Incidence Of New Cases Research Articles

The Need for Large Clinical Studies in Perioperative Medicine

The Need for Large Clinical Studies in Perioperative Medicine

Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in acute care hospitals. Results of the VINCat Program (2008–2010)

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-related infection. Surveillance and prevention of MRSA is a priority in infection control programs. The aim of this study was to describe rates and trends of MRSA colonization or infection in 40 hospitals participating in the VINCat Program from 2008 to 2010.The study included all patients treated in acute care areas of participating hospitals. Hospitals were stratified into 3 groups based on size. The following annual indicators were reported: Methicillin-resistance rate, incidence density of new cases of MRSA and incidence density of MRSA bacteremia.Between 2008 and 2010, the yearly mean rate of resistance to methicillin remained stable for the study period (24%–25%), while the mean incidence of new cases of MRSA decreased from 0.65 to 0.54 cases per 1000 patient-days (p=NS) and the mean incidence of MRSA bacteremia decreased from 0.06 to 0.05 cases per 1,000 patient-days (p=NS).The implementation of a MRSA surveillance system in hospitals that participated in the VINCat Program provides information on the situation of each institution and facilitated interhospital comparisons in order to establish appropriate preventive measures.

The incidence, clinical features, and treatment of type 2 diabetes in children <15 yr in a population-based cohort from Auckland, New Zealand, 1995-2007

The incidence of type 2 diabetes mellitus (T2DM) is increasing in adolescents in most western countries. The time-course of glycemic control and impact of early treatment remain poorly understood. To determine the change in incidence of T2DM, and the time-course of glycemic control in a regional pediatric cohort with T2DM. Retrospective analysis of prospectively collected data on 52 patients with T2DM from a population-based treatment referral cohort from 1 January 1995 to 31 December 2007. The annual incidence of new cases of T2DM in children <15 yr increased fivefold in the Auckland region of New Zealand from 1995 [0.5/100,000; 95% confidence interval (CI) 0.0–2.2] to 2007 (2.5/100,000; 95% CI 1.0–5.5). The average annual incidence per 100,000 over the entire period was 1.3 (95% CI 1.0–1.8) overall, 0.1 (0.0–0.4) in Europeans, and 3.4 in both Maori (2.0–5.3) and Pacifica (2.2–5.0). Fifty-seven percent of children were symptomatic at presentation. Fifty-eight percent of patients were treated with insulin from diagnosis, most of whom were symptomatic (p = 0.003). Follow-up data were available for 48 patients with a mean of 2.4 yr. Although insulin therapy was associated with a greater fall in HbA1c values in the first 12 months of treatment (to a nadir of 7.1 vs. 8.1%, p < 0.05), there was a rapid deterioration after 12 months, and subsequent mean HbA1c values were >9% in both groups. Therapy did not affect body mass index standard deviation score (BMI SDS). The incidence of T2DM in childhood or adolescence increased markedly over a 13-yr period in the Auckland region. Long-

The incidence of hepatitis C in patients with thalassemia after screening in blood transfusion centers: a fourteen‐year study

Blood safety is important in all transfusion centers. The aim has always been to try to guarantee the recipient's safety through careful screening and examination of donors' blood samples. In Iran the hepatitis C virus (HCV) screening test became mandatory for blood donations from 1996. We decided to determine the incidence of new cases of HCV in patients with thalassemia, after screening of blood bags was initiated. The study was done on patients with complete files for anti-HCV test results. Only cases that had a confirmed positive anti-HCV result after a negative result were considered as new cases. The incidence rate was estimated and expressed in person-years (PY). Also, for increased accuracy and comparison of incidence in recent years, the incidence rate was calculated at two 7-year intervals (1996-2002 and 2003-2009). A total of 395 files were studied with a mean age of 27.5 years (SD ± 7.99 years). We had 109 (27.5%) anti-HCV positive, of which 21 (19.2% of positive cases) were exposed after 1996 and considered as new cases. The incidence of HCV cases in 14 years (1996-2009) was 4.2/1000 PY. The incidence in the first 7-year period (1996-2002) was 6.2/1000 PY and 1.3/1000 PY in the second 7-year period (2003-2009). The incidence of HCV is on the decline in Iran, both in blood donors and in recipients. We owe this to the improved blood safety in our transfusion center that has taken up better strategies. Even though the residual risk will never reach zero and we may still have new cases of HCV, it will definitely be with a lower rate. The fact that we have had no new cases among our patients with thalassemia since 2005 bears witness to this matter.

Estratégias e resultados da prevenção do câncer bucal em idosos de São Paulo, Brasil, 2001 a 2009

To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. In 2001, 90,886 elderly were examined vs. 629,613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consolidation, establishment of patient referral flows, practical training with a specialist at the basic health care unit after the follow-up examination of individuals presenting changes in soft tissues, and increase in the number of oral diagnosis services. Between 2005 and 2009, there was a significant reduction in the rate of confirmed cases of oral cancer per 100,000 individuals examined, from 20.89 to 11.12 (P = 0.00003). The campaign was beneficial to the oral health of the elderly and could be extended to include other age groups and regions of the country. It may also provide a basis for the development of oral cancer prevention actions in other countries, as long as local characteristics are taken into account.

Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand).

BackgroundWe aimed to evaluate the incidence of type 1 diabetes mellitus in children <15 years of age (yr) in the Auckland region (New Zealand) over 20 years (1990–2009).MethodsWe performed a retrospective review of all patients <15 yr diagnosed with type 1 diabetes, from an unselected complete regional cohort.ResultsThere were 884 new cases of type 1 diabetes, and age at diagnosis rose from 7.6 yr in 1990/1 to 8.9 yr in 2008/9 (r2 = 0.31, p = 0.009). There was a progressive increase in type 1 diabetes incidence among children <15 yr (p<0.0001), reaching 22.5 per 100,000 in 2009. However, the rise in incidence did not occur evenly among age groups, being 2.5-fold higher in older children (10–14 yr) than in the youngest group (0–4 yr). The incidence of new cases of type 1 diabetes was highest in New Zealand Europeans throughout the study period in all age groups (p<0.0001), but the rate of increase was similar in New Zealand Europeans and Non-Europeans. Type 1 diabetes incidence and average annual increase were similar in both sexes. There was no change in BMI SDS shortly after diagnosis, and no association between BMI SDS and age at diagnosis.ConclusionsThere has been a steady increase in type 1 diabetes incidence among children <15 yr in Auckland over 20 years. Contrary to other studies, age at diagnosis has increased and the greatest rise in incidence occurred in children 10–14 yr. There was little change in BMI SDS in this population, providing no support for the ‘accelerator hypothesis’.

Weighing in on Heart Failure: The Role of SERCA2a SUMOylation

### SUMO1-Dependent Modulation of SERCA2a in Heart Failure Kho et al Nature. 2011;477:601–605. Heart failure is a growing problem but a recent report in Nature provides new insights into the role of post-translational modification of SERCA2a by SUMOylation. The enhanced benefits of SUMOylation may provide new therapeutic venues for the treatment of heart failure. Heart failure is a complex clinical syndrome resulting from structural changes in the myocardium that affects the ability of the ventricle to fill with or eject blood.1 It affects at least 5 million patients in the United States and consumes over 6% of our health care budget.1 Nearly half a million new patients are diagnosed to have heart failure each year and the incidence of new cases are increasing each year due to aging of the population and conversion of acute cardiac problems into chronic disorders. Coronary artery disease is the cause of heart failure in about two thirds of patients with left ventricular dysfunction. Without the ability for complete renewal, loss of functional cardiac myocytes due to MI or other causes will eventually lead to deterioration of myocardial function, resulting in heart failure. Heart failure is characterized by the impaired efflux of cytosolic Ca2+ from the cell due to a sustained defect in SR Ca2+ reloading and release.2 A reduced expression and/or activity of the calcium-transporting ATPase ATP2A2, also known as SERCA2a, is responsible for Ca reuptake during excitation–contraction coupling.3 Over the last decade or more, defective Ca2+ uptake resulting from decreased expression and reduced activity of SERCA2a is recognized as a hallmark of heart failure. A recent …

Noncirrhotic portal fibrosis: a rare cause of end-stage liver disease requiring liver transplantation

Non-cirrhotic portal fibrosis (NCPF) is a disease of uncertain etiology characterized by periportal fibrosis and involvement of small and medium branches of the portal vein, resulting in the development of portal hypertension [1]. This has been reported from different parts of the world under a variety of names, such as idiopathic portal hypertension, hepatoportal sclerosis, and noncirrhotic intrahepatic portal hypertension, etc. In India, NCPF formed an important group of patients with portal hypertension, and accounted for 15–30% of all such patients in early nineties [2]. However, its incidence has considerably decreased over time and it is now believed to be a vanishing disease in the subcontinent [1]. Improvement in sanitary conditions and decrease in bacterial infections has lead to a decline in the incidence of the disease. Similar drop in the incidence of new cases has been reported from Japan and other countries [1, 3]. How NCPF differs from cirrhosis of liver has generated immense interest over the years, although at times it may not be possible to differentiate NCPF from Child A cirrhosis of liver. Majority of these patients present with features of portal hypertension and well-tolerated variceal bleeding and have good long-term prognosis [1, 4]. A long-term followup study of 59 patients with noncirrhotic intrahepatic portal hypertension in one hospital over 30-year period showed a 5-year survival of 90% and a 30-year survival of 55% [5]. However, a small proportion of patients do behave like endstage liver disease and develop features of decompensation in the form of ascites, jaundice and hepatic encephalopathy. This subgroup of NCPF with bad liver functions has been recognized and constitutes\10% of the patients, who have mild jaundice, mild ascites and low serum albumin [4, 6]. Nodular transformation of the liver with extensive subhepatic and portal fibrosis has been reported in these patients and the condition constitutes a late manifestation of NCPF. Incomplete septal cirrhosis and nodular regenerative hyperplasia may also be associated with NCPF or idiopathic portal hypertension and may be the late manifestation of this disorder [7–10]. These severe histological changes and abnormal liver function have been infrequently reported and require longer follow-up studies to look into this aspect. There are no large studies that have looked at the subgroup of patients who undergo decompensation; however, in some patients with NCPH, the complications of portal hypertension are sufficiently severe to warrant liver transplantation [7, 11–16]. The study in this issue of Hepatology International shows that small fraction of patients (*5%) do develop ascites, jaundice, and hepatic encephalopathy making it difficult to differentiate it from cirrhosis of liver [17]. Another interesting observation of this study is the overlap NCPF group which has features of both NCPF and cirrhosis and was not reported earlier. This was seen in ten patients in which cause of chronic liver disease was hepatitis C in five, hepatitis B in one and nonalcoholic fatty liver disease (NAFLD) in four patients. All ten patients in this group had characteristic portal vein changes. This may be in continuum with the spectrum of NCPF not defined earlier due to absence of serological markers of hepatitis B and C and recent identification of NAFLD as a cause of significant liver disease; although nodular regenerative hyperplasia and incomplete septal cirrhosis have been reported earlier. The existence of two diseases in a single S. Taneja Y. Chawla R. K. Dhiman (&) Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India e-mail: rkpsdhiman@hotmail.com

Ten-year natural course of habitual snoring and restless legs syndrome in a population aged 61–63 years at the baseline

We investigated the prevalence, natural course, and associated risk factors of habitual snoring (HS) and restless legs syndrome (RLS) over a period of 10 years among an aging population from their early sixties to their seventies. A population-based follow-up study among all persons born in 1935 and living in the city of Oulu in northern Finland was conducted. In this study, we examined subjects who had participated in two subsequent surveys conducted in 1996-1998 and 2007-2008. The data were gathered by questionnaires, as well as by laboratory and clinical measurements. Altogether 457 (55%) of the 838 eligible subjects participated in both surveys. The prevalence of both RLS and HS decreased during the 10 years from 21% to 15% and from 26% to 19%, respectively. Half of those who snored in 1996-1998 stopped snoring in 10 years time, and half of those who suffered from restless legs at least three times per week in 1996-1998 suffered from this syndrome never or less than once a week in 2007-2008. The 10-year incidence of new cases of both HS and RLS was 7%. Male gender predicted best the incidence of new HS in 10 years, while the Zung sum score as a marker of depressive symptoms and waist circumference predicted RLS. Overall, the prevalence of both HS and RLS seems to diminish during aging. The causes behind this still remain unknown and should be investigated with more sophisticated methods.

Delivering early care in diabetes evaluation (DECIDE): a protocol for a randomised controlled trial to assess hospital versus home management at diagnosis in childhood diabetes.

BackgroundThere is increased incidence of new cases of type 1 diabetes in children younger than 15 years. The debate concerning where best to manage newly diagnosed children continues. Some units routinely admit children to hospital whilst others routinely manage children at home. A Cochrane review identified the need for a large well-designed randomised controlled trial to investigate any significant differences in comprehensive short and long-term outcomes between the two approaches. The DECIDE study will address these knowledge gaps, providing high quality evidence to inform national and international policy and practice.Methods/DesignThis is a multi-centre randomised controlled trial across eight UK paediatric diabetes centres. The study aims to recruit 240 children newly diagnosed with type 1 diabetes and their parents/carers. Eligible patients (aged 0-17 years) will be remotely randomised to either 'hospital' or 'home' management. Parents/carers of patients will also be recruited. Nursing management of participants and data collection will be co-ordinated by a project nurse at each centre. Data will be collected for 24 months after diagnosis; at follow up appointments at 3, 12 and 24 months and every 3-4 months at routine clinic visits.The primary outcome measure is patients' glycosylated haemoglobin (HbA1c) at 24 months after diagnosis. Additional measurements of HbA1c will be made at diagnosis and 3 and 12 months later. HbA1c concentrations will be analysed at a central laboratory.Secondary outcome measures include length of stay at diagnosis, growth, adverse events, quality of life, anxiety, coping with diabetes, diabetes knowledge, home/clinic visits, self-care activity, satisfaction and time off school/work. Questionnaires will be sent to participants at 1, 12 and 24 months and will include a questionnaire, developed and validated to measure impact of the diagnosis on social activity and independence. Additional qualitative outcome measures include the experience of both approaches by a subgroup of participants (n = 30) and health professionals. Total health service costs will be evaluated. A cost effectiveness analysis will assess direct and indirect health service costs against the primary outcome (HbA1c).DiscussionThis will be the first randomised controlled trial to evaluate hospital and home management of children newly diagnosed with type 1 diabetes and the findings should provide important evidence to inform practice and national guidelines.Trial registration numberISRCTN: ISRCTN78114042

Sleep Disorder and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus

Sleep Disorder and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus

Chronic ischemic cerebrovascular diseases: pathogenesis and treatment

The annual incidence of new cases of acute cerebral circulatory disorders is noted to be at least 700 per 100 000 population. Chronic brain ischemia leads to the development of encephalopathy with a wide spectrum of subjective and objective neurological disorders worsening memory and other cognitive functions, physical capacities, and quality of life. The pathogenesis of chronic ischemic disorders of blood supply to the brain and the problems of the diagnosis and treatment of acute and chronic ischemia are discussed.

Echinococcus spp. and echinococcosis

Echinococcus spp. are cestode parasites commonly known as small tapeworms of carnivorous animals. Their medical importance lies in the infection of humans by the larval stage of the parasites, predominantly including Echinococcus granulosus, which is the causative agent of cystic echinococcosis (CE) and Echinococcus multilocularis, which causes alveolar echinococcosis (AE). A few other species or genotypes are only very rarely or not at all found in humans. Due to the emerging situation in many parts of Europe, the present article will predominantly focus on E. multilocularis . The natural life cycle of E. multilocularis involves predominantly red and arctic foxes as definitive hosts, but domestic dogs can also become infected and represent an important infection source for humans in highly endemic areas. In the definitive host, egg production starts as early as 28 days after infection. After egg ingestion by a rodent or a human, larval maturation will occur practically exclusively within the liver tissue. The geographic distribution of E. multilocularis is restricted to the northern hemisphere. In Europe, relatively frequent reports of AE in humans occur in central and eastern France, Switzerland, Austria and Germany. Within the past ten years, the endemic area of Europe now includes many more countries such as Belgium, The Netherlands, Italy, and most former Eastern countries as far as up to Estonia. The Asian areas where E. multilocularis occurs include the whole zone from the White Sea eastward to the Bering Strait, covering large parts of Siberia, western and central parts of China and northern Japan. Worldwide there are scant data on the overall prevalence of human AE. Some well-documented studies demonstrate a generally low prevalence among affected human populations. The annual mean incidence of new cases in different areas including Switzerland, France, Germany and Japan has therefore been reported to vary between 0.1 and 1.2/ 100,000 inhabitants. The incidence of human cases correlates with the prevalence in foxes and the fox population density. Recently, a study documented that a fourfold increase of the fox population in Switzerland resulted in a statistically significant increase of the annual incidence of AE cases [1] (Schweiger et al., 2007). This dramatic increase in red fox populations has also been reported throughout Europe, especially in urban areas. The so-called city-fox phenomenon and, thereafter, the increased proximity of foxes with humans and an urban domestic dog – rodent cycle may, therefore, have significant public health implications [1-3]. In infected humans the E. multilocularis metacestode (larva) develops primarily in the liver. Occasionally, secondary lesions form metastases in the lungs, brain and other organs. The typical lesion appears macroscopically as a dispersed mass of fibrous tissue with a conglomerate of scattered vesiculated cavities with diameters ranging from a few millimeters to centimeters in size. In advanced chronic cases, a central necrotic cavity containing a viscous fluid may form, and rarely there is a bacterial superinfection. The lesion often contains focal zones of calcification, typically within the metacestode tissue. Histologically, the hepatic lesion is characterized by a conglomerate of small vesicles and cysts demarcated by a thin PAS-positive laminated layer with or without an inner germinative layer [4]. Parasite proliferation is usually accompanied by a granulomatous host reaction, including vigorous synthesis of fibrous and germinative tissue in the periphery of the metacestode, but also necrotic changes centrally. In contrast to lesions in susceptible rodent hosts, lesions from infected human patients rarely show protoscolex formation within Correspondence: bruno.gottstein@ipa.unibe.ch Faculty of Medicine, Institute of Parasitology, University of Bern, Bern, Switzerland Gottstein Acta Veterinaria Scandinavica 2010, 52(Suppl 1):S5 http://www.actavetscand.com/content/52/S1/S5

European Porphyria Network (EPNET) for information, epidemiological data, quality and equity of service

Porphyrias are metabolic diseases that affect about 1 in 20,000 of the EU population. Most healthcare professionals rarely encounter these disorders and there is disparity between countries in the levels of support provided for patients and their carers. EPNET is a DG Sanco funded project (1/4/2007-31/3/2010) with 15 participating countries that aims to establish a network of specialist porphyria centres, each working to agreed quality criteria. Work achieved: 1. Information on porphyria for patients in 10 languages, and for healthcare professionals in English, is available at http://www.porphyria-europe.org with easily downloadable pdf files. 2. Data on the safety of drugs in acute porphyria has been collected from participating countries (2901 drug reports on 616 drugs). Information is disseminated on http://www.drugs-porphyria.org 3. European Quality Assessment (EQA) schemes have been established for specialist laboratories (24 participants in 17 countries) and data on laboratory performance collected annually. Variations between centres are being addressed and diagnostic protocols developed. 4. The EPNET registry now contains data on 371 patients (320 new cases; 51 with long term complications) that is being used to calculate the incidence of each porphyria in participating countries and the prevalence of long term complications, The incidence of new cases of acute intermittent porphyria is around 0.15/million/year in most countries. The initial purposes of the EPNET project have been achieved; we have established a rich data resource, a network for improving quality of care and a European platform for expert exchange. EPNET has been funded by the European Commission through its Public Health and Consumer Protection Directorate (DG SANCO), PHEA programme.

The Four Pillars of Rheumatic Heart Disease Control

The National Department of Health has promulgated the first week of August as National Rheumatic Fever Week ever since rheumatic fever was made a notifiable condition in 1989. The results of the Heart of Soweto Study, however, show that very little progress has been made in reducing the burden of rheumatic heart disease over the past 20 years. This prospective study of 4 005 patients with heart disease who presented at Chris Hani Baragwanath Hospital during 2006/07 showed that 960 (24%) had valvular heart disease. The incidence of new cases of rheumatic heart disease for those aged <14 years in Soweto was 23.5 cases/100 000 per annum, which puts this urban community among the high-incidence communities of the world. It is not surprising that this preventable condition remains common, because of inadequate implementation of the guideline for the prevention of rheumatic fever in South Africa. A recent study showed that very few paediatricians were aware that rheumatic fever is a notifiable condition, and that the national notification system administered by the Department of Health was dysfunctional.

Stepped care for depression in primary care: what should be offered and how?

Stepped-care approaches may offer a solution to delivering accessible, effective and efficient services for individuals with depression. In stepped care, all patients commence with a low-intensity, low-cost treatment. Treatment results are monitored systematically, and patients move to a higher-intensity treatment only if necessary. We deliver a stepped-care model targeting patients with depression. The first step consists of "watchful waiting", as half of all patients with a depressive episode recover spontaneously within 3 months. The second step, guided self-help, is the key element of the stepped-care model. Guided self-help, especially when offered through the internet, is effective and cost-efficient. The third step consists of brief face-to-face psychotherapy. Finally, in the fourth step, longer-term face-to-face psychotherapy and antidepressant medication might be considered. Patients are monitored by one person, a care manager, who is responsible for the decision to step up to the next treatment and for continuity of care. The different treatments within the stepped-care model are evidence-based. Data on cost-effectiveness of the full model are still scarce, but we recently demonstrated that the incidence of new cases of depression and anxiety could be halved by introducing stepped care. Effects of web-based guided self-help could be enhanced by incorporating them in a stepped-care model.

Inflammatory breast cancer in Italy

Breast cancer represents the most common cancer among women in Italy. In the last decade, an increase in incidence and a decrease in mortality from breast cancer have been observed in Italy. These findings may be explained at least in part by the implementation of organized screening programs (SMPs). The screening programs are not diffused homogeneously throughout Italy, where approximately 60% of the population in covered, which explains in part the different outcomes observed across Italy. On the basis of the available data, the authors of this report performed a retrospective analysis on the incidence of 2 different groups of breast cancer patients: those covered or and those not covered by SMPs in Italy. The rates of incidence of T4a, T4b, and T4c breast cancer and of T4 inflammatory breast cancer (IBC) overtime appeared to be lower for the population that was covered by SMPs. On the basis of the estimated 40,000 new cases of breast cancer in Italy per year, the authors attempted to extrapolate the approximate incidence of new cases of T4 breast cancer and calculated that there were between 2800 and 3600 new cases per year taking into account the differences in incidence observed in areas covered or not covered by SMPs. Following the same extrapolations, the estimated incidence of IBC was approximately 200 to 800 new cases per year, representing from 0.6% to 2% of all breast cancers diagnosed every year in Italy.

Abstract CN12-02: Towards the control of melanoma

Abstract The incidence of melanoma continues to rise in most fair-skinned populations around the world. This year, 68,720 Americans will be diagnosed with melanoma and more than 8,500 will die from the disease, an enormous toll for a largely preventable cancer. Strategies to control the burden of melanoma include primary prevention, early detection of treatable lesions, and novel therapies for established disease. Primary prevention requires understanding of the modifiable causal factors, and then developing programs to intervene at the population level to reduce the incidence of new cases. To date, the only modifiable factor yet identified is solar ultraviolet radiation (UVR). Somewhat unusually in cancer research, the most compelling human data for a causal association between sunlight and melanoma come from ecological studies comparing the incidence of melanoma across populations, over time, and following migration. Animal models are limited in number, but mostly confirm that exposure to UVR, particularly early in life, causes melanoma. Data regarding the role of solar UVR from observational epidemiological studies is abundant but inconsistent, and data from intervention trials is almost non-existent. Thus the evidence-base with which to enact primary prevention policies for melanoma is limited. Moreover, recent epidemiologic and molecular findings indicating that melanomas arise through multiple causal pathways pose interesting new challenges for designing primary prevention interventions. Early detection is another approach to reducing the melanoma burden. The strategy to identify and remove threatening melanocytic lesions before harm ensues is widely practiced, although nowhere is this done systematically across entire populations. Several considerations have precluded the formal introduction of melanoma screening programs, particularly the low predictive value of current screening methods and the consequent costs of overdiagnosis of pigmented lesions. Research to improve screening performance, including the identification of high-risk populations using phenotypic and genotypic markers, is currently underway and may lead to new approaches. The final pillar of melanoma control lies in finding better treatments, especially for disseminated melanoma which has proven to be largely resistant to ‘traditional’ cancer therapies. Research into the mutations occurring within melanoma tumors is anticipated to identify novel targets for treatments, as well as lead to better understanding of the causes of melanoma. Limited success has been made with c-Kit; it is hoped that other targets will follow from molecular characterization of these tumors. This presentation will introduce these concepts, aspects of which will be addressed in more detail by the panel speakers with respect to both melanoma and keratinocyte cancers. Citation Information: Cancer Prev Res 2010;3(1 Suppl):CN12-02.

Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial

IntroductionPatients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD.MethodsIntensive care patients with an ICU stay of more than 72 hours were recruited to a randomised controlled trial examining the effect of a diary outlining the details of the patients ICU stay on the development of acute PTSD. The intervention patients received their ICU diary at 1 month following critical care discharge and the final assessment of the development of acute PTSD was made at 3 months.Results352 patients were randomised to the study at 1 month. The incidence of new cases of PTSD was reduced in the intervention group compared to the control patients (5% versus 13%, P = 0.02).ConclusionsThe provision of an ICU diary is effective in aiding psychological recovery and reducing the incidence of new PTSD.Trial registrationNCT00912613.

Invited Commentary

Invited Commentary