Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings: a systematic review.

BACKGROUND: Comorbidity is very common among patients with cancer. Multidisciplinary team meetings (MDTs) are increasingly the context within which cancer treatment decisions are made internationally. Little is known about how comorbidity is considered, or impacts decisions, in MDTs. METHODS: A systematic literature review was conducted to evaluate previous evidence on consideration, and impact, of comorbidity in cancer MDT treatment decision making. Twenty-one original studies were included. RESULTS: Lack of information on comorbidity in MDTs impedes the ability of MDT members to make treatment recommendations, and for those recommendations to be implemented among patients with comorbidity. Where treatment is different from that recommended due to comorbidity, it is more conservative, despite evidence that such treatment may be tolerated and effective. MDT members are likely to be unaware of the extent to which issues such as comorbidity are ignored. CONCLUSIONS: MDTs should systematically consider treatment of patients with comorbidity. Further research is needed to assist clinicians to undertake MDT decision making that appropriately addresses comorbidity. If this were to occur, it would likely contribute to improved outcomes for cancer patients with comorbidities.

Factors influencing oxygen concentration gradients in the intervertebral disc. A theoretical analysis.

Oxygen concentration gradients in the intervertebral disc were calculated to examine the effects of exchange area and disc thickness on oxygen concentrations and oxygen flux into the disc. The concentration gradients were determined using the two-dimensional Poisson equation with experimental values for oxygen consumption rate and oxygen diffusion. The calculated gradients were steep, and the oxygen concentrations in the center of thick discs were low, in agreement with experimental gradients. The results support the hypothesis that maximum cell density in the disc is determined by nutrient supply and that exchange area and disc thickness are critical parameters.

Separation of plasma from whole blood by membrane filtration in oscillatory flows.

This paper describes the performance of a microfiltration plasmapheresis unit operating with reversing oscillatory flows. The device consists of a flat channel duct between cellulose nitrate membranes and was used to extract plasma from anticoagulated fresh whole bovine blood. Measurements were made of plasma flux, haematocrit concentration, haemolysis and protein sieving coefficients. The effects on plasma flux are reported for alterations in the stroke and frequency of flow pulsations, transmembrane pressure, membrane properties and blood throughput. It was found that the imposition of oscillatory flows enhanced the plasma extraction rate by a factor of 3, producing about 0.9 litre/min/m2 membrane.