New life for old cellular pathology: a transformational approach to the upcycling of historic e-pathology records for contemporary clinical uses.

AIMS: Cellular pathology ('e-pathology') record sets are a rich data resource with which to populate the electronic patient record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. The aim of this short paper is to describe a solution in a major UK University Hospital which gives immediate visibility and clinical utility to 30 years of e-pathology records METHODS: Over the past decade, we have created a timeline structured and iconographic data framework for the 'whole-of-life' visualisation of the entirety of an EPR. We have enhanced this interface with the sequential extraction of 373 342 e-pathology reports from legacy Ferranti (1990-1997) and Masterlab (1997-2004) files. They have been uploaded into our SQL file servers, following appropriate data quality and patient identity reconciliation checks. RESULTS: We have restored a large repository of previously inaccessible e-pathology records to clinical use and to immediacy of access as a foundation element of our timeline structured EPR. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20 000 cases with e-pathology records dating back to 1990. CONCLUSIONS: The revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.

Design and implementation of the stacked, synchronised and iconographic timeline-structured electronic patient record in a UK NHS Global Digital Exemplar hospital.

BACKGROUND: Conventional electronic screen visualisation formats, which use tabs, dropdown menus, lists and multiple windows, present huge navigation challenges to health professionals. A unifying and intuitive interface for the electronic patient record (EPR) has been an elusive goal for software developers for decades. METHODS: Since 2009, by working in an agile way, we have built and implemented a fully operational and dynamic system, the University Hospital Southampton Lifelines (UHSL), within our clinical data estate, in a UK university hospital. UHSL permits the continuously updated display of the EPR on a single desktop computer screen in an intuitive format. During this iterative evolution, we have resolved a number of practical challenges in data display, while maintaining our core aims of end-user optimisation and radical simplification of the interface. Concurrently, we have upcycled a significant volume of clinical e-content, some from as far back as 1991, into UHSL, and at a marginal cost. OUTCOMES: UHSL went live in 2017 for all authorised staff at the hospital. It displays all e-records for 2.5 million patients and for more than 100 million documents and reports. It significantly reduces the screen time to navigate the individual EPR, and it offers substantial productivity gains in designated clinical services. CONCLUSIONS: UHSL has considerable further development potential as a National Health Service EPR interface, for the integration, display and ease of understanding of medical records across primary, secondary and community care.

Video assisted thoracoscopic excision of mediastinal ectopic parathyroid adenomas: a UK regional experience.

BACKGROUND: To report the first series of video-assisted thoracoscopic surgery (VATS) resection of mediastinal ectopic parathyroid adenomas (MEPAs) in the UK. METHODS: A case series of seven cases undergoing VATS between 2004 and 2009 to treat single gland hyperparathyroidism. Methylene blue (MB) was used in 5/7 cases immediately before exploration to identify the adenomas. Carbon dioxide (CO2) up to pressures of 10 mmHg was used safely to deflate the lung in two cases. RESULTS: There were five women and two men with a mean age of 53 years (range, 27-72 years). Histopathology confirmed successful resection of the parathyroid adenoma in 6/7 cases. There was one conversion to open thoracotomy due to bleeding from the azygos vein resulting from excessive traction. Despite marked MB uptake, this patient proved to have tuberculoid adenopathy and no parathyroid tissue was identified. Postoperative plasma calcium returned to normal in 6/7 patients and parathyroid hormone (PTH) level in 6/7 patients. The median hospital stay was 2 days and there was no mortality in this series. CONCLUSIONS: MEPAs can be safely resected using VATS with minimal surgical morbidity, short drainage time and short hospital stay. CO2 insufflation and the intraoperative use of MB are safe and help to accurately localise the ectopic adenoma. VATS should be considered as the first-line approach for resection of MEPAs.

Clinical Outcomes in the Google Era: The PB Desai Oration, ASICON 2013.

This article is based upon the PB Desai Oration which was given by the author in Ahmedabad on 28th December 2013 at the National Congress of the Association of Surgeons of India at the invitation of the Executive Board of the Indian Association for Surgical Oncology.

The Development of Supportive Care for Cancer Patients in India: A UK Perspective.

This article discusses the development of supportive care for cancer patients in India from a UK professional nursing perspective.

Curating the world's peer-reviewed literature.

New technologies are transforming academic publishing, including surgical research. The author considers a variety of the new systems, platforms and search engines that are fuelling this information revolution, as well as the bibliometrics and citation analysis necessary for filtering quality material for the increasingly inundated researcher.

Breast Screening in India: A UK Perspective on the Practicalities.

This paper is offered as an Editorial, providing a UK perspective on discussions about the merits of a Breast Screening programme in India, based upon the UK and European experience.

Understanding outcomes in cancer surgery through time structured patient records.

To discuss the importance of time and to introduce the concept of the time structured electronic patient record (EPR) in surgical oncology. An essay based upon the NC Misra Oration given to the Indian Association for Surgical Oncology National Conference in Lucknow, September 2011. The time structured EPR offers new insights into the contributions of multidisciplinary cancer therapeutic inputs to clinical outcomes. Indian surgical oncologists are well placed to lead in the application of modern information technology concepts to improve our understanding of cancer.

Near-clinical applications of laser scanning cytometry.

Biological samples from human tissues are characterized by complexity and heterogeneity. The ability to make rapid, reliable, quantitative fluorochromatic measurements on clinical samples allows the development of new and practical assays that could influence diagnosis and treatment in a variety of clinical applications. Laser scanning cytometry (LSC) is a very versatile and adaptable technology that allows for the quantitative analysis of cell samples that are unsuitable for flow cytometry by virtue of their presentation and context. Crucially, it allows the direct visualization of cells and rare events and the correlation of imagery with fluorochromatic measurements. In this chapter, we describe early experiments in the study of cytotoxic drug uptake and resistance in human tumor cells and in the study of sputum cells from asthmatic patients, which harness the specific capabilities of LSC to practical clinical problems.