Guidelines for treatment naming in radiation oncology.

Safety concerns may arise from a lack of standardization and ambiguity during the treatment planning and delivery process in radiation therapy. A standardized target and organ-at-risk naming convention in radiation therapy was developed by a task force comprised of several Radiation Oncology Societies. We present a nested-survey approach in a community setting to determine the methodology for radiation oncology departments to standardize their practice.

Improving medical personnel selection and appointment processes.

Purpose: This paper seeks to argue that processes for selecting and appointing medically qualified personnel in some healthcare organizations may be limited, especially those that emphasize qualifications rather than expanding the criteria to include practice scope, person-organization fit and capability to function within a healthcare team.

Design/methodology/approach: The paper is based on the authors' experiences and a literature review.

Findings: Selection based purely on academic merit, advanced clinical training, skills and professional achievements may not address other essential selection criteria.

Intern culture, internal resistance: uptake of peer review in two Australian hospital internship programs.

Objective: To compare the uptake of peer review among interns in mandatory and voluntary peer-review programs.

Population: All first and second year graduates (n=105) in two Australian hospitals.

Main Outcome Measures: Completion of peer review, and reported responses by doctors to peer review.

The changing role of liver biopsy in diagnosis and management of haemochromatosis.

Liver biopsy with histological examination of liver tissue was for many years the cornerstone of the diagnosis of haemochromatosis, allowing assessment of the degree of iron overload and examination of liver histology for the acute and chronic effects of iron overload. In the past two decades the role of liver biopsy in haemochromatosis has changed dramatically. Liver biopsy is rarely requested for two main reasons: (1) genetic testing for human haemochromatosis (HFE) mutations has proved to be very reliable in the diagnosis of haemochromatosis in Caucasian populations, and (2) the majority of patients with haemochromatosis are now diagnosed at an early stage well before permanent tissue damage occurs, so the need to assess tissue and organ damage has diminished.

Assessment of a peer review process among interns at an Australian hospital.

Purpose: This study considered how a peer review process could work in an Australian public hospital setting.

Method: Up to 229 medical personnel completed an online performance assessment of 52 Junior Medical Officers (JMOs) during the last quarter of 2008.

Results: Results indicated that the registrar was the most suitable person to assess interns, although other professionals, including interns themselves, were identified as capable of playing a role in a more holistic appraisal system.

The clinical relevance of compound heterozygosity for the C282Y and H63D substitutions in hemochromatosis.

Background & Aims: Two major mutations are defined within the hemochromatosis gene, HFE. Although the effects of the C282Y substitution have been well characterized, the clinical significance of the C282Y/H63D state remains unclear. This study assessed the phenotypic expression in C282Y/H63D subjects as compared with C282Y homozygotes.

Interferon-induced depressive illness in hep C patients responds to SSRI antidepressant treatments.

This paper examines the role of selective serotonin reuptake inhibitors (SSRIs) in the treatment of hepatitis-C virus (HCV) patients who have developed interferon-alpha induced depression. A 2-year data analysis of HCV psychiatric liaison clinic has been undertaken. The diagnosis, treatment, and progress of those patients who were treated with interferon-alpha (INF-alpha) are reported.

Private health insurance in developing countries.

A joint Wharton School-World Bank conference called attention to the high proportions of medical care spending paid out of pocket in most developing countries. One of the reasons for this, attendees said, is the problem in such economies of generating high tax revenues in a nondistortive way. Since people are paying out of pocket, they should be able to afford some private insurance that can spread the risk of above-average out-of-pocket payments.

Screening for hemochromatosis in asymptomatic subjects with or without a family history.

Background: Hemochromatosis in white subjects is mostly due to homozygosity for the common C282Y substitution in HFE. Although clinical symptoms are preventable by early detection of the genetic predisposition and prophylactic treatment, population screening is not currently advocated because of the discrepancy between the common mutation prevalence and apparently lower frequency of clinical disease. This study compared screening for hemochromatosis in subjects with or without a family history.

Autosomal dominant hereditary sensory neuropathy with chronic cough and gastro-oesophageal reflux: clinical features in two families linked to chromosome 3p22-p24.

Autosomal dominant hereditary sensory neuropathy (HSN I) is a clinically and genetically heterogeneous group of disorders, and in some families it is due to mutations in the serine palmitoyltransferase (SPTLC1) gene. We have characterized two families with HSN I associated with cough and gastro-oesophageal reflux (GOR). From a large Australian family, 27 individuals and from a smaller family, 11 individuals provided clinical information and blood for genetic analysis.

Probable ischemic colitis caused by pseudoephedrine with tramadol as a possible contributing factor.

Objective: To report a case of acute self-limiting ischemic colitis in a patient who was self-medicating with a proprietary over-the-counter oral decongestant containing pseudoephedrine.

Case Summary: A 46-year-old white man developed clinical, endoscopic, and histologic features of acute ischemic colitis after taking a proprietary oral decongestant containing pseudoephedrine 240 mg/day for one week. The total daily dose was at the upper limit of recommended doses for pseudoephedrine (as a single drug or in combination products).

Ultrastructural changes in hepatic sinusoidal endothelial cells acutely exposed to colloidal iron.

Hepatic sinusoidal endothelial cells form an important interface between the vascular system, represented by the sinusoids, and the space of Disse that surrounds the hepatocyte microvilli. This study aimed to assess the light microscopic and ultrastructural effects of acute exposure of hepatic sinusoidal endothelial cells to colloidal iron by injection of rats with iron polymaltose. Eight minutes after a single intravenous injection of iron polymaltose sinusoidal endothelial cells showed defenestration, and thickening and layering as assessed by transmission electron microscopy.

Acute pancreatitis associated with angiotensin II receptor antagonists.

Objective: To report a case of acute pancreatitis in a patient receiving a combination formulation of irbesartan and hydrochlorothiazide (HCTZ).

Case Summary: A 33-year-old white woman developed acute pancreatitis 10 days after starting irbesartan 300 mg and hydrochlorothiazide 12.5 mg for treatment of hypertension.

Unsaturated iron binding capacity and transferrin saturation are equally reliable in detection of HFE hemochromatosis.

Objective: Unsaturated iron binding capacity (UIBC) has been proposed as an inexpensive alternative to transferrin saturation for detection of hereditary hemochromatosis. The aim of this study was to compare, in a hospital referral clinic, the reliability of transferrin saturation and UIBC for detection of subjects who have inherited HFE (HLA-asociated iron overload) genotypes predisposing to iron overload.

Methods: Serum transferrin saturation, UIBC, and ferritin were tested in 110 consecutive subjects.

A molecular marker tightly linked to P, a gene required for flower and seedcoat color in common bean (Phaseolus vulgaris L.), contains the Ty3-gypsy retrotransposon Tpv3g.

In common bean (Phaseolus vulgaris L.), the expression of color in flower and seedcoat tissues requires the dominant allele of the P gene. The fully recessive p allele completely suppresses color expression in these tissues, whereas in specific genetic backgrounds, the p(gri) allele potentiates a grayish-white seedcoat and pale violet (nearly white) flowers with two violet dots on the banner petals.

Genetic testing for HFE hemochromatosis in Australia: the value of testing relatives of simple heterozygotes.

Background: It is unclear whether screening of relatives of C282Y and H63D heterozygotes (other than compound heterozygotes) for hemochromatosis will detect sufficient numbers of cases to justify introduction of this screening strategy.

Methods: Conditional probabilities were determined using published Australian allele frequencies and penetrance data to determine the detection rate of hemochromatosis by testing the siblings and offspring of heterozygotes (subjects with only one HFE mutation).

Results: The number of individuals who are at risk of developing increased body iron stores because of HFE mutations is substantially higher (1 in 80) than previously estimated.