Inter- and intra-image variability in computer-assisted optic nerve head assessment

A computer-assisted system for optic nerve head analysis was used to measure one eye from each of 15 subjects. These comprised three groups of five, being glaucomatous, ocular hypertensive, and normal subjects. Each eye was imaged with the system 10 times. The 150 images produced were analysed in a randomized masked fashion to test the inter-image variability of the measurements. Linear pallor: disc ratios had mean coefficients of variation of 6.6% (normal), 4.8% (ocular hypertensive) and 2.6% (glaucomatous). This trend of reducing coefficient of variation from normal to ocular hypertensive to glaucomatous was reflected in other parameters also. Intra-image variability was assessed by analysing one image from each subject 10 times, in a randomized masked fashion. The mean coefficients of variation of the linear pallor: disc ratios were 6.3% (normal), 3.6% (ocular hypertensive) and 3.2% (glaucomatous). Fisher's F-test showed that no parameters had significantly lower intra-image rather than inter-image variance (at the 5% level). Variability is apparently due to operator variations rather than the image variations.     

Patient-led breast cancer follow up

The audit aimed to assess patient satisfaction and GP workload following the introduction of patient-led breast cancer follow up (PLFU), comprising regular mammographic surveillance and easy access self-referral to the breast clinic if required. A questionnaire was sent to 217 patients at low risk of recurrence or death following breast cancer treatment and to 302 GPs. From 217 patients there were 130 respondents (60%) and of these 126 (97%) patients had a clear idea of how to contact the breast unit, and only 5 of 130 patients (4%) required a breast clinic appointment. All 106 respondents (100%) were satisfied with the process to contact the breast unit. Only 10 of 277 GP respondents (3.6%) referred a patient on PLFU back to the breast unit during the study period. PLFU has been well received by patients following breast cancer treatment with little increase in GP workload.     

Improved growth of human urothelial carcinoma cell cultures

From January, 1981 through June, 1982 specimens from 21 patients with bladder (urothelial) cancer were placed in tissue culture, and one long term cell line was established (5%). From July, 1982 through February, 1984, using an improved culture medium, seven long term cell cultures were established from 21 patients (33%). In addition, one long term culture from a patient with a bladder melanoma was established using the standard culture medium. The nine cell cultures were derived from the following types of tumors: transitional cell carcinoma (6), adenocarcinoma (1), squamous cell carcinoma (1) and melanoma (1). All of the cell lines have produced tumors in athymic nude mice except for one transitional cell carcinoma. All of the cultures demonstrate aneuploidy. Homogeneously staining regions have been seen in some cell cultures. A common marker chromosome has not been identified.     

Physician response to screening for hypercholesterolaemia in a coronary care unit

Abstract Hypercholesterolaemia is a known risk factor for coronary artery disease. This study describes a retrospective analysis of 176 patients admitted to the Coronary Care Unit (CCU) in a six month period with an admission fasting serum cholesterol of greater than 5.5 millimoles per litre (mmols/L). The patient records were examined at least six months after hospital discharge to determine what action, if any, was instituted in response to their hypercholesterolaemia. One hundred and thirty-four (76%) patients had a discharge diagnosis of myocardial ischaemia or infarction. Of the 176 patients, 73 were referred to a dietitian, 31 were given dietary advice by a medical officer, 13 were commenced on lipid-lowering drugs with nine continuing lipid-lowering drugs and only 13 patients were referred to this hospital's lipid clinic. Sixty-nine (39%) received no response to their hypercholesterolaemia. It is likely that our experience is not unique and greater attention to CCU measured lipid results and risk factor modification should be instituted by physicians. (Aust NZ J Med 1991; 21: 401–404.)