Cancer prognosis by general practitioners

Background: General practitioners are probably asked regularly about the prognosis for patients with cancer. There is no readily available source of information on the accuracy of their estimates.

Objective: To discover studies that have reported general practitioners estimates of prognosis.

Methods: A search for studies of estimates of prognosis in terminal cancer by general practitioners.

Results: Three papers were discovered, reporting on 836 patients. In only a quarter of patients was prognosis accurately estimated by general practitioners, even within broad limits. Hospital doctors and nurses performed similarly. We suggest considerable scope for further studies in general practice, which should not require sophisticated procedures.

Conclusion: Evidence of GP's limited performance in cancer prognostication should push us to do better.     

Acute kidney injury and the critically ill

Acute renal failure is commonly encountered in the intensive care unit. It is associated with considerable morbidity and mortality. There are many possible aetiologies in the critically ill, including nephrotoxic agents, hypovolaemia and sepsis. While many classification systems for acute renal failure exist, the RIFLE (Risk, Injury, Failure, Loss, End-stage) criteria and the Acute Kidney Injury Network (AKIN) criteria are the most commonly utilized. Many supportive therapies are employed to minimize the degree of renal injury once recognized, such as fluid resuscitation, maintenance of an adequate mean arterial pressure (with the use of vasopressors in persistent hypotension despite fluid and treatment of the underlying aetiology). However, if renal failure becomes established, then renal replacement therapy (RRT) may be needed to maintain homeostasis. While there are no clear guidelines with respect to the ideal mode or timing of RRT, we will discuss pros and cons of the various options.     

AGING

No abstract available for this article.     

Determinants for preventive oral health care need among community‐dwelling older people: a population‐based study

The aim was to study the determinants of preventive oral health care need among community‐dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty‐five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co‐morbidity (measured by means of the Modified Functional Co‐morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0–1.5), being pre‐frail or frail, OR 2.5 (CI 1.2–5.1), presence of natural teeth, OR 4.8 (CI 2.2–10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4–114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.     

Preliminary findings of a randomized clinical trial of a virtual training program for applied behavior analysis technicians

As the demand for applied behavior analysis (ABA) services for children with an autism spectrum disorder continues to grow, it is critical to develop efficient, effective, and widely accessible procedures for training technicians to implement ABA interventions. One approach would be to develop efficacious training programs that could be delivered over the Internet via a virtual private network (VPN). In the current study, we developed a 40-h virtual training program in which participants completed e-learning modules and also received behavioral skills training over a VPN to implement behavior reduction and skill acquisition protocols in both discrete-trail and play-based formats. This virtual training program was evaluated in a randomized-clinical trial (RCT) using direct-observation measures on the implementation of discrete-trial training and play-based procedures as the primary dependent variables (which were also collected via a VPN). Participants in the treatment group showed robust and statistically significant improvement in their implementation of behavior reduction and acquisition programs under both discrete-trial and play-based formats, and they rated the training as highly socially acceptable. These preliminary results from an ongoing RCT suggest that this effective, convenient, and socially acceptable virtual training program has the potential to extend access to ABA services to families in rural and other underserved areas or populations.     

Evaluation of nosocomial infection risk using APACHE II scores in the neurological intensive care unit

To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24 hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (p < 0.05). The area under the receiver operating characteristic curve of the APACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (p < 0.05). Thus the APACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients’ condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.     

嘉定某村女性乳腺保健知识、态度、行为调查

目的：了解农村地区女性乳腺保健知识、态度和行为状况。方法：2012年12月采用问卷调查方式对华亭镇某村501名20～74岁女性进行乳腺保健知识的调查分析。结果：12道乳腺疾病知识题回答正确率最高为73.65%,最低为6.79%。26.35%被调查者曾接受乳腺保健知识培训。在过去一年里，有38.12%的被调查者曾行乳腺自查，67.47%的被调查者持积极对待乳腺自我检查。结论：采取适合农村地区健康教育形式开展乳腺健康宣教，加强指导农村妇女开展乳腺自查，促进形成健康行为。