Multimodality imaging of the gastrointestinal manifestations of scleroderma.

Scleroderma is a complex multisystem connective tissue disorder. Early visceral disease, such as gastrointestinal (GI) involvement, is associated with significant morbidity and a poorer prognosis. Prompt diagnosis is crucial to allow disease modifying therapies be initiated early in the course of the disease. The primary underlying pathophysiology in the GI tract is dysmotility, muscular atrophy, and fibrosis, and this is reflected in the imaging features. In this paper, we demonstrate the imaging appearances of involvement of the GI tract and describe the use of advanced imaging with magnetic resonance enterography (MRE). A multimodal imaging approach is required to identify both characteristic features of scleroderma and potential complications. Traditional fluoroscopic contrast (barium) studies are still commonly performed for assessment of the oesophagus. More recent advances in cross-sectional imaging allow for thorough three-dimensional assessment of the entire GI tract. MRE is particularly useful for small bowel evaluation while also allowing "pseudodynamic" functional imaging and concomitant assessment of the other abdominal viscera and structures.

An audit of empiric antibiotic choice in the inpatient management of community-acquired pneumonia.

Adherence to antimicrobial guidelines for empiric antibiotic prescribing in community-acquired pneumonia (CAP) has been reported to be worryingly low. We conducted a review of empiric antibiotic prescribing for sixty consecutive adult patients admitted to the Mercy University Hospital with a diagnosis of CAP. When analysed against local antimicrobial guidelines, guideline concordant empiric antibiotics were given in only 48% of cases, lower than the average rate in comparable studies. Concordance was 100% in cases where the CURB-65 pneumonia severity assessment score, on which the guidelines are based, was documented in the medical notes. The use of excessively broad spectrum and inappropriate antibiotics is a notable problem. This study supports the theory that lack of knowledge regarding pneumonia severity assessment tools and unfamiliarity with therapeutic guidelines are key barriers to guideline adherence, which remains a significant problem despite increased focus on antimicrobial stewardship programs in Ireland.

Contrast harmonic ultrasound of spontaneous liver nodules in 32 dogs.

Thirty-two dogs with spontaneous hepatic nodules were given intravenous ultrasound contrast medium (Definity or Sonovue) and imaged with contrast harmonic software on a conventional ultrasound machine system. Digital video images were initially reviewed to describe the perfusion pattern of malignant nodules. The images were reviewed again to test this pattern against all individual nodules. Subjectively, there was improved conspicuity of malignant nodules after contrast enhancement compared with conventional imaging and increased numbers of malignant nodules were often noted. There was decreased conspicuity of benign nodules and no additional nodules were seen after contrast enhancement. There was a highly significant (P < 0.0001) association of malignancy with a hypoechoic nodule at surrounding normal liver peak contrast enhancement. Benign nodules were isoechoic to the surrounding normal liver at peak contrast enhancement. Only one benign nodule (hepatoma) had regions of hypoechogenicity compared with the surrounding normal liver at peak liver contrast enhancement. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were highly significant (P < 0.0001) (100%, 94.1%, 93.8%, 100%, and 96.9%, respectively). No complications or morbidity was noted throughout the course of the study. Contrast harmonic ultrasound appears to be accurate at discriminating between naturally occurring benign and malignant nodules in the liver of dogs.

Practices and attitudes towards quality assurance, inspection and accreditation in blood collection establishments in the European community.

In the framework of a European Community (EC)-supported project, a survey of practices and attitudes towards quality assurance, inspection and accreditation in Blood Collection Establishments (BCEs) in the EC member states was carried out. Analysis of 352 responses to a structured questionnaire revealed a preference for national standards over international, and an introspective and reactive view to quality management. Four broad categories of operational performance in relation to safety were formed: initial, repeatable, managed and optimising, with the majority of responses (209) being characterized as initial. Although a direct relationship between the size of the BCE and the range and level of quality management practices is apparent in the data, further analysis shows that small BCEs have much higher ratio of personnel per blood unit collected/processed than large BCEs and thus seem to have an inherent potential for improvement. Overall, a clear preference for inspection and accreditation by professional peers at the national level was indicated.

Nursing and health promotion: conceptual concerns.

The importance of health promotion to nursing is now well established. However, different interpretations of health promotion exist. It is argued that many allegations of nursing's inadequacy in this field are misplaced and to a large extent result from the confused and variable ways in which the term health promotion is used. Concepts of health promotion in general are considered and compared with usage of the term in nursing literature. The contribution of nursing to health promotion and health education is discussed and some curricular issues are raised.

Use of a modified Delphi technique to guide coordination of cancer education in Texas medical schools.

Delphi technique is a method of structuring group communication and is useful in achieving consensus on goals, plans, or positions. The Delphi technique was used to determine a course of action to enhance cancer education at each of eight medical schools in Texas. Participants in this study were deans of medicine and a faculty member considered to be the lead cancer expert in the curriculum. A three-generation Delphi study was conducted with the deans using a telephone interview, a personal interview, and a conference of participants, including cancer experts. The Delphi technique was found to be an effective approach for increasing awareness of the statewide cancer plan, for involving all medical schools in achieving the goals of the plan, and for identifying means for enhancing cancer education at each medical school. A consensus was reached to develop a statewide standardized assessment of graduating medical students' knowledge about principles of cancer prevention and screening. The results could serve as a means of determining cancer education needs at each medical school.

The effect of thymosin on patients with disseminated malignancies. A phase I study.

A Phase I clinical trial of thymosin administered in doses of 10 to 250 mg/M2 intramuscularly for seven days was undertaken in ten patients with disseminated malignancies and evidence of immunoincompetence. Toxicity was minimal; one patient experienced a mild urticarial rash which cleared spontaneously, two patients developed low grade fever and one patient experienced pain at the injection site. There was no evidence of systemic toxicity or parenchymal organ dysfunction. Thymosin administration was associated with an increase in the E-rosette forming capacity of the patient's lymphocytes and the development of new skin test reactivity to recall antigens in some of these patients. One objective tumor response was noted. These findings are preliminary but are encouraging for further utilization of thymosin as an immunostimulant in cancer patients with immunoincompetence.

Splenectomy, chemotherapy, and survival in Hodgkin disease.

The question was raised whether routine splenectomy might, by virtue of its effects on the receipt of subsequent chemotherapy, offer long-term benefits to patients with advanced Hodgkin disease. Therefore, we compared followup data from a group of patients who were receiving mechlorethamine hydrochloride, vincristine sulfate, procarbazine hydrochloride, and prednisone (MOPP regimen) and who had had splenectomies to a group of similarly treated, carefully matched control patients on the MOPP regimen who had not had splenectomies. Our results indicate no important difference in duration of survival or long-term remission status. There was only a suggestion that splenectomy in such patients may be followed by impaired resistance to subsequent infections. Therefore, although early splenectomy can be important in the assessment of splenic disease, it must not be considered to be a therapeutic procedure per se.

Combination chemotherapy for disseminated malignant melanoma.

BCNU, hydroxyurea, and imidazole carboxamide (DTIC) were administered to 89 patients with disseminated malignant melanoma. A response rate of 27% was observed. The addition of vincristine in another 89 patients did not significantly improve the response rate (30%). This includes patients who died during or after one course of therapy (less than 28 days). If the early deaths are not considered, the over-all response rate was 38%. (he best responses occurred in patients with skin, lung, and/or lymph node involvement. Liver and brain involvement heralded poor responses. This response rate appeared to be independent of age, sex or previous therapy. Moderate and severe toxicity, predominantly nausea and vomiting, was noted in most patients. The median survival for all evaluable patients was 17 months, and was independent of the regimen used.