Current practice of periprocedural haematological management for patients undergoing image-guided procedures.

OBJECTIVE: To evaluate current UK practice of periprocedural haematological management for image-guided procedures in relation to Cardiovascular and Interventional Radiological Society guidelines, which provide recommendations according to bleeding risk of procedures from Category 1 (lowest) to 3 (highest). METHODS: Survey of practice in UK radiology departments conducted over a 1-year period RESULTS: 48 radiology departments responded. The percentage of departments that stop antithrombotics pre-procedurally are as follows (for Category 1, 2 and 3, respectively): aspirin (31.3%, 43.8%, 54.2%); clopidogrel (54.2%, 68.8%, 72.9%); therapeutic low-molecular-weight heparin (56.3%, 77.1%, 75.0%). The percentage of departments that perform pre-procedural laboratory testing are as follows (for Category 1, 2 and 3, respectively): international normalized ratio (INR; 81.3%, 95.8%, 93.8%); activated partial thrombin time ratio (APTTR; 60.4%, 75.0%, 93.8%); platelet (77.1%, 91.7%, 95.7%); haemoglobin (70.8%, 85.4%, 87.5%). Mean threshold (standard deviation) of laboratory results for conducting procedures (Level 1, 2 and 3, respectively) are as follows: INR [1.53 (0.197), 1.47 (0.186), 1.47 (0.188)]; APTTR [1.50 (0.392), 1.50 (0.339), 1.48 (0.344)]; platelet count (x10(3) cells per microlitre) [74.4 (28.7), 79.9 (29.1), 80.5 (29.3)]; haemoglobin (grams per decilitre) [9.05 (1.40), 9.00 (1.33), 8.92 (1.21)]. No department practices conformed to current recommendations for (1) pre-procedural cessation of antithrombotics and (2) pre-procedural laboratory testing. Two (4.2%) department practices conformed to recommendations for thresholds of haematological parameters. CONCLUSION: Current peri-procedural haematological management is variable and often does not conform to existing recommendations. Further research into the impact of this variation in practice on patient outcome is required. ADVANCES IN KNOWLEDGE: This study demonstrates wide variation in practice in haematological management for image-guided procedures.

Osteoarthritis of the thumb carpometacarpal joint: correlation of ultrasound appearances to disability and treatment response.

AIM: To evaluate grading of thumb carpometacarpal joint (CMCJ) osteoarthritis (OA) using ultrasound, correlating findings with disability and treatment response. MATERIALS AND METHODS: Patients with symptomatic thumb OA attending for ultrasound-guided CMCJ steroid injection and a group of asymptomatic controls were recruited prospectively. Thumb CMCJ ultrasound was graded (osteophytes, joint-space narrowing, capsule size, and measured capsule size), and a Disabilities of the Arm Shoulder and Hand (DASH) questionnaire was completed for each patient. Symptomatic patients then underwent injection with DASH repeated 6 weeks post-treatment. Ultrasound features were correlated with the initial DASH disability score and response as defined by change in DASH 6 weeks after treatment. RESULTS: Thirty-one patients with symptomatic OA and 37 asymptomatic controls were recruited. With the exception of osteophytes (p = 0.017), no statistically significant correlation was demonstrated between severity of ultrasound features and patient disability. However, all features demonstrated statistically significant higher grades in the symptomatic group compared to controls. Ultrasound grading did not have statistical correlation with treatment response. CONCLUSION: No correlation was found between the majority of ultrasound features and the clinical severity of OA or likely response to treatment. However, these features are significantly more common in the symptomatic population.

Usage of prophylactic radiologically inserted gastrostomy in head and neck cancer patients.

AIM: To assess outcomes and usage rate of prophylactic radiologically inserted gastrostomy (RIG) in head and neck cancer (HNC) patients. MATERIALS AND METHODS: Outcome data of all HNC patients who underwent prophylactic RIG over a 22-month period (November 2007 to September 2009) in a tertiary referral centre were collected retrospectively. Thirty-day mortality, major and minor complication rates, and subsequent usage of the RIG were analysed. RESULTS: Fifty-one HNC patients underwent prophylactic RIG. Three minor and no major immediate complications were identified. Sixteen minor and three major complications at 30-days were identified. Three (5.9%) major complications were identified. There was one death due to disease progression and not RIG insertion. The RIG was not used in 17.7% of patients post-procedure. CONCLUSION: Prophylactic RIG in HNC patients has a comparable mortality rate to RIG insertion in HNC patients with mixed indications. However, the number of cases where the gastrostomy is not used raises important concerns and warrants further investigation.

Seat belt use by children brought to an inner-city hospital.

OBJECTIVE: To characterize restraint use among children brought to an inner-city hospital by private car or taxicab. DESIGN: Cross-sectional survey and direct observation of a convenience sample. SETTING: Main entrance and clinic entrance of a large urban public hospital. PARTICIPANTS: Direct observation was made on 352 children brought by 257 vehicles. One hundred seventy-seven parents or caretakers responded to questionnaires for 240 children. INTERVENTION: None. MEASURES AND MAIN RESULTS: Of the 352 children who were directly observed, 256 (73%) arrived by taxicabs and 96 (27%) by private cars. Thirty-three of 352 (9%) children were observed to be appropriately restrained. Children brought by taxicabs were significantly less likely to be restrained than children brought by private cars (1% vs 31%, P < 0.001). Caretakers reported that seat belts were available in 46 of 54 (85%) private cars, compared to 38 of 88 (43%) taxicabs (P < 0.01). Twenty percent of caretakers who came by taxicabs did not check for seat belts. CONCLUSION: Taxicabs, which are exempt from the New York State's mandatory seat belt law, are a common mode of transportation for children in the inner city. While the overall use of child restraints in the study sample is low, it is particularly low for children in taxicabs. The low rate may be related to both the decreased availability of seat belts and the lack of the mandatory seat belt law for taxicabs. Strategies should be sought to improve child restraint availability in taxicabs and mandate seat belt use.