Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines-A Multidisciplinary (SEMI-SEOM-SETH) Expert Consensus.

Despite the growing interest and improved knowledge about venous thromboembolism in cancer patients in the last years, there are still many unsolved issues. Due to the limitations of the available literature, evidence-based clinical practice guidelines are not able to give solid recommendations for challenging scenarios often present in the setting of cancer-associated thrombosis (CAT). A multidisciplinary expert panel from three scientific societies-Spanish Society of Internal Medicine (SEMI), Spanish Society of Medical Oncology (SEOM), and Spanish Society Thrombosis and Haemostasis (SETH)-agreed on 12 controversial questions regarding prevention and management of CAT, which were thoroughly reviewed to provide further guidance. The suggestions presented herein may facilitate clinical decisions in specific complex circumstances, until these can be made leaning on reliable scientific evidence.

Anatomical and functional impairment of the nerve fiber layer in patients with optic nerve head drusen.

OBJECTIVE: To evaluate anatomical and functional impairment of the retinal nerve fiber layer (RNFL) using optical coherence tomography (OCT) and automated perimetry in patients with optic nerve head drusen (ONHD). MATERIALS AND METHODS: Sixty-six eyes (66 patients) were studied with ONHD - confirmed by ultrasound B scan - and 70 eyes (70 subjects) of healthy control subjects. ONHD cases were categorised as visible or hidden. Average RNFL thickness and measurements in terms of the quadrants were analysed using both time-domain optical coherence tomography (TD-OCT) and spectral-domain optical coherence tomography (SD-OCT). Anatomical and visual field alteration of RNFL between visible and hidden ONHD and control groups were compared. RESULTS: Average RNFL thickness in ONHD patients was 94 µm (TD-OCT) and 88 µm (SD-OCT), and in controls 107 µm (TD-OCT) and 96 µm (SD-OCT), with statistically significant differences between both OCTs. All quadrants analysed showed significant differences except the temporal quadrant. The differences were not significant between hidden drusen and controls.Visual field examination in ONHD showed alterations in 56 %. Alterations were greater in visible drusen in relation to non-visible drusen, but there were no significant differences.The association between RNFL defects in superior, inferior and temporal quadrants and visual field defects showed a statistical relation with visible ONHD, but not in hidden ONHD. CONCLUSIONS: ONHD caused anatomical and functional damage of the RNFL, with a clear association between the alteration in ONHD and visual field defects in visible drusen cases.

Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system.

BACKGROUND: The usefulness of sputum culture in guiding microbiological diagnosis of community-acquired pneumonia is controversial. We evaluate and assess it using the Patients Outcome Research Team (PORT) predictive scoring system. METHODS: A cohort of 1669 patients with community-acquired pneumonia was studied. Before administering antibiotic therapy, sputum was collected and its quality evaluated. Samples were gram stained and those of good quality were assessed for a predominant morphotype (PM). Sputum cultures were processed according to standard protocols. RESULTS: A sputum sample was obtained from 983 (59%) of the 1669 patients and 532 (54%) of the samples were of good quality. There was a PM in 240 (45%) of the latter samples (ie, for 14.4% of the 1669 patients) and there was no PM in 292 (55%). Culture yielded a microorganism in 207 (86%) of the 240 samples with PM and 57 (19.5%) of the 292 samples without PM (P<.05). Rates of sputum obtained, good-quality sputum specimens, PM identification, and positive culture were not significantly different among the PORT-score groups of patients (P>.05). The sensitivity and specificity of the gram-positive diplococci identification in the sputum culture of Streptococcus pneumoniae were 60% and 97.6%, and the positive and negative predictive values were 91% and 85.3%, respectively. CONCLUSIONS: Good-quality sputum with PM could be obtained in only 14.4% of all patients. A PORT-score group in which sputum could be of greater usefulness in identifying the causative organism could not be identified. The presence of gram-positive diplococci in gram-stained sputum culture was highly specific for S pneumoniae.

Assessment of feasibility of workplace health promotion.

BACKGROUND: A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context. METHODS: The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability. RESULTS: The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities. CONCLUSION: The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.