Postgraduate medical journal
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Staging for non-small cell lung cancer (NSCLC) requires accurate assessment of the mediastinal lymph nodes which determines treatment and outcome. As radiological staging is limited by its specificity and sensitivity, it is necessary to sample the mediastinal nodes. Traditionally, mediastinoscopy has been used for evaluation of the mediastinum especially when radical treatment is contemplated, although conventional transbronchial needle aspiration (TBNA) has also been used in other situations for staging and diagnostic purposes. ⋯ EBUS-TBNA is more expensive than conventional TBNA but can save costs by reducing the number of more costly mediastinoscopies. Revenue based tariff systems have been slow to reflect the innovation of techniques such as EBUS-TBNA. In the future, endobronchial ultrasound may have applications in airways disease and pulmonary vascular disease.
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Multicenter Study
Does the timing of comorbidity affect colorectal cancer survival? A population based study.
Comorbid conditions in colorectal cancer patients can influence both clinical eligibility for treatment and survival. We aimed to evaluate the effect of comorbidity on 1 year survival from colorectal cancer, and to assess whether this effect varied with the timing of the comorbidity in relation to the cancer diagnosis. ⋯ Administrative data provide a good estimate of the prevalence of most comorbid conditions but may be biased for some comorbid conditions that can be contra-indicators for cancer treatment. The time window in which a comorbid condition occurs in relation to the cancer diagnosis should be taken into account. Adjustment should be carried out, where possible, to provide more robust and clinically appropriate comparisons of population based cancer patient survival.
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Following reports from the National Patient Safety Agency of deaths and serious harm from intercostal chest drains (ICD) we conducted a national survey among chest physicians of their experience of harm associated with ICD. ⋯ 67% of responding trusts had encountered major complications of ICD. The survey raised concerns about training and consent. The National Patient Safety Agency has made recommendations to address these risks which are also addressed in the 2009 update of the British Thoracic Society Pleural Disease Guideline.
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A number of dermatological conditions present with features of systemic inflammatory response syndrome (SIRS). This study evaluated the incidence and outcome of SIRS in patients with dermatological diseases. ⋯ The incidence of SIRS was low in dermatological diseases. In this cohort, CADR was the most common cause of SIRS. Patients who developed sepsis or MODS had a poor outcome.
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Type 2 diabetes is a major public health problem, accounting for significant premature mortality and morbidity. The growth in prevalence of the condition appears to be closely linked with obesity. ⋯ Vitamin D has important effects on insulin action, and may impact on a number of pathways which may be of importance in the development of type 2 diabetes. This article reviews the evidence linking Vitamin D deficiency in the pathogenesis of type 2 diabetes, and suggests areas for urgent further research to determine whether Vitamin D replacement has a role in the prevention of type 2 diabetes.