A quality improvement programme in radiotherapy using workflow audits.

BACKGROUND: Evaluation of the quality of healthcare depends on measures of structures, processes and outcomes. Progress in recording data allows for better measures of processes, such as the completeness of clinical data, the performance of professional tasks and the use of checklists. OBJECTIVES: To report the results of a radiotherapy (RT) workflow audit and a subsequent online survey of user experience. METHODS: The RT workflow audit was developed in 2016 and has been undertaken twice a year at 28 facilities or units, with a total of 32 linear accelerators. Electronic patient folders were reviewed to assess the documentation of 90 task items, of which 64 were scored. The auditor came from another facility. The online survey took place in July 2020. It contained questions on the audit's process, professional value and future use. Invitations were sent by email to the 151 radiotherapist staff at the 28 units where the audit had been implemented. Responses were anonymous. RESULTS: For the RT workflow audit, scores improved from 60% in some units in 2016 to >90% in all units for at least 2 years since 2018. The number of responders to the online survey was 58, giving a responder rate of 38%. The margin of error of the results was 10%. The audit's task items were considered appropriate by 77% of responders, and feedback was reported by 78% of them. The audit was considered very or extremely valuable to their unit's service delivery by 58% of responders. Changes in the unit as a result of the audit were reported by 77% of responders. The audit was very useful or extremely useful to 75% of responders in maintaining personal professional standards. The proportion of responders who were very or extremely supportive of continuing with the audit was 77%. The comments in the online survey will be helpful for ongoing review of the RT workflow audit. CONCLUSIONS: The RT workflow audit extends the scope of accreditation audits by including measures of processes. Users of the audit evaluate its processes favourably and report that it has value both in their unit's clinical service and for their personal professional standards. The audit is effective in developing quality improvement programmes.

Cardiovascular and diuretic activity of kaurene derivatives of Xylopia aethiopica and Alepidea amatymbica.

The extractives, crude and pure, of Alepidea amatymbica (AA) and Xylopia aethiopica (XA) were subjected to bioassay-directed phytochemical examination for potential cardiovascular and diuretic activity. All extractives and derivatives (XA/O, AA/1, xylopic acid, AA/3, AA/4, AA/5, AA/6, XA/1, XA/2, XA/3) displayed low toxicity, with LC(50) 0.5-5.0 ng/ml. For the first time, diterpene kaurenoids were reported to have significant systemic hypotensive and coronary vasodilatory effect accompanied with bradycardia. These effects were attributed to calcium antagonistic mechanism. The diuretic and natriuretic effects found were similar to the effects of chlorothiazide, suggesting inhibition of Na+ and K+ reabsorption in the early portion of the distal tubule. Further experiments are needed to elaborate the exact mechanisms of the hypotensive and diuretic effects of diterpene kaurenoids.

Paroxysmal cold haemoglobinuria coexisting with cold agglutinins in a patient with syphilis resulting in peripheral gangrene: a case report.

Cold-reactive antibodies may cause peripheral ischaemia, occasionally proceeding to gangrene on exposure to cold. A 46-year-old male with syphilis, presented with an unusual combination of both paroxysmal cold haemoglobinuria and cold agglutinin disease, resulting in peripheral gangrene and requiring bilateral below knee amputations.

PIP: Cold autoimmune hemolytic anemia refers to a group of primary or secondary hemolytic disorders in which the causative autoantibodies are maximally reactive at 0-10 degrees Celsius. Disagglutination occurs upon warming and in most patients agglutination ceases at 32 degrees Celsius. Paroxysmal cold haemoglobinuria (PCH) is a rare, acquired hemolytic syndrome caused by cold-active antibodies to antigens of the P blood group system. The condition is most commonly seen in children and young adults during convalescence from viral infections such as mumps, measles, or infectious mononucleosis. Syphilis is now an uncommon cause of PCH. Cold agglutinin disease may be primary or secondary to infections like mycoplasma pneumonia and infectious mononucleosis and lymphoproliferative disorders. Syphilis, however, is a rare cause of secondary cold agglutinin disease. Acrocyanosis and gangrene may result from severe and prolonged cold exposure, especially in primary cold agglutinin disease. The authors describe the case of a 46-year old man with syphilis who presented with the unusual combination of PCH and cold agglutinin disease which resulted in peripheral gangrene and ultimately required bilateral below-knee amputations.

Normal haematological reference values in the adult black population of the Witwatersrand.

Normal haematological reference values for healthy adult blacks residing on the Witwatersrand are given. The haemoglobin concentration was 13.95 +/- 0.8 g/dl for women and 15.82 +/- 1.05 g/dl for men. Leucocyte counts were lower than those found in whites, being 5.60 +/- 1.51 X 10(9)/l for both sexes. Platelet counts were 280 +/- 59.4 X 10(9)/l for men and 317 +/- 64.0 X 10(9)/l for women. The differential counts and other parameters are given in the text.