Learning from Practice: How East Lancashire Hospitals' Pharmacy Service Has Embraced Information Technology.

The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as 'let's make things better'. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy.

Automation of Pressure Control Improves Whole Porcine Heart Decellularization.

Whole heart decellularization combined with patient-specific cells may prove to be an extremely valuable approach to engineer new hearts. Mild detergents are commonly used in the decellularization process, but are known to denature and solubilize key proteins and growth factors and can therefore be destructive to the extracellular matrix (ECM) during the decellularization process. In this study, the decellularization of porcine hearts was accomplished in 24 h with only 6 h of sodium dodecyl sulfate exposure and 98% DNA removal.

Practical assessment of the display performance of radiology workstations.

The performance of 14 primary clinical display monitor workstations in use in the Radiology Department of a large acute NHS Trust was assessed using the methods and guidelines described by the American Association of Physicists in Medicine Task Group 18. Tests undertaken included the measurement of ambient light, display uniformity, luminance ratio, luminance response, maximum luminance and spatial resolution. Four display monitors failed to meet at least one of the test's guideline tolerances.

A survey of MRI quality assurance programmes.

There are currently no national guidelines on appropriate quality assurance (QA) test frequencies for MRI equipment in clinical use. From a random selection of 45 hospitals in England, who were contacted by phone, 35 hospitals agreed to participate in a survey of MRI QA and were sent a questionnaire requesting information on the range and frequency of QA tests, as well as the staff groups who conduct these tests. Twenty-four completed replies were received, representing a 68% response rate from the distributed questionnaires.

Patient radiation doses during invasive cardiac procedures categorised by clinical code.

Patient radiation doses delivered during invasive fluoroscopic cardiology procedures at the University Hospital of North Staffordshire during a 3 year period from November 1999 to August 2002, and comprising 6189 patient records, have been analysed. Cases have been stratified using classification codes from the Office of Population Census and Surveys (OPCS-4 codes), allowing representative doses to be assessed for 34 distinct types of cardiac radiological procedure. In addition, local guidance levels have been derived for the eight most common procedures.

Patient dose optimization in plain radiography based on standard exposure factors.

A computational technique for assessing patient dose in plain radiography is described allowing a large number of examinations to be assessed and enabling dose optimization to be promoted. Entrance surface dose (ESD) was calculated for more than 1500 standard exposure settings in an initial dose assessment. Validation of the technique showed good agreement with thermoluminescent dosimetry and showed broad agreement between the standard exposures and the exposure settings used in practice.

Assessment of health risks to skin and lung of elevated radon levels in abandoned mines.

Radon, together with its progeny, is present in high levels in some underground sites. Radon is known to increase the risk of lung cancer, while increased levels of radon decay products on the skin surface have been implicated in skin cancer induction and at sufficient levels might cause deterministic effects such as erythema. Although radon levels in working mines are controlled, radon in abandoned mines can reach very high levels, which would result in an occupant exceeding recommended annual exposure limits in less than 2 h in some mines.

Variations in radiation dose between the same model of multislice CT scanner at different hospitals.

The variation in exposure factors and patient dose, between seven centres using identical multislice CT scanners, was investigated for six standard examinations. Dose values were compared with each other and the relevant diagnostic reference level (DRL) for each examination. The range in weighted CT dose index (CTDI(w)) values between the seven centres was small for abdominal scans and head scans.

Evidence of seasonality in the diagnosis of monocytic leukaemia.

Evidence of seasonality in the diagnosis of monocytic leukaemia in England and Wales is presented, with a maximum diagnosis rate in February/March and a minimum in August/September. Previous published results for monocytic leukaemia are of small sample size yet appear consistent with this finding.

Personal monitoring of 218Po and 214Po radionuclide deposition onto individuals under normal environmental exposure conditions.

Personal dosemeters have been utilized to monitor the deposition of the radon decay products 218Po and 214Po onto individuals under normal environmental exposure conditions. Each detector consists of TASTRAK alpha-sensitive plastic incorporated into an ordinary working wristwatch. Subsequent analysis provides energy discrimination of the detected alpha-particle decays, and allows events from the individual radon decay products 218Po and 214Po, attached to the detector surface, to be uniquely identified.

Direct injection of 90Y MoAbs into glioma tumor resection cavities leads to limited diffusion of the radioimmunoconjugates into normal brain parenchyma: a model to estimate absorbed radiation dose.

Purpose: Previously we have demonstrated that radioimmunoconjugates can be injected into glioma resection cavities to deliver a boost of radiation to the cavity edge with little toxicity to the normal brain. In the mathematical models we have previously published to assist in the development of this strategy we assumed that antibody remains associated with the cavity edge and no diffusion occurs. However, moderate diffusion might be beneficial while, if this were excessive, it would decrease the therapeutic index markedly.

Alpha-particle dosimetry for the basal layer of the skin and the radon progeny 218-Po and 214-Po.

The population average dose to the basal layer of the skin is evaluated, in terms of dose per alpha-particle decay per unit area, for radon progeny 218-Po and 214-Po attached to the skin surface. Account is taken of the variation in basal layer depth between different individuals, and results are presented for several anatomical regions. On the face, for example, the population average dose to the basal layer from 218-Po is of the order of 0.

Fat cells in red bone marrow of human rib: their size and spatial distribution with respect to the radon-derived dose to the haemopoietic tissue.

Samples of human rib were collected at autopsy and 20 were selected for marrow fat cell measurement, representing an age range of 16-96 years. The mean diameter of fat cells in red bone marrow of human rib was found to increase from around 48 microns at ages 16-29 years to around 65 microns at ages 82-96 years. There was a greater number of fat cells of smaller size range in younger ages compared with that in older ones.

Radon and monocytic leukaemia in England.

The relationship between the standardised registration ratio (SRR) for monocytic leukaemia and the radon concentration by county in England was investigated. Leukaemia data were obtained from the OPCS and cover the age range 0-74 years and the period 1975-86. Radon concentrations were obtained from a recent National Radiological Protection Board report.

Radon and thoron associated dose to the basal layer of the skin.

The radon related alpha-particle annual dose equivalent to the basal layer of the epidermis has been calculated theoretically and is estimated as 2.5 (range 1.7 to 17) mSv y-1, for the exposed, uncovered skin of the face and neck, at the UK average domestic radon exposure of 20 Bq m-3.

Dose to red bone marrow from natural radon and thoron exposure.

The age-dependent radiation dose to the haematopoietic tissue of bone marrow has been calculated for exposure to radon, thoron and their daughter products. The component of dose due to pure radon is dependent on the fat content of the marrow, since the solubility of radon in fat is about 16 times that in tissue. The mean dose equivalent muSv to the total active marrow is estimated for a range of fat cell diameters from 25 to 200 microns, taking account of the percentage cellularity and distribution of active marrow as a function of age.

Radon as a causative factor in induction of myeloid leukaemia and other cancers.

The international incidence of myeloid leukaemia, cancer of the kidney, melanoma, and certain childhood cancers all show significant correlation with radon exposure in the home. For myeloid leukaemia, analysis suggests that in the UK 6-12% of incidence may be attributed to radon. In Cornwall, where radon levels are higher, the range is 23-43%.