Decrease In Number Of Patients Research Articles

Cultural competency training for health care providers in an urban cancer institute and impact on breast care.

6561 Background: The purpose was to improve the cultural competence of healthcare providers at an urban cancer institute and to assess its impact on breast screening and diagnostic benchmarks. Methods: A web-based learning module was developed to address breast cancer disparities in African American women, identifying common barriers to care and highlighting functions of patient-provider education. The module, a pre-and post-test were administered to providers including physicians, nurses, non-clinical employees, diagnostic technicians and medical office assistants (MOA) of MedStar’s Washington Cancer Institute (WCI) and Breast Imaging Center (BIC). Cultural competency discussions began with providers in BIC in April 2011. The module was available to BIC providers in October 2011 and to WCI providers in December 2011. To increase the cancer knowledge-base, a breast education class was offered to 40 MOAs. Statistical analysis was conducted using SAS v.9.1. Results: October 2011-March 2012, 133 providers were offered the module. Seven providers helped create the module, were removed from analyses. Of the 126, 29 did not complete all parts or complete in proper order and were not used in analyses. Overall, providers (n=97) demonstrated an increase in average pre/post test scores (119 vs. 123; P<.01). All providers, except diagnostic technicians, increased cultural competency scores post module. Physician’s average pre/post test scores showed the greatest increase with 11 points (P<.01). From Nov 2011- April 2012, BIC experienced a 59% decrease in number of patients lost to follow up after a screening mammogram, a 11% decrease in lost to follow up for diagnostic patients as well as a decrease of 1 days in average number of days patients return for diagnostic imaging after a mammogram. There was a 32% increase in employee satisfaction within in BIC. Conclusions: This suggests that our learning module had a positive impact on patient-provider communication. The decrease in screening and diagnostic lost to follow up rates illustrates the learning module’s potential for staff motivation in reducing breast cancer disparities. Supported by Susan G. Komen for the Cure NR-11-33340.

Dermatophytes isolated from superficial fungal infections in Krakow, Poland, between 1995 and 2010

Superficial fungal infections due to dermatophytes are common over the world and their frequency is constantly increasing. The aim of our study was to discuss fungal infections with frequency of occurrence, clinical stages and aetiology in patients admitted to dermatological ward and microbiological laboratory of the specialist hospital in Krakow. Investigations performed between 1995 and 2010 included the group of 5333 individuals. Dermatophyte infections, confirmed by culture, were revealed in 1007 subjects (18.9%), i.e. in 553 males and 454 females. The most frequent clinical forms of infections were tinea unguium and tinea pedis, caused mainly by Trichophyton rubrum and by Trichophyton mentagrophytes. Tinea corporis, tinea manuum, tinea capitis and tinea cruris constituted a small percentage of infections and the main aetiological factors of these dermatomycoses were also T. rubrum and T. mentagrophytes. Between 1995 and 2000 there were stated small differences in the number of isolated strains of dermatophytes in comparison with the number of examined patients. Since 2006 there has been observed a decrease in number of patients in our hospital with suspected fungal infections, but per cent of positive cultures has remained unchanged in comparison with earlier period.

Prognostic Impact of Bone Marrow B Lymphocyte Precursors (hematogones) Detection in 95 Acute Lymphoblastic Leukemia Cases

Abstract 4791Acute lymphoblastic leukemia (ALL) multiparameter flow cytometry (MFC) study of bone marrow aspiration after chemotherapy is crucial for determining minimal residual disease (MRD). Hematogones (HGs) have to be distinguishing from leukemic cells in B-cell subtypes and could be quantify during follow-up. To date, the incidence of Hgs in ALL and their prognostic significance have not been investigated. The aim of this multicenter study was to quantify Hgs after chemotherapy in ALL adult patients and to define its prognostic value.We retrospectively analyzed the incidence of HGs in 95 ALL patients, 71 with B-ALL (75%), 24 (25%) with T-ALL in first line treatment. The median age was 37 years [8–71], 20% had t(9;22) cytogenetic abnormality, and 70% had abnormal karyotype. 4/5-color MFC analysis MRD and HGs were performed at different time point (TP) after diagnosis: TP1 (post-induction, day 45 [41–61], n=78), TP2 (post-consolidation, day 111 [94–144] 25, n=42), TP3 (post-intensification/before hematopoietic stem cell transplantation (HSCT), day 179 [125–268], n=58), TP4 (n=11), TP5 (n=17), TP6 (n=9) after a median of 33, 91 and 167 days after HSCT, respectively. A total of 39 patients (41%) relapsed with a median of 26 months [7.7–47.9]. Forty seven patients (50%) received an HSCT in a complete (98%) or partial remission (2%). At TP1, TP2, TP3, TP4, TP5, TP6, the median HGs [range] were as followed: 0.00 [0.00–6.90]%, 0.30 [0.00–11.2]%, 0.98 [0.00–33.00]%, 0.52 [0.00;23.00]%, 5.50 [0.00;25.00]%, 4.60 [0.00;34.00]%, 5.90 [0.32;11.80]%, respectively. Figure 1 showed the percentage of patients with negative MRD (Figure 1A) and detectable HGs (figure 1B) during the follow up of ALL patients. There is a progressive increase of the percentage of patients with detectable HGs during the time of treatment and follow-up.Interestingly, there was no correlation between age and HGs level while in physiological situation the HGs rate decreases with increasing age. There was a negative correlation between positive MRD and detectable HGs at TP1 (p=0.022) but not at TP3 (p=0.88). In univariate analysis positive MRD at P1 and P3, age (/10), the presence of t(9;22) and absence of HGs at TP3 (figure 2) were bad prognostic factors for relapse free-survival (RFS) and overall survival (OS). The presence of HGs at other different time of evaluation was not associated with a significant decrease of relapse or death. However, patients who had a negative MRD at TP1 and detectable HGs in the bone marrow at TP3 exhibited a better RFS and OS (p=0.018 and p=0.065 respectively). Patients who had negative MRD at TP3 and had detectable HGs at TP3 had also a better RFS and OS (p=0.007 and p=0.011, respectively) compared to patients with negative MRD at TP3 and without HGs (figure 3). In patients who had a positive MRD at TP1, detectable HGs at TP3 identified a subgroup of patient with favorable OS compared to patient with positive MRD at TP1 and without detectable HGs (p=0.072).These results should be taken with cautious because of the decreasing number of patients evaluated at different time points. However, HGs analysis could represent a new area of investigation in search of new prognostic factors in the context of adult ALL. [Display omitted] [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Has the DRG system impacted on inpatient allergy care in university dermatology departments in Germany?

Diagnostic provocation tests (ICD Z01.5) have a low cost weight in the German DRG system. We aimed at investigating a possible economic impact on the number of provocation tests in German university medical centers (UMC) for dermatology. We review quality records of 35 German UMC for 2008 and 2010 (ICD Z01.5, total number of patients as well as priority ranking). 33/35 hospitals gave full data for both years including the ten most frequent diagnoses. Between 2008 and 2010, total number of patients treated increased in 23/33 (70 %) UMC, those with ICD Z01.5 only in 11/24 (46 %) UMC with full data. In 2008, the ICD Z01.5 was in the top ten list of main diagnoses in 29/33 (88 %) hospitals, in 2010 in 25/33 (76 %); also, priority ranking tended to decrease. In contrast, total number of ICD Z01.5 in Germany tended to increase slightly. We noticed a tendency for decreasing numbers of provocation tests being performed in dermatological UMC in Germany. As there is no evidence for a decreasing number of patients suffering from allergies, one may speculate about a shift to non-university departments due to an economic impact.

Brain metastases in patients under 50 years of age: retrospective analysis

Several previous publications suggested that younger patients with brain metastases have longer survival than older patients. However, detailed studies of younger patient groups are scarce. Therefore, a multi-institutional analysis of younger patients with brain metastases was performed (defined as adults with age <50years). Prognostic factors for survival were examined by uni- and multivariate analyses and compared to those obtained in patients with age ≥50years. Multivariate analysis of 106 patients (median age 44years, range 23-49years) revealed three independent prognostic factors for survival: performance status, extracranial metastases and primary tumor control. Survival was significantly better in patients treated after the year 2000 (median 9.4months) as compared to those treated before the year 2000 (median 5.1months, p=0.04). This improvement appeared to be related to an increased use of surgery or radiosurgery (SRS) and decreasing numbers of patients with uncontrolled primary tumor. Irrespective of management approach, survival beyond 5years was uncommon (actuarial rate 6%; 17% in patients treated with upfront surgery or SRS). In conclusion, more intense multidisciplinary approaches aiming at control both in the brain, extracranial metastatic sites, and primary tumor site might have contributed to gradual survival improvements in recent years. Nevertheless, further efforts are necessary to improve long-term survival.

Prevalence of left and balanced coronary arterial dominance decreases with increasing age of patients at autopsy. A postmortem coronary angiograms study

In patients presenting with an acute coronary syndrome, left over right coronary dominance appears to be independently associated with increased long-term mortality. This could lead to decreasing numbers of patients with a left dominant coronary artery system in older age groups. We assessed the type of coronary dominance in different age groups in postmortem angiograms that were routinely performed at autopsy between 1993 and 2007. Coronary dominance was determined by identifying the origin of the posterior descending artery and posterolateral branches on postmortem angiography. Age, gender, and cause of death were recorded from the autopsy database. The prevalence of left dominant, right dominant, and codominant systems was determined in three increasing age categories, with cutoffs based on tertiles. A total 1620 coronary angiograms were assessed; 167 were excluded because it was not possible to determine coronary dominance. The median age of all patients was 71 years; 56% were male. Of all deaths, 40% were classified as cardiac. Regarding coronary dominance, 81.2% was right, 9.1% was left, and 9.7% was codominant. Overall, a decrease in prevalence of left and codominant coronary systems was observed with increasing age in the three age cohorts (≤ 63 years, 64-75 years, and ≥ 76 years) (P=.001 for overall comparison). In this large autopsy cohort, the prevalence of a left dominant or codominant coronary system decreased with increasing age. These findings could relate to a slightly higher risk of mortality in case of left versus right coronary artery occlusion.

Changes in sputum bacterial landscape after vaccination against Streptococcus pneumoniae, Haemophilus influenza type b and influenza in patients with chronic obstructive pulmonary disease

Summary. The influence of combined vaccination against Streptococcus pneumoniae, Haemophilus influenzae type b and influenza on sputum bacterial land scape in patients with chronic obstructive pulmonary disease (COPD) has been analyzed in this article. The 1st group of 31 COPD patients (mean age, 59.25 ± 1.12 years) were vaccinated simultaneously with "Pneumo23", "Hiberix", "Grippol plus". The 2nd group consisted of 49 unvaccinated COPD patients (mean age, 57.16 ± 0.98 years). We used a classical microbiological method. Three months after the complete vaccination, there was a significant decrease in number of patients with S. pneumoniae yielded in sputum in comparison with unvaccinated COPD patients.

Psychological characteristics of the patients with juvenile idiopathic arthritis (JIA) of various age groups

fears (73%), communicative disorders (67%), high level of anxiety (40%), aggression (20%), low level of social adaptation (13%). Group 2 high level of anxiety (65%), communicative disorders (55%), fears (42%), increased level of psychoemotional stress (35%), aggression (25%), tendency toward depression (25%), low level of social adaptation (12%) and appearance complexes (12%). Group 3 communicative disorders (69%), high level of anxiety (58%), psychoemotional stress (37%), fears (34%), low level of social adaptation (24%), tendency toward depression (24%), appearance complexes (22%), aggression (20%). Conclusion The studied groups showed the same levels of communicative disorders and aggression. Age increase was followed by the decrease in number of patients with fear; and by increase in number of patients with low level of social adaptation, the percentage of appearance complexes and psychoemotional stress appeared and was increasing. The defined characteristics should be considered during the individual work with the patients.

Acromioclavicular Joint Pain in Patients With Adhesive Capsulitis: A Prospective Outcome Study

Diagnosis of adhesive capsulitis is a clinical diagnosis based on history and physical examination. Afflicted patients exhibit active and passive loss of motion in all planes and a positive capsular stretch sign. The effect of adhesive capsulitis on acromioclavicular biomechanics leading to tenderness has not been documented in the literature. This study reports on the incidence of acromioclavicular tenderness in the presence of adhesive capsulitis. Furthermore, we note the natural history of such acromioclavicular joint pain in relation to that of adhesive capsulitis. Over a 2-year period (2005-2007), 84 patients undergoing initial evaluation for adhesive capsulitis were prospectively examined with the use of validated outcome measures and physical examination. Acromioclavicular joint tenderness results were compared and analyzed on initial evaluation and final follow-up of at least 1 year. Forty-eight patients (57%) with adhesive capsulitis had acromioclavicular joint pain on examination. At final follow-up, as range of motion improved, a significant increase in American Shoulder and Elbow Surgeons/Penn shoulder score and decrease in number of patients with acromioclavicular pain was noted with only 6 patients with residual pain (P<.05). In the presence of adhesive capsulitis, there is not only compensatory scapulothoracic motion but also acromioclavicular motion. This often results in transient symptoms at the acromioclavicular joint, which abate as the frozen shoulder resolves and glenohumeral motion improves. This is important to recognize to avoid unnecessary invasive treatment of the acromioclavicular joint when the patient presents with adhesive capsulitis.

Steroidowrażliwość oraz steroidooporność w dziecięcym idiopatycznym zespole nerczycowym – czy zaszła zmiana na przestrzeni dwóch dekad?

BackgroundIt is widely known that childhood idiopathic nephrotic syndrome (INS) seems to be benign, mostly minimal change glomerulopathy, sensitive to steroids with the tendency to relapse. There are reports that the histopathology and response to treatment in INS may be changing. AimThe aim of the study was to search for changes in the characteristics of the steroid sensitivity and steroid resistance in childhood INS within twenty years. Material and methodsRetrospective chart analysis was done to identify all children with new-onset nephrotic syndrome admitted to the Division of Pediatric Nephrology in Zabrze within 1986–2005. Comparison of clinical characteristics and histopathology in subgroups of steroid sensitive 59 vs 66 and steroid resistant 17 vs 36 patients in two following decades was performed. ResultsIn a group of steroid sensitive patients no significant difference in clinical characteristics at onset apart from increasing frequency of hematuria 16.9% vs 40.9%, p = 0.0034 was found. The frequency of renal biopsy as well as the frequency of relapses didn’t differ significantly in this group. In a group of steroid resistant patients the only clinical feature that differed significantly was a decrease in number of patients with hypertension 70.6% vs 38.9%, p = 0.031. There was no significant difference in histopathology of steroid resistant nephrotic syndrome with only slight increase in focal segmental glomerulosclerosis (FSGS) 17.6% vs 25%, p = 0.73 and mesangio-proliferative glomerulonephritis (MesPGN) 35.3% vs 47.2%, p = 0.41. ConclusionsIn analyzed population besides the increasing rate of hematuria in steroid sensitive patients and the decreasing rate of hypertension in steroid resistant patients, there have been no other changes in clinical and histopathological characteristics of steroid sensitivity and steroid resistance in childhood INS within the period of twenty years.

Left Ventricular Assist Devices Are Underutilized

Heart failure has become one of the fastest growing cardiovascular diagnoses, with estimates as high as 500 000 new cases per year.1,2 This growth is in part a result of the reductions in death from acute coronary syndromes, increased use of implantable cardioverter defibrillators, and improved survival with most cardiovascular interventions, which have led to this continued increase in the number of patients who develop progressive heart failure (HF). The estimated number of people in the United States with the diagnosis of HF may exceed 7 million, based on the estimated average prevalence of 2.6%,3,4 and a census of >300 million population (Figure 1).5,6 HF is clearly age related,1,–,4 with prevalence as low as 0.5% in those 65 years of age.2 This is an important demographic, because it is estimated that the number of people >65 years of age will double in the next 20 to 30 years.4,–,7 HF is not a homogeneous condition. Based primarily on data from recent hospital registries8,9 and other studies,10 nearly half of all patients have HF with preserved systolic function, and the other half have varying degrees of severity of HF with reduced systolic function. Although the prevalence of HF is higher in males at <70 years of age, overall HF is equally common in men and women. Unfortunately, the average survival of patients with either preserved or reduced systolic function is only 40% at 5 years after diagnosis,10,11 and may be as high as 80% when it reaches a refractory stage.12 One study of 3500 patients in Minnesota suggested that there is …

Dinamika indeksa massy miokarda levogozheludochka u patsientov s arterial'noygipertoniey II-III stepeni na fone terapiiKo-renitekom i Gizaarom

The regress or left ventricular (LV) hypertrophy is a main end-point of antihypertensive therapy. The aim of the present study was to compare antihypertensive effects of two fixed combination preparations of ACE inhibitor and thiazide diuretic, enalapril 20 mg/hydrochlorthiazide 12,5 mg (Co-renitec) and losartan 50 mg/hydrochlorthiazide 12,5 mg (Hyzaar) on LV mass index (LVMI), types of left ventricular remodeling in patients with grade II-III arterial hypertension. First group was treated with Co-renitec, second group with Hyzaar during 24-weeks period. Results showed that both preparations significantly and to the same degree decrease LVMI. Number of patients with normal LV geometry increases with accompanying decrease in number of patients with concentric hypertrophy and concentric remodeling. The favorable effects were more remarkable in group treated with Hyzaar.

Étude des infections à VIH nouvellement découvertes entre 2000 et 2007 dans le Nord et l’Est de la France

In France, since 2003, all new HIV infection must be reported. Data collected with the declaration system is not exhaustive and only concerns epidemiological data. Objective The authors’ aim was to study the epidemiologic evolution of new HIV cases between January 1, 2000 and December 31, 2007 in North and East of France, to compare them with national and local data, to complete them, and to identify local specificities. Method A retrospective observational study was made, with a standardized questionnaire completed by any volunteer HIV care center in the North and the East of France. Results Three thousand and thirty questionnaires were analyzed. The main trends over these eight years were similar to those observed in the rest of France: a decreasing number of women and patients of foreign origin, a decreasing number of patients with a late diagnosis, an increasing number of primary infections, and a higher CD4 count on initiation of antiretroviral treatment. However, local specificities appeared, such as: increasing proportion of men having sex with men and a less important proportion of co-infected patients with hepatitis B and/or C than on the national level. The therapeutic regimen is adequate according to expert recommendations, with, however, a marked “center effect” concerning prescription habits. Discussion Such a local epidemiological study, even if it confirms observed trends in the rest of France, allows detailing them and suggesting prevention measures more specifically adapted to local settings.

Study on the epidemiological characteristics and molecular typing of Salmonella enterica subsp. enterica serovar Senftenberg in Shanghai

To study the molecular epidemiological characteristics of Salmonella enterica subsp. enterica serovar Senftenberg (Salmonella senftenberg) in Shanghai, from 2006 to 2007. A retrospective analysis in 2006 and 2007 was performed to explore the source of food-borne Salmonella senftenberg. The isolates from diarrhea patients between 2006 and 2007 were identified, including biochemical test, hilA and invA gene phenotyping, drug susceptibility, Riboprinter((R)) (RP) and pulsed-field gel electrophoresis (PFGE). Of the diarrhea patients isolates in the monitoring program on non-typhi Salmonella infection in the year of 2006 in Shanghai, number of patients caused by Salmonella senftenberg ranked the third. The stock of Salmonella senftenberg food-born isolates were derived from swine and beef products between 2003 and 2005. All of the strains from diarrhea patients were susceptible to antibiotics except tetracylina (75.6%). With RP and PFGE molecular typing, the two groups (with hydrogen sulfide and hilA, invA gene or without) could be divided into two different independent clone cluster in genetics. 34 strains of diarrhea were divided into 16 PFGE typing-pattern, and among them 12 strains including type 4 (4 strains), type 5 (1 strains), type 6 (6 strains), type 7 (1 strains) and 13 strains including type 11 (3 strains), type 17 (5 strains), type 23 (5 strains) were two different dominant clone cluster. The epidemic of Salmonella senftenberg within 2006 might have been the result of a long period of case occurrence in Shanghai. This rare outbreak belonged to a cluster of outbreaks caused by two different PFGE clone clusters. Data suggested that the genetic clone of Salmonella senftenberg might have been unstable and the source of contamination were complicated, with the characteristics as the obvious decreasing number of patients, with no food-borne isolates in 2007.

Differences in complication rates among the centres in the SPACE study

Despite the high grade of standardisation of study protocols, there is still room for variability among the centres in specific treatment aspects. We evaluated the treatment risk in stent-protected angioplasty of the carotid versus endarterectomy (SPACE) associated with the specific patient enrollment rates of the centres. The analysed endpoints were ipsilateral stroke or death [primary outcome event (pOE)] and any stroke or death [secondary outcome event (sOE)] until 30 days after treatment. A binary logistic regression analysis with random effects was performed separately for each treatment arm. The centres were secondarily categorised in three classes: I) > or = 25 patients enrolled, II) ten to 24 patients and III) <10 patients and a hierarchic log linear model was fitted to test the three-way interaction of treatment, number of patients per class and outcome. The random effects logistic regression analysis in the carotid artery stenting (CAS) arm proved a significant increase in pOE with decreasing number of patients enrolled (-0.0190 +/- 0.0085, p = 0.025, deviance 35.7 with 32 df), whereas no such effect was found in the carotid endartectomy (CEA) arm (-0.010 +/- 0.008, p = 0.24, deviance 39.78 with 32 df). In the log linear model, there was a significant interaction between treatment, number of patients per centre and sOE (p = 0.023). The odds ratios for sOE in the enrollment classes (CAS vs. CEA) were 0.98 (95% CI 0.50-1.94, p = 0.95) for class I, 1.13 (95% CI 0.47-2.77, p = 0.77) for class II and 11.56 (95% CI 1.40-253.45, p = 0.01) for class III centres. Despite rigorous standardisation and quality requirements for operator qualification, there seemed to be a decrease in complication rate with increasing patient enrollment numbers in the CAS arm while this signal could not be detected in the CEA arm of SPACE.

Patient Outcomes and Economics of Once-Daily Tacrolimus in Renal Transplant Patients: Results of a Modeling Analysis

Purpose The objective of this study was to model patient outcomes and treatment costs over a 5-year horizon time for renal transplant patients comparing twice-daily tacrolimus to once-daily extended-release tacrolimus as a primary immunosuppressive agent. Methods We constructed a stochastic state-transition model to simulate the incidence of acute rejection, graft loss and subsequent return to dialysis, retransplantation, and mortality among transplanted patients, as well as their associated costs. The two immunosuppressive treatment arms analyzed were twice-daily tacrolimus plus mycophenolate mofetil (MMF) and once-daily extended-release tacrolimus plus MMF. Estimates for the current rate of adherence to twice-daily medication, as well as the improvement in adherence expected in a once-daily medication, were taken from literature reviews. Sensitivities around these estimates were analyzed. Cost data for medical procedures and hospitalization were obtained from Medicare and the United States Renal Data System (USRDS). Medicare ASP prices from July 2006 were used to price pharmaceutical products. Once-daily extended-release tacrolimus was assumed to have the same daily cost as twice-daily tacrolimus. Results Patient outcomes included a decrease in acute rejections, increase in graft survival, and a corresponding decrease in number of patients on dialysis. Using once-daily extended-release tacrolimus increased graft survival at 5 years from 63.0% to 69.1% an absolute increase of 6.1 percentage points. Overall cost savings averaged $9411 per patient over the 5-year treatment using a 5% discount rate. Total costs, including initial transplantation, were $238,144 for twice-daily tacrolimus and $228,734 for once-daily extended-release tacrolimus.

Severe depression and antidepressants: focus on a pooled analysis of placebo-controlled studies on agomelatine

The efficacy of agomelatine in severe depression has been examined in three positive placebo-controlled studies and in a pooled analysis of the data from the three studies in patients treated with 25-50 mg agomelatine (n=357) and placebo (n=360). Agomelatine was significantly more effective than placebo in a subgroup of patients with severe depression with a severity of 25 or more on the Hamilton Depression Rating Scale 17-item scale in each individual study (P<0.05) and in the pooled analysis (P<0.001). Analysis of the pooled data demonstrated that there was an increase in the magnitude of the agomelatine-placebo difference with increasing severity on the baseline Hamilton Depression Rating Scale. When the population was divided into subgroups using increasing cut-off Hamilton Depression Rating Scale values a significant difference between agomelatine and placebo was observed in each subgroup despite the decreasing numbers of patients with higher severity with a difference of 2.06 rising to 4.45 points on the Hamilton Depression Rating Scale. In conclusion, agomelatine is effective in treating severe depression.

The coming of age of radiation-induced hyperparathyroidism: Evolving patterns of thyroid and parathyroid disease after head and neck irradiation

This study investigates the association of thyroid and parathyroid disease in radiation-exposed patients and tests the hypothesis that hyperparathyroidism (HPT) occurs after a longer latency period. Routine questioning identified 40 patients in the endocrine surgery clinic with a history of radiation exposure. Patients with thyroid disease were screened for HPT and vice versa. The known diagnosis at initial referral was thyroid disease alone in 26 of 40 patients, HPT alone in 9 of 40 patients, and both in 5 of 40 patients. After screening was completed, a total of 18 of 40 patients were found to have both thyroid disease and HPT. HPT manifested an average of 17 years later than thyroid disease (52.6 +/- 10.0 years vs 35.5 +/- 13.8 years after radiation therapy [ P < .05]). One third of the patients with HPT had normal serum calcium levels despite elevated parathyroid hormone levels and abnormal parathyroid glands. As the widespread use of x-ray therapy for benign childhood conditions becomes more remote, practitioners should expect a decreasing number of patients with radiation-associated thyroid disease, with an increase in HPT. Patients with radiation exposure and thyroid disease should be evaluated carefully and followed for HPT. Those patients who undergo surgical procedures should have close inspection of the parathyroid glands, with biopsy and excision when appropriate.

Issues concerning Consent in Patients Undergoing Cardiac Surgery—The Need for Patient-Directed Improvements: A UK Perspective

Aims To determine the extent to which informed patient consent for cardiac surgery corresponds with standard guidelines and to assess patient satisfaction with the consent process. Methods A questionnaire developed in accordance with consent guidelines published by the Medical Defence Union (MDU) and the Practicalities Of Producing Patient information (POPPi) Guide was administered to 82 patients after they were consented for cardiac surgery. Results Patients were informed about i) type of operation [ n=80, 97.5%] ii) reason for surgery [n=78, 95%] iii) surgical procedure [ n=77, 94%] iv) length of hospital stay [ n=73, 89%] and v) post-surgical care [ n=79, 96.3%]. However, a decreasing number of patients were notified about i) possible risks of surgery [ n=64, 78%] and ii) consequences of no surgery [ n=62, 75.6%]. Interestingly, patients received less adequate information about i) alternative methods of treatment ( n=34, 41.4%]. ii) future lifestyle ( n=55, 67%] and iii) medications following surgery [ n=40, 48.7%]. 81% ( n=67) were overall ‘satisfied’ with the information provided. More than 95% ( n=78) patients were invited to ask questions. The most commonly asked questions were about i) quality of life ii) length of operation and hospital stay iii) surgical procedure iv) consequences of no surgery. Conclusions The study has highlighted areas of informed consent in cardiac surgical patients that need attention. Although, patients were generally satisfied and well informed about the procedure, less information was presented covering alternative treatments, future lifestyle and medications. This was reflected in the questions asked by patients and their suggested improvements for the consent procedure.

Issues concerning consent in patients undergoing cardiac surgery—the need for patient-directed improvements: a UK perspective

Aims: To determine the extent to which informed patient consent for cardiac surgery corresponds with standard guidelines and to assess patient satisfaction with the consent process. Methods: A questionnaire developed in accordance with consent guidelines published by the Medical Defence Union (MDU) and the Practicalities Of Producing Patient information (POPPi) Guide was administered to 82 patients after they were consented for cardiac surgery. Results: Patients were informed about i) type of operation [ n=80, 97.5%] ii) reason for surgery [ n=78, 95%] iii) surgical procedure [ n=77, 94%] iv) length of hospital stay [ n=73, 89%] and v) post-surgical care [ n=79, 96.3%]. However, a decreasing number of patients were notified about i) possible risks of surgery [ n=64, 78%] and ii) consequences of no surgery [ n=62, 75.6%]. Interestingly, patients received less adequate information about i) alternative methods of treatment ( n=34, 41.4%], ii) future lifestyle ( n=55, 67%] and iii) medications following surgery [ n=40, 48.7%]. 81% ( n=67) were overall ‘satisfied’ with the information provided. More than 95% ( n=78) patients were invited to ask questions. The most commonly asked questions were about i) quality of life ii) length of operation and hospital stay iii) surgical procedure iv) consequences of no surgery. Conclusions: The study has highlighted areas of informed consent in cardiac surgical patients that need attention. Although, patients were generally satisfied and well informed about the procedure, less information was presented covering alternative treatments, future lifestyle and medications. This was reflected in the questions asked by patients and their suggested improvements for the consent procedure.