Using the Patients Concerns Inventory for Distress Screening in Post-treatment Head and Neck Cancer Survivors, Journal of Cranio-Maxillofacial Surgery in press.

Purpose Cancer patients can experience significant distress during their cancer trajectory, which impacts upon clinical outcomes and quality of life. Screening for distress using holistic assessments can help identify and address unmet concerns/needs. The purpose of this study was to evaluate the relationship between concerns and distress, and the impact of distress on clinic outcomes in post-treatment head and neck cancer patients. Methods 170 patients attending routine follow-up clinics were prospectively recruited. All patients completed the Patient Concerns Inventory (PCI) and the Distress thermometer (DT) at preconsultation. Results The rate of significant distress (i.e. DT cut-off score ≥4) was 36% (62/170). Significantly distressed patients selected more items overall than patients without distress (mean, median (QR) of 5.40, 5 (2–8) vs 2.61, 2 (0–4), p < 0.001). Significant distress was most strongly associated with Physical and Functional well-being (p < 0.001) and Psychological and Emotional well-being domains (p = 0.001). On balance, very little difference was noted between cut-off points of either ≥4 or ≥5 PCI items of concern selected. Both cut-off points demonstrated an acceptable level of sensitivity, specificity and predictive values for significant distress. Consultations were longer with increasing numbers of concerns. Conclusions Just over one-third of patients are significantly distressed. They were more likely to express a higher number of concerns. A cutoff score ≥4 or ≥5 PCI items selected can identify those at risk of significant distress. Concerns causing significant distress were related to emotional/psychological issues and physical function

High capacity watermarking technique for medical images using fibonacci decomposition

This paper presents a high capacity watermarking technique in the spatial domain for gray-scale brain MRI. A new scheme, based on Fibonacci decomposition and Knight’s Tour algorithm is proposed in order to increase the hiding capacity for brain MRI. The effectiveness of the proposed scheme is proven by conducting series of experiments with image quality measure matrices namely PSNR and SSIM to allow us to state that the proposed scheme is capable of providing confidentiality to medical images. The experimental results also demonstrate that the proposed scheme has higher capacity compared to other watermarking technique

Review of watermarking techniques for medical images

Recent advancement of technologies has resulted in radical change of medical imaging facilities and medical information systems. These advances introduce new legal and ethical issues particularly during the storing and transmission of medical data and images over open networks. Recent works show the possibility of using digital watermarking to solve the security issues regarding the confidentiality, authenticity, and integrity of electronic medical records. Thus, this paper presents an updated review of the watermarking techniques for medical image applications. The concepts of digital watermarking as well as its variants are firstly introduced to give an in-depth understanding of this field. This is followed by a brief introduction to medical imaging and DICOM format. The review also discussed some of the existing techniques on medical image watermarking

Bilateral Asynchronous Renal Cell Carcinoma with Metastatic Involvement of the Tongue

Renal cell carcinoma (RCC) has a propensity for distant organ metastasis and late recurrence, involving not only the ipsilateral but also contralateral kidney. Lingual metastasis by RCC is rare. We present an unusual case of bilateral asynchronous RCC. Involvement of the right kidney was discovered only after a metastatic tongue lesion was diagnosed. The original RCC had been treated by left nephrectomy 14 years previously. Due to end-stage primary pulmonary malignancy, and poor function of the remaining kidney, immunotherapy was unsuitable. Palliative local resection of the lingual metastasis alleviated functional difficulties and was preventative against airway obstruction, but the patient died five months later