Staffing in hospital transfusion laboratories: UKTLC surveys show cause for concern.

OBJECTIVES: To monitor minimum standards in hospital transfusion laboratories in relation to qualifications, training, competency and the use of information technology over time against published recommendations. BACKGROUND: The United Kingdom Transfusion Laboratory Collaborative was formed in 2006 with representatives from relevant organisations and has published standards for transfusion laboratory practice. The standards are set to ensure safe transfusion laboratory practice. Regular surveys are performed to see the extent to which laboratories are able to meet these standards and where any problems lie. METHODS: An electronic survey is sent to hospital transfusion laboratories on a single mid-week day in the spring and is repeated every 2 years from 2011, to be completed by the lead in transfusion for the day. The questions cover staffing, training, funding and workload. RESULTS: Transfusion laboratories are having difficulty with staffing, particularly recruitment of suitably trained biomedical scientists, and with funding and time for training and education. Laboratory errors reported to the Serious Hazards of Transfusion haemovigilance scheme (SHOT) have not decreased with time, related to the under-resourced workforce. CONCLUSION: Problems in laboratory staffing and expertise in hospital transfusion laboratories need to be urgently addressed. The transfusion laboratory provides a key service to hospitals. The Blood Services in England and Wales are developing supportive strategies.

Feasibility, test-retest reliability, and interrater reliability of the Modified Ashworth Scale and Modified Tardieu Scale in persons with profound intellectual and multiple disabilities.

Caregivers of persons with profound intellectual and multiple disabilities (PIMD) often describe the quality of the daily movements of these persons in terms of flexibility or stiffness. Objective outcome measures for flexibility and stiffness are muscle tone or level of spasticity. Two instruments used to grade muscle tone and spasticity are the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale (MTS). To date, however, no research has been performed to determine the psychometric properties of the MAS and MTS in persons with PIMD. Therefore, the purpose of this study was to determine the feasibility, test-retest reliability, and interrater reliability of the MAS and MTS in persons with PIMD. We assessed 35 participants on the MAS and MTS twice, first for the test and second a week later for the retest. Two observers performed the measurements. Feasibility was assessed based on the percentage of successful measurements. Test-retest and interrater reliability were determined by using the Wilcoxon signed rank test, intraclass correlation coefficients (ICC), Spearman's correlation, and either limits of agreement (LOA) or quadratically weighted kappa. The feasibility of the measurements was good, because an acceptable percentage of successful measurements were performed. MAS measurements had substantial to almost perfect quadratically weighted kappa (>0.8) and an acceptable ICC (>0.8) for both inter- and intrarater reliability. However, MTS measurements had insufficient ICCs, Spearman's correlations, and LOAs for both inter- and interrater reliability. Our data indicated that the feasibility of the MAS and MTS for measuring muscle tone in persons with PIMD was good. The MAS had sufficient test-retest and interrater reliability; however, the MTS had an insufficient test-retest and interrater reliability in persons with PIMD. Thus, the MAS may be a good method for evaluating the quality of daily movements in persons with PIMD. Providing test administrators with training and clear instructions will improve test reliability.

Arthroscopic treatment of instability attributable to capsular injury or laxity.

Among the many causes of shoulder instability are traumatic capsular injury associated with the Bankart lesion and capsular laxity as seen in multidirectional instability. Previously, open surgical procedures were the most commonly accepted surgical treatment of these disorders. However, because of the foresight of surgeons such as Richard Caspari, arthroscopy rapidly is becoming the surgical treatment of choice. Current studies have shown a 97% satisfactory outcome of arthroscopic Bankart repair. Similarly, the arthroscopic treatment of multidirectional instability has produced a 93% satisfactory outcome. These results parallel the gold standard open surgical techniques of the past and subsequently have led to a change in the treatment of shoulder instability.

Postgraduate training in public health medicine: St George's Hospital Medical School Library public health information service.

This article examines the development of the St George's Hospital Medical School Library public health information service. Begun in 1997 as a pilot project to support Public Health Specialist Registrars in South Thames West, it is now an established part of postgraduate training in the region. An outline of the service is described, including the evolution of the post of Public Health Librarian. Issues influencing the development of the service, and the establishment of the Librarian as part of the public health network are discussed. This is a transferable model of public health information provision, which as a centralized resource makes best use of available funding. As a LIS model it is an effective and efficient way of maximizing resources, and delivering a service to a specialist user group that is spread across a wide geographical area.

The effect of Workers' Compensation on clinical outcomes of arthroscopic-assisted autogenous patellar tendon anterior cruciate ligament reconstruction in an acute population.

PURPOSE: To assess the effect of Workers' Compensation (WC) benefits on subjective outcomes of patients following anterior cruciate ligament (ACL) reconstruction. TYPE OF STUDY: Prospective study of ACL reconstruction with bone-patellar tendon-bone in an acute population. METHODS: From October 1991 through June 1997, 1,015 patients underwent ACL reconstruction, 769 with bone-patellar tendon-bone autografts; 235 met the criteria for this study. All chronic injuries, failed and/or bilateral reconstructions were excluded making the total population 139. The final populations included 115 patients in a non-WC group and 24 patients in a WC group. Average follow-up for was 34.5 months for the WC group and 33.6 months for the non-WC group. All patients had equal objective evaluations, which allowed the subjective criteria to be analyzed. RESULTS: The results revealed a significant difference in the subjective data of patients with WC benefits. Uniformly, WC patients rated subjective criteria as far worse than the non-WC group in postoperative stages. The average of the 15-item visual analog scale showed statistically significant (P <.01) differences between the WC and non-WC groups. Average postoperative Tegner scores were 3.05 for the WC group and 6.02 for the non-WC group, which was statistically significant. The WC group did not return to their preinjury Tegner score. CONCLUSIONS: The data show that the patients' perception of their knee function drastically differs from the objective findings on examination; therefore, it should be anticipated that the WC patient might have lower subjective outcomes from surgical treatment when compared with their non-WC counterparts.

Simultaneous application of in situ DNA hybridization and immunohistochemistry on one tissue section.

Combined application of a non-radioactive in situ DNA hybridization procedure and the immunoperoxidase technique on one tissue section is described. Of six potential protocols, only one proved to be successful. First, the immunohistochemical procedure including visualization of enzyme activity is performed; the in situ DNA hybridization protocol is then applied. Using this protocol, several antigens, detected with monoclonal antibodies, and target DNAs, detected by using biotinylated human cytomegalovirus or human papilloma virus type 16 DNA probes, could be distinguished by their peroxidase activity (brown precipitate) and alkaline phosphatase activity (purple-blue precipitate) respectively. The method allows immunophenotyping of virus-infected cells as well as simultaneous visualization of two viral parameters. This technique has important implications for research and diagnostic purposes.

Implausibility of an aetiological association between cytomegalovirus and Kaposi's sarcoma shown by four techniques.

The presence of cytomegalovirus (CMV) was analysed in either lymph node or skin and lung tissue necropsy specimens affected by Kaposi's sarcoma, from 10 patients who had died of AIDS. The different detection techniques used were: (i) immunohistochemical demonstration of CMV immediate early antigen (IEA); (ii) in situ hybridisation with a biotinylated CMV DNA probe; (iii) Southern blot hybridisation of DNA extracted from sequential tissue sections; and (iv) polymerase chain reaction (PCR) with CMV specific primers on the DNA samples. The results of these analyses were compared with the postmortem data on CMV obtained by infectious particle assays and histological examination, especially of adrenal glands of the same patients. The results of the various detection methods correlated very well, yielding a combined score of six of 10 patients positive for CMV; there did not seem to be any association between the presence of CMV and the occurrence of Kaposi's sarcoma in our patients.

Analysis and isolation of cytomegalovirus DNA by field inversion gel electrophoresis.

High molecular weight human cytomegalovirus (CMV) DNA was isolated from agarose-embedded infected human diploid cells by employing field inversion gel electrophoresis. A high yield of CMV DNA molecules was obtained within 1 week of infecting the cell culture. Labelling of the viral DNA with biotin by nick translation enabled the detection of CMV-infected cells in sections of paraffin-embedded human adrenal gland by in situ hybridization.