An analysis of complaints against oral health professionals charged with misconduct at the HPCSA: 2004-2009.

AIM: This study investigates the nature, frequency, and outcome of complaints relating to misconduct laid against oral healthcare professionals (OHPs), charged with misconduct in South Africa. METHODS: Records of the Health Professions Council of South Africa (2004-2009) were analysed and classified using the ethical rules as a reference. "Clinically-related complaints" and "fraud" were added as extra categories. The nature and outcome of the complaints and the penalties were quantified, and the detailed nature of the complaints was qualitatively reported. RESULTS: Two percent of the registered dentists and 5.5% of the registered dental therapists were charged with misconduct. Clinically related complaints (59%) and fraud (29%) were most prevalent amongst the accused dentists. Fraud (46%), clinically related complaints (19%), advertising (15%), infection control (8%), and creating expectations that could not be met (8%) were the most common complaints against dental therapists. CONCLUSIONS: Substandard dental treatment and fraud were the main reasons for patient dissatisfaction that led to OHPs being charged with misconduct. Both these undesirable practices may be financially motivated. OHPs should take cognisance of these statistics and should adjust their professional approach accordingly in order to reflect acceptable ethical behaviour.

Family tracing to identify patients with familial hypercholesterolaemia: the second audit of the Department of Health Familial Hypercholesterolaemia Cascade Testing Project.

BACKGROUND: Family tracing is a method recognized to find new patients with familial hypercholesterolaemia (FH). We have implemented family tracing led by FH Nurses and have determined acceptability to patients, feasibility and costs. METHODS: Nurses were located at five National Health Service (NHS) Trusts; they identified FH patients and offered them family tracing. Responses and test results were recorded on a database and summarized on a family pedigree. RESULTS: The majority ( approximately 70%) of index cases participated; the proportion was lower when patients had been discharged from the clinics and in metropolitan areas. On average, 34% (range 13-50%) of relatives lived outside the catchment area of the clinics and could not attend the nurse-led FH clinics. Of the previously untested relatives, 76% who lived in the catchment area of the clinic came forward to be tested. One-third of the relatives who came forward for testing were children

Are patients with familial hypercholesterolaemia well managed in lipid clinics? An audit of eleven clinics from the Department of Health Familial Hypercholesterolaemia Cascade Testing project.

BACKGROUND: Familial hypercholesterolaemia (FH) is an autosomal co-dominant disorder which is relatively common, leads to high levels of LDL-cholesterol and if untreated to early coronary heart disease. An audit of current practice at National Health Service Trusts in England was undertaken to determine whether FH patients meet the diagnostic criteria for FH; are being offered appropriate advice and treatment; and to what extent their families are contacted and offered testing for the disorder. METHODS: Medical records of known FH patients (over 18 years of age and diagnosed before 31 December 2003) were accessed to obtain information on diagnosis, treatment and family tracing. RESULTS: The records of 733 FH patients were examined, 79% met the UK 'Simon Broome' register criteria for the diagnosis of definite or possible FH. Analyses showed that patients were usually offered appropriate advice and treatment, with 89% being on a statin. However, the audit indicated a high variability in family tracing between the sites, with significant differences in the frequency of inclusion of a family pedigree in the notes (range 1-71%, mean 35%); the general practitioner (GP) being advised that first-degree relatives should be tested (range 4-52%, mean 27%); and the proportion of relatives contacted and tested (range 6-50%, mean 32%). CONCLUSION: FH patients are well cared for in lipid clinics in England, are being given appropriate lifestyle advice and medication, but an increase in recording of LDL-cholesterol levels may lead to improvements in their management. Practice in family tracing appears to vary widely between clinics.

A survey of laboratory practice in the clinical authorization and reporting of results.

BACKGROUND: The aim of this survey was to determine the practice of authorization and reporting of results in clinical biochemistry laboratories in the UK. METHOD: Questionnaires were distributed to the heads of clinical biochemistry departments through the National Audit Committee of the Association of Clinical Biochemists. The standards surveyed were based on guidelines for the reporting of results produced by the Royal College of Pathologists and the relevant Clinical Pathology Accreditation standards. RESULTS: Completed questionnaires were received from 137 laboratories. Workload ranged from 15,000 to 750,000 requests per annum (median 276,883). Most laboratories (98%) release results electronically to at least some wards in real-time. Areas where difficulties were identified included identifying requests that had posed specific questions and access to clinical information at the authorization stage, recording clinical advice given, and ensuring comments remained attached to printed reports or were on the same screen on computer reports. All but six laboratories had consultant advice available, including out of hours, but only 17% had an arrangement for clinical authorization to occur out of hours. CONCLUSION: Only 45 laboratories (33%) were able to achieve 100% compliance with the standards that currently exist, but many others showed evidence of good practice. The practical obstacles still to be overcome include limitations in the capabilities of laboratory computer systems, the lack of accessible electronic clinical records, the difficulties of covering work out of hours and insufficient appropriately trained staff.

Effect of low protein concentration on serum sodium measurement: pseudohypernatraemia and pseudonormonatraemia!

BACKGROUND: The effect of high concentrations of protein or lipid on the measurement of plasma sodium by indirect ion selective electrode (ISE) causing pseudohyponatraemia and pseudonormonatraemia is well described. The effect of a low total protein concentration, however, has not been described. METHODS: In order to examine this, over a 2-week period the total protein concentration was measured on all samples received for urea and electrolyte measurement. All samples with a low (<50 g/L) or a high (> 80 g/L) total protein concentration had sodium measured by both direct and indirect ISE. RESULTS: There were approximately equal numbers of samples with a protein concentration less than 50 g/L (1.3%) as samples with a protein concentration greater than 80 g/L (1.3%). The frequency of erroneous sodium results owing to the use of an indirect ISE was less in hypoproteinaemic (2%) than in hyperproteinaemic (20%) samples.

[The ethics of dental records]. / Die etiek van tandheelkundige rekords.

This article highlights five aspects of necessary record-keeping in practices: ethicolegal requirements, confidentiality and disclosure, risk management and consent, accounts and practice management, and forensic functions. Patient records therefore have ethical, moral, legal and management implications. Unfortunately, they are often underestimated or ignored by practitioners. In the light of increasing litigation and disciplinary hearings, it is necessary to remind practitioners that every clinical action also contains an administrative component which has to fulfill many requirements.

Pilot randomised study of early intervention based on tumour markers in the follow-up of patients with primary breast cancer.

BACKGROUND: This pilot study aimed to test the possibility of therapeutic benefit imparted by early intervention based on sequential tumour marker (TM) measurements during follow-up of primary breast cancer (PBC) patients. METHODS: Patients with oestrogen receptor positive PBC with no clinical and/or radiological evidence of metastases were recruited and followed-up 3-monthly with clinical assessment and TM (CA15.3 and CEA) measurements. The clinical team was blinded to the TM results. Asymptomatic patients who developed raised TMs (based on pre-defined cut-offs) were randomised to either 'treatment change' (either start or change of adjuvant endocrine agent to another agent) or 'no change' (control). Patients who developed symptomatic metastases came off the study. The primary and secondary endpoints were intervals from randomisation to symptomatic metastases and to last follow-up/death respectively. RESULTS: Eighty-five patients (median age = 54 years (30-72)) were recruited with a median follow-up of 81 months (1-124). Sixteen patients were randomised as described. There was no significant difference (treatment change versus no change) with regards to interval from randomisation to symptomatic metastases - 23 (2-62) and 22 (1-63) months respectively (p = 0.9), as well as interval from randomisation to last follow-up/death - 36 (7-63) and 37 (10-63) months respectively (p = 0.9). CONCLUSIONS: Despite long follow-up (up to 10+ years), this small study has thus far shown no significant difference in outcome. However, we have confirmed the feasibility of this study design but a larger study will be required to show if there is a benefit to this approach.

Alendronate sodium in the management of osteoporosis.

Alendronate is one of the best and most extensively studied bisphosphonates in the treatment of osteoporosis. This review considers in detail the major pivotal study, the fracture intervention trial (FIT), upon which the use of alendronate is based and which was a landmark study in terms of design, size and clinical impact. The role of alendronate has subsequently been underscored by a range of studies extending the clinical indications for its use and consolidating the effect on reducing both vertebral and non-vertebral fracture risk. Although the emphasis of these studies has predominantly been on the management of postmenopausal osteoporosis, data is also available in primary prevention, men, and glucocorticoids-induced osteoporosis. Direct comparison between the different drugs used to treat osteoporosis with fracture end points are needed for patients and doctors to make informed choices, but the size of such studies are prohibitive. Clinical trials using surrogate markers such as bone mineral density and biochemical markers of bone turnover have been performed which provide some helpful information but the limitations of this approach need to be recognized.

Geographic mitochondrial DNA variation in the rock hyrax, Procavia capensis.

Restriction-fragment-length polymorphisms in mitochondrial DNA (mtDNA) were used to evaluate geographic population genetic structure in the rock hyrax, Procavia capensis, a species which occurs widely, though restricted to rocky habitat, throughout South Africa. Ten restriction endonucleases were employed to assay mtDNAs from 55 specimens representing 10 localities. Haplotypes showed strong geographic patterning, and estimates of nucleotide sequence divergence indicate two major clades thought to be dispersing along separate routes. The divergence time of approximately 2 Myr between clades is relatively high for intraspecific variation. We speculate that the marked genetic break distinguishing the northwestern populations from those constituting the south/central clade may be indicative of two species in what has conventionally been regarded as P. capensis.

The ecophysiological significance of calcium bicarbonate in the urine of subterranean rodents: testing a hypothesis.

1. A comparative study of calcium and bicarbonate in the urine was carried out on the subterranean mole rat Cryptomys hottenttus and the terrestrial vlei rat Otomys irroratus. 2. The two species were kept on two different diets; carrots, a high calcium diet (41 mg/ 100 kg) or potatoes, a low calcium diet (14 mg/ 100g). 3. The results show that the urine of the mole rat contained high values of calcium bicarbonate on either diet. 4. The urine of the vlei rat showed high values of calcium bicarbonate only when kept on the high calcium diet. 5. From these results we assume that in subterranean rodents excretion of calcium bicarbonate is an adaptive mechanism to unload CO2 without increasing its concentration in the hypercapnic environment.

Evaluation of neutrophil and lymphocyte function in subjects with iron deficiency.

Neutrophil function was studied in a group of 15 children, 7 with iron deficiency (4 with iron deficiency anaemia) and 8 age-matched controls; by clinical and laboratory criteria, all were uninfected. In a second group of 28 children, 14 iron-deficient (6 with iron deficiency anaemia) and 14 controls, numbers of circulating T and B lymphocytes and responsiveness to the mitogens phytohaemagglutinin and concanavalin A were assessed. Levels of salivary IgA were estimated in every patient. Neutrophil chemotaxis to autologous endotoxin-activated serum and control serum, phagocytosis of Candida albicans and post-phagocytic nitro-blue tetrazolium reduction were similar in both the iron-deficient and control groups. Likewise, levels of secretory IgA, serum immunoglobulins, total haemolytic complement and complement components, and numbers of T and B lymphocytes were comparable in both iron-deficient groups and the control group. However, transformation to both mitogens was reduced in the group with iron deficiency anaemia.