Seventy-two patients with a carcinoma of the head and neck, who were treated with surgery and postoperative irradiation, were reviewed to determine the local recurrence rates and survival in patients with inadequate surgical margins. Tumor recurrence rate was 31% for patients with microscopic tumors at resection margins and 50% for those with macroscopic tumor. Actuarial 3-year survival for these patients was 71% and 43%, respectively. All 4 patients who were irradiated later than 6 weeks after surgery developed recurrent malignancy despite the resection margins being free of tumor. Excluding these patients the 3-year survival for R0 patients was similar to that of R1 patients. It is concluded that postoperative irradiation is effective in patients with tumor at the surgical margins. It is suggested that the time interval between surgery and radiation therapy be limited to less than 6 weeks. Radiation dose prescriptions for various clinical situations are discussed.

The authors conducted a multivariate analysis of the prognostic factors in 96 patients with early glottic cancer treated by radiation therapy. Of these, 73 had T1 and 23 had T2 tumor. The primary tumor was controlled in 82% of T1 and 74% of T2 lesions. Actuarial five-year survival rates were 87% for T1 and 74% for T2. Carcinoma of the anterior commissure associated with bilateral vocal cord involvement, subglottic tumor extension, persistent or recurrent laryngeal edema, and impaired cord mobility was found to adversely influence the prognosis. The data suggest that irradiation is the treatment of choice for glottic cancer limited to the vocal cords or with minimal extension to the anterior commissure or supraglottic larynx.

Predicting whether a student will be successful on the National Council Licensure Examination for Registered Nurses (NCLEX-RN ® ) has been an important endeavor for faculty in schools of nursing for the past 2 decades. Extensive documentation exists in the literature concerning research aimed at exploring the academic and nonacademic predictors of success on the NCLEX-RN. Reviews of the findings of these studies indicate that various factors emerge as academic predictors of success. The results of this study suggest that first-time success on the NCLEX-RN can be predicted with a high level of accuracy using existing student data. The findings also support the belief that it is possible to identify students who may be at risk for unsuccessful first time performance on the NCLEX-RN. Early identification of at-risk students will promote timely intervention strategies to optimize the students' potential for success.

No abstract

No abstract

Protocol changes prompted by the Joint Commission mandating intravenous (IV) fluid bags to be used within 1 hour of spiking because of possible bacterial contamination have sparked clinical and economic concerns. This study investigated the degree of bacterial growth in which samples were obtained from spiked IV fluid bags at the time of spiking and 1, 2, 4, and 8 hours after spiking. No bacterial growth occurred in any of the 80 bags of Lactated Ringer's (LR) IV solutions sampled. This study demonstrated that LR IV bags do not support any bacterial growth for up to 8 hours after spiking.

\s=b\Data from 92 patients with stage III or IV squamous cell carcinoma of the head and neck treated with surgery and planned postoperative radiotherapy were analyzed to determine the incidence and patterns of tumor recurrence. Overall, recurrent tumor in the cervical region developed in 19 patients (21%). Of these, eight were in the neck alone and 11 in both the neck and the primary site. All recurrences were in the ipsilateral cervical region and none in the contralateral neck. The presence of two or more metastatic nodes at the time of surgery correlated with tumor recurrence and decreased survival. Extracapsular tumor spread increased the recurrence rate. Our data suggest that postoperative radiotherapy decreases ipsilateral cervical tumor recurrence in only those patients with more than two metastatic lymph nodes, and contralateral neck recurrence in all patients. (Arch Otolaryngol 1983;109:753-756) The extent of metastatic spread to cervical lymph nodes is an impor¬ tant prognostic indicator in patients with head and neck cancers. Studies correlating the clinical and pathologic characteristics of cervical lymph nodes have demonstrated that num¬ ber,1"4 position,3 and size of metastatic cervical lymph nodes5 and presence of extracapsular tumor spread6·7 ad¬ versely influence the treatment results. Combinations of surgery and preop¬ erative postoperative irradiation are used in attempts to improve the results obtained with only surgery or irradiation alone.810 Selected reports dealing with the use of preoperative irradiation and surgery in stages III and IV head and neck cancers indi¬ cated decreased cervical tumor recur¬ rence rates.3 8 However, errors in clini¬ cal staging of cervical node involve¬ ment,247 as well as a relative increase in postsurgical complications11 have led clinicians to favor the use of radi¬ ation therapy postoperatively. Anoth¬ er advantage attributed to postopera¬ tive irradiation over preoperative irradiation is the ability to identify patients at risk for tumor recurrence following the detailed study of surgi¬ cal specimens. Since 1976, we have adopted a policy of routinely using postoperative radiotherapy for patients with clinical stage III or IV squamous carcino¬ ma of head and neck sites. The ratio¬ nale for such a policy has been to decrease the tumor recurrence at the primary site and in the dissected and contralateral cervical regions. In this study, we assessed the effect of planned postoperative radiotherapy on the cervical tumor recurrence rate and drew conclusions providing guide¬ lines for future treatment protocols. METHODS Between 1976 and 1981, a total of 92 patients with resectable stage III or IV12 squamous carcinoma of the head and neck were treated with surgical resection and planned postoperative radiotherapy at the

No abstract