Can smaller-scale comprehensive cancer centers provide outstanding care in abdominal and thoracic pediatric solid tumor surgery? Results of a 14-year retrospective single-center analysis.

PURPOSE: Quality of care and its measurement represent a considerable challenge for pediatric smaller-scale comprehensive cancer centers (pSSCC) providing surgical oncology services. It remains unclear whether center size and/or yearly case-flow numbers influence the quality of care, and therefore impact outcomes for this population of patients. PATIENTS AND METHODS: We performed a 14-year, retrospective, single-center analysis, assessing adherence to treatment protocols and surgical adverse events as quality indicators in abdominal and thoracic pediatric solid tumor surgery. RESULTS: Forty-eight patients, enrolled in a research-associated treatment protocol, underwent 51 cancer-oriented surgical procedures. All the protocols contain precise technical criteria, indications, and instructions for tumor surgery. Overall, compliance with such items was very high, with 997/1,035 items (95 %) meeting protocol requirements. There was no surgical mortality. Twenty-one patients (43 %) had one or more complications, for a total of 34 complications (66 % of procedures). Overall, 85 % of complications were grade 1 or 2 according to Clavien-Dindo classification requiring observation or minor medical treatment. Case-sample and outcome/effectiveness data were comparable to published series. Overall, our data suggest that even with the modest caseload of a pSSCC within a Swiss tertiary academic hospital, compliance with international standards can be very high, and the incidence of adverse events can be kept minimal. CONCLUSION: Open and objective data sharing, and discussion between pSSCCs, will ultimately benefit our patient populations. Our study is an initial step towards the enhancement of critical self-review and quality-of-care measurements in this setting.

"And the rich man also died; and he was buried in hell" : the social ethos in mendicant sermons

Doctoral dissertation, University of Tampere

Treatment strategies in primary vitreoretinal lymphoma: a 17-center European collaborative study.

IMPORTANCE: The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown. OBJECTIVE: To evaluate the outcomes of treatment regimens used for PVRL in the prevention of subsequent CNSL. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging data on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period. INTERVENTIONS: The term extensive treatment was used for various combinations of systemic and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy. MAIN OUTCOMES AND MEASURES: Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens. RESULTS: Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35% [95% CI, 50% to 86%]) than in patients without CNSL (68% [95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure. CONCLUSIONS AND RELEVANCE: In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.

Gestió de la informació d'interès d'un treballador autònom

L’objectiu principal d’aquest treball és fer un programa que permeti portar la informació que un treballador autònom li interessa, d’acord amb les seves necessitats. En el nostre cas es tracta d’un centre d’estètica, que té més d’una seu, el qual li interessa portar tota la cartilla de clients, centres associats, proveïdors ... a més de poder fer les factures corresponents als centres associats, poder calcular en el moment que en el treballador li interessi, els ingressos realitzats durant un període de temps determinat i poder portar una agenda actualitzada dels dos centres, on es mostren totes les visites que hi ha en un dia. Per tal de realitzar el programa, s’han portat a terme mitjançant dos aplicacions, i connectant-los en una base de dades. Per una banda tenim una aplicació implementada amb C++, per l’altra, una pàgina web amb PHP, finalment com a sistema gestor de base de dades utilitzem el MySQL Server. El programa fet amb C++, consta de tota la part d’entrada i/o modificacions de dades, en aquesta part només hi pot accedir el treballador autònom, ja que és la única persona que pot fer aquesta feina. En la pàgina web, hi pot accedir qualsevol persona que tingui un nom d’usuari i una contrasenya. A través de la web es pot fer qualsevol tipus de consulta, fer tot el control de les agendes, portar a terme tot el tema de facturació i ingressos, i com a excepció l’entrada de dades de clients, ja que s’ha de poder realitzar en qualsevol moment i lloc. Per acabar, tenim la necessitat de tenir un servidor, aquest ha d’estar format, mínim, per la base de dades. Com que l’aplicació amb C++ i la base de dades han d’estar ubicades al mateix lloc. A més, necessitem un servidor web per tal de tenir la nostra pàgina a la xarxa, per aconseguir això, utilitzem un programa anomenat DynDNS, que es fa servir per a convertir una IP dinàmica en una IP estàtica i d’aquesta manera convertir un ordinador qualsevol amb un servidor web.

Infrastructure Annual Status Report - DOT

Per legislative requirement, attached is the Iowa Department of Transportation’s summary of project status for infrastructure projects that have been appropriated revenue from various funds including Rebuild Iowa Infrastructure, Health Restricted Capitals, Bridge Safety, and Revenue Bonds Capitals. If you have any questions, please contact Stuart Anderson at 515-239-1661 or stuart.anderson@dot.iowa.gov.

Report on a review of the funding for construction of the Lewis and Clark Interpretive Center at Lewis and Clark State Park in Monona County for the period February 25, 1999 through December 31, 2008

Report on a review of the funding for construction of the Lewis and Clark Interpretive Center at Lewis and Clark State Park in Monona County for the period February 25, 1999 through December 31, 2008

Audit report on the City of Center Point, Iowa for the year ended June 30, 2009

Audit report on the City of Center Point, Iowa for the year ended June 30, 2009