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Introduction: Diagnostic genomic sequencing is the emerging standard of care in nephrology. There is a growing need to scale up the implementation of genomic diagnostics nationally to improve patient outcomes., Methods: This pragmatic study provided genomic or genetic testing to patients with suspected monogenic kidney disease through a national network of kidney genetics clinics (KGCs). We sought to evaluate the experiences of implementing genomic diagnostics across Australia and associated diagnostic outcomes between 2013 and 2022., Results: We successfully established and expanded a nationwide network of 20 clinics as of 2022; concurrently developing laboratory, research, and education programs to scale the clinical application of genomics in nephrology. We report on an Australian cohort of 1506 kidney patients, of whom 1322 received their test results. We assessed barriers to implementation in the nephrology context, and where possible, applied real-time solutions to improve clinical processes over 10 years., Conclusion: Developing a multidisciplinary kidney genetics model across multiple health services nationally was highly successful. This model supported optimal care of individuals with monogenic kidney disease in an economically responsible way. It has continued to evolve with technological and service developments and is now set to scale further as genomic testing for kidney patients transitions to health care system funding., (© 2024 International Society of Nephrology. Published by Elsevier Inc.)

Background: Pathological margin assessment is an essential component of surgical management of oral cavity squamous cell carcinoma (OCSCC), however, in many studies, variable definitions of involved margins have been used. The purpose of the present study was to compare the prognostic ability of involved margins according to Royal College of Pathologists (RCPath) and College of American Pathologists (CAP) guidance., Methods: Retrospective study of 300 patients with previously untreated OCSCC undergoing definitive surgical management. Main specimen margin status was defined according to RCPath guidance and CAP guidance. "Final margin status", incorporated the results of frozen sections and extra tumour bed resections. The prognostic impact of each margin definition was studied using univariate analysis, and in multivariate models including T-stage (AJCC 8th edition), nodal status (pN+), extranodal extension (ENE), and use of adjuvant radiotherapy., Results: Both RCPath and CAP positive margins were associated with local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) on univariate analysis, while final margin status was associated with LR and DSS, but not OS. On multivariate analysis, only CAP positive main specimen margin status was independently associated with LR (odds ratio 2.44, 95% CI 1.37, 4.34), DSS (odds ratio 2.28, 95% CI 1.31, 3.82), and OS (odds ratio 1.59, 95% CI 1.04, 2.42)., Conclusions: Involved main specimen margin as defined by CAP guidance has the advantage of being an independent prognosticator of LR and survival in our cohort., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Two major changes to the staging of oral cavity squamous cell carcinoma (OCSCC) were adopted in TNM8: (1) depth of invasion is now used for T staging and (2) extranodal extension for N staging. The aim of this study was to evaluate if TNM8 stratifies OCSCC patients more accurately than TNM7 based on overall survival (OS) statistics and hazard discrimination., Methods: Retrospective study of 297 patients with OCSCC who underwent surgery at our institution. Clinical and pathological data were previously populated from review of medical charts and histological reports. Slides were re-reviewed for depth of invasion measurements. Patients were staged using both TNM7 and TNM8 with overall survival statistics analysed., Results: Overall 118 patients (39.7%) were upstaged using TNM8. Both TNM7 and TNM8 stage categories were highly significant for OS (all p values < 0.0001). Hazard discrimination analysis showed that TNM7 could only differentiate stage III from stage IV disease with significance (OS p = 0.01). In comparison TNM8 could distinguish between stage II and III disease (OS p = 0.047) and between stage III and IV disease (OS p = 0.004). Subsite analysis suggested that both editions of the staging system perform best for tongue primaries., Conclusions: Although TNM8 showed improved hazard discrimination in comparison to TNM7, problems with discriminative ability persisted with 8th edition staging criteria. Large scale validation studies will be required to direct future refinement of the staging rules and to establish if the continued use of a single staging system for all oral cavity subsites is appropriate., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: While positive surgical margins in oral squamous cell carcinoma (OSCC) is generally considered an adverse prognosticator, the significance of close (≤5 mm) margins is more debatable, and has not been widely adopted as an indicator for radiotherapy., Materials and Methods: Retrospective study of 244 patients undergoing primary surgical resection of OSCC. The impact on local control (LC), disease-specific survival (DSS) and overall survival (OS) of margins at 1 mm intervals was studied., Results: 65 patients had involved (<1 mm), 119 close (1-5 mm), and 60 clear (>5 mm) main specimen margins. Involved margins was predictive of DSS (p = 0.04), but not LC (p = 0.20) or OS (p = 0.09). Both the 2 mm and 3 mm margin cut-offs were significantly associated with LC (p = 0.02, and p = 0.01), DSS (p = 0.02, and p = 0.007), and OS (p = 0.03. and p = 0.005). In a 3-tier model, use of 3 mm for demarcation between close and clear yielded good separation between survival curves of clear (≥3 mm), and close (1-<3 mm) or involved (<1 mm). Final margins, determined after incorporation of frozen sections and extra margins taken separately, was significant for LC (p = 0.04), but not for DSS (p = 0.05) or OS (p = 0.17). On multivariate analysis, <3 mm margin, T-classification, nodal status, extranodal spread, and postoperative radiotherapy, were independent predictors of DSS and OS. For LC, only T-classification was significant., Conclusion: A 3 mm main specimen margin is significantly associated with survival in OSCC and may be useful for demarcation between close and clear. Further study is required to determine any impact on survival of radiotherapy for patients with <3 mm margins as sole indicator for radiotherapy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: This study sought to determine genetics and oncology specialists' views of integrating BRCA1 and BRCA2 testing in epithelial ovarian and breast cancer into routine practice., Methods: Qualitative interviews were designed using the Consolidated Framework for Implementation Research. Questions included experiences or views of the BRCA testing processes, implementation needs of oncology health professionals, perceived challenges, and future ideas for interventions to integrate genetic testing into oncology., Results: Twenty-two participants were interviewed from twelve health organizations and four themes were identified: (1) embracing the shift to mainstream genetic testing, with the majority of participants viewing BRCA testing as clinically useful and routine use important for maintaining a patient centered process; (2) the need for communication networks and role delineation to integrate routine genetic testing; (3) factors that influence sustaining routine genetic testing, including ongoing training, resources and funding, real-world adaptation, system complexity, and champions; and (4) variation in system interventions for integrating routine genetic testing align to organizational context., Conclusion: Findings illustrate the need for integrating genetic testing into routine oncology, and that adaptation of interventions and processes is essential to sustain a feasible model. An understanding of individual and organizational implementation factors will help to prepare for future integration of routine genetic testing in other cancers.

Background: Recent studies suggest that time of day affects survival from in-hospital cardiac arrest. Lower survival rates are observed during nights and on weekends, except in areas with consistent physician care, such as the Emergency Department. Since 1997, our hospital has utilized a standard, hospital-wide "Code Blue Team" (CBT) to respond to cardiac arrests at any time. This team is always led by an emergency physician, and includes specially trained nurses., Objective: To assess if time of day or week affects survival from in-hospital cardiac arrest when a trained, consistent, emergency physician-led CBT is implemented., Methods: This is an analysis of prospectively collected data on initial survival rates (return of spontaneous circulation >20 min) of all cardiac arrests that were managed by the CBT from 2000 to 2008. Cardiac arrests were also subcategorized based on initial cardiac rhythm. Survival rates were compared according to time of day or week., Results: A total of 1692 cardiac arrests were included. There was no significant difference in the overall rate of initial survival between day/evening vs. night hours (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.83-1.29), or between weekday vs. weekend hours (OR 1.10, 95% CI 0.85-1.38). This held true for all cardiac rhythms., Conclusion: At our institution, there is no significant difference in survival from cardiac arrest when a standardized "Code Blue Team" is utilized, regardless of the time of day or week., (Copyright © 2012. Published by Elsevier Inc.)

This study was undertaken to explore the prevalence of perceived dysphoria in a poor, urban, predominantly Puerto Rican community. A cross-sectional sample of 704 adult respondents were asked a single validated question, with a five-item Likert scale response, about their level of perceived dysphoria. Chi-squared analysis and Spearman's correlation coefficients were used to assess the association of level of dysphoria with social characteristics, barriers to health care, health status, and substance use. Linear regression modeling was used to control for confounding variables. Twenty percent of the respondents were dysphoric. Respondents with no health insurance or no source of health care were least likely to be dysphoric. Persons who perceived distance to the hospital and the doctor, and understanding language of the doctor and office staff as barriers to care were more likely to be dysphoric. Ethnicity was not correlated with level of perceived dysphoria; however, age, gender, and health status were found to be associated with level of dysphoria after controlling for other correlated variables. These results indicate that the psychological needs of communities need to be understood and interventions that are appropriate for the population need to be devised.

Parenteral nutrition support is the provision of essential nutrients intravenously, bypassing the intestinal tract. It is used in a variety of clinical settings and medical conditions. Parenteral nutrition is a complex technology that requires the input of many professionals, including dietitians. The role of the dietitian in parenteral nutrition support involves direct patient care, consultative services, education, program development, and research. Even though this field of practice is still developing, some common practices can be described. Nutrition assessment determination of macronutrient and micronutrient requirements, and monitoring are vital aspects of the provision of parenteral nutrition support that benefit from the knowledge and experience of a dietitian. The future of parenteral nutrition includes identification of preferred fuels for specific disease states, development of new lipid emulsions, and identification of conditionally essential nutrients.

Of 141 women with twin pregnancies, 72 were randomly assigned to outpatient care and 69 to hospital admission between 26 and 30 weeks' gestation. There were no differences between the groups in the frequencies of major maternal complications in pregnancy and labour but more of those admitted to hospital than of the outpatient group had to be admitted after 30 weeks. There were no differences between the groups in the mean birthweights of the twins by birth order, or in their mean gestation at birth whether analysed by intention to treat or by the treatment given. 22 infants were delivered before 32 weeks' gestation in the inpatient group compared with 10 in the outpatient group. With the exception of small-for-dates infants, any trend towards greater morbidity or mortality was seen in the inpatient group. The policy of routine hospital admission of women with twin pregnancies from 26 weeks' gestation is not beneficial to mother or babies and should be abandoned.

The relationship between patients' characteristics and dentists' perceptions as well as the associations between these dimensions and specific dentist behaviors as perceived by patients are explored. Dentist perceptions of patient sophistication and anxiety were related to several patient characteristics, but perceptions of patient likability were unrelated to patient personal and social characteristics. Perceptions of patient likability were associated with more specific dentist behaviors than were other dentist perceptions noted by patients. The results suggest that dentists' views are influenced primarily by those patient characteristics manifested during treatment. In general, dentists like patients who are dentally sophisticated and not anxious.

Almost 1,000 American dentists attending the 1982 Association annual meeting completed a self-administered questionnaire on sources of stress in dental practice. Most respondents identified dentistry as more stressful than other occupations. However, most believed that other dentists were under more stress than themselves. Dentists use a variety of ways to cope with their stress but a fourth report they do nothing. The stressors particularly noted included falling behind schedule, striving for technical perfection, causing pain or anxiety in patients, canceled or late appointments, and lack of cooperation from patients in the chair. However, all of the 25 listed stressors were endorsed by at least some dentists. Among the stressors lowest in the composite ratings included: isolation from fellow practitioners, competition, monotony, lack of acceptance by patients of the preferred treatment plan, and lack of appreciation. An exploratory factor analysis leads us to hypothesize six sources in dentists' stress: problems of patients' compliance, pain, and anxiety; interpersonal relations; the physical strain of work; economic pressures; third-party constraints; and the strain of perfectionism and seeking ideal results. As the well-being of the dentist and that of the staff and patients are dependent on successful management of occupational strains, this topic deserves more empirical study than it has so far received. We strongly suggest more studies dealing with stresses that occur daily in the immediate environment of office, waiting room, and operatory.

Our sample of 376 dentists in general practice provided a number of useful insights into the problems that dentists experience with their patients. For general problems of patient cooperation, the frequency of occurrence and annoyance to the dentist were related. High on the list in both categories were maintaining poor oral hygiene, missing or being late for appointments, and not paying bills. Not providing an accurate history ranked first in bother to the dentist but appears to occur infrequently. When specific chair problems were considered, an inverse relationship was found between frequency of occurrence and bother to the dentist. Showing fear was the most frequent behavior but ranked lowest in bother. Grabbing the dentist's hand ranked first in bother but last in frequency of occurrence. Some annoying patient behaviors, such as those that devalue, criticize, or question the dentist's performance, are attempts to cope with anxiety. Viewed in this fashion, the incidence of fear-related behaviors may be higher than actually perceived by dentists. Because such behaviors are likely to result in feelings of personal assault on the dentist's part, they are likely to have a deleterious effect on the dentist-patient relationship. Dentists who are able to avoid feeling threatened by patient hostility may be able to successfully resolve the potential conflict to the mutual benefit of both dentist and patient. The actual problems that dentists have with their patients have been neglected and need extensive research. Our study is a first attempt to outline the boundaries of this area. Even these descriptive findings point to crucial elements in dentist-patient relationships. We hope that our findings will lead to further research on the dentist in the dentist-patient equation as well as to practical means of coping with the problems that patients present.

This study relates perceived dentist behaviors to anxiety reduction in patients during treatment, and to satisfaction with the dental visit. The sample consisted of 250 adult patients, 110 men and 140 women, at two outpatient hospital dental clinics. Immediately after treatment, patients were asked to respond to a list of 25 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained by patients were self-ratings of anxiety during treatment and satisfaction measures from the DVSS. Ten behaviors were significantly associated with anxiety reduction. A stepwise multiple regression analysis with anxiety reduction as the dependent variable indicated that to the patient, the dentist's explicit dedication to prevent pain was the most important dentist behavior, with friendliness, working quickly, being calm, and giving moral support, being important auxiliary behaviors. Most of the 25 dentist behaviors studied were associated with patient satisfaction. A stepwise multiple regression analysis indicated that the dentist's empathy and communicativeness were among important correlates of patient satisfaction. An experimental approach to causal analysis of anxiety reducing behaviors needs to be studied.

A serum assay was performed on 605 women for pregnancy-specific beta 1-glycoprotein (SP-1) between 31 and 34 weeks' gestation. SP-1 was also estimated for 255 of these women between 15 and 20 weeks' gestation, coincidental with maternal serum alpha-fetoprotein (AFP) screening. A clinical classification of pregnancy outcome was constructed for ech group. SP-1 values at 31 to 34 weeks' gestation in pregnancies that resulted in the birth of a small-for-dates (SFD) infant were statistically different from those in normal pregnancies (p less than 0.001). A value of 100 mg per liter was chosen as a suitable discriminatory level at 31 to 34 weeks, below which SP-1 had a sensitivity of 64%, a predictive value of 24%, and defined a relative risk of 5.3 for SFD infants. These parameters compare favorably with published data on the use of human placental lactogen as a screening test. No statistical relationship was found between SP-1 values at 31 to 34 weeks and birth weight, placental weight, parity, or other abnormal pregnancy outcomes. SP-1 screening at 15 to 20 weeks' gestation showed no correlation with serum AFP or with other parameters studied.

Dentists participating in a health screening at the 1983 ADA annual session were asked to complete a brief questionnaire concerning their attitudes and methods of managing anxious patients. Most dentists see patient fear as an extremely important dimension of their practice and believe it to be the most important impediment to patient satisfaction. Behavioral methods such as "talking" appear to be the most frequently used methods of dealing with fearful patients. Finally, most dentists appear to learn their behavioral management methods through informal means.

This study relates perceived dentist behaviors to anxiety in patients during treatment and to satisfaction during the dental visit. The sample consisted of 231 adult patients, 107 men and 124 women, at a public hospital dental clinic. Immediately after treatment, patients were asked to respond to a list of 21 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained were ratings of anxiety by patients during treatment and measures from the DVSS. None of the dentist behaviors was related to anxiety in patients in a way that would suggest that dentist behavior either reduced or increased anxiety. DAS scores obtained before treatment were the best predictor of anxiety in patients during treatment. Most of the dentist behaviors were significantly related to satisfaction in patients. Stepwise multiple regression analyses using DVSS scores as criterion variables indicated that those variables contributing most to satisfaction in patients were indicative of dentist communication that was accepting and caring. Anxiety in patients during treatment also was an important negative predictor of satisfaction. The results indicate that the dentist behaviors explored in this study were associated with satisfaction in patients, but were not clearly related to anxiety reduction.

Dentists participating in a health screening at the 1984 annual session completed a brief questionnaire concerning patient turnover. In most dentists' opinions, patients more frequently leave a practice for reasons independent of the practice: they change residences and jobs. Patients' dissatisfaction with how they are treated, with the quality of care, and with pain and anxiety control also are believed to be among the factors "pushing" away patients. Lay referral is the major source of new patients, together with general community reputation and practice location.