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Breaking bad news in cancer : an assessment of Maltese patients’ preferences

Fri, 01 Dec 2017 00:00:00 GMT

Title: Breaking bad news in cancer : an assessment of Maltese patients’ preferences Authors: Azzopardi, Joelle; Gauci, Dorothy; Parker, Patricia A.; Calleja, Neville; Sloan, Jeff A.; Zammit, Raymond Abstract: Purpose: It is unclear whether Maltese cancer patients wish to know their diagnosis or to what extent they want to be informed. The aim was to assess patients’ preferences for receiving a cancer diagnosis and being involved in the decision-making process, and then compare these with results from similar international studies. Methods: Two hundred fifty-two Maltese adult cancer patients were invited to complete two standardised tools: the Measure of Patients’ Perspective (MPP), assessing patients’ preferences for receiving news about their cancer, and the Control Preferences Scale (CPS), examining involvement in decision-making. Results: Maltese patients rated the ‘content’ subscale (information given; mean 4.17, SD 0.59) as significantly more important (p<0.001) than ‘support’ (offering comfort/support; mean 3.73, SD 0.68) and ‘facilitation’ (how information is given; mean 3.86, SD 0.68). Patients with higher levels of education had significantly higher scores for ‘content’ (p=0.018) and ‘facilitation’ (p<0.001) on the MPP, while lower education levels preferred a passive role (p=0.01) on the CPS. Although there is a trend towards a collaborative and even an active role in treatment decisions, patients still exhibit a paternalistic attitude towards their physician. Age, gender and medical variables had no significant influence on response. Conclusions: Maltese cancer patients want to be informed of their cancer diagnosis, its treatment and prognosis, similar to other international studies. However, 60% of Maltese patients prefer a more paternalistic approach towards their physician when compared to other studies.

Catheter ablation in atrial fibrillation : a burning issue

Fri, 01 Dec 2017 00:00:00 GMT

Title: Catheter ablation in atrial fibrillation : a burning issue Authors: Meilak, Samuel; Aquilina, Oscar Abstract: Catheter ablation has, over the recent years, become central to the management of atrial fibrillation. As the latest studies consistently demonstrate it safety and increasing efficacy, AF ablation is being performed in many centres worldwide, with a Class IA recommendation in those with recurrent symptomatic AF despite medical therapy. Concomitantly, continuous technological advances accompany the development on new electrophysiological techniques. In this review, the authors seek to address the need among the local medical community of more in-depth knowledge of the technique and its indications, especially in view of the recent introduction of such service at our national hospital.

A local perspective on basal cell carcinoma : frequency of subsequent skin tumours

Fri, 01 Dec 2017 00:00:00 GMT

Title: A local perspective on basal cell carcinoma : frequency of subsequent skin tumours Authors: Gauci, Jessica; Muscat, Gordon; Aquilina, Susan Abstract: Background: Basal cell carcinoma (BCC) is the commonest skin malignancy with a significant risk of recurrence and new primaries. The major risk factor is ultraviolet (UV) radiation, which is relevant to Malta, where the UV index is high for most of the year. Objective: The aim of this study was to follow up a group of patients diagnosed with BCC and analyse the occurrence of subsequent malignant and pre-malignant skin tumours, to obtain a local perspective and aid screening methods and follow-up protocols. Method: All patients registered with BCC in the Malta National Cancer Registry in 2007 were included in our study. This cohort was followed up by searching for histology results showing subsequent skin tumours until the end of 2014. Results: A total of 382 patients were diagnosed with BCC in 2007. The majority of patients were males older than 60. Almost one third of these patients (30.1%) had at least another skin tumour biopsied on follow up; 71.7% of these tumours were BCCs. Squamous cell carcinomas and actinic keratoses were also commonly biopsied. Nine patients developed malignant melanoma. The commonest location for BCCs and other non-melanoma skin tumours was the face. Males and the elderly had significantly higher risks to develop further skin tumours, reflected by the Chi^2 test for Independence and hazard ratios. Conclusion: Our results are consistent with most international data. Since BCC fulfils most criteria for screening, regular follow-up in high risk patients is recommended.

Recreational drug use and the emerging challenges of psychoactive substances in Malta : a case series

Fri, 01 Dec 2017 00:00:00 GMT

Title: Recreational drug use and the emerging challenges of psychoactive substances in Malta : a case series Authors: Bonnici, Jeffrey; Coulson, James; Gauci, Dorothy Abstract: Introduction: Recreational drug-related hospital admissions, excluding alcohol, appeared to be relatively constant in Mater Dei Hospital (MDH), Malta’s sole public, acute general hospital. While ‘classical’ recreational drugs such as cocaine, heroin and Methylenedioxymethamphetamine (MDMA) were always seen as the main culprits, intoxications secondary to novel psychoactive substances (NPS) have recently emerged in MDH. The aim of this study was to determine the challenges of recreational drug intoxication, including NPS, in MDH. Methods: All the MDH admissions secondary to recreational drug intoxication between 2010 and 2015 were investigated. MDH clinical performance unit (CPU), hospital data files, hospital discharge letters and the hospital database software system were utilised for data collection. Intoxications associated with self-harm, trauma and lone alcohol ingestions were excluded. Results: 286 patients were admitted to MDH with recreational drug intoxication between 2010-2015, with a peak of 71 patients in 2015. 78.3% were males and the median age was 26 years. While 79% of the admissions were Maltese nationals, there was a surge in foreigner admissions, from 11.8% between 2010-2012 to 28.3% between 2013-2015 (p<0.001). Admissions occurred mostly in spring and summer, on Saturday or Sunday, and at night. 52.4% of admissions were acutely confused. Ethanol co-ingestion (40.9%) and polydrug use (39.9%) were common in these admissions. 16% needed admission to critical care. 91.3% admissions were secondary to ‘Classical’ recreational drugs, mostly heroin and cocaine. In 2015, 36.6% of admissions were secondary to NPS, mostly synthetic cannabinoids (SCRA). SCRA admissions were associated with severe sympathomimetic and neuropsychiatric features. An SCRA toxidrome mnemonic (MEET_SCRA) is proposed from the most common features of lone intoxications. Conclusion: Recreational drugs were associated with significant hospital burden, with NPS representing a new threat to MDH and Maltese public health. The toxidrome mnemonic MEET_SCRA could potentially aid in the identification of SCRA intoxications.