Supplement to the 2004 update of the AAPM Task Group No. 43 Report

Since publication of the 2004 update to the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report (TG-43U1), several new low-energy photon-emitting brachytherapy sources have become available. Many of these sources have satisfied the AAPM prerequisites for routine clinical use as of January 10, 2005, and are posted on the Joint AAPM/RPC Brachytherapy Seed Registry. Consequently, the AAPM has prepared this supplement to the 2004 AAPM TG-43 update. This paper presents the AAPM-approved consensus datasets for these sources, and includes the following 125I sources: Amersham model 6733, Draximage model LS-1, Implant Sciences model 3500, IBt model 1251L, IsoAid model IAI-125A, Mentor model SL-125/ SH-125, and SourceTech Medical model STM1251. The Best Medical model 2335 103Pd source is also included. While the methodology used to determine these data sets is identical to that published in the AAPM TG-43U1 report, additional information and discussion are presented here on some questions that arose since the publication of the TG-43U1 report. Specifically, details of interpolation and extrapolation methods are described further, new methodologies are recommended, and example calculations are provided. Despite these changes, additions, and clarifications, the overall methodology, the procedures for developing consensus data sets, and the dose calculation formalism largely remain the same as in the TG-43U1 report. Thus, the AAPM recommends that the consensus data sets and resultant source-specific dose-rate distributions included in this supplement be adopted by all end users for clinical treatment planning of low-energy photon-emitting brachytherapy sources. Adoption of these recommendations may result in changes to patient dose calculations, and these changes should be carefully evaluated and reviewed with the radiation oncologist prior to implementation of the current protocol.     

The leaking pancreatic duct in childhood chronic pancreatitis

The leaking pancreatic duct in childhood chronic pancreatitis presents with ascites and pleural effusion and is a potentially lethal condition. Seven children with this condition were seen in the period 2003–2006. The correct diagnosis was not entertained till a raised serum amylase was discovered. The diagnosis was confirmed by very high levels of amylase in the aspirated abdominal or pleural fluid. Computerized tomogram was the most useful imaging study and demonstrated a dilated pancreatic duct. All children were operated within 6 days of diagnosis by a Puestow’s procedure in six and peripancreatic drainage in one. Six children made a prompt and lasting recovery after a Puestow’s procedure while one child, also suffering from metastatic neuroblastoma, died in the immediate post operative period after peripancreatic drainage. We recommend prompt and definitive surgical management of this potentially lethal condition.     

Monitoring of mass measles campaign in AILA-affected areas of West Bengal

A mass measles campaign was organized in AILA-affected areas of West Bengal in July-August 2009. The present cross-sectional study was conducted with the objectives to monitor and assess the cold chain maintenance, safe injection practices, IEC methods adopted, and to observe the conduction of the sessions in the campaign. All the cold chain points at the block level had adequate vaccines and equipments, twice monitoring of temperature which was in optimal range. 82% sessions had team according to microplan, AWW was present and team members were actively mobilizing the children in 83% sessions, puncture proof container was used and vaccines were given in correct sites in more than 95% sessions. The study observed satisfactory conduction of the whole campaign, still the injection safety procedures should be strengthened considering the potential harm to the health care providers.     

Critical appraisal of healthcare delivery services by multipurpose workers in rural West Bengal

This cross-sectional study of 35 multipurpose workers (MPWs) of Goalpokhar--II (Chakulia) block selected by random sampling in the district of Uttar Dinajpur showed that 30 respondents were female mostly in the age group less than 30 years and rest were male in the age group of above 30 years. Majority of respondents (65.7%) were educated up to the level of higher secondary. On an average each MPW used to spend only 5.8 hours per week for home visit. During referral of the patients, the problems faced by the health workers were due to non-availability of vehicles (71.4%), difficulties in the means of communication ie, long distance, road problems, etc (85.7%), and lack of awareness about referral centre (2.8%). Only 5.5% of the MPWs stated absence of difficulty during referral to the higher facility. Regarding difficulties faced during transmission of health related information, 25.7% of MPWs were unaware of the location of the reporting centre; 17.4% of MPWs were unaware of authority to be informed and 14.3% of MPWs complained about social barrier and 22.8% experienced non-availability of manpower. However 42.9% of MPWs did not face any problem while transmitting health related events/information to the higher authority. Most of the respondents (23.5%) opined that their performance may be enhanced by increasing community awareness.     

Herniation of a broad ligament dermoid cyst through sciatic foramen--a rare cause of gluteal swelling

A 35-year-old lady presented with a slowly growing lump in her left buttock. Examination revealed a soft, partly reducible swelling having expansile impulse on coughing. CT scan and real time ultrasound showed it to be an extension of intrapelvic cystic space occupying lesion. At laparotomy, the cyst was found to be arising in between two layers of broad ligament and leaving the pelvis through greater sciatic foramen. Contents of the cyst were cheesy material and hair. Histopathological examination of the cyst wall confirmed the diagnosis. As such, sciatic hernia is a very rare surgical entity. Over and above, herniation of a dermoid cyst arising in the broad ligament is also an equally rare event.     

Medical errors in psychiatry

Medical errors in the general medical sector result in significant patient deaths and injuries, as well as high costs to the health care system. Despite the growing literature on errors in medical and surgical specialties, few studies have examined the incidence, nature, predictors, and prevention of errors that may occur in mental health treatment settings. The purpose of the current review is to examine the lessons learned from patient-safety research in the general medical sector, provide examples of types of errors in psychiatry, review the errors identified in the literature, offer a discussion of error-reduction strategies for improving patient safety, and provide recommendations for future research. Increased attention to medical errors in psychiatry is necessary in order to build safer health systems and promote a culture of safety among providers, thereby producing better care for patients with mental disorders.     

Prevalence of human immunodeficiency virus-associated cognitive impairment in a group of Hispanic women at risk for neurological impairment

Human immunodeficiency virus (HIV)-associated cognitive impairment, a significant cause of morbidity, affects up to 30% of HIV-infected people. Its prevalence doubled as patients began to live longer after the introduction of highly active retroviral therapy. Women are now one of the fastest growing groups with acquired immunodeficiency syndrome (AIDS) in the United States and Puerto Rico, but relatively little is known about the prevalence and characteristics of cognitive dysfunction in HIV-infected women. In this study the authors investigated its prevalence in a group of HIV-1-seropositive Hispanic women in Puerto Rico. Forty-nine women with a nadir CD4 cell count of < or = 500 cells/mm3 were enrolled. Cognitive impairment was defined according to the American Academy of Neurology criteria for HIV dementia as modified to identify an "asymptomatic cognitively impaired" group. Observed prevalence was compared with prevalence in other populations in United States, Europe, and Australia. Differences in clinical markers and neuropsychological test performance among the cohort stratified by cognitive impairment were tested. Cognitive impairment was observed in 77.6% (38/49) of cases; asymptomatic cognitive impairment in 32.7% (16/49); minor cognitive motor disorders in 16.3% (8/49); and HIV-associated dementia (HAD) in 28.6% (14/49). Cognitive impairment did not correlate with age, CD4 cell count, viral load, or treatment modality. The cross-sectional prevalence of HIV-associated cognitive impairment was 77.6% (28.6% for HAD). These findings should enhance awareness of the prevalence of HIV-associated cognitive impairment, both clinically apparent and "asymptomatic," in Hispanic women and lead to improvements in areas such as education and compliance and to reevaluation of treatment interventions.