How many cisplatin administration protocols does your department use?

GREYSTOKE A.P., JODRELL D.I., CHEUNG M., RIVANS I. & MACKEAN M.J. (2009) European Journal of Cancer Care 19 , 80–90
How many cisplatin administration protocols does your department use? The introduction, 30 years ago, of the co‐administration of appropriate hydration and ensuring a diuresis occurs during the administration of cisplatin was important in its development, allowing clinically significant doses to be given with acceptable rates of toxicity. The clinical usage of cisplatin has increased and hydration protocols have been amended to increase patient comfort and reduce resource utilization. We suspected that this had led to unnecessary variations in practice both in clinical trials and subsequently in the clinic. Therefore, we reviewed practice in the Edinburgh Cancer Centre and discovered that 25 different hydration protocols were in use, with wide variation in dilution of cisplatin, total fluid administered, use of electrolyte (potassium and magnesium) supplementation and diuretics. These differences are a reflection of adoption of variations in hydration regimes published in pivotal clinical trials. A review of the available evidence relating to cisplatin associated hydration regimens was performed and recommendations will be made for the future design of evidence‐based protocols.     

Regulation of data protection in health care]

Computers are widely used in different fields of health care, the traditional administrative systems being replaced by softwares. However, the use of computer technology in health care has not yet brought to a definite improvement in the field of data protection and data security, what is more, new problems have been revealed. The legal regulation of data protection in Hungary dates back to 1992. There are technological norms, different standards, guidelines and the regulation of data protection in health care on a sectoral level. What is missing is the security regulations of information systems in the institutions. Joining the European Community requires the implementation of an adequate data protection being able to ensure the security of personality rights also in the field of health care. The use of an up-to-date insurance card would strengthen the data protection and security functions offering the possibility for introducing an almost "paperless" administrative system in health care.     

Male and female experiences of having fertility matters raised alongside a cancer diagnosis during the teenage and young adult years

Discussion and management of potential reproductive health sequelae of adolescent cancer are essential and challenging components of care for the multidisciplinary team. Despite this, research has been limited to specific experiences (e.g. sperm banking) or fertility-related concerns of adult survivors. This grounded theory study of 38 male and female survivors of adolescent cancer aged 16–30 years drew on in-depth single interviews to map the range of experiences of being advised that treatment might affect fertility. Strong support for being told at around diagnosis was found regardless of gender, age, incapacity or availability of fertility preservation services. Age and life stage appeared less significant for impact than the perceived level of threat to personal and social well-being. Women were more likely to achieve lower levels of comprehension about the physiological impact, to report later distress from lack of fertility preservation services and to revisit more frequently those decisions made by the few offered fertility preservation. Men found decision making about sperm banking straightforward on the whole and reported satisfaction with having the choice regardless of outcome. Findings suggest that young people can cope with this information alongside diagnosis especially when professional and parental support is proportionate to the particular impact on them.     

Role and value of whole genome sequencing in studying tuberculosis transmission

BackgroundTuberculosis (TB) remains a serious public health threat worldwide. Theoretically ultimate resolution of whole genome sequencing (WGS) for Mycobacterium tuberculosis complex (MTBC) strain classification makes this technology very attractive for epidemiological investigations.ObjectivesTo summarize the evidence available in peer-reviewed publications on the role and place of WGS in detection of TB transmission.SourcesA total of 69 peer-reviewed publications identified in Pubmed database.ContentEvidence from >30 publications suggests that a cut-off value of fewer than six single nucleotide polymorphisms between strains efficiently excludes cases that are not the result of recent transmission and could be used for the identification of drug-sensitive isolates involved in direct human-to-human TB transmission. Sensitivity of WGS to identify epidemiologically linked isolates is high, reaching 100% in eight studies with specificity (17%–95%) highly dependent on the settings. Drug resistance and specific phylogenetic lineages may be associated with accelerated mutation rates affecting genetic distances. WGS can be potentially used to distinguish between true relapses and re-infections but in high-incidence low-diversity settings this would require consideration of epidemiological links and minority alleles. Data from four studies looking into within-host diversity highlight a need for developing criteria for acceptance or rejection of WGS relatedness results depending on the proportion of minority alleles.ImplicationsWGS will potentially allow for more targeted public health actions preventing unnecessary investigations of false clusters. Consensus on standardization of raw data quality control processing criteria, analytical pipelines and reporting language is yet to be reached.     

First worldwide proficiency study on variable-number tandem-repeat typing of Mycobacterium tuberculosis complex strains

Although variable-number tandem-repeat (VNTR) typing has gained recognition as the new standard for the DNA fingerprinting of Mycobacterium tuberculosis complex (MTBC) isolates, external quality control programs have not yet been developed. Therefore, we organized the first multicenter proficiency study on 24-locus VNTR typing. Sets of 30 DNAs of MTBC strains, including 10 duplicate DNA samples, were distributed among 37 participating laboratories in 30 different countries worldwide. Twenty-four laboratories used an in-house-adapted method with fragment sizing by gel electrophoresis or an automated DNA analyzer, nine laboratories used a commercially available kit, and four laboratories used other methods. The intra- and interlaboratory reproducibilities of VNTR typing varied from 0% to 100%, with averages of 72% and 60%, respectively. Twenty of the 37 laboratories failed to amplify particular VNTR loci; if these missing results were ignored, the number of laboratories with 100% interlaboratory reproducibility increased from 1 to 5. The average interlaboratory reproducibility of VNTR typing using a commercial kit was better (88%) than that of in-house-adapted methods using a DNA analyzer (70%) or gel electrophoresis (50%). Eleven laboratories using in-house-adapted manual typing or automated typing scored inter- and intralaboratory reproducibilities of 80% or higher, which suggests that these approaches can be used in a reliable way. In conclusion, this first multicenter study has documented the worldwide quality of VNTR typing of MTBC strains and highlights the importance of international quality control to improve genotyping in the future.     

Routine direct detection of Mycobacterium tuberculosis with a rapid test of polymerase chain reaction applied to a Hungarian patient population]

The results of the present study, based on 1869 examined clinical specimens of 543 patients, represent the Hungarian parameters of a PCR test. By using the final and resolved results, the clinical sensitivity, specificity, positive and negative predictive values were 83.8%, 99.2%, 95.4% and 97%, respectively for PCR, 63.5%, 100%, 100% and 93.5%, respectively for culture, and 16.2%, 100%, 100% and 86.3%, respectively for Ziehl-Neelsen (ZN) staining. These results are essential to allow Hungarian clinicians to interpret PCR results in accordance with local conditions. The present study has demonstrated a high sensitivity (PCR vs. culture and smear, p < 0.01) and an excellent specificity of PCR. Our results indicate that the majority of M. tuberculosis-positive specimens can be identified rapidly with the test and, because of the high negative predictive value, the PCR test can help to exclude tuberculosis from the differential diagnosis in 24 hours. Moreover, the PCR can detect the presence of M. tuberculosis in 66.6% of ZN-negative and subsequently culture-positive specimens at the time of admission. The results of PCR must be interpreted with extreme caution, and the procedure is recommended only for laboratories, which simultaneously perform culture and microscopy for control of the performance of PCR tests.     

Molecular epidemiology of drug-resistant tuberculosis in Hungary

Sixty-eight drug-resistant Mycobacterium tuberculosis isolates (44.2% of all resistant cases) were analyzed by IS6110 restriction fragment length polymorphism fingerprinting and spoligotyping to provide a deeper insight into the status of drug-resistant tuberculosis in Hungary. A total of 54.4% of the drug-resistant cases and 75% of the multidrug-resistant cases could be clustered. Analysis of the spoligotyping patterns of the strains revealed a high rate (66.2%) of infection by the Haarlem genotype, while none of the patients were infected by the Beijing genotype. The magnitude and the dynamics of drug-resistant tuberculosis are underestimated in Hungary.