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2.
Pediatr Blood Cancer ; 66(4): e27567, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30548169

RESUMO

BACKGROUND: Criteria for the pathological classification of adult adrenocortical tumours (ACTs) have been found to overestimate the malignant potential of childhood ACTs. We sought to evaluate the accuracy and utility of criteria developed for paediatric ACT compared to current criteria for adults. METHODS: ACTs treated between January 2006 and December 2016 in two paediatric institutions were evaluated. Patients classified clinically as malignant (CM) had locally invasive disease at surgery requiring extensive en bloc resection to achieve clear margins, had local recurrence or distant metastasis. Slides were reviewed by pathologists blinded to the clinical outcome. A grade was assigned to each tumor according to the Weiss, Aubert, Wieneke and Dehner-Hill criteria. The pathological grade was compared to the clinical outcome. RESULTS: The median follow-up was 60 months (interquartile range 25-80 months). Based on clinical criteria, of 22 patients 14 (64%) had a benign course and eight (34%) behaved malignant. The malignant potential was overestimated by Weiss criteria in 23% and Aubert criteria in 27%. Wieneke and Dehner-Hill criteria showed good clinicopathological correlation; no child who had a benign course was classified as malignant. The Dehner-Hill criteria, however, classified five (23%) children as intermediate risk of which three had a clinically benign and two a CM course. CONCLUSION: The Wieneke criteria accurately predicts the clinical course in childhood ACTs and could be considered the gold standard in their pathological characterization.


Assuntos
Neoplasias do Córtex Suprarrenal/mortalidade , Neoplasias do Córtex Suprarrenal/terapia , Neoplasias do Córtex Suprarrenal/patologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia
3.
Hum Pathol ; 151: 105634, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39117025

RESUMO

PURPOSE: No consensus on the definition of right and left colorectal cancer (CRC) exists, nor studies offering histological or molecular basis for such categorisation. This study investigated the regional variations in the histological and molecular characteristics of CRCs, with the objective of determining an optimal division point between right and left CRCs. MATERIALS AND METHODS: An observational study of consecutive patients who underwent CRC resection (1995-2022) at Concord Hospital, Sydney was performed. Clinicopathological data were extracted from a prospective database and seven permutations of right-left divisions considered. Logistic regression tested association between the right-left divisions and pathological characteristics. Receiver operating characteristic and area under the curve (AUC) analyses determined the discriminative ability of each division to predict 18 pathology characteristics. RESULTS: 3753 patients underwent a CRC resection (2120 male; mean 69.5yrs [SD12.6]). There was regional variation in tumours with respect to tumour infiltrating lymphocytes (TILs), mismatch repair deficiency (dMMR), and mutant BRAF (mBRAF). Left-sided tumours were less likely to demonstrate TILs (P < 0.001), be dMMR (P < 0.001), and express mBRAF (P < 0.001). Division at the descending-sigmoid junction yielded highest discriminative abilities: TILs - AUC 0.66, dMMR - AUC 0.76, and mBRAF - AUC 0.73. CONCLUSION: This is the first study to provide a pathological basis on which right- and left-sided cancers may be defined, and found the optimal division point between the right and left colorectum to be at the descending-sigmoid junction. Further research is needed to determine whether this can facilitate individualised patient management.


Assuntos
Neoplasias Colorretais , Linfócitos do Interstício Tumoral , Proteínas Proto-Oncogênicas B-raf , Humanos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/genética , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas B-raf/genética , Linfócitos do Interstício Tumoral/patologia , Linfócitos do Interstício Tumoral/imunologia , Reparo de Erro de Pareamento de DNA , Idoso de 80 Anos ou mais , Mutação , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética
5.
J Law Med ; 15(2): 296-302, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18035845

RESUMO

There is increasing global concern about the potential impact of pandemic infections, including influenza, SARS and bioterrorist attacks involving infectious diseases. Many countries have prepared plans for responding to a major pandemic. In Australia, the Federal and State pandemic plans include measures such as contact tracing, ensuring availability of antimicrobials, quarantine and social distancing. Many of these measures would involve severe restrictions on individual citizens and small businesses. Issues of compensation for cooperation and compliance with pandemic plans need to be addressed in policy discussion. The instrumental benefits of compensation in the event of a pandemic have not been sufficiently recognised. Greater attention paid now to mechanisms to compensate individual and business costs associated with compliance would increase trust in government pandemic plans, encourage compliance and reduce the health and economic impact of a pandemic.


Assuntos
Compensação e Reparação , Surtos de Doenças/prevenção & controle , Controle Social Formal , Controle de Doenças Transmissíveis , Saúde Global , Humanos
6.
J Grad Med Educ ; 5(2): 232-7, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24404265

RESUMO

BACKGROUND: Medical officers (trainees) in their first to third postgraduate years (PGY-1-3s) work in complex, busy environments, performing tasks that require concentration and application of learned skills. There are frequently competing demands, and being paged is among the most common. OBJECTIVE: We quantified and described the effect of interruptions that paging created on the clinical workflow of PGY-1-3s during ward duties. METHODS: This prospective study was conducted at 2 teaching hospitals in Sydney, Australia. Medical students were recruited as observers to log interruptions of PGY-1-3s' workflow arising from pages from other members of the hospital team. RESULTS: Forty-two pairs consisting of a PGY-1-3 trainee and an observer were recruited, with 24 proceeding to data collection. Nursing was the most frequent source of pages (47%); other medical staff accounted for 16% of pages, allied health for 12%, and others for 24% (with pharmacy the most common). Pages commonly involved direct patient care (46%), followed by medication issues (21%). Tasks interrupted by pages encompassed direct patient care (37%), indirect patient care (15%), and documentation (12%). Only 27% of pages were assessed as appropriate and urgent, while 58% were considered appropriate but not urgent, and 16% were not appropriate. Only 38% of pages were judged to be clinically more important than the task they interrupted. CONCLUSIONS: Pages frequently interrupted direct patient care activities for PGY-1-3 trainees, and a significant proportion of pages were identified as either not requiring immediate attention or not appropriate, resulting in potentially avoidable interruptions to clinical workflow. Alternate means of alerting trainees to nonurgent tasks may reduce interruptions and facilitate patient care.

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