Annotation: Developing a national programme for VTE prevention

The National Venous Thromboembolism Prevention Programme was launched in England, in 2010. Its central objective was to reduce morbidity and mortality from preventable deep vein thrombosis and pulmonary embolism through introduction of a comprehensive systematic approach. The cornerstone of the programme was the introduction of mandatory documented risk assessment for venous thromboembolism, supported by national thromboprophylaxis guidance. Despite widespread uptake of risk assessment, measuring the impact of the national programme on outcomes has proved challenging. The aim of this paper is to review the implementation and outcomes of the national programme.     

Communication skills training for health care professionals improves the adult orthopaedic patient’s experience of quality of care

Rationale: Despite the fact that communication has become a core topic in health care, patients still experience the information provided as insufficient or incorrect and a lack of involvement. Objective: To investigate whether adult orthopaedic patients’ evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods: The study was designed as an intervention study offering professionals training in communicating with patients and colleagues. The outcome was measured by assessing patients’ experience of quality of care. Data were collected by means of a questionnaire and analysed using a linear regression model. Approval was obtained from the Danish Data Protection Agency. Results: A total of 3133 patients answered the questionnaire, 1279 before staff had attended courses and 1854 in the postcourse period, with response rates of 67.8 and 77.8%, respectively. After the course period, significant increases in responses indicating ‘considerable’ improvement were recorded for 15/19 questions, nonsignificant increases were registered for 3/19 questions and a statistically significant decrease for one question. Study limitations: This being an effectiveness study, it is deemed that the organizational changes taking place during the study period constitute no serious limitation. Response rates were comparable to those of other studies. Conclusion: Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications: We recommend that healthcare professionals are trained in patient‐centred communication and that training is extended to the entire organization.     

Baseline Serum 25-Hydroxyvitamin D Levels in Men Undergoing Radical Prostatectomy: Is There An Association With Adverse Pathologic Features?

Introduction/BackgroundThe purpose of this study was to evaluate the prevalence of vitamin D (VitD) deficiency in men undergoing radical prostatectomy and determine whether an association exists between preoperative VitD levels and adverse pathologic features.Patients and MethodsPatients scheduled to undergo radical prostatectomy for clinically localized disease from January to August 2012 were prospectively followed and those with available preoperative serum 25-hydroxyvitamin D levels were included. Men with a known diagnosis of VitD deficiency or taking VitD supplementation were excluded. Cox regression analysis was performed to determine whether preoperative VitD level is predictive of adverse pathologic outcomes.ResultsOne hundred consecutive men were included. Mean age was 62 (range, 42-79) years and mean VitD level was 26 (range, 6-57) ng/mL. Overall, 65 men (65%) had suboptimal levels of VitD (< 30 ng/mL), and 32 (32%) had deficiency (< 20 ng/mL). There was no significant correlation between VitD and age (P = .5). In logistic regression analysis, VitD level was not predictive of pathologic Gleason (P = .11), pathologic stage (P = .7), or positive margin status (P = .8).ConclusionThe association between VitD and prostate cancer has been controversial and data suggesting an increased risk of aggressive cancer in men with low levels of VitD have been inconsistent. We found that baseline preoperative VitD level was not associated with any adverse pathologic features. However, VitD deficiency is a common finding in this population, although unrelated to patient age. These results represent the first time the correlation between VitD and prostate cancer has been evaluated in a cohort of men undergoing radical prostatectomy.     

Cancer Core Europe: A consortium to address the cancer care – Cancer research continuum challenge

European cancer research for a transformative initiative by creating a consortium of six leading excellent comprehensive cancer centres that will work together to address the cancer care-cancer research continuum.Prerequisites for joint translational and clinical research programs are very demanding. These require the creation of a virtual single ‘e-hospital’ and a powerful translational platform, inter-compatible clinical molecular profiling laboratories with a robust underlying computational biology pipeline, standardised functional and molecular imaging, commonly agreed Standard Operating Procedures (SOPs) for liquid and tissue biopsy procurement, storage and processing, for molecular diagnostics, ‘omics’, functional genetics, immune-monitoring and other assessments. Importantly also it requires a culture of data collection and data storage that provides complete longitudinal data sets to allow for: effective data sharing and common database building, and to achieve a level of completeness of data that is required for conducting outcome research, taking into account our current understanding of cancers as communities of evolving clones. Cutting edge basic research and technology development serve as an important driving force for innovative translational and clinical studies. Given the excellent track records of the six participants in these areas, Cancer Core Europe will be able to support the full spectrum of research required to address the cancer research- cancer care continuum. Cancer Core Europe also constitutes a unique environment to train the next generation of talents in innovative translational and clinical oncology.     

不同体质指数对高热患者药物降温效果的影响

正人体正常腋温一般为36~37℃,当下丘脑体温调节中枢受致热源的刺激时,机体温度调定点水平将上移,从而导致产热增多,散热减少,当体温升高大于0.5℃即为发热[1-2],是临床患者常见症状。目前,针对发热患者常采用口服对乙酰氨基酚、布诺芬或阿司匹林等退热药物进行降温处理,其作用机制主要是通过抑制中枢神经系统前列腺素的合成,使外周血管扩张、皮肤血流增加、出汗,因而使散热增加,降温效果显