Prospective analysis of phoned potassium results and what general practitioners do with them: a pilot study.

Background Communicating abnormal results to requesting clinicians is an essential part of clinical authorisation. Guidance from the Royal College of Pathologists on communication of critical/unexpected results is issued as 'advice to pathologists'. The 2017 guidelines advise rapid communication of serum potassium results ≤2.5 mmol/L and ≥6.5 mmol/L. Little is known about what happens after the results have been communicated. We wished to establish answers to the following questions: Are phoned results acted on? If so, when? What is the outcome of any action taken? Methods A prospective study of primary care potassium results authorised out of hours was undertaken. Potassium requests from primary care were retrieved from the laboratory information management system. The potassium result was recorded, along with other data. Data were analysed for potassium results that were validated out of hours (18:00 h-08:00 h). Results Over six months, 220 potassium results <3.1 mmol/L and >5.9 mmol/L from primary care were validated out of hours. A subset of these (27) were phoned to the general practice out of hours 'hub', and 16 patients referred to hospital out of hours, on account of the potassium results. The remaining potassium results phoned out of hours were acted on subsequently. Conclusions Critical potassium results were phoned urgently and are acted on, although not always out of hours. For potassium results phoned out of hours, the most frequent action was to refer to hospital out of hours. Different actions occurred for similar potassium results, reflecting the fact that actions taken and their urgency depend on the patient, the clinician and the practice policy for handling results.

Colorectal cancer screening practices in Saskatchewan: Survey of family physicians.

OBJECTIVE: To evaluate current colorectal cancer (CRC) screening practices in Saskatchewan and identify barriers to screening with the goal of improving current practice. DESIGN: Survey of family physicians. SETTING: Saskatchewan. PARTICIPANTS: A total of 773 family physicians were surveyed. MAIN OUTCOME MEASURES: Demographic characteristics, individual screening practices, and perceived barriers to screening. RESULTS: The response rate to the survey was 44.5%. When asked what method they used for fecal occult blood testing, almost 40% of respondents were either unsure or did not answer the question. Of those who did respond, 35.8% employed hemoccult testing following digital rectal examination, a practice not recommended for CRC screening. Screening guidelines for average-risk patients were generally well adhered to, with 79.9% of respondents recommending screening beginning at age 50. For screening patients at increased risk of CRC owing to family history, only 64.2% of respondents began screening 10 years before the age of the index patient at diagnosis. Physicians who were more likely to follow guidelines were female, in practice fewer than 10 years, trained in Canada, and practising in urban areas. More than 90% of family physicians agreed that a standard provincewide screening program would be beneficial. CONCLUSION: We have identified considerable knowledge gaps with regard to CRC screening. There is confusion about which fecal occult blood tests are recommended for screening. Also, screening guidelines for patients with a family history of CRC are poorly understood. These findings suggest that better physician education about CRC screening is required. Introduction of a provincewide screening program should improve overall screening success.

The intracellular uptake of CD95 modified paclitaxel-loaded poly(lactic-co-glycolic acid) microparticles.

The CD95/CD95L receptor-ligand system is mainly recognised in the induction of apoptosis. However, it has also been shown that CD95L is over-expressed in many cancer types where it modulates immune-evasion and together with its receptor CD95 promotes tumour growth. Here, we show that CD95 surface modification of relatively large microparticles >0.5 µm in diameter, including those made from biodegradable polylactic-co-glycolic acid (PLGA), enhances intracellular uptake by a range of CD95L expressing cells in a process akin to phagocytosis. Using this approach we describe the intracellular uptake of microparticles and agent delivery in neurons, medulloblastoma, breast and ovarian cancer cells in vitro. CD95 modified paclitaxel-loaded PLGA microparticles are shown to be significantly more effective compared to conventional paclitaxel therapy (Taxol) at the same dose in subcutaneous medulloblastoma (∗∗∗P < 0.0001) and orthotopic ovarian cancer xenograft models where a >65-fold reduction in tumour bioluminescence was measured after treatment (∗P = 0.012). This drug delivery platform represents a new way of manipulating the normally advantageous tumour CD95L over-expression towards a therapeutic strategy. CD95 functionalised drug carriers could contribute to the improved function of cytotoxics in cancer, potentially increasing drug targeting and efficacy whilst reducing toxicity.

Differences in leg bone geometry in young, old and very old women.

Bone geometry is an important measure of bone strength and is known to be affected by weight-bearing and adult ageing. Engagement in weight-bearing activity decreases with age, thus in this study we compared bone geometry changes between weight-bearing (tibia) and non-weight-bearing (fibula) leg bones in three different age groups of women. Magnetic resonance images of the right leg were acquired in 9 young (20-27 years), 7 old (61-69 years) and 7 very old (71-80 years) women. Total and cortical bone volumes and medullary cavity volumes (mm(3)) were calculated at proximal and distal sites for both bones. Tibial cortical bone volume was significantly less at the proximal site in old (17%) and very old (24%) groups versus young subjects. Cortical bone volume in the proximal fibula was also significantly reduced in the older groups (7 and 12%), but to a substantially lesser extent than in the tibia. In contrast, distal bone geometry appeared largely to be conserved in both tibia and fibula. Proximally, medullary cavity volume was greater in the older groups in the tibia but not the fibula. Distally, the only difference found in either bone was a significantly greater fibular medullary cavity in the very old group. These findings suggest weight-bearing bones in women are more susceptible than non-weight-bearing bones to age-related changes in bone geometry likely due to decreases in weight-bearing activities. Also, weight-bearing activity appears to provide a greater osteogenic stimulus at the distal portions of the leg bones.