To determine the practices, knowledge and opinions of health care providers regarding a prenatal genetic screening program in Ontario.
Cross-sectional self-reported survey.
Ontario.
Random sample of ...2000 family physicians, all 565 obstetricians and all 62 registered midwives in the province. Among subjects who were eligible (those providing antenatal care or attending births) the response rates were 91% (778/851), 76% (273/359) and 78% (46/59) respectively.
Which patients were offered maternal serum screening (MSS), how results were being communicated, knowledge of the test's sensitivity, likes and dislikes about MSS and recommendations regarding the program.
Most (97%) of respondents stated that they were offering MSS to the pregnant women in their practices; 88% were offering it routinely to all pregnant women (87% of the family physicians, 90% of the obstetricians and 100% of the midwives). Most (92%) of the respondents stated that they communicate positive results to their patients personally as soon as they are received; 23% did so for negative results. The respondents correctly identified the initial positive rate but underestimated the false-positive rate. About one-third did not respond to these knowledge questions. Of those who gave feedback on the screening program, 50% recommended that it not be changed, 29% suggested that it be changed, and 22% recommended that it be scrapped.
Participation in the Ontario Maternal Serum Screening Program by health care providers has been good, although knowledge about MSS is far from ideal. Many providers have reservations about the program. In light of concerns raised about the high false-positive rate and the anxiety such results generate in pregnant women, there is a need for more education of providers and patients and a better understanding of women's experiences with genetic screening.
Following a recommendation from the International Conference on Harmonisation, pharmaceutical companies are now monitoring possible drug effects on sperm motility in the rat during preclinical safety ...studies by assessing sperm motility (velocity). However, it is not known precisely how changes in sperm motility relate to fertility. Therefore, the effects of α-chlorohydrin on sperm motility were investigated and related to fertility both in vivo and in vitro. α-Chlorohydrin was given orally to male rats using a range of doses: 0, 5, 10, and 20 mg/kg for at least 5 consecutive days. Sperm were then assessed for motility using a standard scoring system (operators' observation of sperm) that graded degree of motility (i.e., 0 = i mmotile to 4 = very motile). The results showed a dose-related decrease in sperm motility. The sperm also appeared to move with a “jerky” action. Surprisingly, when this was correlated to fertility, none of the females mated with treated males became pregnant. A dose-related decrease in pregnancy would perhaps have been expected. There was no effect on sperm morphology, and testicular and epididymal pathology were only seen after doses of 20 mg/kg. When sperm from untreated rats were incubated with α-chlorohydrin in vitro at concentrations of 0, 0.5, 1.0, and 1.5 mM, sperm motility and motion were similarly affected as observed in vivo. However, the fertilization capacity (in vitro fertilization) of the treated sperm showed a concentration-related reduction in percentage fertilization, and there was also evidence of abnormal embryo development. These findings suggest that the present standard scoring system used in preclinical safety studies is not a comprehensive indicator of sperm function and/or fertility. A better understanding of sperm movement, therefore, is desirable so effects on sperm motility can be related to fertility.
Focussing on dose Woods, Joanne; Messer, Simon
Synergy,
09/2009
Trade Publication Article
Introduction Radiosraphers have a responsibility, under the Ionising Radiation (Medical Exposures) Regulations 2000 to produce ? mases of optimum diasnostic quality whilst keepms the radiation dose ...to patients as low as reasonably practicable - the ALARP principle In the past, numerous techniques have been utilised to minimise patient dose durins x-ray procedures, mcludins accurate positionins, careful collimation, appropriate selection of equipment, exposure factors, film-screen combinations, and throush the use of lead shielding where appropriate ; In x-ray departments with computed radiography (CR) systems, most of these techniques are still applicable. ... the authors recosnise that FFD is more familiar to practitioners, so have used the term throughout. Research has shown that geometric factors, ie, the inverse square law, are the main contributors to dose reduction when utilising this method ' Increases the FFD has the same effect as reducins the mAs, ie, less photons reach the imase receptor, but it also has the additional benefits of reducins magnification and geometric unsharpness in the image produced5,13,14,15,16,17 Database and journal searches found no research investigating the effects of increased FFD on patient dose and image quality using a CR system, although earlier research into the effects of altering the FFD has been conducted using traditional film-screen radiosraphy, with the results demonstratins that this method can significantly reduce patient dose For example, Brennan et al16 demonstrated a 34.5% reduction in entrance surface dose for an anteroposterior (AP) pelvic examination when the FFD was increased to 130cm, with no loss of image quality.
... the results from the patient's urine sample analysis had already shown raised levels of a type of protein found in bladder cancer cells, and he would not consent to a cystoscopy due to its ...invasive nature. Because the patient had a high likelihood of malignancy, and was over 40, CT urography would have been an appropriate choice of imaging modality, because diagnosis and staging could have been performed together.\n PET/CT is a relatively new imaging modality that allows the acquisition of PET and CT images in one examination, thus providing combined anatomical and physiological information30,35 (figure 8).
