Palliative care in gynecological cancer

According to the WHO definition, “Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and treatment of other problems, physical, psychosocial and spiritual” [1]. In addition, “Palliative care is required from early in the disease course, can be delivered alongside potentially curative treatment, and continues to include end-of-life or terminal care” [2]

EvaluLEAD: A Guide for Shaping and Evaluating Leadership Development Programs

Provides a framework for evaluating leadership development based on values, norms, and performance factors. Explains key concepts of the approach and supplies a step-by-step map for creating a leadership evaluation plan

Carriage of Haemophilus influenzae in Cape Town children

Little is known about the epideIDiology of Haemophilus influenzae infections in South Africa. This study was designed to determine the prevalence, serotype distribution, antimicrobial susceptibility pattern and effect of age and hospitalisation on the carriage of H. influenzae in 322 Cape Town children.The overall and type b specific carriage rates in normal children (N =107) were 45,8% and 4,7% respectively. The yield following nasopharyngeal culture was twice that following throat culture (P < 0,001). Children hospitalised with tuberculosis (N =62) had significantly greater carriage rates, 66,1% and 37,1% respectively (P =0,02). Institutionalised mentally handicapped children (N =77) and children with tuberculosis attending an outpatient clinic (N =76) had lower carriage rates (P < 0,02). Antimicrobial resistance was a major problem only in children hospitalised with tuberculosis (rifampicin 100%, penicillin 43,9%, erythromycin 85,4%, co-trimoxazole 82,9%). This universal resistance to rifampicin has not been reported previously. There was no difference in the mean age of children with positive or negative cultures, with the exception of those hospitalised with tuberculosis. In this group children infected with type b were much younger (mean 19,7 months) than those with other and non-typeableinfections (32,1 months) and the non-infected(50,1 months) (P =0,04). Duration of hospitalisation or outpatient therapy in the patients with tuberculosis did not influence carriage rates.We conclude that carriage of H. influenzae in normal children is similar to that reported from other countries and that carriage, particularly of type b, in children hospitalised with tuberculosis was of significance and probably contributed to an outbreak of multi-resistant invasive H. influenzae disease in this group

Paediatric trauma care

Paediatric trauma care varies in different countries. In South Africa injury is the leading cause of death in the 5 - 14-yearold age group - 1,5 - 3,8 times higher than in the USA. In 1978 the Child Safety Centre was established and prospectively collected data on paediatric injuries. The various types of injuries are discussed. Trauma is responsible for the highest percentage of years of life lost but the least amount of money is being spent on research and prevention of injuries. The Child Accident Prevention Foundation of Southern Africa has been constituted to research, prevent and reduce the risk factors of the injuries and to improve facilities for the injured child

Delayed nephrectomy has comparable long-term overall survival to immediate nephrectomy for cT1a renal cell carcinoma: A population-based analysis

Objectives: Early surgical resection remains the recommended treatment option for most small renal mass (≤4 cm). We examined the long-term overall survival (OS) of patients managed with delayed and immediate nephrectomy of cT1a renal cancer. / Patient and methods: We utilized the National Cancer Database (2005–2010) to identify 14,677 patients (immediate nephrectomy: 14,050 patients vs. late nephrectomy: 627 patients) aged 180 days from diagnosis, respectively. Inverse probability of treatment weighting–adjusted Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in the 2 treatment arms. Influence of patient age and Charlson Comorbidity Index on treatment effect was tested by interactions. Sensitivity analysis was performed to explore the outcome of delaying nephrectomy for >12 months. / Results: Median patient age was 55 years with a median follow-up of 82.5 months. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves suggest no significant difference between treatment arms (immediate nephrectomy [180 days]) (Hazard ratio 0.96; 95% confidence interval 0.73–1.26; P = 0.77). This outcome was consistent between all patients regardless of age (P = 0.48). Sensitivity analysis reports no difference in OS even if nephrectomy was delayed by >12 months (P = 0.60). / Conclusions: We report that delayed and immediate nephrectomy for cT1a renal cell carcinoma confers comparable long-term OS. These findings suggest that a period of observation of between 6 and 12 months is safe to allow identification of renal masses, which will benefit from surgical resection

Delayed blood transfusion is associated with mortality following radical cystectomy

Objectives: To examine the temporal association between blood transfusion and 90-day mortality in patients with bladder cancer treated with radical cystectomy. / Methods: This represents a retrospective cohort study of patients treated with radical cystectomy within the Premier Hospital network between 2003 and 2015. Patients outcomes were stratified those who received early blood transfusion (day of surgery) vs delayed blood transfusion (postoperative day ≥1) during the index admission. Primary end point was 90-day mortality following surgery. / Results: The median age of 12,056 patients identified was 70 years. A total of 7,201 (59.7%) patients received blood transfusion. Within 90 days following surgery, 57 (2.2%), 162 (5.9%) and 123 (6.7%) patients in the early, delayed and both early and delayed transfused patients died respectively. Following multivariate logistic regression to account for patient (age and Charlson Comorbidity Index [CCI]) and hospital (surgeon volume, surgical approach and academic status) factors, delayed blood transfusion was independently associated with 90-day mortality (Odds ratio [OR], 2.64; 95% Confidence Interval [CI], 1.98–3.53; p < 0.001). A sensitivity analysis defining early blood transfusion as <2 days postoperatively, increased 90-day mortality persisted in patients receiving delayed transfusion (OR, 2.20; 95% CI, 1.63-3.00; p < 0.001). Older patients (≥77 years) with the highest CCI (≥2) had a 7% absolute increase in the predicted probability of 90-day mortality if they were transfused late compared to patients transfused early. / Conclusion: Patient undergoing cystectomy may benefit from expedited transfusion to prevent subsequent clinical deterioration which may lead to patient mortality. Future work is needed to elucidate the optimal timing of blood transfusion

Books

Oral cancer Oral Cancer: Epidemiology, Etiology and Pathology. Ed. by Colin Smith, Jens Pindborg and W. H. Binnie. Pp. ix + 106. Illustrated. R183,30. USA: Hemisphere. 1990.HPV and cervical cancer Human Papillomavirus and Cervical Cancer. Ed. by N. Munoz, F. X. Bosch and O. M. Jensen. Pp. xii + 155. Illustrated. France: International Agency for Research on Cancer. 1989.Child health Child Health in a Multicultural Society. Ed. by John Black. Pp. 75. Illustrated. £7 (including postage). London: BMJ. 1989. (Available also from Libriger Book Distributors).Merck manual of geriatics Merck Manual of Geriatrics. Ed. by William B. Abrams The Andrew J. Fletcher. Pp. xxii + 1267. Illustrated. RI4,50. and I: Merck. 1990. USALiver disease Progress in Liver Diseases. Vol 9. Ed. by Hans Popper and Fenton Schaffner. Pp. xv + 750. Illustrated. RllO. England: Harcourt Brace Jovanovich. 1990.Clinical dietetics and nutrition Clinical Dietetics and Nutrition. 3rd ed. Ed. by F. P. Antia. Pp. xvi +438. Illustrated. Oxford: Oxford University Press. 1989.Atlas of human anatomy Wolf-Heidegger's Atlas of Human Anatomy. Ed. by H. F. Frick, B. Kummer and R. V. Putz. pp. viii + 599. £(j(J. Basel: Karger. 1990.Health system decentralisation Health System Decentralization. Ed. by A. Mills, J. P. Vaughan, D. L. Smith and I. Tabibzadcll. pp. 151. Illustrated. SFr. 26. Geneva: World Health Organisation. 1990.Handbook of occupational medicine Handbook of Occupational Medicine. Ed. by Robert J. McCunney. Pp. xxiii + 510. Illustrated. Boston: Little, Brown. 1988.Leukaemia Leukaemia. 5th ed. Ed. by Edward S. Henderson and T. Andrew Lister. Pp. vii + 821. Illustrated. RHO. Kent: Harcoun Brace Jovanovich. 1990

The Possibility of Emersion of the Outer Layers in a Massive Star Simultaneously with Iron-Core Collapse: A Hydrodynamic Model

We analyze the behavior of the outer envelope in a massive star during and after the collapse of its iron core into a protoneutron star (PNS) in terms of the equations of one-dimensional spherically symmetric ideal hydrodynamics. The profiles obtained in the studies of the evolution of massive stars up to the final stages of their existence, immediately before a supernova explosion (Boyes et al. 1999), are used as the initial data for the distribution of thermodynamic quantities in the envelope.We use a complex equation of state for matter with allowances made for arbitrary electron degeneracy and relativity, the appearance of electron-positron pairs, the presence of radiation, and the possibility of iron nuclei dissociating into free nucleons and helium nuclei. We performed calculations with the help of a numerical scheme based on Godunov's method. These calculations allowed us to ascertain whether the emersion of the outer envelope in a massive star is possible through the following two mechanisms: first, the decrease in the gravitational mass of the central PNS through neutrino-signal emission and, second, the effect of hot nucleon bubbles, which are most likely formed in the PNS corona, on the envelope emersion. We show that the second mechanism is highly efficient in the range of acceptable masses of the nucleon bubbles ($\leq 0.01M_\odot$) simulated in our hydrodynamic calculations in a rough, spherically symmetric approximation.Comment: 14 pages, 11 figure