Ethical (mis)use of prehistory

Medicine, Health Care and Philosophy -     

Correction: Beyond ethical post-mortems

Medicine, Health Care and Philosophy -     

Tolerability,Safety, and Outcomes of Neoadjuvant Chemoradiotherapy With Capecitabine for Patients Aged ≥ 70 Years With Locally Advanced Rectal Cancer

Introduction

In studies of colorectal cancer, the elderly have been frequently underrepresented because comorbid conditions and functional status often lead to study exclusion. For elderly patients with an indication for neoadjuvant chemoradiotherapy (nCRT), physicians usually decide using clinical factors whether nCRT should be offered. The aim of the present retrospective study was to assess the tolerability of nCRT with capecitabine and the surgical outcomes in patients aged ≥ 70 years with locally advanced rectal cancer.

Preventing accidents in childhood: A European perspective

Accidental injury is a principal public health issue with important individual, societal and economic consequences. Crude figures show that 2.7 million deaths from injury and poisoning are reported worldwide. In developing and industrialized countries 10–30% of all hospital admissions are due to accidental injuries. In particular, children and adolescents are at risk. In all industrialized countries accidental injuries are the major cause of death and morbidity among children above the age of one. In the domestic safety area much effort has to be invested in improving the safety of the environment and products. In the European region, collaboration among authorities in the framework of the European Community (EC) has been shown to be productive in the area of safety. Although trade interest is predominant in the EC objectives, the need to harmonize national regulations and standards towards common European standards has appeared to be an important vehicle for establishing standards at an optimum level of safety. It has also fostered some collaboration in data collection and analysis and in implementing prevention measures. An even stronger international collaboration is needed for ensuring that appropriate priorities are being set and prevention measures are effectively being implemented.     

Is It Safe? Reliability and Validity of Structured Versus Unstructured Child Safety Judgments

Background

The LIRIK, an instrument for the assessment of child safety and risk, is designed to improve assessments by guiding professionals through a structured evaluation of relevant signs, risk factors, and protective factors.

Objective

We aimed to assess the interrater agreement and the predictive validity of professionals’ judgments made with the LIRIK in comparison to unstructured judgments.

Method

In study 1, professionals made safety and risk judgments for 12 vignettes with the LIRIK (group 1, n = 36) or without an instrument (group 2, n = 43). In study 2, we compared professionals’ safety and risk judgments for 370 children made with the LIRIK (group 1, n = 278) or with no instrument (group 2, n = 92), with outcomes indicating actual unsafety in files 6 months later.

Results

In study 1, agreement about safety and risks was poor to moderate in both groups. Differences between groups were small and inconsistent. In study 2, the predictive validity of judgments was weak to moderate in both groups. In neither group had unsafe outcomes increased consistently when unsafety or risks were assessed as higher.

Conclusions

Judgments made with the LIRIK were not more reliable or valid than unstructured professional judgments. These findings raise important questions about the value of risk assessment instruments and about how professional safety and risk judgments can be improved.

     

Is HLA type a possible cancer risk modifier in Lynch syndrome?

Lynch syndrome (LS) is the most common inherited cancer syndrome. It is inherited via a monoallelic germline variant in one of the DNA mismatch repair (MMR) genes. LS carriers have a broad 30% to 80% risk of developing various malignancies, and more precise, individual risk estimations would be of high clinical value, allowing tailored cancer prevention and surveillance. Due to MMR deficiency, LS cancers are characterized by the accumulation of frameshift mutations leading to highly immunogenic frameshift peptides (FSPs). Thus, immune surveillance is proposed to inhibit the outgrowth of MMR-deficient cell clones. Recent studies have shown that immunoediting during the evolution of MMR-deficient cancers leads to a counter-selection of highly immunogenic antigens. The immunogenicity of FSPs is dependent on the antigen presentation. One crucial factor determining antigen presentation is the HLA genotype. Hence, a LS carrier's HLA genotype plays an important role in the presentation of FSP antigens to the immune system, and may influence the likelihood of progression from precancerous lesions to cancer. To address the challenge of clarifying this possibility including diverse populations with different HLA types, we have established the INDICATE initiative (Individual cancer risk by HLA type, http://indicate-lynch.org/ ), an international network aiming at a systematic evaluation of the HLA genotype as a possible cancer risk modifier in LS. Here we summarize the current knowledge on the role of HLA type in cancer risk and outline future research directions to delineate possible association in the scenario of LS with genetically defined risk population and highly immunogenic tumors.     

Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: initial clinical trials

Eleven patients with suspected adult respiratory distress syndrome (ARDS) and five control patients were studied using a computerized gamma imaging and analysis technique and 99mTc-labeled human serum albumin. The heart and right lung were imaged, lung:heart ratio was plotted vs. time, and a linear regression was fitted to the data points displayed. The slope of this fit was termed the "slope index." An index value of 2 standard deviations greater than the control mean was considered positive. Radiographs from the six positive studies revealed typical diffuse air-space disease. Radiographs from two of the five negative studies demonstrated air-space consolidation. Both of these patients had elevated pulmonary capillary wedge pressure, cardiomegaly, and clinical course consistent with cardiogenic pulmonary edema. These preliminary data demonstrated a good correlation between positive slope index and clinical ARDS.     

Physiologie der Gangliensysteme der Wirbellosen

Ohne Zusammenfassung     

Patterns of mental health care in two European areas: Mannheim, Federal Republic of Germany; and Groningen, The Netherlands

All consecutive cases entering the mental health services cooperating with the cumulative psychiatric case register of Mannheim between 1-31 July 1976 were followed up until the end of June 1978 and compared with the consecutive cases entering the mental health services cooperating with the psychiatric case register of Groningen between 1 January and 1 May 1979. Patterns of in-, day- and outpatient care delivered to these 2 cohorts of patients, who were greater than or equal to 15 years of age, and who had not been in contact with one of the services for at least 6 months prior to entry, were compared by diagnostic category. The most common episode of care was the relatively brief outpatient one. Mixed types of care and chronic cases were more common among patients with a psychosis or an addiction than in other diagnostic categories. Between 6 and 24 months after first contact 76% of the patients in Mannheim and 43% of the patients in Groningen had no more contacts. Between 18 and 24 months after the first contact the percentages had increased to 90 and 72% (respectively). In Groningen a higher percentage of patients received outpatient care only. Although a larger percentage of patients in Mannheim received inpatient care, the accumulation of "new chronic" patients was larger in Groningen, as a result of a greater length of stay in Groningen.