Treatment of respiratory syncytial virus infection in adult patients with hematologic malignancies based on an institution-specific guideline

A total of 26 adults with hematologic malignancies and/or hematopoietic stem cell transplant were treated for respiratory syncytial virus (RSV) infection based on an institutional guideline. Thirteen patients received aerosolized ribavirin, and 13 received aerosolized ribavirin and intravenous palivizumab. Two deaths, not attributed to RSV infection, occurred within 90 days of diagnosis.

Alternative food improves the combined effect of an omnivore and a predator on biological pest control. A case study in avocado orchards

Ecological communities used in biological pest control are usually represented as three-trophic level food chains with top-down control. However, at least two factors complicate this simple way of characterizing agricultural communities. First, agro-ecosystems are composed of several interacting species forming complicated food webs. Second, the structure of agricultural communities may vary in time. Efficient pest management approaches need to integrate these two factors to generate better predictions for pest control. In this work, we identified the food web components of an avocado agro-ecosystem, and unravelled patterns of co-occurrence and interactions between these components through field and laboratory experiments. This allowed us to predict community changes that would improve the performance of the naturally occurring predators and to test these predictions in field population experiments. Field surveys revealed that the food-web structure and species composition of the avocado community changed in time. In spring, the community was characterized by a linear food chain of Euseius stipulatus, an omnivorous mite, feeding on pollen. In the summer, E. stipulatus and a predatory mite, Neoseiulus californicus, shared a herbivorous mite prey. Laboratory experiments confirmed these trophic interactions and revealed that N. californicus can feed inside the prey nests, whereas E. stipulatus cannot, which may further reduce competition among predators. Finally, we artificially increased the coexistence of the two communities via addition of the non-herbivore food source (pollen) for the omnivore. This led to an increase in predator numbers and reduced populations of the herbivore. Therefore, the presence of pollen is expected to improve pest control in this system.

A simplified gentamicin dosing chart is quicker and more accurate for nurse verification than the BNFc

BACKGROUND

At least 5% of paediatric admissions are complicated by medication error. Nurses can prevent some errors by correctly verifying prescriptions before administering drugs, which requires adequate drug calculation skills and familiarity with the BNFc. We wished to explore whether a newly devised chart would improve nurses' dose calculation ability and thus potentially reduce doctors' prescription errors.

AIMS

To explore nurses' ability to calculate doses of gentamicin for neonates and children using a new simple dosing chart compared with the BNFc.

METHODS

Two gentamicin dosing charts (paediatric and neonatal) devised by a multidisciplinary group to simplify dose calculation and selection of frequency were compared with the BNFc using four questions (two neonatal, two paediatric) asking ward nurses to calculate gentamicin doses. Answers were scored for both the correct dosage and correct frequency.

RESULTS

51 nurses participated. 11 nurses (22%) answered all four questions correctly. A higher proportion correctly answered both the dosage and frequency questions simultaneously when using the chart compared with the BNFc: paediatric questions 100% (51/51 chart) versus 80% (41/51 BNFc) (OR 0.20) and neonatal questions 55% (28/51 chart) versus 35% (18/51 BNFc) (OR 0.2). Errors when using the BNFc were due to selection of the incorrect regimen (23%), wrong frequency (17%) and one 10-fold dosing error. When using the chart, there were no dosing errors, only frequency errors for the neonatal regimen.

CONCLUSION

The chart was more reliable, quicker and may be useful for patient safety. Revising the format of the BNFc may be beneficial for nurses.

Voodoo dolls and the cancer patient: patients do trust their doctors

OBJECTIVES

To determine oncology patients' pattern and rationale of complementary and alternative medicine (CAM) use, and canvass their views on the relative merits of allopathic and alternative medicine.

DESIGN

Observational study of opinions from a cohort of patients using self-completion questionnaires.

SETTING

Oncology departments of two UK teaching hospitals.

PARTICIPANTS

Voluntary participation of 200 oncology patients attending clinic.

MAIN FINDINGS

Twenty-two percent of patients used CAM, with a preponderance towards younger, female patients. The commonest reasons for CAM use is to make the patient feel better and to help with their cancer. However, patients seldom believe there is more evidence for CAM or that CAM will cure them, indeed often noticing no benefits from the treatment. CAM users do not resort to complementary medicine due to dissatisfaction with their doctor but instead have considerable trust in their physicians. Only a minority believes their doctor knows about their CAM use.

CONCLUSION

CAM use by oncology patients in the UK is less common than that reported elsewhere. Although patients try CAM in the hope that it will help with their treatment, they are realistic about its likely benefits. It uptake is not as an indication of lack of faith in doctors, yet physicians are frequently unaware of use. Therefore, the medical profession should not feel threatened by patients resorting to CAM but instead focus on understanding the reasons behind it.

Identifying uncontrolled asthma in young children: clinical scores or objective variables?

OBJECTIVE

Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children.

METHODS

During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma.

RESULTS

The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV(1)) differed among patients with different control status (p < 0.001 for C-ACT and DSS; p = 0.014 for FEV(1)). Logistic regression confirmed that UA was associated with DSS (p < 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV(1) (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p < 0.001), followed by PEF (p = 0.006) and FEV(1) (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA.

CONCLUSIONS

C-ACT is better than objective parameters in identifying young Chinese children with UA.

Genotypic Approaches to Therapy in Children (GATC): using information technology to improve drug safety

Adverse drug reactions (ADRs) are a major cause of morbidity and mortality in children. Current models of ADR surveillance have repeatedly demonstrated little pragmatic value to practicing clinicians. ADR reporting rates in the US and Canada suggest that only 5% of ADRs are reported. The Genotypic Approaches to Therapy in Children (GATC) network was established to identify and solve drug safety problems in paediatrics. We hypothesized that genetic polymorphisms underlie a significant portion of concentration-dependent ADRs in children. Our objective was to establish an ADR active surveillance network in paediatric hospitals across Canada. Surveillance clinicians evaluate clinical information from ADR cases and drug-matched controls, and collected DNA samples from all patients. The surveillance network will enable the identification of predictive genomic-markers for ADRs. With this knowledge, children at risk can be identified before therapy is initiated and enable personalized adjustments to therapy based on genetic make-up.

Intravascular effect in velocity-selective arterial spin labeling

Arterial spin labeling (ASL) has been developed into a useful tool for measuring local tissue perfusion with magnetic resonance imaging (MRI). Velocity-selective ASL (VS-ASL) tags spins on a basis of flow velocity, instead of the spatial distribution that is commonly used by conventional ASL techniques. Using a 90 degrees-180 degrees-90 degrees radiofrequency pulse train in combination with flow-sensitive gradients, VS-ASL can potentially generate tags that are very close to the imaging plane and whereby avoid the main error source of conventional ASL techniques coming from T1 relaxation during inflow time (TI). In practice, however, TI of VS-ASL should still be chosen with caution with respect to intravascular signal and cutoff velocity (Vc). With higher Vc, the maximum of VS-ASL signal was observed at shorter TI, which is due to intravacular signal in large vessels. For perfusion measurement in human brain, small Vc (=<2cm/s) is recommended. In contrast to the previous studies that suggested CSF suppression for Vc < 5cm/s, this study used lower amplitude and longer separation of diffusion gradients in the VS pulse train, which reduced b-value and eliminated the necessity of CSF suppression for Vc down to 2 cm/s.

Poster - Thurs Eve-40: The potential of using SPECT ventilation information with IMRT for functional lung avoidance in radiotherapy of non small cell lung cancer

We have investigated the feasibility of using ventilation scans obtained from single photon emission computed tomography (SPECT) in intensity-modulated radiation therapy (IMRT) planning in lung cancer radiotherapy to avoid well functioning lung. We fused SPECT ventilation scans acquired at GE Hawkeye SPECT-CT of ten stage-III lung radiotherapy patients with planning CT in treatment planning system (Pinnacle v8.0, Philips Medical Systems). We automatically segment out 50% and 70% ventilated volumes. For each patient, we generated IMRT plans using nine equally spaced beams with and without avoiding well ventilated volume. They were compared with three beam IMRT plans with beam directions chosen to minimize the mean dose to the ventilated lung volumes, while keeping cord dose below tolerance and dose uniformity in the target. The plans generated using functional lung avoidance information reduces the doses to the functioning lung. With both IMRT avoidance plans, we could not obtain better functional avoidance or lower V-20Gy (volume receiving 20Gy or more) for total lung when the planning target volume (PTV) was surrounded by functional lung volumes. We were able to achieve better ventilated lung avoidance and lower total lung V-20Gy when the PTV is close to, but not surrounded by functioning lung volumes. For patients with the PTV that is far from 50% and 70% functional lung volumes, three-field IMRT spare the ventilated lung as well as nine-field IMRT ventilation avoidance plan, with a lower total lung V20-Gy.