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Local Protocol (local + protocol)
Selected AbstractsSurveillance of vision and ocular disorders in children with Down syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2007Elma Stephen MBBS MD MRCPCH Children with Down syndrome have a high prevalence of ocular disorders. The UK Down's Syndrome Medical Interest Group (DSMIG) guidelines for ophthalmic screening were locally implemented into a protocol that included neonatal eye examination by an opthalmologist and a comprehensive ophthalmological examination (cycloplegic refraction, ophthalmoscopy, and orthoptic assessement) by at least the age of 3 years, followed by preschool follow-up as indicated. We audited retrospectively surveillance for ocular disorders before and after the DSMIG-based guidelines were locally adopted in 1995. Results were compared for children born before and after the implementation of screening guidelines. A total of 81 children (43 females, 38 males) with Down syndrome were identified. After the DSMIG protocol, 34/36 children received a full ophthalmological examination in the neonatal period, compared with 9/27 children before 1995 (p<0.001). Neonatal screening resulted in the detection of cataracts in three infants. Mean age of first comprehensive ophthalmic screening outside the neonatal period was similar in the two groups (1y 6mo before guidelines vs 1y 9mo after), as were the proportion of children receiving preschool eye checks (27/30 before; 17/18 after). Overall, 65.7% children were screened in accordance with the guidelines, improving to 100% in recent years. At school age, 43% of the study population had significant refractive errors, with 27% having hypermetropia and astigmatism. Earlier prescription of glasses for refractive errors was seen (mean age 5y 6mo before guidelines; 3y 6mo after; p<0.001). Prevalence of other ocular disorders included strabismus (34/72, 47%), nasolacrimal duct obstruction (26/73, 35.6%), cataracts (5/64, 7.8%), and nystagmus (12/72, 16%). Establishment of the DSMIG-based local protocol has streamlined ocular surveillance. It is anticipated that this will improve developmental and functional outcomes in Down syndrome. [source] A novel approach to the intraoperative assessment of the uncinate margin of the pancreaticoduodenectomy specimenHPB, Issue 2 2007MAHMOUD A. KHALIFA Abstract Background. Currently, there is no consensus regarding the pancreaticoduodenectomy (PD) margins examined intraoperatively or the technical protocol for frozen section examination. The aim of this work was to summarize our experience regarding the intraoperative examination of the uncinate margin and to compare it with the published literature. Materials and methods. Our local protocol for the intraoperative assessment of the uncinate margin of the PD specimen is described in this article. A PubMed® search limited to English language publications using terms along the theme of pancreaticoduodenectomy and margin was performed. Retrieved articles were categorized according to whether they discussed frozen section margin examination. Results. Ten articles published between 1981 and 2005 were retrieved which discussed the intraoperative examination of PD specimens. Of the 10 articles, 5 discussed the intraoperative consultation for diagnostic purposes only, 2 discussed the consultation for both diagnostic purposes and assessment of margins, and 3 discussed intraoperative assessment of margins only. Of the total of five articles that discussed the intraoperative assessment of margins, none detailed the technical protocol for examining the uncinate margin. Discussion. Our proposed protocol for the intraoperative assessment of the uncinate margin of PD specimens allows for its accurate evaluation and has not been described previously in the English literature. [source] Malnutrition and neutropenia in children treated for Burkitt lymphoma in MalawiPEDIATRIC BLOOD & CANCER, Issue 1 2009Trijn Israëls MD Abstract Background Infection in neutropenic children is a major cause of morbidity and mortality in children treated for cancer. In developing countries, children with cancer are often malnourished at diagnosis. In Blantyre, Malawi, children with Burkitt lymphoma are treated with a local protocol with limited toxicity. The aim of this study was to evaluate the incidence and outcome of febrile neutropenia during this treatment and the association with malnutrition at diagnosis. Methods We documented nutritional status, febrile and/or neutropenic episodes, antibiotic therapy and short term outcome of all children with Burkitt lymphoma treated according to the local protocol and admitted from January 2007 to March 2008. Results Fifty eight (69%) of 84 patients were acutely malnourished at diagnosis with an arm muscle area (AMA) below the 5th percentile. Malnutrition at diagnosis was associated with a significantly higher rate of profound neutropenia. This association remained significant (OR 12; 95% C.I. 1.5 - infinitely; P,=,0.012) after control for clinical stage of disease, bone marrow involvement and HIV infection which are possible confounders. All patients with profound neutropenia, prolonged neutropenia and treatment related deaths were malnourished at diagnosis. Four (4.9%) of 81 patients died of treatment related causes; three of them due to a Gram negative septicaemia. Conclusion Acute malnutrition at diagnosis is associated with significantly more treatment related profound neutropenia. The intensity of chemotherapeutic regimens has to be adapted to the level of available supportive care and patients' nutritional status and tolerance to avoid unacceptable morbidity and mortality. This local treatment protocol for Burkitt lymphoma has a treatment related mortality of 5% in patients in Malawi. Pediatr Blood Cancer 2009;53:47,52. © 2009 Wiley-Liss, Inc. [source] The comparative diagnostic accuracy of conventional and liquid-based cytology in a colposcopic settingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2005T. Hussein Objective This study was conducted to compare the performance of liquid-based cytology (LBC) and conventional cytology (CS) in the high prevalence setting of colposcopy clinic. Design A split sample of matched ThinPrep (TP) and conventional smear from 563 patients were evaluated blindly. The performance of both techniques was compared with the gold standard of biopsy results or normal colposcopy examination in 441 cases. Setting Colposcopy clinic of an inner city hospital for women and children. Sample Five hundred and sixty-three women referred to colposcopy clinic over 14-month period. Methods Cervical smears were taken from 563 women referred for colposcopy. Using the split-sample technique, the material was spread on a conventional (CS) slide and the remaining material rinsed in a PreservCyt solution. A T2000 processor was used to prepare LBC preparations. All women underwent colposcopy/biopsy according to local protocol. Four hundred and forty-one women met the diagnostic standard criteria of the study, which was either a normal colposcopy or histopathology result. Sensitivity, specificity and positive and negative predictive values were calculated for both methods of cytology preparations. Main outcome measures Matched TP and conventional smears, detection of abnormality, matched biopsies, sensitivity, specificity, and positive and negative predictive values. Results Inadequate rates for CS and LBC (TP) were 4.3% and 0.68%, respectively. In 73% of cases, the CS and the LBC preparations showed exact agreement, whereas 77% agreement was seen when comparison was made for amalgamated low grade and high grade abnormalities. Low grade cytological abnormalities accounted for 44% of LBC slides versus 37% in CS slides. High grade cytological abnormalities accounted for 22% of LBC versus 17% seen in CS cases (P < 0.001). LBC showed increased sensitivity in the detection of CIN2 or worse than CS (92% and 83%, respectively) and CS showed greater specificity than LBC (82% and 76%, respectively). Conclusions In high prevalence setting, LBC performed at least as well as CS. The inadequate rate was significantly lower with LBC. The numbers are too small, however, to make confident comments about increased sensitivity and negative predictive value with LBC. Larger studies are required to verify these findings. [source] The BSCC Code of Practice , exfoliative cytopathology (excluding gynaecological cytopathology)CYTOPATHOLOGY, Issue 4 2009A. Chandra Exfoliative cytopathology (often referred to as non-gynaecological cytology) is an important part of the workload of all diagnostic pathology departments. It clearly has a role in the diagnosis of neoplastic disease but its role in establishing non-neoplastic diagnoses should also be recognised. Ancillary tests may be required to establish a definitive diagnosis. Clinical and scientific teamwork is essential to establish an effective cytology service and staffing levels should be sufficient to support preparation, prescreening, on-site adequacy assessment and reporting of samples as appropriate. Routine clinical audit and histology/cytology correlation should be in place as quality control of a cytology service. Cytology staff should be involved in multidisciplinary meetings and appropriate professional networks. Laboratories should have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd. Consultant pathologists should sign out the majority of exfoliative cytology cases. Where specimens are reported by experienced biomedical scientists (BMS), referred to as cytotechnologists outside the UK, this must only be when adequate training has been given and be defined in agreed written local protocols. An educational basis for formalising the role of the BMS in exfoliative cytopathology is provided by the Diploma of Expert Practice in Non-gynaecological Cytology offered by the Institute of Biomedical Science (IBMS). The reliability of cytological diagnoses is dependent on the quality of the specimen provided and the quality of the preparations produced. The laboratory should provide feedback and written guidance on specimen procurement. Specimen processing should be by appropriately trained, competent staff with appropriate quality control. Microscopic examination of preparations by BMS should be encouraged wherever possible. Specific guidance is provided on the clinical role, specimen procurement, preparation and suitable staining techniques for urine, sputum, semen, serous cavity effusion, cerebrospinal fluid, synovial fluid, cyst aspirates, endoscopic specimens, and skin and mucosal scrapes. [source] Reviewing child deaths,learning from the American experience,CHILD ABUSE REVIEW, Issue 2 2005Lisa Bunting Abstract Current systems for investigating child deaths in England, Wales and Northern Ireland have come under intense scrutiny in recent years and questions have been raised about the accuracy of child death investigations and resulting statistics. Research has highlighted the ways in which multidisciplinary input can contribute to investigative and review processes, a perspective which is further supported by recent UK policy developments. The experience of creating multidisciplinary child death review teams (CDRTs) in America highlights the potential benefits the introduction of a similar system might have. These benefits include improved multi-agency working and communication, more effective identification of suspicious cases, a decrease in inadequate death certification and a broader and more in-depth understanding of the causes of child deaths through the systematic collection and analysis of data. While a lack of funding, regional coordination and evaluation limit the impact of American CDRTs, the positive aspects of this process make it worthwhile, and timely, to consider how such a model might fit within our own context. Current policy developments such as the Home Office review of coroner services, the Children Bill and related Department for Education and Skills (DfES) work on developing screening groups demonstrate that strides have been made in respect of introducing a multidisciplinary process. Similarly, the development of local protocols for the investigation and[sol ]or review of child deaths in England, Wales and Northern Ireland highlights an increased focus on multidisciplinary processes. However, key issues from the American experience, such as the remit of CDRTs[sol ]screening panels, the need for national coordination and the importance of rigorous evaluation, can inform the development of a similar process in the UK. Copyright © 2005 John Wiley & Sons, Ltd. [source] The BSG/ACPGBI guidelines for colonoscopic screening: what are we missing?COLORECTAL DISEASE, Issue 7 2008A. Subramanian Abstract Introduction, Before publication of the British Society of Gastroenterology and Association of Coloproctology of Great Britain and Ireland guidelines in 2002, screening for people with a family history of colorectal cancer was sporadic and largely dependant on unvalidated local guidelines. Since 1990 we have been screening patients with both high and moderate risk family histories of colorectal cancer using local protocols which were more liberal than the new guidelines. In this study, we have analysed the pathology that would have been missed if we had been using the new guidelines in the period 1990,2002. Method, A total of 399 consecutive patients with a positive family history of colorectal malignancy underwent screening endoscopy according to local guidelines. Demographic, endoscopic and pathologic data were prospectively collected. Patients were retrospectively divided into those who would have been screened under the new guidelines (group 1) and those who would not (group 2). The recorded pathology was graded as significant or insignificant and the findings compared between the two groups. Results, A total of 399 patients underwent 557 endoscopies of which 278 (50%) were indicated under the new guidelines (group 1) and 279 (50%) were not indicated (group 2). A significant pathology or carcinoma was found in 15.8% of group 1 endoscopies and 10.0% of group 2 endoscopies. This difference was significant. Conclusion, If we had been using the new guidelines in the period 1990,2002, we would not have performed 279 (50%) of the 557 procedures, but would not have discovered significant pathology in 10% of the moderate risk endoscopies representing 39% of the significant pathology, which was actually present in this population. [source] | ||||||||||