A prospective international cooperative information technology platform built using open-source tools for improving the access to and safety of bone marrow transplantation in low- and middle-income countries

Jagriti Innovations developed a collaboration tool in partnership with the Cure2Children Foundation that has been used by health professionals in Italy, Pakistan, and India for the collaborative management of patients undergoing bone marrow transplantation (BMT) for thalassemia major since August 2008. This online open-access database covers data recording, analyzing, and reporting besides enabling knowledge exchange, telemedicine, capacity building, and quality assurance. As of February 2014, over 2400 patients have been registered and 112 BMTs have been performed with outcomes comparable to international standards, but at a fraction of the cost. This approach avoids medical emigration and contributes to local healthcare strengthening and competitiveness. This paper presents the experience and clinical outcomes associated with the use of this platform built using open-source tools and focusing on a locally pertinent tertiary care procedure—BMT.     

Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing

Purpose

To determine the most common errors of epinephrine administration during severe allergic-like contrast reaction management using high-fidelity simulation surrogates.

Materials and methods

IRB approval and informed consent were obtained for this HIPAA-compliant bi-institutional prospective study of 40 radiology residents, fellows, and faculty who were asked to manage a structured high-fidelity severe allergic-like contrast reaction scenario (i.e., mild hives progressing to mild bronchospasm, then bronchospasm unresponsive to bronchodilators, and finally anaphylactic shock) on an interactive manikin. Intravenous (IV) and intramuscular epinephrine ampules were available to all participants, and the manikin had a functioning intravenous catheter for all scenarios. Video recordings of their performance were reviewed by experts in contrast reaction management, and errors in epinephrine administration were recorded and characterized.

Results

No participant (0/40) failed to give indicated epinephrine, but more than half (58% [23/40]) committed an error while doing so. The most common mistake was to administer epinephrine as the first-line treatment for mild bronchospasm (33% [13/40]). Other common errors were to administer IV epinephrine without a subsequent IV saline flush or concomitant IV fluids (25% [10/40]), administer an overdose of epinephrine (8% [3/40]), and administer epinephrine 1:1000 intravenously (8% [3/40]).

Conclusion

Epinephrine administration errors are common. Many radiologists fail to administer albuterol as the first-line treatment for mild bronchospasm and fail to flush the IV catheter when administering IV epinephrine. High-fidelity contrast reaction scenarios can be used to identify areas for training improvement.     

Outcome predictors in the management of spinal cord ependymoma

The aim of this study was to determine predictors of functional outcome and survival in a retrospective cohort of spinal cord ependymomas treated at a single institution. Twenty-six patients who underwent treatment of spinal cord ependymoma at a single institution were retrospectively analysed. The clinicopathological features were reviewed and correlated with functional outcome (measured using the Frankel grade), recurrence (clinical or radiological), progression-free survival (PFS) and overall survival (OS). Seventy-nine percent of patients with complete excision had maintained or improved functional outcome, compared to 75% in the incomplete resection plus radiotherapy group. Patients with a good pre-operative Frankel grade tended to maintain their functional status, though this did not reach statistical significance (Fisher’s Exact test, P = 0.090). Univariate analysis revealed that longer symptom duration prior to treatment was associated with poorer functional outcome (P = 0.006). Extent of resection and the use of adjuvant radiotherapy did not influence PFS or OS; however, early diagnosis and treatment are paramount in the management of spinal ependymoma if a good functional outcome is to be achieved.     

Marigold (Calendula officinalis L.): an evidence-based systematic review by the Natural Standard Research Collaboration

An evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology and dosing.     

Intra-cardiac Burkitt's lymphoma mimicking acute pulmonary embolism

Primary cardiac lymphoma is a rare clinical entity with poor prognosis and delayed diagnosis is often due to variable and non-specific clinical presentation. The case of an elderly male is reported with multiple co-morbidities, who had undergone a spinal laminectomy two weeks prior to presentation, later presented to the emergency room (E.R.) with acute chest pain, dyspnea and hypoxemia. A diagnosis of intracardiac thrombus was made, based on the clinical picture and echocardiography findings but per-operatively, he was found to have an extensive, non-resectable cardiac tumor.