Quality assurance system must balance functionality with data security

The evaluation and selection of a QA system should include scrutiny of its security mechanisms. When the system is implemented, evaluate access by all users, establish security policies, and, most importantly, enforce them. Security features should not overburden the system to the point that it becomes cumbersome. As many security features as possible should be inherent in its day-to-day operations. After all, automation is intended to provide access to clinical and financial information easily and quickly. QA professionals must weigh security issues against the need for patient and physician-specific performance information. Finally, include medical staff in the early stages of system implementation so they are aware of the security precautions you have taken. They will be assured that you are protecting confidential information while meeting the needs of both the medical staff and the quality management team.     

Effect of 50 mg enteric-coated aspirin (Astrix) on thromboxane and prostacyclin synthesis

Although low-dose soluble aspirin can be recommended as a useful anti-thrombotic drug regimen in patients with vascular disease, enteric-coated preparations have a theoretical advantage for aspirin preparations which are to be ingested daily for many years. We have demonstrated that a 50 mg enteric-coated aspirin formulation (Astrix) which has an absorption rate much lower than soluble aspirin, is sufficient to inhibit platelet thromboxane synthesis while causing no major decrease in vascular prostacyclin synthesis.     

Cyclical mastalgia: clinical and mammographic observations in a screened population

The incidence of cyclical mastalgia in well women presenting for breast screening was 69 per cent. The incidence of cyclical mastalgia increases with age up to the menopause. There was a higher incidence of 'high risk' mammographic patterns and a lower incidence of 'low risk' patterns, according to the Wolfe classification, in women with cyclical mastalgia compared with the rest of the screened population. This finding correlated with the severity, duration and need for treatment. The differences in breast pattern did not persist after the menopause. The question of whether or not cyclical mastalgia can be regarded as a risk factor for breast cancer is uncertain and needs further evaluation.     

The natural tooth pontic — a compromise treatment for periodontally involved anterior teeth

A technique which uses a natural tooth pontic to replace a periodontally compromised tooth is described. Following extraction and root resection of a maxillary central incisor, the crown was bonded to the adjacent teeth using acid-etched composite resin located in proximal cavity preparations. Some advantages of the technique are discussed.     

Comparison of hepatic artery and portal vein reperfusion during orthotopic liver transplantation.

BACKGROUND: During orthotopic liver transplantation (OLT), it is standard procedure to reperfuse the liver via the portal vein (PV) despite having a lower oxygen content and perfusion pressure than the hepatic artery (HA). There are no published studies that describe graft function and outcome when the HA is used for reperfusion. We report a retrospective comparison of graft outcome after HA or PV reperfusion when the piggyback technique was used. METHODS: We identified 26 patients who had undergone OLT with HA reperfusion and 26 patients reperfused via the PV. Demographics, primary diagnosis, surgeon, warm and cold ischemic times, and blood product use were recorded. In each patient, whole blood lactate concentration, prothrombin time (PT), and alanine aminotransferase (ALT) were measured at defined time points during and after surgery as indices of graft lactate metabolism, synthetic function, and reperfusion injury, respectively. Thirty-day and 1-year outcome data were recorded. Data were compared between the HA and PV groups. RESULTS: Demographics, blood product use, primary diagnosis, cold ischemic time, and surgeon were similar between the groups. Warm ischemic time was longer in the HA group (mean [SD] HA 51.2 [14.7], PV 40 [9.1] min, P=0.002). Blood lactate concentrations were similar at all time points. There was no difference in 24-hr postoperative PT between the groups (median [InterQuartile (IQ) range] HA 17.5 [16-28.3], PV 19 [16-24] sec, P=0.85). Peak postoperative ALT values were comparable (median [IQ range] HA 1031 [668-1701], PV 1107 [754-1824] IU/ml, P=0.78). There were no statistically significant differences in 30-day or 1-year mortality, but more early deaths occurred in the HA group. Using our data, we calculated that a prospective randomized trial would need approximately 300 patients to be sure that mortality was the same with both techniques. CONCLUSION: We have demonstrated no clinically or statistically significant differences in indices of graft function, reperfusion injury, or outcome between primary HA or PV reperfusion.