The diagnostic role of ventilation/perfusion scans versus computed tomography pulmonary angiography in obstetric patients investigated for pulmonary embolism at Wellington Hospital from 2010 to 2012.

AIM: To develop best practice clinical guidelines for the use of ventilation/perfusion (V/Q) scanning and computed tomography perfusion angiography (CTPA) in pregnancy and the postpartum period. METHOD: Retrospective analysis of the clinical findings and radiologic investigation for pulmonary embolism (PE) in obstetric women at Wellington Hospital from 2010 to 2012. RESULTS: Fifty-four women were investigated for PE with a V/Q scan or CTPA, including 29 antenatal women and 25 postnatal women. Eleven (37.9%) antenatal women had V/Q scans and 18 (62%) had CTPAs. Five (20%) postnatal women had V/Q scans, 19 (76%) had CTPAs and one (4%) had a V/Q scan followed by a CTPA. Three of the 54 women (5.6%) had a positive radiologic finding of PE (two by V/Q scan and one by CTPA). Four (22.2%) antenatal women and 5 (25%) postnatal women had a diagnosis made on CTPA, which was not seen on chest x-ray. CONCLUSION: This audit found that clinicians varied in their investigation of cases suspected of PE. We have proposed a clinical pathway for the investigation of PE in pregnancy and the postpartum period.

A surveillance sector review applied to infectious diseases at a country level.

BACKGROUND: The new International Health Regulations (IHR) require World Health Organization (WHO) member states to assess their core capacity for surveillance. Such reviews also have the potential to identify important surveillance gaps, improve the organisation of disparate surveillance systems and to focus attention on upstream hazards, determinants and interventions. METHODS: We developed a surveillance sector review method for evaluating all of the surveillance systems and related activities across a sector, in this case those concerned with infectious diseases in New Zealand. The first stage was a systematic description of these surveillance systems using a newly developed framework and classification system. Key informant interviews were conducted to validate the available information on the systems identified. RESULTS: We identified 91 surveillance systems and related activities in the 12 coherent categories of infectious diseases examined. The majority (n = 40 or 44%) of these were disease surveillance systems. They covered all categories, particularly for more severe outcomes including those resulting in death or hospitalisations. Except for some notifiable diseases and influenza, surveillance of less severe, but important infectious diseases occurring in the community was largely absent. There were 31 systems (34%) for surveillance of upstream infectious disease hazards, including risk and protective factors. This area tended to have many potential gaps and lack integration, partly because such systems were operated by a range of different agencies, often outside the health sector. There were fewer surveillance systems for determinants, including population size and characteristics (n = 9), and interventions (n = 11). CONCLUSIONS: It was possible to create and populate a workable framework for describing all the infectious diseases surveillance systems and related activities in a single developed country and to identify potential surveillance sector gaps. This is the first stage in a review process that will lead to identification of priorities for surveillance sector development.