Nomograms are key decision-making tools in prostate cancer radiation therapy.

BACKGROUND: The use of nomograms for predicting clinical endpoints has been well documented. Nomograms provide an individualized prognosis and help clinicians determine the effectiveness of treatment for a given patient. Early identification of potential treatment failure or toxicity allows alternative approaches to be considered, reducing unnecessary treatment, morbidity, and cost. This review aims to evaluate clinical potential of nomogram use for the management of prostate cancer radiotherapy patients. METHODS: PubMed, Embase, and Scopus were searched for literature published between 2006 and 2016. The reported correlation between measured and nomogram-predicted probabilities of biochemical control, disease progression, survival and toxicity was reviewed, through an analysis of concordance indexes and areas under the curves. RESULTS: Sixteen studies were reviewed. Outcomes predicted by the nomogram were very close to outcomes measured (concordance index of 0.7 and above) in the majority. But a combination of under and overestimation of outcome was also reported. The predictive accuracy of nomograms was very variable, however, most nomograms had accuracy greater than chance, indicated by a concordance index higher than 0.5. CONCLUSION: Nomograms can be used as prognostic guides to aid clinical decision-making for prostate cancer patients until further research addresses the limitations presented in this review. Strict definitions of end points should be added to future models and perhaps models could be enhanced with the incorporation of genomic variables or tumor specific parameters.

An investigation into the knowledge and attitudes towards radon testing among residents in a high radon area.

The aim of this study was to investigate the knowledge and attitudes of residents in the Castleisland area to radon. Castleisland in Co. Kerry was described as a high radon area following the discovery of a house in the area with radon levels 245 times that of the national reference level. Residents in this area were then asked to measure their homes for radon in the Castleisland radon survey. The uptake of this measurement was 17%. In order to investigate this response rate further, a questionnaire was designed and distributed to residents in the Castleisland area. This questionnaire measured the testing history of the participants, the reasons for testing/not testing, the factors important to them when considering having their home tested, radon knowledge and finally intentions to measure their home for radon. It was found that the main reason people do not test their home for radon is that they believe their home does not have a problem. Optimistic bias was thought to play a role here. The subjective norm component of the theory of planned behaviour was found to have a significant independent contribution in the variation in intentions to measure one's home for radon and this in turn could be targeted to increase uptake of radon measurement in the future.

Oral cancer: knowledge, practices and opinions of dentists in Ireland.

PURPOSE OF THE STUDY: Early detection of oral cancer improves prognosis, but the malignancy is often detected at advanced stages, when more aggressive therapies, often with poor and devastating outcomes for the patient, are needed. Oral cancer can be detected by opportunistic screening of oral mucosa without need of sophisticated equipment. Dentists are important in primary and secondary prevention of oral cancer; therefore, assessing their knowledge, opinions and practices is crucial. MATERIALS AND METHODS: A questionnaire survey of dentists was conducted regarding knowledge of risk factors and diagnostic concepts of oral cancer, practices of primary and secondary prevention, and opinions of the effectiveness of formal undergraduate training for early detection and prevention of this disease. The survey explored dentists' potential training needs. RESULTS: Dentists appear to be generally knowledgeable regarding diagnostic concepts and risk factors. A total of 89% reported providing screening of intra- and extra-oral soft tissue to adult patients (18+) to exclude oral cancer. A total of 27% always provide tobacco use cessation counselling, and 12% provide alcohol moderation/cessation assistance. A total of 54% felt adequately trained to palpate the lymphatic nodes associated with oral cancer. Over half of dentists reported that their knowledge of and training on oral cancer was current; however, 74% reported lack of patient education materials regarding prevention and early detection of oral cancer. CONCLUSIONS: The survey findings suggest that dentists are underutilised in the prevention and early detection of oral cancer, and one of the barriers is lack of training. Dentists' knowledge and skills must be reinforced and systematically updated by continuing professional education. Greater emphasis should be placed on the fact that dentists have a larger role to play in the prevention and detection of this malignancy at its early, curable stages.

A national survey of telemedicine in the Republic of Ireland.

We conducted a national survey of hospitals in the Republic of Ireland to assess their use of telemedicine. Information was sought from 187 hospitals and replies were received from 157, a response rate of 84%. Activity was identified in a total of 40 hospitals (25% of the respondents). The main disciplines using telemedicine were radiology, pathology, neurosurgery, oncology and paediatrics, and the main applications were teleradiology (25 hospitals), videoconferencing (16) and telepathology (5). Dublin, the capital city, was found to act as a centre for telemedicine activity for the whole country. A number of regional networks had developed in the east, but the pattern of development in the west was very different where there were mainly isolated links. One fully operational national network was found but this was only used for consultation in one discipline (neurosurgery). It appears that the development of telemedicine in the Republic of Ireland has been unplanned. A national telemedicine strategy might lead to an integrated national network in the future, which could help to provide more equitable access to health care.