Nurse-led renal cell carcinoma clinic: a single center review.

BACKGROUND: In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes. OBJECTIVES: The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol. PATIENT AND METHODS: All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols. RESULTS: After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines. CONCLUSION: Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.

From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa.

SETTING: Thirteen primary health care (PHC) facilities in the Stellenbosch District, South Africa. OBJECTIVE: To assess the use of a sputum register to evaluate the tuberculosis (TB) diagnostic process and the initiation of TB treatment in selected PHC facilities in a country with a centralised laboratory system. DESIGN: This prospective study was conducted between April 2004 and March 2005. The names of all individuals submitting sputum samples for TB testing were noted in a newly introduced sputum register. We classified all TB suspects with two positive smears as TB cases and consulted TB treatment registers until 3 months after sputum submission to determine how many had started treatment. RESULTS: A total of 4062 persons aged > or =15 years submitted sputum samples, of whom 2484 were TB suspects. There were 2037 suspects with at least two results, 367 (18%) had at least two positive smears and 64 (17%) of these did not start treatment (initial defaulters). Over the entire diagnostic process, up to 5% of TB cases were missed, and up to 26% did not start treatment and were not reported. CONCLUSION: By correcting diagnostic weaknesses identified in the sputum register, PHC facilities will be able to detect, treat and cure a higher percentage of TB patients.

Initial default from tuberculosis treatment: how often does it happen and what are the reasons?

A study in 11 primary health care facilities in and around Cape Town determined the proportion of bacteriologically confirmed tuberculosis (TB) cases who did not start treatment (initial default) and identified reasons for it. Databases from centralised laboratories were compared with electronic TB treatment registers. Fourteen per cent (373/2758) of TB suspects were TB cases. Of the 58 (16%) initial defaulters, 14 (24%) died, while 26 (45%) could not be interviewed for address-related reasons. The 18 subjects who were interviewed indicated reasons for initial default that were (56%) or were not (44%) directly linked to services. High initial default rates require improvement in the quality of health services.

Effect of Boophone disticha on human neutrophils.

Boophone disticha (Amaryllidaceae) are mainly used in Southern Africa for inflammatory conditions. It is also known for its toxic effects. Because of the putative effects on components of the immune system and inflammatory response the effects of extracts of the bulb of Boophane disticha were investigated on ATP production in isolated human neutrophils. Furthermore, one possible mechanism of Boophone disticha's therapeutic properties might be its inhibition of superoxide release from neutrophils. The effect of the extracts on superoxide production of human neutrophils was also investigated. Aqueous and ethanol extracts of the outer and inner scales of the bulb of Boophone disticha was investigated for their effect on human neutrophils. It was decided to test the dry other scales separately from the fleshy inner scales as the parts are also used separately by traditional healers for different applications. ATP production was significantly decreased by ethanol extracts of the inner scales of the bulb. Superoxide production was significantly inhibited by aqueous extracts of the inner and outer scales of the bulb.

Leap-frog is a robust algorithm for training neural networks.

Optimization of perceptron neural network classifiers requires an optimization algorithm that is robust. In general, the best network is selected after a number of optimization trials. An effective optimization algorithm generates good weight-vector solutions in a few optimization trial runs owing to its inherent ability to escape local minima, where a less effective algorithm requires a larger number of trial runs. Repetitive training and testing is a tedious process, so that an effective algorithm is desirable to reduce training time and increase the quality of the set of available weight-vector solutions. We present leap-frog as a robust optimization algorithm for training neural networks. In this paper the dynamic principles of leap-frog are described together with experiments to show the ability of leap-frog to generate reliable weight-vector solutions. Performance histograms are used to compare leap-frog with a variable-metric method, a conjugate-gradient method with modified restarts, and a constrained-momentum-based algorithm. Results indicate that leap-frog performs better in terms of classification error than the remaining three algorithms on two distinctly different test problems.

Backpropagation uses prior information efficiently.

The ability of neural net classifiers to deal with a priori information is investigated. For this purpose, backpropagation classifiers are trained with data from known distributions with variable a priori probabilities, and their performance on separate test sets is evaluated. It is found that backpropagation employs a priori information in a slightly suboptimal fashion, but this does not have serious consequences on the performance of the classifier. Furthermore, it is found that the inferior generalization that results when an excessive number of network parameters are used can (partially) be ascribed to this suboptimality.

Optical correlator production system neural net.

A new neural net is described that can easily and cost-effectively accommodate multiple objects in the field of view in parallel. The use of a correlator achieves shift invariance and accommodates multiple objects in parallel. Distortion-invariant filters provide aspect-invariant distortion. Symbolic encoding, the use of generic object parts, and a production system neural net allow large class problems to be addressed. Optical laboratory data on the production system inputs are provided and emphasized. Test data assume binary inputs, although analog (probability) input neurons are possible.

Optical laboratory morphological inspection processor.

Morphological transformations are applied to industrial inspection problems. A real time optical architecture to implement morphological transformations such as erosion, opening, closing, and skeletonization is described and analyzed. The first real time optical laboratory results of erosion and opening are presented for locating string in tobacco.

Optical symbolic substitution for morphological transformations.

An optical architecture that uses symbolic substitution to perform morphological transformations is proposed. It is shown how the four basic morphological transformation operations can be posed as symbolic substitution problems. Representative examples of the application of morphological transformations to image processing are given.

Optical production systems using neural networks and symbolic substitution.

Two optical implementations of production systems are advanced. The production systems operate on a knowledge base where facts and rules are encoded as formulas in propositional calculus. The first implementation is a binary neural network. An analog neural network is used to include reasoning with uncertainties. The second implementation uses a new optical symbolic substitution correlator. This implementation is useful when a set of similar situations has to be handled in parallel on one processor.

Determination of plasma amino acids by gas chromatography.

A complete methodology, incorporating a novel clean-up technique, for quantitative determination of amino acids in plasma by gas chromatography is described. Glucose, a component causing major analytical interference, is removed by an enzymic reaction included in the pre-chromatographic clean-up. The procedure for derivatisation of amino acid standards is shown to be reproducible down to a level of 2.5 micrograms for each amino acid, relative standard deviations for all amino acids except arginine and histidine being 3% or lower. For the entire procedure applied to plasma, relative standard deviations for most amino acids are below 5% with recoveries ranging from 90 to 120%. Normal values, obtained using eighteen plasma samples, are in reasonable agreement with published data. Plasma amino acid values were determined simultaneously by gas chromatographic and ion-exchange chromatographic techniques. Statistical evaluation shows there to be no significant difference between corresponding values for eleven amino acids. Values for tyrosine, histidine and particularly phenylalanine show significant differences (p less than 0.001).

Preliminary report on the effect of prostaglandin F(2)alpha on the duration of the oestrus interval in beagle bitches.

In an attempt to shorten the oestrus interval of bitches, ten nonpregnant beagles were treated with prostaglandin F (PGF(2)alpha) within eight weeks of oestrus. The dose varied from 60 to 500 mug/kg/day administered over three to six days. Fifteen untreated bitches served as controls. The average oestrus interval of treated bitches was four months, while that of the controls was 6.55 months.

Chest physiotherapy during mechanical ventilation.

The effects of three different physiotherapy techniques on arterial oxygen tensions and A-aO2 gradients were evaluated in 17 patients subjected to mechanical ventilation. No significant changes were detected and the clinical significance of these findings, which contrast with those of other investigators, is discussed.