The inherent value of staging in the management of gynaecological cancers

Staging can be defined as assessing the anatomical extent of the tumour. Stages are an artificial subdivision of the ongoing disease process based on the applicable anatomical landmarks. The main goals in treating patients with cancer are to improve cure rates, increase survival time and enhance quality of life. The most crucial factor pertaining to cancer outcome is the disease extent at the time of presentation. The stage of the disease is used to indicate this extent. This is essential to optimally manage the cancer patient.www.ogf.co.zaam201

Palliative care

The World Health Organisation (WHO) defines palliative care as care aimed at improving the quality of life of patients and their families confronted with the challenges associated with a terminal illness, by way of preventing and relieving suffering through early recognition and dealing with physical, psychosocial and spiritual difficulties. The current WHO definition is given in Box 1.1 While care provided by hospice is regarded as palliative care, not all palliative care provided is in a hospice. Palliative care can be delivered to patients at any point during the course of a life-threatening illness, even simultaneous with curative or lifeprolonging therapies.2 Palliative care can be offered in any setting and is not dependant on high-level equipment, classy buildings or technology.http://www.journals.co.za/content/journal/medogam2017Obstetrics and Gynaecolog

Uterine smooth muscle tumours of uncertain malignant potential : a case report and literature review

A 41 year-old, gravida 2, para 2, was referred with abnormal uterine bleeding that got progressively worse over the past 6 months. Examination and ultrasound revealed a large fundal myoma of 8 x 8cm. Pap smear and endometrial biopsy was normal. Patient opted for a hysterectomy after appropriate counselling. Histopathology reported a smooth muscle tumours of uncertain malignant potential (STUMP).http://www.journals.co.za/content/journal/medoghj2020Obstetrics and Gynaecolog

Prevention and management of wound complications

A wound can be defined as the disturbance of the skin’s normal structure and function and the soft tissue beneath it.1 Wound complications are major contributors to both early and late postoperative morbidity.2 It can cause significant physical and emotional distress to both patients and the treating physician. Most surgeons will agree that wound complications can be challenging to treat and everything possible should be done to prevent it from happening. Wounds are classified as clean-, clean-contaminated-, contaminated- or dirty wounds. Clean wounds can be described as an incision into tissue, other than hollow viscera, in which neither infection nor inflammation is present followed by primary closure afterwards. Cleancontaminated wounds result from intentional entry into the respiratory, gastro-intestinal, genital or urinary tracts without remarkable contamination. Contaminated wounds can be characterized by unintentional entry into a hollow viscus, a major disruption in sterility, or encountering areas of nonpurulent inflammation. Dirty wounds include old wounds with residual devitalised tissue, perforated viscera or current clinical infection.http://reference.sabinet.co.za/sa_epublication/medogam201

Surrogate endpoints in liver surgery related trials: a systematic review of the literature

AbstractBackgroundAlthough the safety of liver surgery has improved enormously, hepatic surgery continues to face challenging complications. Therefore, improvements supported by evidence‐based guidelines are still required. The conduct of randomized controlled trials in liver surgery using dichotomous outcomes requires a large sample size. The use of surrogate endpoints (SEPs) reduces sample size but SEPs should be validated before use.AimThe aim of this review was to summarize the SEPs used in hepatic surgery related trials, their definitions and recapitulating the evidence validating their use.MethodA systematic computerized literature search in the biomedical database PubMed using the MeSH terms ‘hepatectomy’ or ‘liver resection’ or ‘liver transection’ was conducted. Search was limited to papers written in the English language and published between 1 January 2000 and 1 January 2010.ResultsA total of 593 articles met the search terms and 49 articles were included in the final selection. Standard biochemical liver functions tests were the most frequently used SEP (32 of 49 the studies). The used definitions of SEPs varied greatly among the studies. Most studies referred to earlier published material to justify their choice of SEP. However, no validating studies were found.ConclusionMany SEPs are used in liver surgery trials however there is little evidence validating them

Let's go back to work: survival analysis on the return-to-work after depression

Absence from work due to mental disorders is substantial. Additionally, long-term absence from work is associated with a reduced probability of return-to-work (RTW). Major depressive disorder (MDD) is a prevalent condition in Dutch occupational health care settings. An early estimate of the prognosis regarding RTW in patients with MDD could serve both as a point of departure for the identification of high-risk cases and as an instrument to monitor the course of the disorder and of RTW. In the current study, we aimed to assess the added value of health-related quality of life (HRQoL) and severity of depression to predict the time to RTW

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008–2017) on 1194 outpatient emergencies involving children aged 6–18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient’s home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used

Human papillomavirus-type distribution in South African women without cytological abnormalities : a peri-urban study

OBJECTIVES: Knowledge of human papillomavirus (HPV) distribution in the general population is crucial for the development of new HPV vaccines and to provide a baseline from which to monitor the impact of current HPV vaccines in the future. HPV-type distribution in the Tshwane area, South Africa, might be different to that in other regions and countries. DESIGN: This was a retrospective descriptive study, representative of women without cervical cytological abnormalities. SETTING SUBJECTS: Women attending primary health clinics in the region of Tshwane were screened for cervical abnormalities with conventional cytology. OUTCOME MEASURES: Women without cytological abnormalities were included, and HPV DNA typing, using HPV Linear® Array Genotyping Test (Roche Molecular Systems, Branchburg, USA) was performed on all women. RESULTS: Demographic data were available for 1 238 patients. The mean age was 40.9 years. The majority of the women (14.6%) were between 35 and 39 years of age. 19.4% of women were younger than 30 years of age. The prevalence of HPV types was 67.1% and high-risk HPV infections, 44.9%. The average number of HPV-type infections was 3.2 in the 845 patients with HPV infections. The most common high-risk virus was HPV 16 (10.8%), followed by HPV 51 (9.3%), and HPV 58 (7.9%). HPV 18 was observed in 5.9%, and HPV 45 in 7.5%, of participants. HPV 62 (15.6%) and HPV 84 (14.4%) were the most prevalent low-risk types. CONCLUSION: HPV infections were highly prevalent in this population. The prevalence of HPV 16 and 18 was higher than that reported in other world regions. HPV 16 was the most prevalent high-risk type infection in women without cytological abnormalities. HPV infections other than HPV 16 and 18 were also prevalent, and this is important for future vaccine development.The Cancer Association of South Africa and Discovery Foundation.http://www.sajgo.co.za/index.php/sajgoam201