Evolving progress in oncologic and operative outcomes for esophageal and junctional cancer : lessons from the experience of a high-volume center

Objective: Modern series from high-volume esophageal centers report an approximate 40% 5-year survival in patients treated with curative intent and postoperative mortality rates of less than 4%. An objective analysis of factors that underpin current benchmarks within high-volume centers has not been performed. Methods: Three time periods were studied, 1990 to 1998 (period 1), 1999 to 2003 (period 2), and 2004 to 2008 (period 3), in which 471, 254, and 342 patients, respectively, with esophageal cancer were treated with curative intent. All data were prospectively recorded, and staging, pathology, treatment, operative, and oncologic outcomes were compared. Results: Five-year disease-specific survival was 28%, 35%, and 44%, and in-hospital postoperative mortality was 6.7%, 4.4%, and 1.7% for periods 1 to 3, respectively (P < .001). Period 3, compared with periods 1 and 2, respectively, was associated with significantly (P < .001) more early tumors (17% vs 4% and 6%), higher nodal yields (median 22 vs 11 and 18), and a higher R0 rate in surgically treated patients (81% vs 73% and 75%). The use of multimodal therapy increased (P < .05) across time periods. By multivariate analysis, age, T stage, N stage, vascular invasion, R status, and time period were significantly (P < .0001) associated with outcome. Conclusions: Improved survival with localized esophageal cancer in the modern era may reflect an increase of early tumors and optimized staging. Important surgical and pathologic standards, including a higher R0 resection rate and nodal yields, and lower postoperative mortality, were also observed. Copyright © 2012 by The American Association for Thoracic Surgery.

A new procedure for using envelope analysis for rolling element bearing diagnostics in variable operating conditions

In the field of rolling element bearing diagnostics envelope analysis, and in particular the squared envelope spectrum, have gained in the last years a leading role among the different digital signal processing techniques. The original constraint of constant operating speed has been relaxed thanks to the combination of this technique with the computed order tracking, able to resample signals at constant angular increments. In this way, the field of application of squared envelope spectrum has been extended to cases in which small speed fluctuations occur, maintaining the effectiveness and efficiency that characterize this successful technique. However, the constraint on speed has to be removed completely, making envelope analysis suitable also for speed and load transients, to implement an algorithm valid for all the industrial application. In fact, in many applications, the coincidence of high bearing loads, and therefore high diagnostic capability, with acceleration-deceleration phases represents a further incentive in this direction. This paper is aimed at providing and testing a procedure for the application of envelope analysis to speed transients. The effect of load variation on the proposed technique will be also qualitatively addressed.

Practice & procedure : Personal Injuries Proceedings Act 2002

The decision of Atkinson J in Watkins v State of Queensland [2007] QSC 057 on an application for disclosure of documents under s27 of the Personal Injuries Proceedings Act 2002 (Qld) required determination of a range of issues relating to the disclosure of documents and legal professional privilege.

Practice & procedure : disclosure obligations - Personal Injuries Proceedings Act 2002 s27

In Huag v Jupiters Limited [2007] QCA 199 the Queensland Court of Appeal allowed an appeal from interlocutory orders made in the trial division of the court and concluded that, although provisions such as s27 of the Personal Injuries Proceedings Act 2002 (Qld) should be given a broad, remedial construction, this did not mean the words of limitation in the section could be ignored.

Practice & procedure : gratuitous services

In Carroll v Coomber [2006] QDC 146 the plainliff was injured in a motor vehicle accident on September 7, 2003. Liability was admitted and it remained to assess the plaintiff's damages. In light of the date of the accident, the damages were to be assessed under the Civil Liability Act 2003 (the act) and the Civil Liability Regulations.

Stop and revive? The effectiveness of nap and active rest breaks for reducing drivers sleepiness

The purpose of this study was to compare the effects of two commonly utilised sleepiness countermeasures: a nap break and an active rest break. The effects of the countermeasures were evaluated by physiological (EEG), subjective, and driving performance measures. Participants completed two hours of simulated driving, followed by a 15 minute nap break or a 15 minute active rest break then completed the final hour of simulated driving. The nap break reduced EEG and subjective sleepiness. The active rest break did not reduce EEG sleepiness, with sleepiness levels eventually increasing, and resulted in an immediate reduction of subjective sleepiness. No difference was found between the two breaks for the driving performance measure. The immediate reduction of subjective sleepiness after the active rest break could leave drivers with erroneous perceptions of their sleepiness, particularly with increases of physiological sleepiness after the break.

The effectiveness of information-sharing interventions as a means to reduce anxiety in families waiting for surgical patients undergoing an elective surgical procedure : a systematic review protocol

Review question/objective What are the most effective information sharing strategies used to reduce anxiety in families of patients undergoing elective surgery? This review seeks to synthesize the best available evidence in relation to the most effective information-sharing intervention to reduce anxiety for families waiting for patients undergoing an elective surgical procedure. The specific objectives are to review the effectiveness of evidence of interventions designed to reduce the anxiety of families waiting whilst their loved one undergoes a surgical intervention. A variety of interventions exist and include surgical nurse liaison services, intraoperative reporting either by face-to-face or telephone delivery, informational cards, visual information screens, and intraoperative paging devices for families. Inclusion criteria Types of participants All studies of family members over 18 years of age waiting for patients undergoing an elective surgical procedure will be included, including those waiting for both adult and paediatric patients. Studies of families waiting for other patient populations, eg emergency surgery, chemotherapy or intensive care patients will be excluded. Types of intervention(s)/phenomena of interest All information-sharing Interventions for families of patients undergoing an elective surgical procedure will be included, including but not limited to: surgical nurse liaison services, in-person intraoperative reporting, visual information screens, paging devices, informational cards and telephone delivery of intraoperative progress reports. Interventions that take place during the intraoperative phase of care only will be included in the review. Preadmission information sharing interventions will be excluded. Types of outcomes The outcomes of interest include: Primary outcome: the level of anxiety amongst family members or close relatives whilst waiting for patients undergoing surgery, as measured by a validated instrument (such as the S-Anxiety portion of the State-Trait Anxiety Inventory).4 Secondary outcomes: family satisfaction and other measurements that may be considered indicators of stress and anxiety, such as mean arterial pressure (MAP) and heart rate.

Practice and procedure - District Court Act 1967 s79 - transfer of proceeding pending in Magistrates Court to District Court

In Lambert v Surplice [2004] QDC 092 McGill DCJ considered the extent to which the court should exercise a discretion on an application under s79 of the District Court Act 1967 to transfer a proceeding pending in the Magistrates Court to the District Court.

Practice and procedure - Disclosure of documents - application of UCPR r222 to documents referred to in exhibit to affidavit

In Century Drilling Limited v Gerling Australia Insurance Company Pty Limited [2004] QSC 120 Holmes J considered the application of a number of significant rules impacting on the obligation to disclose under the Uniform Civil Procedure Rules 1999

Practice and procedure - Motor Accident Insurance Act 1994 s45 - duty of claimant to cooperate with insurer

In Suncorp Metway Insurance Limited v Brown [2004] QCA 325 the Queensland Court of Appeal considered the extent of the duty of cooperation imposed on a claimant under s45 of the Motor Accident Insurance Act 1994 (Qld). The issue is an important one because it affects virtually all claims made under the Act.

Practice and Procedure - Personal Injuries Proceedings Act 2002 - whether "urgent need" under s43 to start proceeding notwithstanding non-compliance with chapter 2 part 1

In Lamb v State of Queensland [2003] QDC 003 McGill DCJ considered an application under s43 of the Personal Injuries Proceedings Act 2002. That provision permits the court to give a claimant leave to start a proceeding notwithstanding non-compliance with part 1 of chapter two of the Act, "if the court is satisfied there is an urgent need to start the proceeding."

Practice and Procedure - Uniform Civil Procedure Rules 1999 r 212(2) - whether draft expert reports must be disclosed

In Mitchell Contractors Pty Ltd v Townsville-Thuringowa Water Supply Joint Board [2004] QSC 329, Douglas J considered the issue of broad significance for litigation practitioners of whether draft expert reports fall within the description in r212(2) of the Uniform Civil Procedure Rules 1999 (Qld) of documents "consisting of a statement or report of an expert" and are therefore not privileged from disclosure.

Practice and Procedure - offers to settle - no costs benefit if no compromise

In Jones v Millward [2005]QCA76 the Queensland Court of Appeal held that an offer to settle under the UCPR will not attract a costs benefit unless it involves some element of compromise

Right to trial by jury - construction of Uniform Civil Procedure r474

In Smit v Chan [2001] QSC 493 (Supreme Court of Queensland, S1233 of 1995, Mullins J, 21.12.2001) the sixth defendant successfully obtained an order that a complex medical negligence action be tried without a jury. This was the first application to be decided under r474 of UCPR 1999, and the decision is a significant precedent for defendants in similar cases who want to avoid the unpredictability of outcome and the inflated damages awards sometimes associated with jury trials.

Practice and procedure : solicitors' liens for costs

In Patterson v Cohen [2005] NSWSC 635 Hamilton J examined the authorities in relation to what are commonly called 'fruits of litigation' liens. The judgment provides a very useful summary of the principles which apply.