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PubMed2006

[The practice guideline 'Carcinoma of the oral cavity and oropharynx'].

With a total incidence of ca. 800 per year, oral cavity or oropharyngeal carcinoma represents only a small fraction of the total number of cases of cancer in The Netherlands. In order to achieve as much nationwide uniformity as possible in its diagnosis, treatment, after-care and follow-up, a practice guideline has now been developed. The diagnosis of the primary tumour and the neck, careful clinical examination is complemented by echography, often combined with a biopsy, MRI and CT, while technetium scintigraphy in combination with an orthopantomogram is used to detect invasion of the mandible. The smaller oropharyngeal carcinomas (T1 and T2), surgery and radiotherapy (external therapy or brachytherapy) are equally useful, but for the larger carcinomas (T3 and T4) in patients in good general condition, surgery in combination with radiotherapy is preferred. When radiotherapy is chosen, then brachytherapy is preferred for the smaller tumours of the tongue and the floor of the mouth. In patients without demonstrable metastases to the lymph nodes, just as in the case oforopharyngeal carcinomas, the decision whether or not to treat the neck depends on the chances that cervical lymph node metastases are present: when the risk is smaller than 20% (as with smaller tumours), then a wait-and-see policy is justified, but if the risk is greater than 20% (as with larger tumours or very thick rumours), then the neck should be treated, either surgically or by radiotherapy. The practice guideline also contains information regarding decision making, information and communication, palliative therapy and symptomatic treatment, psychosocial assistance, prosthetic reconstruction, physiotherapy, oral hygiene, nutrition and dietetics, swallowing and speech rehabilitation, and the policy with regard to smoking and alcohol consumption.

Brachytherapy↗
PubMed1990

Influence techniques and activities clinical dietitians use when interacting with physicians.

A national survey was conducted to identify and differentiate influence techniques clinical dietitians use when interacting with physicians, to ascertain which of selected demographic variables explain variations in influence techniques used, and to identify and differentiate activities clinical dietitians perform. A three-part (influence, demographic, activity) questionnaire was developed and mailed to 600 randomly selected members of the Nutrition Support dietetic practice group. Usable responses were received from 458 dietitians, yielding a response rate of 77%. Factor analysis revealed that respondents assumed five of six possible postures of influence techniques (block/threaten, ingratiation, coalition, assertiveness, and transitional rationality) and three of four possible postures of activity (diet oriented, physician oriented, and case oriented). Multivariate analysis showed use of ingratiation techniques related inversely to age and education of practitioners, use of assertiveness techniques related inversely to age, and use of transitional rationality techniques related positively to age and education combined. The survey indicates that somewhat of a paradox exists among clinical dietitians; i.e., even though the percentage of selected practitioners performing high-level case-oriented activities has apparently declined since 1982, a critical number perceive themselves to be acculturating toward the sixth and highest influence (convincing rationality) and the highest activity (diagnosis and research orientation unique to dietetics) postures to be attained.

Adult↗
PubMedDate not supplied

[Use of dietetic canned meats in the nutrition of infants with food allergy].

Formulas have been developed for special canned pig meat "Pig meat puree" and "Cheburashka" and horse meat "Konek-gorbunok", and a combination of pig and horse meat "Vinni Pukh", without extractives. The above canned meat produced a high therapeutic effect when it was included into the diet of infants suffering from food allergy because of sensitization to cow milk and beef proteins. The canned meat permits correcting the ration by protein component and providing 25-30% of daily protein requirement of an infant.

Food Hypersensitivity↗