Geographical access to radiation therapy in North Queensland: a retrospective analysis of patient travel to radiation therapy before and after the opening of an additional radiotherapy facility.

INTRODUCTION: Access to radiation therapy (RT) underlies optimal care for prostate and breast cancer patients. This study investigates the impact of opening a new RT clinic on distance and road travel time to RT, and overall utilisation for prostate and breast cancer patients over a 3-year period in North Queensland (NQ), Australia. METHODS: The study used retrospective audit of two radiotherapy databases and a geographic information system to illustrate patient origins and distance to the RT clinic used over 3 years. Prostate and female breast cancer patients were selected from the radiation oncology databases of The Townsville Hospital (TTH) and Radiation Oncology Queensland (ROQ) Cairns between 1 July 2010 and 30 June 2013. Distance from a patient's home origin to the RT facility was mapped using a geographic information system (ArcGIS software), and travel time (minutes) and road distance (km) determined by Google Maps road directions. RESULTS: Overall number of prostate and breast cancer patients treated by RT in Cairns and Townsville clinics increased by 16% in 2011-2012 and by 29% in 2012-2013 from year 1 values. In 2010, 44% of the patients travelled 200-400 km to RT, which reduced to 21% in 2013. By 2013, with a second treatment facility, more than 70% of patients lived within 200 km of an RT facility (p<0.0001). Total median road travel time reduced annually from 201 minutes in 2010-2011 to 66 minutes in 2011-2012 and 56 minutes in 2012-2013 (p<0.0001), corresponding to a decrease in the median distance travelled to an RT facility. CONCLUSIONS: An additional RT facility in NQ has led to an increase in patients treated with RT for prostate and breast cancer and, on average, less travel distance and time to treatment, suggesting improvement in access to RT in NQ.

Regulated Medical Waste Reduction in the Dermatology Clinic.

INTRODUCTION: The disposal of regulated medical waste (RMW) in the healthcare setting can be both costly and environmentally harmful. Prior studies have found large amounts of waste disposed of in RMW containers are inappropriately placed. Few studies to date have investigated the efficacy of waste reduction practices in the dermatology setting. METHODS: This study aims to evaluate the effectiveness of a practice-wide intervention in reducing RMW in the outpatient dermatology setting. By performing daily waste audits and two concurrent educational interventions, the amount of RMW produced and percent of appropriately placed RMW will be measured. Further analysis will occur by comparing pre-intervention values to post-intervention values. RESULTS: The percentage of waste properly placed in RMW containers prior to any intervention was 11%. Following both educational interventions, the percentage of waste properly placed in RMW containers increased by 56.1% (CI 43.7-68.5%) and the percentage of total waste produced that was identified and disposed of as RMW decreased by 6.0% (95% CI 1.2-10.8%). CONCLUSION: Our study provides practical data for dermatology providers to make small changes which can result in significant reductions of regulated medical waste, potentially providing benefits to the environment and cost-savings.

Creutzfeldt-Jakob Disease Presenting as Stroke: A Case Report and Systematic Literature Review.

BACKGROUND: Creutzfeldt-Jacob disease (CJD) is a human prion disease generally characterized by subacute changes in behavior and intellectual function, often followed by ataxia, vision changes, and myoclonus. Ten percent of cases may present atypically, both symptomatically and in respect to initial investigations. METHODS: We report a case of CJD mimicking acute stroke and review all similar cases in the magnetic resonance imaging era reported in English, identified through a PubMed and SCOPUS search. RESULTS: A 68-year-old woman presented with an acute left parietal syndrome, initially referred as a left middle cerebral artery territory stroke. Structural imaging was unremarkable and focal electroencephalogram changes suggested nonconvulsive status epilepticus. Subsequent clinical progression, with the development of cortical high signal on diffusion-weighted imaging and positive 14-3-3 protein in the cerebrospinal fluid, confirmed a diagnosis of CJD. Review of the literature identified 14 further cases mimicking both anterior and posterior stroke syndromes. CONCLUSIONS: CJD develops primarily within a population in whom stroke risk factors are common and represents a rare but important stroke mimic. Negative vascular imaging in elderly patients with apparent acute stroke syndromes should prompt diagnostic review including consideration of prion diseases.