The need for multidisciplinarity in specialist training to optimize future patient care

Harmonious interactions between radiation, medical, interventional and surgical oncologists, as well as other members of multidisciplinary teams, are essential for the optimization of patient care in oncology. This multidisciplinary approach is particularly important in the current landscape, in which standard-of-care approaches to cancer treatment are evolving towards highly targeted treatments, precise image guidance and personalized cancer therapy. Herein, we highlight the importance of multidisciplinarity and interdisciplinarity at all levels of clinical oncology training. Potential deficits in the current career development pathways and suggested strategies to broaden clinical training and research are presented, with specific emphasis on the merits of trainee involvement in functional multidisciplinary teams. Finally, the importance of training in multidisciplinary research is discussed, with the expectation that this awareness will yield the most fertile ground for future discoveries. Our key message is for cancer professionals to fulfil their duty in ensuring that trainees appreciate the importance of multidisciplinary research and practice

Molecular Testing in Microbiology

There are significant challenges associated with qualitative and quantitative nucleic acid tests performed in diagnostic laboratories. The development of internationally available certified reference materials which can be traced to reference measurements will contribute to a better understanding of the performance characteristics of nucleic acid tests and enhance reliability and comparability of clinical data. Next generation sequencing may have a future role in the identification and resistance detection of clinical pathogens, however, the current complexity of bioinformatics to support this technology makes its routine use in a diagnostic laboratory problematic. However, next generation sequencing is starting to impact epidemiological studies used to investigate the pathways of disease transmission in outbreaks and to determine microbial populations in metagenomics studies

A model of auto immune response

Abstract Background In this work, we develop a theoretical model of an auto immune response. This is based on modifications of standard second messenger trigger models using both signalling pathways and diffusion and a macro level dynamic systems approximation to the response of a triggering agent such as a virus, bacteria or environmental toxin. Results We show that there, in general, will be self damage effects whenever the triggering agent’s effect on the host can be separated into two distinct classes of cell populations. In each population, the trigger acts differently and this behavior is mediated by the nonlinear interactions between two signalling agents. Conclusion If these interactions satisfy certain critical assumptions this will lead to collateral damage. If the initial triggering agent’s action involves any critical host cell population whose loss can lead to serious host health issues, then there is a much increased probability of host death. Our model also shows that if the nonlinear interaction assumptions are satisfied, there is a reasonable expectation of oscillatory behavior in host health; i.e. periods of remission

Mycoplasma pneumoniae infection in a clinical setting.

Background: Mycoplasma pneumoniae infection predominantly affects the respiratory tract, although the other organs may also be involved. Previous studies compared the clinical features of patients with M. pneumonia pneumonia to other pathogens and these studies were predominantly adult case series rather than involving children. The objectives of the present study were to compare the clinical features, laboratory, and radiographic findings in children seropositive for M. pneumoniae infection with children tested for suspected M. pneumoniae infection who were seronegative. Methods: Using a retrospective review of children who had complement fixation test (CFT) performed for suspected M. pneumoniae infection, children were classified as seropositive if the acute phase serum titer was ≥64, or paired samples taken 2–4 weeks apart showed a fourfold or greater rise in serum titer. In contrast, a patient with an antibody titer <64 or with paired sera showing less than a fourfold rise in titer was considered seronegative. Results: One hundred and fifty-one children were included. Seventy-six children had serological evidence of M. pneumoniae infection and the remaining 75 were seronegative. Children with M. pneumoniae infection were more likely to have fever >6 days duration prior to admission, crackles on auscultation, radiographic consolidation and thrombocytosis at presentation. In addition, M. pneumoniae infection was associated with pneumonia whereas seronegative children were more likely to have upper respiratory tract infection or asthma. Conclusions: Certain clinical parameters could assist in gauging the likelihood of M. pneumoniae infection in children, and thus direct whether antibiotic treatment is needed

Peripheral nerve conduction velocity and brainstem auditory evoked responses in small for gestational age preterm infants

Ulnar nerve conduction velocity (NCV) and brainstem auditory evoked responses (BAER) were measured in each of 11 preterm small for gestational age (SGA) infants born at less than 35 weeks gestation. The mean motor NCV in the SGA infants was similar to that reported for infants who were appropriately grown for their gestational age (AGA). However, the mean central conduction time of the BAER in SGA infants was significantly shorter than that of AGA infants of the same post-menstrual age. Thus, the precocious development of auditory brainstem neural function in preterm SGA infants is not accompanied by changes in functional maturation of the peripheral motor nerves

Echovirus 19 associated with a case of acute flaccid paralysis

Acute flaccid paralysis can be caused by many members of the enterovirus genus, most notably the three poliviruses types 1 to 3. We report the case of acute flaccid paralysis caused by echovirus 19. The Western Pacific region has been declared polio free by the WHO since 2000. Australia is now using inactivated polio vaccine in the National Immunization Schedule. This vaccine does not carry the extremely rare risk of vaccine associated acute flaccid paralysis but it does leave our newly vaccinated population open gastrointestinal infection with polioviruses and the risk of circulation of the wild-type virus. Continued surveillance of cases of acute flaccid paralysis is to detect polioviruses is essential until poliovirus is completely eradicated. © 2012 The Authors. Journal of Paediatrics and Child Healt

Immunisation and multi-dose vials

The current novel H1N1 09 influenza virus pandemic has resulted in 37,722 diagnoses, 4992 hospitalisations, and 191 deaths in Australia as of 11 June 2010. A mass immunisation campaign has commenced using a multi-dose vial formulation to assist rapid deployment. However, in the past multi-dose vials have been associated with transmission of infective agents. Having the vaccine in single-dose vials with a lesser risk of transmission of infection but increased delay in implementation and increased cost needs to be weighed against the imperative to vaccinate the population against pandemic H1N1 09 influenza virus. This article reviews the infectious risks associated with multi-dose vials