Assessment of a patient consultation questionnaire-based scoring system for stratification of outpatient risk of colorectal cancer.

BACKGROUND: The UK government's fast-track 2-week wait (2WW) rule and colorectal cancer guidelines aimed to detect patients at high risk of having colorectal cancer, but the yield has been poor. A patient consultation questionnaire (PCQ)-based scoring system may be an effective tool for prioritizing colorectal referrals. The aim of this study was to validate the system in a large and ethnically diverse population and to compare it with 2WW referrals. METHODS: Over a 1-year period, all colorectal referrals (2WW and traditional letters) at nine hospitals in Leicestershire were sent a PCQ to complete and return. A weighted numerical score (WNS), which reflects the patient's risk of having colorectal cancer, was calculated and compared with the hospital diagnosis. RESULTS: Of a total of 1422 PCQs returned, 83 patients were diagnosed with colorectal cancer. The 2WW referrals constituted 35.7 per cent of all referrals. The mean WNS of patients with colorectal cancer was significantly higher than that of the other patients (mean 76.3 versus 48.9 respectively; P < 0.001). For similar cancer detection rates (or sensitivity), the specificity of a WNS cut-off of 70 was significantly better than that of the 2WW system (82.7 versus 66.1 per cent; P < 0.001). CONCLUSION: The PCQ-based WNS system improves specificity for detecting colorectal cancer, particularly when the WNS exceeds 70.

CO2 laser sterilization in the surgical treatment of infected median sternotomy wounds.

BACKGROUND: We examined the use of CO2 laser sterilization in the surgical treatment of infected median sternotomy wounds. Deep wound infection after median sternotomy is infrequent (1% to 5% of all cases) but is associated with significant morbidity, mortality, and cost. METHOD: Twenty-four consecutive patients with median sternotomy wound infection were treated by one plastic surgeon using a CO2 laser to sterilize wounds after debridement and before flap closure. The rectus abdominis muscle flap was primarily used, but the choice of muscle flap was case dependent. RESULTS: To date, no patient in this series has had postoperative wound infection, breakdown, or flap loss. One patient did have superficial skin loss. CONCLUSION: Although the morbidity rate was 17%, all patients had intact wounds. None of the 5 deaths was related to wound infection. We found that CO2 laser sterilization in the surgical treatment of sternal wound infections decreased morbidity, mortality, and cost.

Organ transplanting in Japan: the debate begins.

OBJECTIVES: Japan is currently considering changing its long-standing policy of banning most organ transplants. This paper reviews the current state of organ transplantation in Japan and presents results from a recently conducted survey regarding attitudes toward the removal of organs from brain-dead donors, and potential methods of allocating those organs in a fair manner. METHODS: Survey data were collected by the Research Project Team on Network Systems for Organ Transplants funded by the Japanese Ministry of Health and Welfare. The sample consisted of 1093 randomly selected citizens. Predictors of attitudes supporting organ transplantation were analyzed using logistic regression. RESULTS: Although many Japanese people support organ transplantation, few are willing to donate their organs. General knowledge of transplantation was the best predictor of support for such a program and willingness to donate organs. In addition, younger respondents and male respondents were more likely to support programs and donate organs. Implications of these results are discussed.

Association between attitudes toward health promotion and opinions regarding organ transplants in Japan.

Health promotion activities to educate the public about health lifestyles have been performed widely in industrialized countries where chronic adult diseases have become prevalent. According to a basic principle of health promotion activities, the symptoms of many diseases are regarded as the result of inadequate health behavior, curable by modifying health behavior. It is thus possible that an exposure to health promotion activities might instill negative attitudes towards organ transplants, because program participants may conclude that persons who need an organ transplant have become unhealthy as the result of their own poor health habits. In this study, two types of surveys were undertaken to test this hypothesis. The subjects of the first cross-sectional study were 712 male and female Japanese citizens, and those of the second case-control study were 240 female company employees in Japan. In the first study, a logistic regression analysis was used and the following findings were obtained. (1) Compared with the persons who felt that they did not have enough practical knowledge about individual health practices, those who felt that they had adequate knowledge were 0.66 times less likely to support organ transplants. (2) Compared with those who were not willing to spend money on healthful things, the persons who were willing to do so were 0.51 times less likely to support organ transplants. In the second case-control study, it was revealed that the subjects who had negative attitudes towards organ transplants had consistently healthier lifestyles than did those who had positive attitudes towards organ transplants. Based upon the present findings and the nature of the basic principles of health promotion activities, we infer that community health promotion activities have a negative influence upon citizens' opinions of organ transplants. Since these findings have health policy implications, more studies are necessary to conclusively evaluate the effects of health promotion activities upon attitudes toward organ transplants.

Survey of tissue-diagnostic services in United States dental schools, 1953-1980.

A survey of tissue-diagnostic services in United States dental schools was conducted, covering the services' activities during 1980. This survey was compared to similar surveys done in 1953, 1958, 1969, and 1975. A significant increase in the number of specimens processed has occurred, and there has been a parallel increase in the number of malignant specimens. The percentage of malignancies in relation to total specimens remains stable at 2.0 percent. As could be expected, higher fees are being charged by the schools for processing specimens.

Survey of tissue diagnostic services in United States dental schools, 1953-1975.

A survey of tissue diagnostic services in United States dental schools was conducted, covering the services' activities during 1975. This survey was compared to similar surveys made in 1953, 1958, and 1969. Most significantly, many more biopsies are being processed, with a great increase in the number of malignant specimens. As could be expected, higher fees are being charged by the schools for processing specimens.