100% peer review in radiation oncology: is it feasible?

PURPOSE: Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. METHODS AND MATERIALS: Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. RESULTS: Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-training-physicians and one physicist. Median time per session was 38 (4-72) minutes. 59.5% of cases presented in 1-4 min, 32.4% in 5-9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). CONCLUSION: Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.

Reducing milking frequency in early lactation improved the energy status but reduced milk yield during the whole lactation of primiparous Holstein cows consuming a total mixed ration and pasture.

To investigate the immediate and long-term performance effects of milking frequency during early lactation of primiparous dairy cows consuming a total mixed ration and pasture, 20 Holstein cows were assigned in a randomized block design to either once-daily (1×) or twice-daily (2×) milking during the first 8 wk of lactation (treatment period). After the treatment period, all cows were milked 2× until wk 43 of lactation. Cows were fed a total mixed ration (approximately 15 kg of DM/cow per day) and allowed to graze an oat pasture (Avena sativa). Dry matter intake was 19.1 kg of DM/cow per day on average and was not affected by treatments. Milk yield was 40% lower in cows milked 1× during the treatment period, and a carryover effect existed until wk 21 of lactation, resulting in a final reduction of 15% of milk yield in the whole lactation. Milk lactose concentration decreased, whereas fat and protein concentrations increased for cows milked 1×. Mobilization of energy reserves during the treatment period occurred in both groups, but cows milked 1× showed greater body condition score and greater backfat thickness. In conclusion, milking 1× during the first 8 wk of lactation resulted in immediate and carryover negative effects on milk and milk solid yield without affecting feed intake, resulting in the improved energy status of primiparous dairy cows.

The functional and organoleptic characterization of a dairy-free dessert containing a novel probiotic food ingredient.

New eating habits and diversification of tastes of consumers have led to the scientific community and the food industry to expand the range of probiotic foods and novel probiotic ingredients. Scant information is available about the viability and functionality of probiotics during shelf life and its effect on the nutritional characteristics of dairy-free products. The aim of the study was to formulate a fermented dairy-free dessert using a novel food ingredient based on a pumpkin by-product and containing Lactobacillus casei (ATCC®393™) (NFI). The effect of NFI and the soluble solids (SS) of soy milk on the probiotic viability, physical stability, colour, and firmness of dairy-free dessert was studied using a response surface methodology. The different levels of SS and NFI significantly (p < 0.05) affected the response variables. Thereafter, two formulations were selected and the physico-chemical, nutritional and organoleptic characterization were evaluated. The L. casei count reached the desired therapeutic level (>107 UFC mL-1) after gastrointestinal digestion at 21 days of storage. In general, both the fermentation process and storage reduced (p < 0.05) the content of phytic acid, raffinose and stachyose, which implies a nutritional improvement of the final product. Scores above 5.0 on a 9-point scale were obtained for colour, odour, texture and overall acceptability in the consumer acceptance test. Therefore, a dairy-free dessert with good physical properties, suitable nutritional characteristics, and sensorial acceptability could be successfully formulated with the NFI.

Probiotic properties of native Lactobacillus spp. strains for dairy calves.

The use of native microorganisms with probiotic capacity is an alternative tool for the treatment and prevention of several diseases that affect animals, such as neonatal calf diarrhoea. The selection of probiotic strains within a collection is based on different in vitro and in vivo assays, which predict their potential. The aim of this study was to characterise a group of native Lactobacillus spp. strains isolated from faeces of healthy calves using an in vitro approach and to assess their ability to colonise the gastrointestinal tract (GIT) of calves. Native Lactobacillus spp. strains were evaluated on their capacity to survive low pH conditions and bile salts presence, biofilm formation and adhesion to both mucus and Caco-2 cells. Based on the in vitro characterisation, four strains (Lactobacillus johnsonii TP1.1, Lactobacillus reuteri TP1.3B, L. johnsonii TP1.6 and Lactobacillus amylovorus TP8.7) were selected to evaluate their capacity to colonise and persist in the GIT of calves. The assessment of enteric persistence involved an in vivo assay with oral administration of probiotics and quantification in faeces of the administered bacterial species with real-time quantitative PCR (qPCR). The study was conducted using 15 calves (1-month-old) which were divided into five groups of three animals, four of which were treated with four different selected strains and one was the control group. Strains TP1.3B and TP1.6 managed to persist in treated animals until ten days after the end of the administration period, indicating that they could be promising candidates for the design of probiotics for calves.

Reoperations after primary breast conserving surgery in women with invasive breast cancer in Catalonia, Spain: a retrospective study.

BACKGROUND: Although complete tumor resection is accepted as the best means to reduce recurrence, reoperations after lumpectomy are a common problem in breast cancer. The aim of this study was to assess the reoperation rates after primary breast conserving surgery in invasive breast cancer cases diagnosed in Catalonia, Spain, between 2005 and 2011 and to identify variations based on patient and tumour characteristics. METHODS: Women with invasive incident breast cancer identified from the Patient's Hospital Discharge Database [174.0-174.9 codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the primary diagnosis] and receiving primary breast conserving surgery were included in the study and were followed up to 3 and 12 months by collecting information about repeat breast cancer surgery. RESULTS: Reoperation rates after primary breast conserving surgery decreased from 13.0 % in 2005 to 11.7 % in 2011 at 3 months and from 14.2 % in 2005 to 12.9 % in 2011 at 12 months' follow-up. While breast conservation reoperations saw a slight, non-significant increase in the same period (from 5.7 to 7.3 % at 3 months, and from 6.0 to 7.5 % at 12 months), there was a significant decrease in radical reoperation (from 7.3 to 4.4 % at 3 months and from 8.2 to 5.4 % at 12 months). Overall, additional breast surgeries decreased among younger women. CONCLUSIONS: Despite the rise of breast conserving surgery, reoperation rates following initial lumpectomy in Catalonia decreased by 10 % at 3 and 12 months' follow-up, remaining low and almost unchanged. Ultimately, there was also a significant decrease in mastectomies.

Neuroparacoccidioidomycosis: case reports and review.

Cerebral and cerebellar masses occurred in patients with paracoccidioidomycosis. Correct diagnosis was delayed due to overlooking the abnormal lung roentgenograms and the history of previous disease in a different localization. The fungus was identified through biopsy and direct examination of the samples. In two patients necropsy confirmed the diagnosis. None of the patients responded to amphotericin B or cotrimoxazole. A 10 year English and Latin American literature review on neuroparacoccidioidomycosis was performed through a MEDLINE and LILACS (Latin American Literature Search System) data base systems.

The carriage of Escherichia coli resistant to antimicrobial agents by healthy children in Boston, in Caracas, Venezuela, and in Qin Pu, China.

BACKGROUND AND METHODS: The healthy members of a community represent its largest reservoir of bacteria resistant to antimicrobial agents. We compared the resistance to eight agents of Escherichia coli in stool samples from untreated, healthy children in cities on three continents. RESULTS: When screened by a selective method that detected 1 resistant colony in 10,000 colonies, nearly half the children in Boston (18 of 39) had no resistant colonies--a finding consistent with the findings of other surveys performed in developed countries. However, all but 1 of 41 children screened in Caracas, Venezuela, and all but 2 of 53 in Qin Pu, China, carried resistant strains. Only 1 child in Boston but 25 in Caracas and 34 in Qin Pu carried strains resistant to trimethoprim. None of the children in Boston or Caracas but 17 in Qin Pu carried strains resistant to gentamicin. Among 10 colonies selected randomly from each stool sample, the average frequency of resistance in Caracas was 3.6 times greater than in Boston, and that in Qin Pu was 5.3 times greater. There was resistance to five or more antimicrobial agents in 20 percent of the Qin Pu strains and in 6 percent of the Caracas strains but in none of the Boston strains. CONCLUSIONS: In addition to clinical isolates, as reported previously, the bacteria that colonize health children in the community may be resistant far more often in some regions than in others. A low rate of carriage of antimicrobial resistance in the community should become a public health goal.

[Intrahepatic cholestasis and thromboembolism disease due to oral contraceptives]. / Colestasis intrahepática y enfermedad tromboembólica por anticonceptivos orales.

PIP: The article reports on the case of a 30-year-old woman who had been on OC (oral contraception) for several years, who died in the space of 10 days for thrombosis of the superior longitudinal sinuses and of the uterine vasa, and on the case of a 26-year-old woman, also on OC, who suddenly developed cholestatic jaundice. The relationship between OC and hepatic or/and blood coagulation effects has been amply described in the literature, although the mechanism causing the problems are not yet well known. The authors insist on discontinuation of OC treatment at the first negative symptoms, and on careful examination of the clinical family history of patients before administration of OC.^ieng

[Incidence of hepatitis surface antigen among all the blood donors of the blood banks of the Venezuelan Institute of Social Security in the federal district]. / Incidencia del antígeno de superficie de la hepatitis sérica entre los donantes de los bancos de sangre del instituto venezolano de los seguros sociales, en el distrito federal.

The presence of H Bs-Ag was studied by means of counterimmunoelectrophoresis in the sera of 879 voluntary donors who gave blood between May and September 1974 at the federal District's blood banks of the Venezuelan Institute of Social Security. Eight hundred twenty-eight were male and fifty one female. Five sera samples were positive HBs-Ag which represents an incidence of 0.56%. A bibliographic review of the subject is made. The necessity of making mandatory the determination of HBs-Ag in all blood prior to transfusion is emphasized.