Current Concussion Knowledge, Beliefs, Education, and Management Practices Among Irish Post-Primary PE Teachers.

Purpose: Physical education (PE) teachers play an important role in concussion recognition and management in schools both in an academic and activity based setting. This study aimed to identify Irish post-primary PE teachers' concussion knowledge, beliefs, education and management practices. Methods:  An anonymous online survey, adapted to the Irish context from the validated BAKPAC-TEACH, was completed by 128 PE teachers (female = 74/123; 60.2%; male = 49/123; 39.8%, 36.1 ± 10.9 years), representing 4% of registered PE teachers in Ireland. Results: PE teachers reported 3.5 ± 4.7 students suffer with a sports-related concussion in their classroom annually and 43.9% previously had a student sustain a concussion during their PE class. Most received concussion education (58.6%), largely provided by sporting bodies. They frequently identified dizziness (93.0%) and headaches (92.2%) as concussion symptoms, but less commonly emotional (more emotional = 36.5%, nervous or anxious = 33.6%, sadness = 28.9%) or sleep (35.2%) symptoms. All PE teachers knew that a concussion requires immediate removal from a game/practice. PE teachers demonstrated less perceived knowledge and confidence relating to academic adjustments and return to learn criteria. Just 31.3% reported their school facilitates academic adjustments. Conclusion: Tailored concussion education addressing knowledge gaps highlighted in this study should be developed. A concussion policy and an academic support team in each school should be established and widely publicised to enhance the support of concussed students in returning to school.

Difficulties in diagnostics of lung tumours in biopsies: an interpathologist concordance study evaluating the international diagnostic guidelines.

AIMS: Accurate and reliable diagnosis is essential for lung cancer treatment. The study aim was to investigate interpathologist diagnostic concordance for pulmonary tumours according to WHO diagnostic criteria. METHODS: Fifty-two unselected lung and bronchial biopsies were diagnosed by a thoracic pathologist based on a broad spectrum of immunohistochemical (IHC) stainings, molecular data and clinical/radiological information. Slides stained with H&E, thyroid transcription factor-1 (TTF-1) clone SPT24 and p40 were scanned and provided digitally to 20 pathologists unaware of reference diagnoses. The pathologists independently diagnosed the cases and stated if further diagnostic markers were deemed necessary. RESULTS: In 31 (60%) of the cases, ≥80% of the pathologists agreed with each other and with the reference diagnosis. Lower agreement was seen in non-small cell neuroendocrine tumours and in squamous cell carcinoma with diffuse TTF-1 positivity. Agreement with the reference diagnosis ranged from 26 to 45 (50%-87%) for the individual pathologists. The pathologists requested additional IHC staining in 15-44 (29%-85%) of the 52 cases. In nearly half (17 of 36) of the malignant cases, one or more pathologist advocated for a different final diagnosis than the reference without need of additional IHC markers, potentially leading to different clinical treatment. CONCLUSIONS: Interpathologist diagnostic agreement is moderate for small unselected bronchial and lung biopsies based on a minimal panel of markers. Neuroendocrine morphology is sometimes missed and TTF-1 clone SPT24 should be interpreted with caution. Our results suggest an intensified education need for thoracic pathologists and a more generous use of diagnostic IHC markers.

Diagnosis and management of microscopic colitis: current perspectives.

Collagenous colitis and lymphocytic colitis, together constituting microscopic colitis, are common causes of chronic diarrhea. They are characterized clinically by chronic nonbloody diarrhea and a macroscopically normal colonic mucosa where characteristic histopathological findings are seen. Previously considered rare, they now have emerged as common disorders that need to be considered in the investigation of the patient with chronic diarrhea. The annual incidence of each disorder is five to ten per 100,000 inhabitants, with a peak incidence in 60- to 70-year-old individuals and a predominance of female patients in collagenous colitis. The etiology and pathophysiology are not well understood, and the current view suggests an uncontrolled mucosal immune reaction to various luminal agents in predisposed individuals. Clinical symptoms comprise chronic diarrhea, abdominal pain, fatigue, weight loss, and fecal incontinence that may impair the patient's health-related quality of life. An association is reported with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. The best-documented treatment, both short-term and long-term, is budesonide, which induces clinical remission in up to 80% of patients after 8 weeks' treatment. However, after successful budesonide therapy is ended, recurrence of clinical symptoms is common, and the best possible long-term management deserves further study. The long-term prognosis is good, and the risk of complications, including colonic cancer, is low. We present an update of the epidemiology, pathogenesis, diagnosis, and management of microscopic colitis.

[The participation of pharmacist in antibiotic related activities of Hungarian hospitals and intensive care units]. / A gyógyszerészek szerepvállalása a kórházak és intenzív osztályaik antibiotikumokkal kapcsolatos tevékenységében.

The present paper describes the antibiotic related activities of Hungarian adult intensive care units (ICUs) and their parent hospitals, specially focusing on the role of hospital pharmacists. Information was gathered by a structured questionnaire, which was sent to the head of ICU departments by post and by email. The multidisciplinary team of authors developed and validated the questions. Results were compared to recommendations set up by the Antibiotic Resistance Prevention And Control (ARPAC) project. Minimal requirements appointed by the ARPAC have not been fulfilled by many aspects: multidisciplinary hospital commitees were not realized and the activity of these committees in antibiotic guideline developments was not satisfactory. Continuous education and calculation of standardized antibiotic use was rarely performed at ICUs. The role of pharmacist remained marginal in every field. All these findings suggest the need for appointment of a responsible, multidisciplinary antibiotic manamement team including also a pharmacist.

[Microbiological service for intensive care units in Hungary]. / Milyen mikrobiológiai laboratóriumi háttér áll rendelkezésre az intenzív betegellátást végzo osztályok számára?

For the effective treatment of patients with infectious diseases in intensive care units, reliable microbiological diagnoses and correct evaluations of results by expert infectious disease specialists/microbiologists are indispensable. A 97-question survey was conducted about the antibiotic policy, the available background of the microbiological diagnoses and the consultation possibilities in infectious diseases/microbiology at intensive care units in Hungary. Sixty-two percent (60/96) of questionnaires were returned. Of these units, 55% had a microbiological laboratory in-house. Microbiological reports usually serve as basis for the choice of antibiotic treatment. It is an undesirable practice that during working days and during week-ends the proportions of positive microbiological reports sent back to the wards within the optimal time are only 50% and <20%, respectively. Helpful opinion of an expert infectious disease specialist or microbiologist was available in >90% of the cases during working hours, while out of working hours the help of an infectious disease specialist and a microbiologist specialist was available in 70% and 55% of the cases, respectively. Almost half of the units requested the help of an infectious disease specialist whereas only one-third of them turned to a microbiologist. Accordingly, the background for microbiological laboratory diagnoses available for intensive care units is far from optimal in Hungary and is not adequately stipulated in their working conditions.

[Histologic chorioamnionitis is associated with cerebral palsy]. / Az intrauterin fertozés és a szülés körüli agysérülé sek közötti összefüggés.

OBJECTIVE: The objective of this study was to determine the interaction between histologic chorioamnionitis and unexplained neonatal cerebral palsy among low-birth-weight infants. METHODS: 105 preterm infants delivered under 1500 g between 2000-2004 were studied. The clinical data, the neonatal neuroimaging, the laboratory results finds and the histopathologic features of fetal parts (placenta, umbilical cord and membranes) were evaluated. RESULTS: During the study period cerebral palsy were detected in 7.6% (8/105) of the newborns. The frequency of silent histologic chorioamnionitis was 39.7% (31 cases). The rate of caesarean section was 80.9% (72/89 deliveries), and elective operation was made in 51 cases (70.1%). In a logistic regression analysis controlling for confounding factors, compared with data on uninfected infants, histologic chorioamnionitis was significantly associated with risk of unexplained cerebral palsy (p = 0.006). There was also significant interaction between the maternal genital infections and chorioamnionitis (p = 0.024), and the maternal infections and positive smear of neonatal gastric aspirates (p = 0.033). There was no significant association between of intrapartum distress, the maternal genital infections, the prematurity and the maternal complications (hypertension, preeclampsia, diabetes mellitus, IUGR). Neither mechanic nor hypoxic ischaemic encephalopathy were demonstrated. CONCLUSION: Intrauterine exposure to maternal infection was associated with a marked increase in risk for cerebral palsy in infants of birth weight less than 1500 g.

[Surgical aspects of breast cancer screening at our hospital]. / Az emloszures sebszeti vonatkozásai kórházunkban.

In addition to discussing effectiveness of breast cancer screening initiated within the National Public Health Programme, the problem of how to treat non-palpable, early invasive and in situ breast cancer (DCIS) is considered. The theoretical issue of the sentinel lymph node and its impact on biopsy practice have also been dealt with. In the authors' region, screening was introduced in 1999 and after a short break has been continued since 2002. Patient data of three periods, each of two years, each with ten years' interval (1982-1983, 1992-1993, 2002-2003) have been analysed. Changes in the number of surgical operations and tumour size, incidence of in situ cancer, lymph node involvement and distribution of types of surgery have been studied. Biopsy of the sentinel lymph node has been applied since May, 2003 (with 45 biopsies performed until 31 December, 2004). The number of persons participating in the screening programme has gradually increased, the number of surgical operations because of breast cancer increased from period to period. Size of the detected tumours has decreased, the percentage of non-palpable cases has been significant (445 surgical interventions during the years 2002-2004: surgery: 19%). The proportion of DCIS has increased to nearly four times as compared to data of years immediately preceding the era of screening (1993-1998: 11 cases, 2%; 1999-2004: 62 cases, 7.5%). Specificity of sentinel lymph node biopsy was 90%, with a sensitivity of 65%. The proportion of breast saving surgery has increased above 50%. The authors regard screening as successful, in their opinion, its benefits cannot be questioned, in spite of some controversial issues. As to the treatment of non-palpable, early invasive cancer, they underline the importance of preoperative evaluation--cytology, core biopsy--and establishing dignity. The issues of localisation--wire hook marking--and histological processing--large blocks--have also been dealt with. In spite of the fact that the risk for potential malignancy of DCIS lesions has not yet been fully clarified, adequate treatment is indicated; the authors take stand on the issues of indication for surgery, postoperative radiotherapy and use of Tamoxifen. Indications and contraindications of sentinel lymph node biopsy have been summed up.