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The advent of computed tomography–based planning coupled with modern tools for target delineation and hypofractionated treatment schedules has increased efficiency and throughput for patients with breast cancer. While the benefit of adjuvant radiation therapy (RT) in reducing locoregional recurrences is established, disentangling local versus regional recurrence risks with modern treatment protocols has become an area of active research to de-escalate treatment. Delineation guidelines for nodal regions either attempt to replicate results of conventional RT techniques by translating bony landmarks to clinical target volumes or use landmarks based on the fact that lymphatic channels run along the vasculature. Because direct comparisons of both approaches are implausible, mapping studies of nodal recurrences have reported on the proportion of nodes included in these delineation guidelines, and larger, bony, landmark-based guidelines appear intuitively appealing for patients with unfavorable risk factors. A pooled analysis of these studies is reported here, along with literature supporting the exclusion of the true chest wall from postmastectomy/breast-conserving surgery clinical target volumes and the selective (versus routine) use of bolus during postmastectomy RT. The risk-adapted approach suggested here accounts for the risk of recurrence as well as toxicity and endorses nuanced target volume delineation rather than a one-size-fits-all approach. [ABSTRACT FROM AUTHOR]

Background: Accumulating data suggest blood biomarkers could inform stroke etiology.Objective: The purpose of this study was to investigate the performance of multiple blood biomarkers in elucidating stroke etiology with a focus on new-onset atrial fibrillation (AF) and cardioembolism.Methods: Between January and December 2017, information on clinical and laboratory parameters and stroke characteristics was prospectively collected from ischemic stroke patients recruited from the National University Hospital, Singapore. Multiple blood biomarkers (N-terminal pro-brain natriuretic peptide [NT-proBNP], d-dimer, S100β, neuron-specific enolase, vitamin D, cortisol, interleukin-6, insulin, uric acid, and albumin) were measured in plasma. These variables were compared with stroke etiology and the risk of new-onset AF and cardioembolism using multivariable regression methods.Results: Of the 515 ischemic stroke patients (mean age 61 years; 71% men), 44 (8.5%) were diagnosed with new-onset AF, and 75 (14.5%) had cardioembolism. The combination of 2 laboratory parameters (total cholesterol ≤169 mg/dL; triglycerides ≤44.5 mg/dL) and 3 biomarkers (NT-proBNP ≥294 pg/mL; S100β ≥64 pg/mL; cortisol ≥471 nmol/l) identified patients with new-onset AF (negative predictive value [NPV] 90%; positive predictive value [PPV] 73%; area under curve [AUC] 85%). The combination of 2 laboratory parameters (total cholesterol ≤169 mg/dL; triglycerides ≤44.5 mg/dL) and 2 biomarkers (NT-proBNP ≥507 pg/mL; S100β ≥65 pg/mL) identified those with cardioembolism (NPV 86%; PPV 78%; AUC 87%). Adding clinical predictors did not improve the performance of these models.Conclusion: Blood biomarkers could identify patients with increased likelihood of cardioembolism and direct the search for occult AF. [ABSTRACT FROM AUTHOR]

The development of underground spaces serves a range of common urban functions, including workspaces. However, underground workplaces, work-related factors and the indoor environmental quality (IEQ) parameters within them may negatively affect worker's mental health. This study assessed the prevalence of psychological distress with repeated measures over time in aboveground and underground workspaces, and assessed the association between perceived IEQ parameters and work-related factors with psychological distress. A total of 329 workers in similar aboveground and underground workspaces were followed-up in three assessments over 12 months in Singapore. Psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12) and defined as a GHQ-12 score ≥2. Perceived IEQ (air quality, temperature, noise, light) in the workplace were collected using the OFFICAIR questionnaire. We used generalised estimating equation models to assess the association between working underground, perceived IEQ, and work-related factors with psychological distress. The overall prevalence of psychological distress was 21.9%, 26.1% and 21.9%, at baseline, 3- and 12-months follow-up, respectively. The fully-adjusted multivariable analysis did not show any association between working underground and psychological distress, however, perceived IEQ parameters and longer working hours were significantly associated with psychological distress. Regardless of working in under or aboveground workplaces, perceived IEQ was associated with psychological distress. Future studies are needed in order to examine the relationship between objective measures of IEQ and psychological distress and the impact of healthy building policies and improved IEQ on psychological distress. • There was no association between working underground and psychological distress. • Perceived IEQ in the workplace was associated with psychological distress. • Stress at work and longer working hours were associated with psychological distress. [ABSTRACT FROM AUTHOR]

Context: One of the key outcomes of advance care planning is whether patients had received care that was consistent with their expressed goals and preferences.Objectives: The aims of this study were to illustrate the feasibility of using routinely collected health care data that include hospital procedural codes, diagnosis-related codes, health services utilization, and death registry data and to ascertain the level of concordance between care received and the stated goals.Methods: In this retrospective cohort study, medical treatments were ascertained using a combination of hospital procedural codes and diagnosis-related codes. Places of care were obtained by reviewing the sequence of health services used, and the place of death was obtained from the national death registry. To ascertain concordance, medical treatment, places of care, and place of death were compared against the individual's preferences.Results: The sample includes 1731 decedents (aged 21 years and above) who completed their advance care planning documentation as part of a national program. Ninety-eight percent who wished for comfort measures met their preferences. Sixty-five percent of individuals who wished to be cared for at home received care at home. Nearly 40% of all individuals who opted to die at home achieved their wishes, whereas 76% of those who opted for home or hospital and home or hospice had their preferences fulfilled.Conclusion: Administrative data offer a cost-efficient and powerful method for assessing outcomes for a large population-based national program. However, this approach is still at an early stage of development and needs to be further validated before it can be used at scale. [ABSTRACT FROM AUTHOR]

Purpose: Chronic wounds are a major public health challenge, but little is known about the true burden with studies reporting different estimates because of disparities in study designs and measurement methods. This hampers efficient resource allocation, planning, and improvement of wound care.Methods: Our study aimed to pool prevalence estimates from a global perspective by systematically carrying out searches in MEDLINE, EMBASE, Cochrane, CINAHL, Global Health, and PsycINFO databases for articles reporting the prevalence of chronic wounds in adults, from January 2000 to June 2018. The included publications had to define wound chronicity by duration (≥3 weeks), and/or labeling the wounds as chronic, complex, or hard-to-heal.Results: Seventeen studies met the inclusion criteria, and 11 studies analyzing chronic wounds in the general population were included in random effects meta-analyses to calculate pooled prevalence. Chronic wounds of mixed etiologies (n = 3) showed a pooled prevalence of 2.21 per 1000 population, and for chronic leg ulcers (n = 9), the prevalence was estimated at 1.51 per 1000 population.Conclusions: Our findings, aligned to previous studies reporting point prevalence of chronic wounds identified within the healthcare system, showed that the vast majority of chronic wounds in epidemiological studies are made up by chronic leg ulcers. [ABSTRACT FROM AUTHOR]

Abstract: The diagnostic utility of inducer and inhibitor based assays among 214 AmpC positive isolates of Pseudomonas aeruginosa were evaluated. Of different methods, combination of ceftazidime–imipenem antagonism and boronic acid inhibition tests came up with maximum sensitivity (76%) and specificity (100%). This combination showed reliability for both inducible and non-inducible AmpC producers. [Copyright &y& Elsevier]