The Canadian blood donor health assessment questionnaire: lessons from history, application of cognitive science principles, and recommendations for change

Over the last 20 years, the Canadian Blood Services' (CBS) Donor Health Assessment Questionnaire (DHAQ), used to screen prospective blood donors to determine their eligibility, has grown in complexity and length. Its growth is inextricably linked to the evolution of the environment within which CBS operates from unregulated collection and distribution of labile blood products to a fully regulated environment and to the need to satisfy both Health Canada and US Food and Drug Administration (FDA) requirements. Within this context, the development of the CBS DHAQ has been characterized by addition of questions and items without any periodic reevaluation of the need for retaining existing questions and/or items. In this review, we apply principles from cognitive science relating to how people think when answering questionnaires to the situation of blood donors completing the DHAQ. We show that some items that were added at different times in separate questions, for reasons that were historically relevant, could be now asked more simply with a single question. The historical development of the DHAQ, resulting in the condensing of many items into lists, the use of complex wording, and the sheer number of items included in the questionnaire make accurate retrieval of information from the donor's memory difficult. Thus, we believe that redesigning the DHAQ will improve the quality and accuracy of the donors' answers to screening questions.     

Endoscopic ultrasound-guided fine-needle aspiration of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas: a report of 2 cases with literature review

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas is rare. Histologically it mimics the giant cell tumor of the bone and may be associated with a ductal adenocarcinoma. We recently encountered two such cases, both of which were biopsied by EUS-guided FNA. Abundant multinucleated osteoclast-like giant cells and many uniform mononuclear cells were present in case 1 so that the diagnosis was made. In case 2, many mononuclear tumor cells with vacuolated and basophilic cytoplasm were present, and rare osteoclast-like giant cells were seen. A diagnosis of adenocarcinoma was made. In both cases, no conspicuous nuclear pleomorphism was noted in the mononuclear cells or the multinucleated giant cells. The histology of case 2 revealed a pure undifferentiated carcinoma with osteoclast-like giant cells. In addition, a liver biopsy revealed globular amyloidosis. To our knowledge, this is the first report of pancreatic undifferentiated carcinoma with osteoclast-like giant cells sampled by EUS-guided FNA and the first case of hepatic globular amyloidosis associated with this tumor.     

Hemorrhagic liver cyst

INTRODUCTION: Simple cysts of the liver are usually discovered incidentally on abdominal imaging, and asymptomatic simple cysts do not require treatment regardless of size. DISCUSSION: We report a case of a symptomatic simple cyst of the liver complicated by intracystic hemorrhage for which a partial hepatectomy was performed. Treatment of simple hepatic cysts is indicated in the presence of associated symptoms or complications, and inability to exclude a cystic neoplasm requires operative intervention.     

Metadata and meaningful use

The healthcare industry will find out soon if ONC intends to include metadata requirements in stage 2 of the meaningful use program. Many feel it is too soon. But given metadata's potential to support health information exchange, the expanded and standardized use of metadata tagging in healthcare is ultimately a matter of when, not if.     

Diagnostic accuracy and role of fine needle aspiration cytology in management of thyroid nodules

The diagnostic accuracy of fine needle aspiration cytology (FNAC) was evaluated in thyroid nodules in 100 consecutive cases, who subsequently underwent thyroidectomy between the years 1989–1991. FNAC as a diagnostic test for thyroid nodules demonstrated an accuracy of 90.9%, a sensitivity of 76.5%, a specificity of 95.9% with a false positivity of 2%, false negativity of 4%, positive and negative predictive values of 86.7% and 92.2%, respectively. A correct classification of the carcinoma type on the basis of FNAC was possible only in 69% patients. As a result, FNAC is the first line of investigation in most nontoxic nodular goiters and often the only procedure necessary to obtain an accurate diagnosis. However, it is recommended only as an adjunct to clinical judgment and is not intended to replace it. © 1995 Wiley-Liss, Inc.     

Optic disc morphology in primary open-angle glaucoma versus primary angle-closure glaucoma in South India

Purpose:The aim of this study was to investigate the optic disc morphology in primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG) in South Indians.Methods:A total of 60 patients (60 eyes) with PACG and 52 patients (52 eyes) with POAG were included in a cross-sectional observational study. The glaucoma diagnosis was based on a glaucomatous appearance of the optic disc correlating with visual field defects. The glaucoma was graded as early, moderate, or severe, depending upon perimetric loss. All patients underwent an ophthalmic evaluation, including visual field examination and planimetric analysis of 30° stereoscopic color optic disc photographs.Results:The POAG and PACG groups did not differ significantly in a disc or rim area, rim width, and frequencies of disc hemorrhages or rim notches. However, early POAG group (n = 15) had a significantly deeper cup depth (P = 0.01), larger beta zone (P = 0.01), and a higher frequency of localized retinal nerve fiber layer (RNFL) defects (P = 0.02) than early PACG (n = 20).Conclusion:In the early stage of the disease, POAG compared to PACG may be characterized by deeper disc cupping, a larger beta zone of peripapillary atrophy, and a higher frequency of localized RNFL defects. Such differences in early glaucoma may suggest differences in pathophysiology in POAG and PACG.     

When does the brain inform the eyes whether and where to move? An EEG study in humans

The current study addressed when in the course of stimulus processing, and in what brain areas, activity occurs that supports the interpretation of cues that signal the appropriateness of different and competing behaviors. Twelve subjects completed interleaved no-go-, pro-, and antitrials, whereas 64-channel electroencephalography was recorded. Principle component and distributed source analyses were used to evaluate the spatial distribution and time course of cortical activity supporting cue evaluation and response selection. By 158 ms poststimulus, visual cortex activity was lower for no-go trials than it was for both pro- and antitrials, consistent with an early sensory filter on the no-go cue. Prefrontal cortex (PFC) activity at 158 ms was highest during antitrials, consistent with this brain region's putative involvement in executive control. At 204 ms poststimulus, however, PFC activity was the same for pro- and antitrials, consistent with an ostensible role in response selection. PFC activity at 204 ms also was robustly inversely correlated (r = -0.75) with visual cortex activity on antitrials, perhaps indicating top-down modulation of early sensory processing that would decrease the probability of an error response. These data highlight how a distributed neural architecture supports the evaluation of stimuli and response choices.     

Disseminated Mycobacterium bovis infection after deceased donor liver transplantation: A case report

This case demonstrates the significance, and ongoing relevance of mycobacterial infections, especially in patients who have recently been started on immunosuppression.     

Multiple non-odontogenic cysts--a case report

Nonodontogenic cysts have been identified at various locations in oral cavity. These occur primarily in relation to fusion of maxillary process either with its counterpart or different portions of nasal part of frontonasal process. Usually solitary, these primarily affect maxilla alone; can rarely be seen in ramus of mandible. We present a case of multiple non-odontogenic cysts involving both maxilla and mandible.