Infectious pulmonary tuberculosis in a New Zealand cancer centre.

This report details the investigation of oncology and haematology patients, as well as cancer centre staff, friends and family who were exposed to an oncology patient with reactivated pulmonary tuberculosis (TB) in a New Zealand cancer centre. A total of 46 patients, seven staff members and 14 family and friends were identified as being exposed to the index case of TB (Mr K). These people were screened for TB infection by the use of a symptom questionnaire, Qiagen QuantiFeron (QFT)® Gold Plus test and, if potentially immunocompromised, a chest x-ray (CXR). There were no confirmed secondary cases of TB in any of the groups screened for infection, but surveillance for signs and symptoms of TB disease in those with significant risk is ongoing. In this article we discuss the public health response to TB in a cancer centre and potential preventative strategies for the future.

Previous antibiotic-related adverse drug reactions do not reduce expectations for antibiotic treatment of upper respiratory tract infections.

BACKGROUND: Patients' expectations may influence prescribers' decisions about antibiotic prescribing for upper respiratory tract infection (URTI). We examined whether a history of an antibiotic related adverse drug reaction (aADR) influenced a person's perception about the safety of antibiotics or their expectation of receiving an antibiotic prescription for an URTI. METHODS: We developed a questionnaire and surveyed 103 hospital inpatients, 38 of whom (37%) reported past experience of aADR. RESULTS: Of the 88 participants who reported recent antibiotic use, participants with a history of aADR reported increased perception of harm from their last antibiotic treatment (P<0.05). Overall, 41/103 (40%) participants expected their doctors to prescribe antibiotics to treat an URTI. Participants' perceptions of antibiotic safety or expectation of antibiotic treatment for an URTI did not differ between those who had personal experience of an aADR compared with those with no history of aADR. CONCLUSIONS: The almost universal belief that antibiotics are safe, beneficial medications, even among people with prior aADR, helps to explain the strong patient expectations for antibiotic treatment in a range of conditions. Educational campaigns about the prescription of antibiotics for viral URTI should include information that the risk of harm far outweighs any potential benefits.

Oral and oropharyngeal cancer and the role of sexual behaviour: a systematic review.

OBJECTIVES: This systematic review identified and evaluated the evidence for the role of sexual behaviours in the development of oropharyngeal cancers (OPCs) and oral cavity cancers (OCCs). METHODS: Following the PRISMA guidelines, we identified observational and interventional studies reporting associations between several different sexual behaviours and OPC or OCC. Study quality was assessed independently by two reviewers using a validated scoring system. RESULTS: From 513 papers identified, 21, reporting on 20 studies, fulfilled the inclusion criteria. Two cohort studies were rated as moderate quality. The 18 case-control studies were rated as weak; nine comparing people with OPC or OCC to people without cancer, eight comparing HPV-positive to HPV-negative cancer patients and one comparing OPCs to other head and neck cancers. One study was a pooled analysis of seven of the included studies with some additional information. Twelve sexual behaviours were assessed and 69 associations reported. The studies differed in the comparisons made, the sexual behaviours assessed, and how these were reported and categorized, so no quantitative meta-analyses were appropriate. Most studies combined OPC and OCC. Several significantly increased risks were seen with a high number of lifetime sexual partners (nine studies) and with the practice of oral sex (five studies), although two studies found a significant negative association with OCC and ever performing oral sex. Two cohort studies of men and women in homosexual relationships found increases in oral cancer risk, and a cohort study of men married to women who had a history of cervical cancer also showed an increased risk of oral cancers. Results for other sexual behaviours were limited and inconsistent, and these included the following: younger age at first sexual intercourse, number of lifetime oral sex partners, the practice of oral-anal sex, the number of oral-anal sex partners, and ever performing anal sex. Only one study assessed casual sex, never or rare use of a condom and having a sexual partner with a history of genital warts, finding significant associations in the two former behaviours. CONCLUSION: The current evidence for sexual behaviours being risk factors for oral and oropharyngeal cancer is limited and inconsistent. Evidence suggests that the number of sexual partners and performing oral sex are associated with a greater risk. Furthermore men whose partners have had cervical cancer may have an increased risk. More studies looking at OPC specifically will be useful to determine whether these behaviours are subsite-selective.

Accreditation as an alternative to specialty recognition.

The Commission on Dental Accreditation does not currently accredit postdoctoral training in general anesthesia. This is related to the traditional linkage of accreditation of postdoctoral training programs to ADA specialty recognition. The aforementioned ADA Guidelines are important because they provide the foundation for the continued use of sedation and general anesthesia within dentistry. The one mechanism that would "ensure safety and effective use," maintain "a strong educational foundation," provide "access to adequate training ... develop programs at the postgraduate level" and support expansion of both basic and clinical research is CDA accreditation of postdoctoral programs. Prior to 1991, hen general anesthesia training was acquired by dentists primarily through accredited medical programs, there was little need for anything more than guidelines to protect the public. With the development of non-accredited dental anesthesiology programs in accredited dental schools (primarily in the late 1980's) and the loss of access to general anesthesia training in accredited medical anesthesiology residency programs in the summer of 1991, primary responsibility for all general anesthesia training of dentists shifted to organized dentistry. However, the ADA House declined to recognize dental anesthesiology as a dental specialty on three separate occasions even though the ADA Council on Dental Education felt all requirements were met and favorably recommended specialty recognition in all three instances. Specialty recognition would have provided the needed accreditation mechanism to validate dentistry's continued use of deep sedation and general anesthesia by those practitioners not classified as oral and maxillofacial surgeons. As an alternative to the specialty recognition process and in view of the need to accredit postdoctoral general anesthesia training for dentists, the American Society of Dentist Anesthesiologists has recently requested the CDA offer accreditation for these dental programs. To address this issue and those of other non-ADA-recognized disciplines, the CDA is currently in the initial stages of developing requirements for accrediting non-ADA recognized postdoctoral training programs. This material will be circulated to communities of interest for their input. Details of the process will be forthcoming from ADA sources in the near future.