Despite the existence of the American College of Veterinary Pathology guidelines for tumour biopsy specimens, anecdotally the authors' have seen inconsistency of reporting of information on the ...pathology report for canine soft tissue sarcomas (STSs). If crucial aspects are not reported this can result in slower or impeded patient care. This retrospective study evaluated 255 STS histopathology reports submitted from across the United States. Reports were evaluated by a single observer to assess for information contained in 5 main categories: patient history and signalment, gross and microscopic description, grading, histologic margins and the comments section. Inclusion criteria for histopathology reports included a final diagnosis of STS, having a microscopic description and resulting from the initial surgical resection. The majority of the reports stated the patient signalment (91.2%) and clinical history (90.8%). However, only 64.8% of the reports had a gross description of the specimen. Histologic margin description was present in 229 reports (91.6%), however, only 149 reports (59.6%) stated an objective measurement of these margins. Histologic classification was stated in 50.0% of the reports, while grade was given on 97.2% of the reports. Variability in histopathologic reporting including histologic margin description for resected canine STS was identified. Given surgical treatment is the mainstay for STS and histopathological assessment plays an important role in determination of whether additional surgery, radiation or chemotherapy is needed. Standardization or checklists like the American College of Pathology utilize may be helpful to ensure histopathologic characteristics are reported that may guide further treatment recommendations.
Abstract
BACKGROUND
Stereotactic radiosurgery (SRS) is a common treatment modality for vestibular schwannoma (VS), with a role in primary and recurrent/progressive algorithms. At our institution, ...routine magnetic resonance imaging (MRI) is obtained at 6 and 12 mo following SRS for VS.
OBJECTIVE
To analyze the safety and financial impact of eliminating the 6-mo post-SRS MRI in asymptomatic VS patients.
METHODS
A prospectively maintained SRS database was retrospectively reviewed for VS patients with 1 yr of post-treatment follow-up, 2005 to 2015. Decisions at 6-mo MRI were binarily categorized as routine follow-up vs clinical action—defined as a clinical visit, additional imaging, or an operation as a direct result of the 6-mo study.
RESULTS
A total of 296 patients met screening criteria, of whom 53 were excluded for incomplete follow-up and 8 for NF-2. Nine were reimaged prior to 6 mo due to clinical symptoms. Routine 6-mo post-SRS MRI was completed by 226 patients (76% of screened cohort), following from which zero instances of clinical action occurred. When scaled using national insurance database-derived financials—which estimated the mean per-study charge for MRI of the brain with and without contrast at $1767—the potential annualized national charge reduction was approximated as $1 611 504.
CONCLUSION
For clinically stable VS, 6-mo post-SRS MRI does not contribute significantly to management. We recommend omitting routine MRI before 12 mo, in patients without new or progressive neurological symptoms. If extrapolated nationally to the more than 100 active SRS centers, thousands of patients would be spared an inconvenient, nonindicated study, and national savings in health care dollars would be on the order of millions annually.
Objective: the aim of this study was to compare digital and conventional radiography for diagnostic accuracy, direct costs, and quality of care. Materials and methods: diagnostic accuracy was ...assessed by a critical review of the literature on sensitivity, specificity and ROC analysis of these imaging techniques and by a survey with a panel of radiologists. Direct costs and quality of care were evaluated with a before/after study of the implementation of digital radiography in a Department of Radiology in `Hospices Civils de Lyon' (France). We included 292 patients and measured duration of examinations and direct costs of equipment, films, maintenance and depreciation. To evaluate any changes in working conditions and patient management, a questionnaire was filled out by the staff of the department. Results: diagnostic accuracy with digital radiography was equivalent to that of conventional radiography but there were wide variations depending on the type of examination. In 1993, although digital radiography resulted in savings of FF 18 000 including tax (US$ 3600) on film consumption for 1 year of examinations, there was a global additional cost of FF 253 000 (US$ 50 600) for maintenance and depreciation. Results showed a nonsignificant tendency to reduced procedure times for all examinations. Working conditions improved, including greater availability for the patient, improved safety, and increased job interest. Conclusion: digital radiography can be introduced into a large hospital to improve patient and staff conditions, at a higher cost than analog radiography, and depending on the type of examinations performed by the radiology department.
Cette étude avait pour objectif d’évaluer la qualité de l’information contenue dans les dossiers d’un service de cancérologie, dans le cadre d’un programme d’assurance qualité du dossier de ...cancérologie mis en œuvre actuellement aux Hospices civils de Lyon. La méthode utilisée a été celle de l’audit, qui consiste à comparer les données observées dans la population de patients à un standard de référence défini préalablement à l’étude ; l’analyse des résultats permet de repérer les écarts significatifs et les points pour lesquels des mesures d’amélioration peuvent être proposées. Un premier audit, en 1997, portant sur 80 dossiers de quatre services de cancérologie, a mis en évidence des écarts significatifs sur des critères importants. Ces écarts observés ont permis de cibler sept critères qui ont été retenus pour le deuxième audit et dont la présence était recherchée dans les dossiers : code postal du lieu de naissance, poids, état général, TNM, pTNM, siège des métastases, présence du compte rendu anatomopathologique qui affirme le diagnostic de cancer ; ce deuxième audit a porté sur 127 dossiers d’un service de cancérologie. L’analyse des résultats obtenus a montré un écart significatif pour le pTNM et le code postal de naissance. Parallèlement à la réalisation de ce deuxième audit, un manuel de procédures a été rédigé et diffusé dans le service et une réévaluation sera faite dans un an afin de mesurer l’impact des recommandations proposées dans ce manuel de procédures.
The objective of this study was to assess the quality of information contained in the medical files of patients in an oncology unit of the Lyons Civil Hospices. Prior to the audit, the health care teams established a set of consensus standards to compare with observed procedures. The analysis of the results led to propositions for guidelines designed to improve points where significant deviations were observed. In the first audit, 80 medical files from patients cared for in four oncology units were retrospectively analysed to determine information quality. Seven items of this audit were retained for a second audit on 127 medical files of patients in a cancerology unit; those items were: postal code of birth place, weight, codified evaluation of general status, TNM classification, pTNM classification, presence of pathology report, localisation of metastasis. Significant deviations were observed for pTNM classification and postal code of birth. During the second audit, a manual of procedures was distributed in the unit, and a new evaluation will be done in one year to assess the impact of guidelines.
Gastric dilatation volvulus (GDV) is a common life-threatening surgical emergency seen in large and giant breed dogs. Incisional gastropexy is a common surgical procedure used to treat GDV following ...gastric derotation and for prevention of GDV in those breeds at risk for developing GDV. This manuscript describes two specific surgical errors that occurred during an incisional gastropexy procedure in two dogs. Both surgical errors were addressed with a second surgery and resulted in good outcomes. This report highlights specific surgical errors that can occur when performing an incisional gastropexy and discusses how to avoid these adverse events.
Western corn rootworm, Diabrotica virgifera virgifera LeConte, has overcome crop rotation in several areas of the north central United States. The effectiveness of crop rotation for management of ...corn rootworm has begun to fail in many areas of the midwestern United States, thus new management strategies need to be developed to control rotation-resistant populations. Transgenic corn, Zea mays L., effective against western corn rootworm, may be the most effective new technology for control of this pest in areas with or without populations adapted to crop rotation. We expanded a simulation model of the population dynamics and genetics of the western corn rootworm for a landscape of corn; soybean, Glycine max (L.); and other crops to study the simultaneous development of resistance to both crop rotation and transgenic corn. Results indicate that planting transgenic corn to first-year cornfields is a robust strategy to prevent resistance to both crop rotation and transgenic corn in areas where rotation-resistant populations are currently a problem or may be a problem in the future. In these areas, planting transgenic corn only in continuous cornfields is not an effective strategy to prevent resistance to either trait. In areas without rotation-resistant populations, gene expression of the allele for resistance to transgenic corn, R, is the most important factor affecting the evolution of resistance. If R is recessive, resistance can be delayed longer than 15 yr. If R is dominant, resistance may be difficult to prevent. In a sensitivity analysis, results indicate that density dependence, rotational level in the landscape, and initial allele frequency are the three most important factors affecting the results.
Objective
To investigate the psychometric properties of the Multiple Sclerosis Impact Scale (MSIS-29) and to assess the relationship between the Kurtzke Expanded Disability Status Scale and the ...physical and psychological parts of this score.
Methods
A population-based study identified cases with definite multiple sclerosis (MS) in the north-east region of Ireland. They were examined and completed the MSIS-29. Cases were classified as mild (Expanded Disability Status Score (EDSS) 0–3.0), moderate (EDSS 3.5–5.5), or severe (6.0–9.5) MS.
Results
The 248 participants (82 male, 166 female) had a mean age of 49.1 years (SD 12.4). EDSS ranged from 0 to 9.5 (median 6.0). Data quality was excellent (0.02% missing data), physical and psychological scores spanned the entire range with low floor and ceiling effects. Internal consistency was high (Cronbach’s alpha 0.97 – physical score, 0.93 – psychological score). The convergent validity of the physical impact score of the MSIS-29 with the Kurtzke EDSS was confirmed with a high Spearman’s rank coefficient correlation of 0.63 (P = 0.01). Physical impact scores for mild, moderate, and severe disability as were statistically different at 25.9%, 48.0%, and 63.9%, respectively. Mean psychological score was non-significantly higher in the moderately disabled group at 47.4% compared with the severely disabled at 44.3% (P = 0.58).
Conclusions
The MSIS-29 is an acceptable, reliable, and valid method of recording quality of life. A significant relationship between higher physical impact scores of the MSIS-29 and higher Kurtzke EDSS values suggests that is may be of use in clinical trials to monitor progression.
This study used a postal questionnaire to seek the views of adults who stammer concerning the effect of stammering on their lives, the speech and language therapy and other remedies they have tried, ...and their hopes for speech and language therapy in the future. The 332 returned questionnaires indicated that stammering had the greatest adverse effect on school life and occupation. Speech and language therapy had been helpful to many, but the nature of the benefits and specific therapies used were not cited in many responses. An emergent theme in unhelpful therapy was the dissatisfaction that arises when individual needs are not met. In the future, people want help in controlling stammering and in developing coping strategies. The desire for timely and effective therapy for children, ongoing help and for group or intensive work has implications for service organization and therapist’s skills. The survey highlights the need for therapists and clients to negotiate therapy aims and procedures that are clearly defined, appropriate to individual needs, achievable, and, if possible, recorded and measured.
Educational
objectives:
The reader will learn about and be able to list (1) the areas most and least affected by stammering, (2) the therapy approaches respondents had found helpful, and (3) other remedies that tried to help stammering.
