Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy.

BACKGROUND: Appropriately timed cessation of chemotherapy is an important aspect of good quality palliative care. There is wide variation in the reported rates of chemotherapy administration within the last 30 days of life. AIMS: To identify predictors of death within 30 days of receiving palliative chemotherapy, and to propose a standard definition by which oncologists and cancer centres can be compared. METHODS: Patients who received palliative chemotherapy at a regional cancer centre and its rural outreach unit between 2009 and 2011 were included. An adjusted logistic regression model, including all variables, was fit to identify predictors of death within 30 days of receiving palliative chemotherapy. RESULTS: Over a 3-year period, 1131 patients received palliative chemotherapy, 138 (12%) died within 30 days of receiving palliative chemotherapy. Predictors of death within 30 days of palliative chemotherapy were: less than 30 days contact with palliative care (odds ratio 3.30 (95% confidence interval 2.04-5.34), P < 0.001) and male gender (odds ratio 2.02 (95% confidence interval 1.24-3.31), P = 0.0049), but treating clinician, tumour chemoresponsiveness, age, body mass index and survival from initial diagnosis were not. CONCLUSION: Patients who received chemotherapy in the last 30 days of life were more likely to be male and have a shorter duration of palliative care team involvement. In this study, the observed rate of death within 30 days of chemotherapy is within the range of published data. It is recommended that a standard definition be used to benchmark medical oncology centres and individual oncologists, and to allow comparison over time.

New layer-based imaging and rapid prototyping techniques for computer-aided design and manufacture of custom dental restoration.

Fixed dental restoration by conventional methods greatly relies on the skill and experience of the dental technician. The quality and accuracy of the final product depends mostly on the technician's subjective judgment. In addition, the traditional manual operation involves many complex procedures, and is a time-consuming and labour-intensive job. Most importantly, no quantitative design and manufacturing information is preserved for future retrieval. In this paper, a new device for scanning the dental profile and reconstructing 3D digital information of a dental model based on a layer-based imaging technique, called abrasive computer tomography (ACT) was designed in-house and proposed for the design of custom dental restoration. The fixed partial dental restoration was then produced by rapid prototyping (RP) and computer numerical control (CNC) machining methods based on the ACT scanned digital information. A force feedback sculptor (FreeForm system, Sensible Technologies, Inc., Cambridge MA, USA), which comprises 3D Touch technology, was applied to modify the morphology and design of the fixed dental restoration. In addition, a comparison of conventional manual operation and digital manufacture using both RP and CNC machining technologies for fixed dental restoration production is presented. Finally, a digital custom fixed restoration manufacturing protocol integrating proposed layer-based dental profile scanning, computer-aided design, 3D force feedback feature modification and advanced fixed restoration manufacturing techniques is illustrated. The proposed method provides solid evidence that computer-aided design and manufacturing technologies may become a new avenue for custom-made fixed restoration design, analysis, and production in the 21st century.

Extracoronal resilient attachments in distal-extension removable partial dentures.

Esthetics is often compromised in patients who wear removable partial dentures with metal clasps placed on anterior teeth. Clinical procedures are presented for a new design of a removable partial denture that improves esthetics and function through a new dental attachment. The extracoronal resilient attachment system offers vertical resiliency and universal stress relief for use where a resilient prosthesis is indicated. The removable partial denture retained by these attachments provides esthetics, vertical resiliency, and easy replacement of worn attachments.

MRI-guided stereotatic aspiration for the treatment of deep-seated tentorial empyema: a case report.

Tentorial empyema is a rare intracranial infection. In the past, most authors treated the subdural empyema by craniotomy, craniectomy or burr hole drainage. In the case presented, magnetic resonance imaging (MRI)-guided stereotatic aspiration was used to treat deep-seated extensive tentorial empyema successfully, via a simple burr hole to avoid any brain resection and retraction. This operation method is relative simple and effective for treating deep-seated intracranial empyema, significantly reduces the risk of injury to the lateral temporal lobe cortex or transection of optic radiations. On the other hand, it must be emphasized that contrast-enhanced MRI scan may offer a more sensitive and better diagnostic procedure than contrast enhanced computed tomography (CT) scan.