Overview of shorthand medical glossary (OMG) study.

BACKGROUND: Shorthand is commonplace in clinical notation. While many abbreviations are standard and widely accepted, an increasing number are non-standard and/or unrecognisable. AIM: We sought to describe the frequency of inappropriate and ambiguous shorthand in discharge summaries. METHODS: Eighty electronic discharge summaries from the four General Medical Units at the Royal Melbourne Hospital were randomly extracted from the hospital's electronic records. Extraction was stratified by the four units and by the four quarters between July 2012 and June 2013. All abbreviations were assigned into one of four categories according to appropriateness: 1. 'Universally accepted and understood even without context'; 2. 'Understood when in context'; 3. 'Understood but inappropriate and/or ambiguous'; and 4. 'Unknown'. These categories were determined by the authors, which included junior and senior medical staff. RESULTS: The 80 discharge summaries contained 840 different abbreviations used on 6269 occasions. Of all words, 20.1% were abbreviations. Of the 6269 occasions of shorthand, 6.8% were categorised as 'Understood but inappropriate and/or ambiguous' or 'Unknown' (category 3 or 4), equating to 1.4% of all words, and an average of 5.4 words per discharge summary. CONCLUSION: Abbreviations are common in electronic discharge summaries, occurring at a frequency of one in five words. While the majority of shorthand used seems to be appropriate, the use of inappropriate, ambiguous or unknown shorthand is still frequent. This has implications for safe and effective patient care and highlights the need for better awareness and education regarding use of shorthand in clinical notation.

Frequency and significance of granulomas in a cohort of incident cases of Crohn's disease.

BACKGROUND AND AIMS: Epithelioid granulomas is one of the best histological criterion for distinguishing Crohn's disease (CD) from other inflammatory bowel diseases. Few data are available on the time of occurrence of epithelioid granulomas, and the value of epithelioid granulomas in predicting outcome has been determined only in cohorts of prevalent CD cases. Our objective was to evaluate epithelioid granuloma occurrence in incident CD cases and to examine the associations between epithelioid granulomas and outcome. PATIENTS AND METHODS: We reviewed the histological reports of endoscopic and surgical specimens in a cohort of 188 consecutive incident CD cases seen in 1994 and 1995, and recorded the occurrence of epithelioid granulomas, isolated giant cells, and microgranulomas. Kaplan-Meier curves were plotted for time from CD diagnosis to immunosuppressive treatment or surgery, and associations between epithelioid granulomas and outcome were evaluated in a multivariate analysis. Follow up was at least five years. RESULTS: Granulomas were found in 69 (37%) patients, including 46 (25%) at presentation. Median time from CD diagnosis to epithelioid granuloma detection was 0.16 (0-63) months overall, and 9.59 (0.1-63) months in 23 patients who became epithelioid granuloma positive during follow up. Isolated giant cells were found in 6% of patients and microgranulomas in 12%. Epithelioid granuloma detection increased with the number of endoscopic sampling procedures; sampling site had no influence. By multivariate analysis, epithelioid granulomas were associated with surgical resection but not immunosuppressive therapy. CONCLUSIONS: Epithelioid granulomas may separate CD into two pathological subsets and may indicate aggressive disease.

Synthesis and characterization of regiorandom and regioregular poly(3-octylfuran).

Poly(3-octylfuran) has been synthesized with three regioregularities: P3OF-95, P3OF-75, and P3OF-50, where the number signifies the percentage HT content. The 95% HT material is highly crystalline with a structure similar to that of HT-poly(3-octylthiophene), P3OT. The lamellar spacing is 22.1 A and the pi-stacking distance is 3.81 A. UV-vis spectroscopy reveals that P3OF-95 is aggregated in CHCl(3) solution, and solid films of P3OF-95, but not P3OF-75 or -50, show Davydov and exciton band splitting due to the interactions of the pi-systems in the stacked morphology. An estimate of the Davydov splitting is 0.15 eV (1200 cm(-1)). P3OF is reversibly oxidized at 0.32 V vs ferrocene/ferrocenium, but increasing the potential to 1.15 V leads to irreversible oxidation. Films of P3OF may be p-doped with iodine vapor. Doped P3OF-95 and -75 films have electrical conductivities of 10(-2) and 10(-7) S/cm, respectively. The UV-vis-NIR spectra of the iodine-doped films are interpreted in terms of molecular-like transitions involving the LUMO, HOMO, HOMO-1, and transitions across a Peierls distortion-induced gap in the intermolecular conduction band that is formed by the overlap of the pi-systems of the stacked partially oxidized chains. The conduction band gap estimated for P3OF-95 is 0.34 eV, and that for P3OF-75 is 0.9 eV. The P3OF samples are thermally stable in N(2) atmosphere to between 275 degrees C (P3OF-50) and 380 degrees C (P3OF-95), but suffer thermal oxidation above 150 degrees C or light-induced oxidation at room temperature.

Selective survival of only the healthy fetus following prenatal diagnosis of thalassaemia major in binovular twin gestation.

Selective feticide is the procedure of choice when, in twin binovular pregnancy, only one of the fetuses is shown to be affected. As the probabilities for this condition are almost 1:2 when the genetic disease is due to homozygosity for two autosomal recessive genes, the problem is expected to occur frequently among the ever increasing number of couples seeking prenatal diagnosis of thalassaemia and the haemoglobinopathies. The present report is the first case of this condition and the ninth in the overall medical literature.

The use of 15-methylated derivative of prostaglandin F2a for the therapeutic termination of pregnancy and management of late fetal death.

The administration of 15-me-PGF 2a for the therapeutic termination of pregnancy and management of intrauterine death of the embryo during the second and third trimester of pregnancy was studied in 92 patients. Of these, 52 came because of intrauterine death with an average gestational age of 28.7 weeks while the rest came for therapeutic termination of pregnancy with an average gestational age of 21 weeks. Successful abortion was achieved in 90 patients. The mean abortion induction time was 7.3 hours for patients with intrauterine death and 12.6 hours for the patients who came for therapeutic termination. The results and complications of the intramuscular administration of the 15-me-PFG2a are analysed in the present work.

An evaluation of emergency medical technicians' ability to use manual ventilation devices.

Three hundred twenty emergency medical technicians (EMTs) were tested for their ability to ventilate a precalibrated Recording Resusci-Annie (Laerdal Medical Corporation) using both a bag-valve-mask and a pocket mask. More than 50% of the EMTs were not capable of ventilating to the minimum standard using a bag-valve-mask. The study demonstrates that the pocket mask method is far superior to the bag-valve-mask method. If these experimental results are confirmed by clinical findings, we recommend that future educational courses teach the bag-valve-mask as a four-hand/two-person skill, with one rescuer squeezing the bag with both hands and the second rescuer maintaining hyperextension.

Role of fibreoptic bronchoscopy in the diagnosis of mycobacterial diseases.

From January 1976 to December 1981 mycobacteria were recovered for the first time from the respiratory tract of 179 patients. Twenty-three patients had undergone fibreoptic bronchoscopy during initial investigation after three or more expectorated sputum specimens were negative for acid-fast bacilli. Three of these patients had nodular lesions on the chest radiograph and the diagnosis of mycobacterial disease was made only after thoracotomy. In the remaining 20 patients bronchial brushings yielded a positive culture in 19, while bronchial brushing was negative in one patient in whom culture of sputum before bronchoscopy had been positive. In eight of these 19 patients (group A) bronchial brushing was the only source that gave a positive result from culture, while in 11 patients (group B) both bronchial brushing and prebronchoscopy sputum yielded positive cultures. When these two groups were compared no difference was seen in their clinical presentation or radiographic findings but there was a notable difference in the quality of the presentation or radiographic findings but there was a notable difference in the quality of the prebronchoscopy sputum. Six of eight patients in group A had poor prebronchoscopy sputum, while 10 of 11 in group B had good prebronchoscopy sputum. It is concluded that, if a patient is unable to produce sputum or is able to produce only a poor specimen, fibreoptic bronchoscopy may be a useful means of obtaining additional material for culture.

Empyema thoracis during a ten-year period. Analysis of 72 cases and comparison to a previous study (1952 to 1967).

In this series of 72 cases of empyema, 28 patients (38.8) had anaerobes isolated from their pleural fluid cultures. In 22 patients, anaerobes were the only isolates, and in six there were also aerobes. This observed frequency (38.8%) of anaerobic empyema is notably greater than the frequency noted in an earlier study (1952 to 1967) from the Veterans Administration Medical Center, Wood, Wis, while the contribution of various pathogenetic mechanisms was similar. Although closed chest tube drainage was instituted initially in 51 patients, 18 patients (35%) subsequently required additional procedures. The case-fatality ratio was 51.4% in this study compared with 46.6% in the earlier study. Twenty-two patients died during the same hospitalization period while the empyema was an active problem. Six (8.3%) of these empyema-related deaths occurred in patients without underlying disease, while 16 (22.2%) were in patients with underlying diseases.

Pulmonary tuberculosis: a multifaceted disease.

One reason for the increasing misdiagnosis of tuberculosis in adults is the fact that one of every three patients may present with a roentgenographic pattern considered atypical for the disease. In this article a number of such atypical patterns--pleural manifestations, nodular forms of the disease, and infiltrates in unusual locations--are discussed and illustrated by means of case summaries. Awareness of these variations would help in the diagnosis of tuberculosis, which is progressively becoming a responsibility of physicians involved in primary care.

Intrathoracic lipomas. Report of three cases and review of the literature with emphasis on endobronchial lipoma.

Intrathoracic lipomas are rare, benign neoplasms of unknown origin, with symptoms depending primarily on their location and size. They frequently represent on incidental roentgenographic finding and are clinically significant in that they may simulate malignant tumors and, when located endobronchially, may cause irreparable lung damage. Three cases of intrathoracic neoplasms are reported herein, and the English literature on the subject reviewed. In some cases, bronchoscopic examination may yield the diagnosis of endobronchial lipoma but, in general, thoracotomy is required for diagnosis. A more complete classification is suggested and the preferred mode of treatment is discussed.