Utilizing the Canadian Emergency Department Triage and Acuity Scale (CTAS) in an oncology urgent care clinic: the university health network experience.

The Canadian Triage Acuity Score (CTAS) is a validated triage method used in Canadian emergency departments (ED) that groups patients according to severity of presenting illness (CIHI, 2005). According to Tanabe, Gimbel, Yarnold and Adams (2004), five-level triage systems can be utilized in order to benchmark with similar programs. CTAS, a five-level triage system, can also be used as an instrument to determine triage quality and to predict admission rates, hospital length of stay and diagnostic utilization (Jiminez et al., 2003). In June 2009, Princess Margaret Hospital launched REACH (Reducing Emergent and Acute Care Hospitalization), an oncology-specific urgent care clinic. In order to appropriately utilize resources, assist patients in a timely manner according to acuity, and compare and contrast data to that which is traditionally reported from our area EDs, we implemented the use of a validated triage methodology, CTAS, in this urgent care clinic. The following paper describes the University Health Network experience with utilizing CTAS in an oncology population.

Quantification of cyclical fluctuations in cerebral blood volume in healthy infants.

Cyclical fluctuations in cerebral blood flow velocity in Doppler measurements are a well known phenomenon. In 1992 Livera et al have shown in one patient, that cyclical fluctuations of cerebral blood volume could be measured with near infrared spectroscopy (NIRS). The aim of the present study was a quantification of the amplitude of cyclical fluctuations of cerebral blood volume (represented by total haemoglobin [Hbtot]) in a large number of healthy infants. Furthermore changes of oxygenated haemoglobin (HbO2) and deoxygenated haemoglobin (Hb) were investigated. Measurements were done during two hours of undisturbed daytime sleep. Fifty-eight infants (30 male, 28 female) were included in the study. All but one infant showed cyclical fluctuations. For quantification of cyclical fluctuations only periods during quiet sleep with excellent tracing quality were used. A number of 7894 cycles was analyzed for each of the three NIRS parameters. The median amplitude of the cycling fluctuations was: delta Hbtot 1.1 mumol/l, delta HbO2 1.1 mumol/l, and delta Hb 0.2 mumol/l. The frequency was changing within a range of 3 to 6 cycles/minute. Polynominal regression analysis showed that the relationship of delta HbO2 and delta Hbtot was distinctively stronger compared to the relationship of delta Hb and delta Hbtot. In conclusion we think that these data represent "normal ranges" for parameter fluctuations in long-time NIRS tracings.

Blood stem cell collection: factors influencing the recovery of granulocyte-macrophage colony forming cells.

We evaluated data from all blood cell (BC) collections performed in our institution between 1989 and 1995 to determine factors influencing the outcome of collection. One hundred and thirty-three collections were performed on 106 patients. Malignant diagnoses were: non-Hodgkins lymphoma (NHL) in 35%, multiple myeloma in 31%, breast cancer in 26%, and Hodgkin's disease in 8%. Collections were obtained routinely in myeloma and breast cancer and due to bone marrow involvement with malignancy or inaspirable bone marrow in lymphoma patients. Collections were obtained on a Cobe Spectra or Baxter-Fenwall CS3000+. Engraftment potential was determined by methylcellulose colony assay (CFU-GM), with a target of > 10 x 10(4) CFU-GM/kg. Apheresis nucleated cell count correlated significantly, albeit weakly (r = 0.26), with CFU-GM with a cell count of > 5 x 10(8)/kg resulting in an adequate number of CFU-GM in 78% of patients. In univariant analysis outcome of collection was significantly influenced by the patients age (p = 0.01), malignant diagnosis (p < 0.001), reason for collection (p = 0.002), and the mobilization regimen (p = 0.01). The nature of the apheresis device used did not influence outcome. Only malignant diagnosis was significant (p < 0.001) in multivariate analysis. We conclude that the outcome of BC is most strongly influenced by patient factors such as malignant diagnosis. These factors must be considered when comparing the outcome of different mobilization regimens and when planning collection strategies.

Peripheral blood progenitor cell collections in multiple myeloma: predictors and management of inadequate collections.

Thirty-seven patients with previously treated multiple myeloma (MM) underwent peripheral blood progenitor cell (PBPC) collection following high-dose cyclophosphamide and GM-CSF or sequential IL-3 and GM-CSF. Patients with an inadequate collection were considered for a second or third collection. 25 patients underwent subsequent autotransplant. The only variable predictive of CFU-GM yield was the extent of prior melphalan therapy. All repeat collections were unsuccessful and patients infused with an autograft obtained from multiple sets of collections had a high incidence of delayed engraftment. We conclude that melphalan should be avoided or PBPC collection performed early in the disease course in patients who are potential transplant candidates.