Patient's Compliance on the Use of Extended Low Molecular Weight Heparin Post Major Pelvic Surgeries in Cancer Patients at King Hussein Cancer Center

Effective Venous Thrombo-Embolism (VTE) prophylaxis is used in less than 50% of oncology patients despite its wide availability. Low molecular weight heparin (LMWH) as a daily injection is an essential tool for effective prophylaxis against deep vein thrombosis (DVT). Daily outpatient self-injection by the patients or their family members is common practice. The effectiveness of this measure depends on patient compliance.

OBJECTIVE

The purpose of this study is to determine the degree of compliance and the factors that affect compliance to the extended out-patient use of prophylactic LMWH for 1 month after major abdominal/pelvic surgeries in cancer patients at King Hussein Cancer Center (KHCC).

PATIENTS AND METHODOLOGY

Following major abdominal/pelvic surgeries, data on 160 cancer patients at KHCC from January 2007 until July 2012 were collected concerning knowledge of DVT and compliance with prophylactic self-injections by answering a questionnaire.

RESULTS

We have achieved a high compliance rate, this was explained by the medical team's role in educating the patients about the risk of VTE and the importance of thromboprophylaxis. The compliance with self-injections was directly associated with younger age, employment and higher degree of education.

CONCLUSION

The high compliance rate outside clinical trials can be achieved through comprehensive patient education by a well-qualified medical team, clarification of the importance of DVT prophylaxis and patients' support.

Self-awareness of foot health status in patients with Type 2 diabetes: the Fremantle Diabetes Study Phase II

AIMS

To determine self-awareness of diabetes-related foot problems and its associates in a community-based cohort of people with Type 2 diabetes.

METHODS

A survey concerning diabetic foot problems was administered to 358 consecutive patients with Type 2 diabetes [mean ± SD age 67.4 ± 10.8 years, 56.1% males, median (interquartile range) diabetes duration 9.0 (3.9-16.8) years] attending for detailed clinical, biochemical and questionnaire assessment as part of the longitudinal observational Fremantle Diabetes Study Phase II.

RESULTS

Compared with the 213 patients (59.5%) who considered their feet to be normal, the 145 (40.5%) who considered their feet to be abnormal were older, had longer diabetes duration and were more likely to have sensory neuropathic symptoms and self-reported poor circulation (P < 0.001). In those who considered their feet to be normal, 67.9% had peripheral sensory neuropathy (score >2/8 on the Michigan Neuropathy Screening Instrument clinical portion), 9.9% had an ankle-brachial index < 0.9, 6.1% had both peripheral sensory neuropathy and an ankle-brachial index < 0.90, and 86.9% had one or more features on inspection, such as deformity, dry skin, callus and fissures that could facilitate more serious complications, despite the majority having had at least one foot examination by a healthcare professional in the previous year.

CONCLUSIONS

Self-assessment of diabetes-related foot problems by patients in the Fremantle Diabetes Study Phase II was unreliable. The present data suggest that self-perceived foot health should be assessed together with foot examination findings. Intensive education and monitoring may be necessary in those who consider their feet to be normal but who have neurovascular, structural and/or other precursors of serious foot pathology.

Evaluation of two-stage system for neutron measurement aiming at increase in count rate at Japan Atomic Energy Agency-Fusion Neutronics Source

In order to increase the count rate capability of a neutron detection system as a whole, we propose a multi-stage neutron detection system. Experiments to test the effectiveness of this concept were carried out on Fusion Neutronics Source. Comparing four configurations of alignment, it was found that the influence of an anterior stage on a posterior stage was negligible for the pulse height distribution. The two-stage system using 25 mm thickness scintillator was about 1.65 times the count rate capability of a single detector system for d-D neutrons and was about 1.8 times the count rate capability for d-T neutrons. The results suggested that the concept of a multi-stage detection system will work in practice.

Age-specificity of Toxoplasma gondii seroprevalence in sheep, goats and cattle on subsistence farms in Bangladesh

Toxoplasma gondii is a zoonotic protozoan parasite that infects humans and domestic animals. In this study, the seroprevalence of T. gondii antibodies was investigated using serum samples collected from 83 sheep, 146 goats and 37 cattle from a dozen subsistence farms in Bangladesh. Fifty-eight out of 83 sheep (69.9%), 89 out of 146 goats (61.0%) and 10 out of 37 cattle (27.0%) were seropositive for the parasite. Seroprevalence in young goats (<1 year old) was significantly lower than that of the adult goats (>1 year old). In contrast, seroprevalence for young and adult sheep was similar. These results indicate that acquired infection with T. gondii occurs in this region of Bangladesh, at least among goats.

Investigation of activation cross-section data of proton induced nuclear reactions on rhenium

In the frame of systematic investigations of activation cross-section data for different applications the excitation functions of (nat)Re(p,x)(185)Os, (183m)Os, (183g)Os, (182)Os, (181m)Os, (186g)Re, (184m)Re, (184g)Re, (183)Re, (182m)Re, (182g)Re and (181g)Re reactions were measured up to 70MeV. The data for the (nat)Re(p,x) (183m)Os, (183g)Os, (182)Os, (181g)Os,(186g)Re, (184m)Re,(182m)Re, (182g)Re, and (181)Re reactions are reported for the first time. The activation method, the stacked foil irradiation technique and γ-spectroscopy for activity detection were used. The experimental data were compared with predictions of three theoretical codes. From the measured cross-section thick target integral yields were also calculated and presented.

Compton spectroscopy for rotation-mode computed tomography

In computed tomography (CT) systems, it is desirable to know the X-ray energy spectra for various applications, including medical CT imaging, and diagnostic field and heavy ion therapy. However, because of the restricted space, the only practical solution is to use Compton spectroscopy, where the incident spectrum is inferred from the scattered spectrum. The geometry of the scatterer and its position within the CT can affect the spectrum of the secondary beam, making it difficult to determine the primary spectrum during operation of the CT system. A modified Compton spectrometer is described that allows measurement of the X-ray energy spectra during operation, and most importantly, in rotation mode. The geometry of the scatterer was optimized to reduce the energy broadening of the secondary beam. The performance of the system was evaluated by comparing the reconstructed exposure to that measured directly using an ion chamber.

Changes in chest wall thickness during four-dimensional CT in particle lung treatment planning

Four-dimensional (4D) CT images for charged particle lung therapy were acquired using a 256 multislice CT without couch movement. The thickness of the posterior right chest wall changed with respiration with a water equivalent path length (WEL) of more than 5 mm over the mid-exhalation phase but the thickness of the left chest wall did not vary.

Construction of a model to estimate the CYP3A inhibitory effect of grapefruit juice

Grapefruit juice (GFJ) is known to affect the pharmacokinetics of a variety of drugs administered concomitantly and this is due to inhibition of intestinal CYP3A, a barrier protein for drug absorption. Some compounds such as furanocoumarin derivatives have been reported as inhibitors of the enzyme. On the other hand, inhibitory potentials of GFJ on CYP3A-oxidation activities differ widely between brands of juices. Information on the percentage contributed by ingredients in GFJ is also limited. Therefore, construction of prediction models for the CYP3A inhibitory potentials of GFJ brands was attempted by using concentrations of ingredients in GFJ. Concentrations of bergaptol, bergamottin, 6', 7'-dihydroxybergamottin, naringin, and naringenin in 23 kinds of GFJ were determined with high-performance liquid chromatography (HPLC). Furthermore, inhibitory effects on CYP3A activity were measured based on the initial rate for testosterone 6beta-hydroxylation in the presence of each GFJ. Results of multi-regression analyses between the ingredients and the enzymatic inhibitory effects revealed that concentrations of bergamottin, 6',7'-dihydroxybergamottin, and naringin were significant variables for CYP3A inhibition of GFJ. According to the standard partial regression coefficient for each explanatory variable, bergamottin and 6',7'-dihydroxybergamottin are the most important factors for inhibition. The multiple correlation coefficient (R) and the multiple correlation coefficient with leave-one-out cross validation (Q) of the model equation were 0.94 and 0.91, respectively. These results suggest that the concentrations of ingredients can explain most variances of inhibitory effects among brands. This model may be a useful method for the prediction of the GFJ interaction potential.

Efficacy and safety of pregabalin for treating neuropathic pain associated with diabetic peripheral neuropathy: a 14 week, randomized, double-blind, placebo-controlled trial

AIMS

To evaluate the efficacy, safety and pharmacokinetics of pregabalin in treating neuropathic pain associated with diabetic peripheral neuropathy in Japanese patients.

METHODS

A randomized, double-blind, placebo-controlled, multicentre 14 week clinical trial was conducted. Japanese patients with diabetic peripheral neuropathy (n = 317) were randomized to receive placebo or pregabalin at 300 or 600 mg/day. The primary efficacy measure was a change of mean pain score from baseline to end-point from patients' daily pain diaries.

RESULTS

Significant reductions in pain were observed in patients treated with pregabalin at 300 and 600 mg/day vs. placebo (P < 0.05). Improvements in weekly pain scores were observed as early as week 1 and were sustained throughout the study period (300 and 600 mg/day difference from placebo at study end-point, -0.63 and -0.74, respectively). Pregabalin produced significant improvements in weekly sleep interference scores, the short-form McGill Pain Questionnaire, the Medical Outcomes Study-Sleep Scale, the 36-item Short-Form Health Survey scale, and the Patient and Clinical Global Impression of Change. Patient impressions of numbness, pain and paraesthesia were also significantly improved. Regarding treatment responders, 29.1 and 35.6% of patients treated with 300 and 600 mg/day, respectively, reported ≥ 50% improvement in mean pain scores (vs. 21.5% for placebo). Pregabalin was well tolerated; somnolence (26%), dizziness (24%), peripheral oedema (13%) and weight gain (11%) were the most common adverse events and generally were reported as mild to moderate.

CONCLUSIONS

Pregabalin was effective in reducing pain and improving sleep disturbances due to pain, and was well tolerated in Japanese patients with painful DPN.