Service provision for children and young people with acquired brain injury: Practice recommendations.

BACKGROUND: Providing appropriate rehabilitation services for Acquired Brain Injury (ABI) in childhood presents a number of challenges for caregivers, health and education professionals and the young person as they develop. PRIMARY OBJECTIVE: To record the challenges and possible creative solutions generated by an international group of professionals to address the needs of children with ABI. Review of information: Recommendations were generated from children's special interest group meetings of the International Brain Injury Association (Turin, Italy, 2001; Stockholm, Sweden, 2003; Melbourne, Australia, 2005; Lisbon, Portugal, 2008) and through meetings of the International Paediatric Brain Injury Society (IPBIS), formed in 2009. Delegates participating in the workshops were representative of nations from around the world and included The Netherlands, New Zealand, Australia, the UK, Finland, Germany, South Africa, the US, Canada, Sweden, Brazil and Italy. OUTCOMES: The information presented is based on a retrospective review of those meetings and the summaries of the topics considered.

Implementing a teaching service for voluntary faculty in obstetrics and gynecology: long-term results.

OBJECTIVE: To ensure the highest quality of resident training, by engaging community private physicians (PMDs) as voluntary faculty, through implementing teaching services in both obstetrics (OB) and gynecology (Gyn) in July 2003. We now report on the long-term success and challenges of the strategy. STUDY DESIGN: The case volume performed by residents was analyzed using the Accreditation Council for Graduate Medical Education self-reported resident statistics log, while resident educational satisfaction was analyzed using an anonymous survey. RESULTS: Approximately 90% and 60% of eligible PMDs participated in the Gyn and OB teaching services, respectively. Following implementation of teaching services, resident vaginal delivery volume increased from 859 cases in 2003 to 1,750 in 2004 (104% increase). Gynecologic surgery volume increased from 2,397 cases in 2003 to 3,436 in 2004 (43% increase). Survey of the residents in 2009, 5 years after implementation, indicated that 61% felt the teaching services improved their training experience, 47% that it improved resident-nurse interaction, and 72% that it improved resident-medical staff interaction. However, 28% also felt that the presence of the teaching services frequently caused confusion regarding residents' roles and responsibilities. CONCLUSION: The implementation of voluntary faculty teaching services in a residency training program enhanced the volume of cases available for training, with residents perceiving an improvement in their training and their interactions with attending staff. However, of concern was continued confusion regarding residents' patient care responsibilities.

The prognostic significance of thrombocytosis in epithelial ovarian carcinoma.

OBJECTIVE: The objective of this study was to determine the incidence of thrombocytosis in epithelial ovarian carcinoma and examine associations with clinico-pathologic features. Thrombocytosis (platelet counts >400 x 10(9)/l) has been identified as a poor prognostic factor in many cancers. Platelet-secreted factors may contribute to metastasis, invasion, and primary tumor growth. METHODS: One hundred eighty-three patients with invasive epithelial ovarian or primary peritoneal carcinomas were identified between January 1996 and December 2000. Records were retrospectively reviewed and data analyzed using chi(2), Student's t test, and Cox proportional hazards model; survival was analyzed by the method of Kaplan and Meier. RESULTS: Forty-one of 183 (22.4%) patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have greater elevations of CA-125 (P = 0.026), more advanced stage disease (P = 0.016), higher grade tumors (P = 0.010), more frequent lymph node metastases (P = 0.018), and greater volume of ascites (P < 0.0001). One hundred sixty of 183 (87.4%) patients achieved optimal cytoreduction; patients with thrombocytosis demonstrated a greater likelihood of suboptimal resection (residual disease >1 cm; 19/41 vs. 4/142 in patients without thrombocytosis, P < 0.0001). Patients with thrombocytosis had a shorter disease-free interval (12 vs. 34 months, P < 0.0001) and overall survival (28 vs. 79 months, P < 0.0001). On multivariate analysis, thrombocytosis retained significance as a poor prognostic indicator in patients with stage III and IVA disease (P = 0.04). CONCLUSIONS: Thrombocytosis is a frequent preoperative finding in ovarian and peritoneal carcinomas and may be a marker of aggressive tumor biology.