Patients' attitudes to risk in lung cancer surgery: a qualitative study

Objectives Lung cancer surgery leads to long term survival for some patients but little is known about how patients decide whether to accept the associated surgical risks. The objective of this qualitative study was to explore patients’ attitudes to the risks associated with lung cancer surgery. Methods Fifteen patients with resectable lung cancer, recruited via multi-disciplinary team meetings at an English tertiary referral centre, participated in semi-structured interviews to explore their attitudes to the morbidity and mortality risks associated with lung cancer surgery. Transcripts were analysed using the framework method. Results Participants reported being ‘pleased’ to hear that they were suitable for surgery and felt that surgery was not a treatment to be turned down because they did not see any alternatives. Participants had some knowledge of perioperative risks, including mortality estimates; however, many voiced a preference not to know these risks and to let the medical team decide their treatment plan. Some found it difficult to relate the potential risks and complications of surgery to their own situation and appeared willing to accept high perioperative mortality risks. Generally, participants were willing to accept quite severe long-term postoperative breathlessness; however, it was apparent that many actually found this possibility difficult to imagine. Conclusion Patients do not necessarily wish to know details of risks associated with lung cancer surgery and may wish to defer decisions about treatment to their medical team. Investment in the doctor-patient relationship, particularly for the surgeon, is therefore important in the management of patients with lung cancer

Sedimentary Environment Influences the Effect of an Infaunal Suspension Feeding Bivalve on Estuarine Ecosystem Function

The suspension feeding bivalve Austrovenus stutchburyi is a key species on intertidal sandflats in New Zealand, affecting the appearance and functioning of these systems, but is susceptible to several environmental stressors including sedimentation. Previous studies into the effect of this species on ecosystem function have been restricted in space and time, limiting our ability to infer the effect of habitat change on functioning. We examined the effect of Austrovenus on benthic primary production and nutrient dynamics at two sites, one sandy, the other composed of muddy-sand to determine whether sedimentary environment alters this key species' role. At each site we established large (16 m2) plots of two types, Austrovenus addition and removal. In winter and summer we deployed light and dark benthic chambers to quantify oxygen and nutrient fluxes and measured sediment denitrification enzyme activity to assess denitrification potential. Rates of gross primary production (GPP) and ammonium uptake were significantly increased when Austrovenus was added, relative to removed, at the sandy site (GPP, 1.5 times greater in winter and summer; ammonium uptake, 8 times greater in summer; 3-factor analysis of variance (ANOVA), p<0.05). Denitrification potential was also elevated in Austrovenus addition plots at the sandy site in summer (by 1.6 times, p<0.1). In contrast, there was no effect of Austrovenus treatment on any of these variables at the muddy-sand site, and overall rates tended to be lower at the muddy-sand site, relative to the sandy site (e.g. GPP was 2.1 to 3.4 times lower in winter and summer, respectively, p<0.001). Our results suggest that the positive effects of Austrovenus on system productivity and denitrification potential is limited at a muddy-sand site compared to a sandy site, and reveal the importance of considering sedimentary environment when examining the effect of key species on ecosystem function

Glutaraldehyde exposure and its occupational impact in the health care environment

Despite the search for effective and less toxic substitutes, glutaraldehyde (GA) remains one of the few substances capable of high-level instrument disinfection in modern health care. Workers commonly affected include operating room nurses, radiographers, x-ray technicians and cleaners. Widespread hospital usage combined with its well-known irritant properties, has ensured an increase in occupationally-related illnesses during recent years. Operating room nurses, laboratory workers and x-ray technicians frequently contact GA in both the liquid and vapor form. Workplace exposure is usually dependent on job tasks, ventilation levels and the use of protective equipment. GA is a relatively potent irritant and sensitizer, with a well-documented history of symptoms following occupational exposure. Although mechanisms for GA toxicity have been postulated, research on the toxicological, teratogenic, and carcinogenic potential of this chemical has shown inconsistent results. Reducing workplace exposure to its lowest possible level represents the most important hazard reduction strategy. This may be achieved by keeping GA containers tightly sealed when not in use, maintaining adequate ventilation levels and the rigid adherence to appropriate personal protective equipment. Substitution with automated cold sterilization machines may be another appropriate measure, while banning unnecessary practices such as GA fogging and its use as a surface disinfectant may also be helpful in reducing occupational exposure in the health care environment

Mussel farming impacts on trophic status and benthic community structure in Maliakos Gulf (Eastern Mediterranean)

The impact of shellfish farming on the water column nutrient concentration and the benthic community structure was investigated seasonally at a mussel farm (Mytilus galloprovincialis L.) of Maliakos Gulf (Eastern Mediterranean). In most cases concentration of nutrients and chl a at the farm site was lower than those observed at the control sites. Statistical analysis in concentration of all nutrients and chl a indicated significant interactions between sites and seasons, which in all cases were temporal. Furthermore, no significant interactions were found between sites and seasons for all sediment and benthic community parameters, except for Shannon-Wiener diversity index and species richness. The significant interactions detected in the biotic data were temporal. Analysis of similarity and similarity percentages analysis revealed a certain fluctuation of benthic macrofaunal community during the overall sampling year mainly due to temporal rather than spatial effects. Cluster analysis and multidimensional scaling ordination plot indicated the clearly separation of the farm site and the control sites in most of the seasons. K-dominance curves showed small difference in elevation and overlap indicating minimal difference in biological stress between the farm site and the control sites. All the above indicates that probably the farming of mussels was beneficial for the trophic status of Maliakos Gulf and that there was a minimal environmental stress caused by the shellfish farming for the surrounding benthic environment