Francis Sibson (1814-1876): the unsung hero of modern surgery and anesthesia.

Francis Sibson (1814-1876) was a British physician and anatomist widely regarded as a true pioneer of the medical profession. He overcame a tragic and difficult childhood to become an avid educator at several medical schools and dedicated his life to research. For modern scientists, he is most remembered for describing Sibson's fascia, his experimental use of curare in the treatment of hydrophobia and tetanus, and his detailed description of the positions and movements of internal organs. He died on September 7, 1876 at the age of 62 from complications of an aortic aneurysm.

Randomized Trial Comparing Two Algorithms for Levothyroxine Dose Adjustment in Pregnant Women With Primary Hypothyroidism.

Context: Regulation of maternal thyroid hormones during pregnancy is crucial for optimal maternal and fetal outcomes. There are no specific guidelines addressing maternal levothyroxine (LT4) dose adjustments throughout pregnancy. Objective: To compare two LT4 dose-adjustment algorithms in hypothyroid pregnant women. Design: Thirty-three women on stable LT4 doses were recruited at <10 weeks gestation during 38 pregnancies and randomized to one of two dose-adjustment groups. Group 1 (G1) used an empiric two-pill/week dose increase followed by subsequent pill-per-week dose adjustments. In group 2 (G2), LT4 dose was adjusted in an ongoing approach in micrograms per day based on current thyroid stimulating hormone (TSH) level and LT4 dose. TSH was monitored every 2 weeks in trimesters 1 and 2 and every 4 weeks in trimester 3. Setting: Academic endocrinology clinics in Washington, DC. Main Outcome Measure: Proportion of TSH values within trimester-specific goal ranges. Results: Mean gestational age at study entry was 6.4 ± 2.1 weeks. Seventy-five percent of TSH values were within trimester-specific goal ranges in G1 compared with 81% in G2 (P = 0.09). Similar numbers of LT4 dose adjustments per pregnancy were required in both groups (G1, 3.1 ± 2.0 vs G2, 4.1 ± 3.2; P = 0.27). Women in G1 were more likely to have suppressed TSH <0.1 mIU/L in trimester 1 (P = 0.01). Etiology of hypothyroidism, but not thyroid antibody status, was associated with proportion of goal TSH values. Conclusions: We compared two options for LT4 dose adjustment and showed that an ongoing adjustment approach is as effective as empiric dose increase for maintaining goal TSH in hypothyroid women during pregnancy.

Provision of survivorship care for patients with haematological malignancy at completion of treatment: A cancer nursing practice survey study.

PURPOSE: Many haematological cancer survivors report long-term physiological and psychosocial effects, which persist far beyond treatment completion. Cancer services have been required to extend care to the post-treatment phase to implement survivorship care strategies into routine practice. As key members of the multidisciplinary team, cancer nurses' perspectives are essential to inform future developments in survivorship care provision. METHODS: This is a pilot survey study, involving 119 nurses caring for patients with haematological malignancy in an Australian tertiary cancer care centre. The participants completed an investigator developed survey designed to assess cancer care nurses' perspectives on their attitudes, confidence levels, and practice in relation to post-treatment survivorship care for patients with a haematological malignancy. RESULTS: Overall, the majority of participants agreed that all of the survivorship interventions included in the survey should be within the scope of the nursing role. Nurses reported being least confident in discussing fertility and employment/financial issues with patients and conducting psychosocial distress screening. The interventions performed least often included, discussing fertility, intimacy and sexuality issues and communicating survivorship care with the patient's primary health care providers. Nurses identified lack of time, limited educational resources, lack of dedicated end-of-treatment consultation and insufficient skills/knowledge as the key barriers to survivorship care provision. CONCLUSION: Cancer centres should implement an appropriate model of survivorship care and provide improved training and educational resources for nurses to enable them to deliver quality survivorship care and meet the needs of haematological cancer survivors.