How to recognize and manage psychological distress in cancer patients

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.     

Pandemic (H1N1) 2009 and Seasonal Influenza A (H1N1) Co-infection, New Zealand, 2009

Co-infection with seasonal influenza A (H1N1) and pandemic (H1N1) 2009 could result in reassortant viruses that may acquire new characteristics of transmission, virulence, and oseltamivir susceptibility. Results from oseltamivir-sensitivity testing on viral culture suggested the possibility of co-infections with oseltamivir-resistant (seasonal A [H1N1]) and -susceptible (pandemic [H1N1] 2009) viruses.     

Comparison of the performance of visual and verbal multiple-choice questions

A study was carried out to determine whether multiple-choice questions based on visual trigger material, such as micrographs, photographs or radiographs, were more difficult and more discriminating than corresponding verbal questions testing: (i) the same information; (ii) different information in the same content area. Seventy-seven question triplets, each of which contained a visual (X) question, a verbal (Y) question testing the same information and a verbal (Z) question testing different information in the same content area were set in twelve Part 1 FRACS examinations. The questions were arranged in such a way that the X and Z questions in a triplet were set in the same examination, while the Y question was set in the corresponding examination of the previous or the following year. The specific outcomes studied were those on facility index and r biserial discriminating index. An analysis of variance on the data pertaining to each index did not indicate significant differences among the groups. None of the differences between pairs of mean facility indices among question groups X, Y and Z was found to be significant at P less than 0.05, nor were any of the differences between pairs of r biserial discriminating indices found to be significant at P less than 0.05. It was concluded that visual questions set in the Part 1 FRACS examination were not demonstrably more difficult or more discriminating than the corresponding verbal questions. The findings do not detract, however, from the obvious importance of visual recognition for future surgeons.     

Effects of publishing multiple-choice questions on their subsequent item analysis

A prospective study was carried out to determine what effects publication within a multiple-choice question (MCQ) book of 63 selected items from a bank had on their performance in subsequent examinations. A closely corresponding group of 63 unpublished questions set both before and after publication of the book was used as control. The specific outcomes studied were those on facility index, r biserial discriminating index and differences in performance between abler (upper 25%) and weaker (lower 25%) candidates. The mean facility index of the published questions increased significantly (P less than 0.01) after publication, while no significant change was observed in the mean facility index of control questions (P greater than 0.05) or in the mean discriminating index of published (P greater than 0.05) and control (P greater than 0.05) questions. Contrary to expectations the mean facility index of published questions increased, after publication, to a greater extent (P less than 0.01) for abler candidates than for weaker candidates. The study supports the hypothesis that publication of questions from a bank makes them easier to answer. The practice of adjusting the cut-off mark for passing according to the proportion of published questions in a given examination, however, is not justified. The findings highlight the need to advise less able candidates to make greater use of the MCQ book in preparing for an examination.     

Health effects of marine bathing in New Zealand

Prospective epidemiological studies on the possible health effects from sea bathing were carried out at seven popular New Zealand bathing beaches over the 1995 summer. The association of gastrointestinal/ respiratory symptoms or other infections with human or animal faecal contamination of the beach water was examined. Beach users were interviewed at the beach and then followed up within 5 days to ascertain any illness symptoms. On each of the 107 interview days multiple samples of the beach water were examined for three faecal indicators (faecal coliforms, E. coli , enterococci). Of the usable responses, 2307 users did not enter the water; 1577 did. Log-linear modelling showed that enterococci was most strongly and consistently associated with illness risk for the exposed groups, particularly for respiratory illness among paddlers and long-duration swimmers. Crude risk differences for these two groups were 7 and 33 per 1000 individuals, rising to 62 and 87 per 1000 individuals for the highest enterococci quartile. No substantial differences in illness risks were found between the human and animal waste impacted beaches, though both were markedly different from the control beaches. The results are being used to develop recommendations for sampling design and use of single-sample maxima in new bathing-water guidelines.     

Molecular Basis for Drug Resistance in HIV-1 Protease

HIV-1 protease is one of the major antiviral targets in the treatment of patients infected with HIV-1. The nine FDA approved HIV-1 protease inhibitors were developed with extensive use of structure-based drug design, thus the atomic details of how the inhibitors bind are well characterized. From this structural understanding the molecular basis for drug resistance in HIV-1 protease can be elucidated. Selected mutations in response to therapy and diversity between clades in HIV-1 protease have altered the shape of the active site, potentially altered the dynamics and even altered the sequence of the cleavage sites in the Gag polyprotein. All of these interdependent changes act in synergy to confer drug resistance while simultaneously maintaining the fitness of the virus. New strategies, such as incorporation of the substrate envelope constraint to design robust inhibitors that incorporate details of HIV-1 protease's function and decrease the probability of drug resistance, are necessary to continue to effectively target this key protein in HIV-1 life cycle.