wards A-C showed improvement: 81.3% of informal inpatients were aware of their legal status, versus 54.2% in 2009 (P = 0.101). Including new wards D-K, 90.2% knew their status (P = 0.0002). Of the informal patients, 65.6% knew they could refuse treatment (P = 0.0184) (on wards A-C, 68.8%, P = 0.105) versus 37.5% in 2009. Despite some improvement, the patient experience of informal admission or detention in hospital still sometimes crosses legal boundaries. This audit highlights the need to improve awareness of patient rights and demonstrated how local presentation of audit improves practice.     

Prevalence of multiple antibiotics resistant (MAR) Pseudomonas species in the final effluents of three municipal wastewater treatment facilities in South Africa

The final effluents of three (Alice, Dimbaza, and East London) wastewater treatment plants (WWTPs) were evaluated to determine their physicochemical quality and prevalence of multiple antibiotics resistant (MAR) Pseudomonas species, between August 2007 and July 2008. The annual mean total Pseudomonas count (TPC) was 1.20 × 10(4) (cfu/100 mL), 1.08 × 10(4) (cfu/100 mL), and 2.66 × 10(4) (cfu/100 mL), for the Alice, Dimbaza, and East London WWTPs respectively. The effluents were generally compliant with recommended limits for pH, temperature, TDS, DO, nitrite and nitrate; but fell short of target standards for turbidity, COD, and phosphate. The tested isolates were highly sensitive to gentamicin (100%), ofloxacin (100%), clindamycin (90%), erythromycin (90%) and nitrofurantoin (80%); whereas high resistance was observed against the penicillins (90-100%), rifampin (90%), sulphamethoxazole (90%) and the cephems (70%). MAR index ranged between 0.26 and 0.58. The study demonstrated that MAR Pseudomonas species were quite prevalent in the final effluents of WWTPs in South Africa; and this can lead to serious health risk for communities that depend on the effluent-receiving waters for sundry purposes.     

Gene Expression Ratio Test Distinguishes Normal Lung from Lung Tumors in Solid Tissue and FNA Biopsies

Lung cancer is the leading cause of cancer-related deaths worldwide. Prognosis and survival are dependent on cell type, early detection, and surgical treatment. Hence, optimal screening strategies and new therapies are urgently required. Although surveillance with low-dose computed tomography can reduce lung cancer mortality by 20%, the number of false-positive detections is significant. Tissue diagnosis aids in the identification of benign nodules, reducing the number of false positive detections. To determine whether molecular testing of fine-needle aspirations (FNAs) can reduce false-positive detections, we developed a gene expression–based test that distinguishes normal from cancerous lung tissues. The test first was applied to published microarray data, showing overall sensitivity and specificity values of 95% (95% CI, 90%–98%) and 100% (95% CI, 40%–100%), respectively. Subsequently, it was validated on 30 solid and ex vivo FNA lung cancer tumor samples and matched normal lung specimens using real-time PCR. The validation test was 93% (95% CI, 78%–99%) sensitive and 100% (95% CI, 88%–100%) specific for the detection of tumor versus normal lung on solid samples, whereas FNA specimens yielded a sensitivity of 91% (95% CI, 72%–99%) and a specificity of 94% (95% CI, 70%–100%). This study supports the hypothesis that the gene-ratio approach reliably distinguishes normal lung from cancerous tissues in FNA samples and can be optimized to diagnose benign nodules.Lung cancer is the leading cause of cancer-related deaths worldwide for both men and women.¹ Approximately 85% of lung cancers have histologic features characterized as non-small cell lung cancer (NSCLC).² The histologic subtypes of NSCLC include squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, and large cell carcinoma.³ Management of NSCLC usually is determined by stage of disease at diagnosis. Early stage cancers (I to IIIA) are treated surgically (with or without neoadjuvant or adjuvant therapy), and more advanced stage cancers (IIIB to IV) are treated with chemotherapy with or without radiation therapy.^4,5 The high mortality rate of lung cancer is attributed to the following: a diagnosis occurring in advanced stages as a result of the late onset of symptoms, the relative lack of screening strategies, and ineffective treatment approaches for advanced cancer. Currently, a definitive diagnosis of cancer in patients with documented pulmonary nodules can be established by surgical resection, percutaneous image-guided needle biopsy, or bronchoscopy with bronchioalveolar lavage.^6–8Percutaneous image-guided, fine-needle aspiration (FNA) biopsy is a minimally invasive technique that allows sampling of tumors for diagnosis. Cells are aspirated directly from the solid lesion and analyzed by a cytopathologist.⁹ The accuracy of this approach, however, diminishes with the size of the suspected nodule(s) as a consequence of technical challenges associated with accessing small lesions and the difficulty of obtaining sufficient amounts of cytologically diagnostic material.¹⁰ Until recently, lung cancer subtyping in FNA specimens was based entirely on morphology.¹¹ The difficult interpretation of poorly differentiated tumors and the presence of inadequately preserved samples strongly affected the cytopathologist''s ability to render an accurate diagnosis.¹¹ In addition, the relative lack of tissue architecture and cellular dispersion in cytology samples further limited correct tumor subtyping. In more recent years, these barriers to accurate diagnosis have been removed by increasing reliance on improved immunocytochemistry and novel adjunctive molecular biology techniques for more precise tumor diagnosis.^12,13We previously developed a bioinformatic algorithm using gene expression ratio–based tests to translate comprehensive expression profiling data into simple clinical tests based on the expression levels of a relatively small number of genes.^14–17 In addition, we have used this algorithm to generate a gene ratio–based test for the differential diagnosis of solitary lung nodules using 23 genes, and we have tested it in 29 ex vivo FNA biopsies from normal lung and suspected tumor nodules.¹⁸ This algorithm was 87% and 100% accurate in detecting cancer in FNAs from normal tissue and tumor, respectively.In this study, we used published microarray data¹⁹ to develop an expression-based test capable of distinguishing normal lung from lung cancer as a pilot study to determine the feasibility of using molecular gene-based ratio tests for the diagnosis of lung cancer. We compared the diagnostic accuracy of applying the test to FNA biopsy specimens and to corresponding solid tumor samples from the resected specimens. Our aim was to determine whether a molecular test that was capable of distinguishing between normal lung and cancerous tissues using FNA biopsy could be added to cytologic tests to improve the detection and diagnosis of lung cancer.     

Untersuchungen zur Stimulation der Lungentumorrate durch Diäthylnitrosamin bei O-20-Mäusen

Zusammenfassung 100 weibliche und männliche O-20-Mäuse erhielten ein-bzw. zweimal wöchentlich 50 mg/kg KG Diäthylnitrosamin subcutan über 4 Wochen. Neben den bekannten Leberveränderungen zeigte sich die Zunahme der Lungenadenomrate bei erheblich verkürzter Latenzzeit.

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Studies on the stimulation of the rate of lung tumors by di-ethyl-nitrosamine in O-20-mice

Summary 50 mg/kg body weight of di-ethyl-nitrosamine was administered subcutaneously to 100 female and male O-20-mice once or twice weekly over a period of 4 weeks. Beside the well-known changes of the liver an increase of the rate of lung adenomas at significantly shortened latency period could be observed.

     

Methodisch einfache Cytodiagnostik carcinogen-induzierter Lungen-Tumoren am syrischen Goldhamster

Zusammenfassung Am syrischen Goldhamster wird nach Induktion von Lungentumoren mit N-Methyl-N-Nitrosoharnstoff (intratracheal) und Dibutylnitrosamin (subcutan) eine einfache Methodik zur Gewinnung von Bronchialsekret und die Ergebnisse der cytologischen und histologischen Untersuchung beschrieben.

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A simple method for the cytodiagnosis of carcinogenically induced lung tumors in the Syrian golden hamster

Summary After inducing lung tumors with N-Methyl-N-Nitrosourea (intratracheally) and Dibutylnitrosamine (subcutaneously) in the Syrian golden hamster, a simple method was devised for collecting bronchial secretions. The results of the cytological and histological investigation are described.