Clinical utility of plain-film abdominal radiographs for inpatients outside standard working hours in a large university teaching hospital

INTRODUCTION

Plain film abdominal radiographs (PFAs) are frequently the initial investigation ordered for patients with abdominal symptoms. However, increasing use of emergency ultrasound and availability of emergency CT raises the question of whether PFA remains an appropriate first line investigation. We investigated the impact of out of hours (OOH) PFAs on inpatient management.

METHODS

All consecutive PFAs over an 8-week period were included to determine the impact on patient management. OOH was classified as from 5pm to 9am Monday to Friday, weekends and bank-holidays. PACS and hospital records were accessed to determine patient pathways. The institution is a tertiary referral centre with 850 acute beds and serves a population of 950,000.

RESULTS

A total of 758 consecutive PFAs were performed in total (58.3% male, mean age 58.1 (range 0-93)). 310 (40.9%) were requested from the emergency department (ED) and 382 (50.4%) were requested from wards. 160 (21.1%) met the criteria of OOH, of these 120 (72.2%) were from ED and 28 were on adult inpatients. Of these 28, none had a change in management based on the PFA result.

CONCLUSION

Our study suggests that OOH PFAs of inpatients are of limited clinical utility. These patients are exposed to extra radiation.

IMPLICATIONS FOR PRACTICE

We propose that OOH PFAs of inpatients should be questioned as a viable investigation due to the limited contribution they offer in managing patients, the deleterious effects they confer on the patient and the associated economic cost. Further studies are needed to assess if these results are generalizable to other large hospitals.

Super-resolution radar imaging for breast cancer detection with microwaves: the integrated information selection criteria

This paper focuses on the data preprocessing scheme, as well as on the frequency selection and spatial filtering modules integrated with a Time-Reversal Multiple Signal Classification (TR-MUSIC) algorithm, for microwave breast imaging. This algorithm is part of the data processing chain of the Wavelia Microwave Breast Imaging (MBI) system prototype, which has been recently installed at the University Hospital of Galway, Ireland, for a first-in-human clinical trial. Indicative results from application of the algorithm on an experimental phantom dataset, and on a first patient dataset, are presented in this paper. Good correspondence between the two datasets is demonstrated, confirming the validity of the experimental setup used so far for the on-site acceptance of the Wavelia system, after installation at the hospital for clinical testing.

Modelling the impact of biosecurity practices on the risk of high pathogenic avian influenza outbreaks in Australian commercial chicken farms

As of 2018, Australia has experienced seven outbreaks of highly pathogenic avian influenza (HPAI) in poultry since 1976, all of which involved chickens. There is concern that increases in free-range farming could heighten HPAI outbreak risk due to the potential for greater contact between chickens and wild birds that are known to carry low pathogenic avian influenza (LPAI). We use mathematical models to assess the effect of a shift to free-range farming on the risk of HPAI outbreaks of H5 or H7 in the Australian commercial chicken industry, and the potential for intervention strategies to reduce this risk. We find that a shift of 25% of conventional indoor farms to free-range farming practices would result in a 6-7% increase in the risk of a HPAI outbreak. Current practices to treat water are highly effective, reducing the risk of outbreaks by 25-28% compared to no water treatment. Halving wild bird presence in feed storage areas could reduce risk by 16-19% while halving wild bird access of potential bridge-species to sheds could reduce outbreak risk by 23-25%, and relatively small improvements in biosecurity measures could entirely compensate for increased risks due to the increasing proportion of free-range farms in the industry. The short production cycle and cleaning practices for chicken meat sheds considerably reduce the risk that an introduced low pathogenic avian influenza virus is maintained in the flock until it is detected as HPAI through increased mortality of chickens. These findings help explain HPAI outbreak history in Australia and suggest practical changes in biosecurity practices that could reduce the risk of future outbreaks.

Abstract P5-02-06: The impact of the introduction of breast cancer screening on a symptomatic breast cancer unit

This abstract was not presented at the symposium.

Significant features of the epidemiology of equine influenza in New South Wales, Australia, 2007

Equine influenza (EI) was first diagnosed in the Australian horse population on 24 August 2007 at Centennial Park Equestrian Centre (CPEC) in Sydney, New South Wales (NSW), Australia. By then, the virus had already spread to many properties in NSW and southern Queensland. The outbreak in NSW affected approximately 6000 premises populated by approximately 47,000 horses. Analyses undertaken by the epidemiology section, a distinct unit within the planning section of the State Disease Control Headquarters, included the attack risk on affected properties, the level of under-reporting of affected properties and a risk assessment of the movement of horses out of the Special Restricted Area. We describe the epidemiological features and the lessons learned from the outbreak in NSW.

Prokaryotic expression of bovine lactoferrin deletion mutants that bind to the Ca2+-dependent lactoferrin receptor on isolated rat hepatocytes

We generated a series of recombinant variants of bovine lactoferrin (Lf) as fusion proteins using two prokaryotic expression vectors and examined the ability of the expressed proteins to compete with native Lf for binding to the Ca2+-dependent Lf receptor on isolated rat hepatocytes. A near-full-length bovine Lf cDNA (pN16b) was expressed in pGEMEX-2 as a gene 10 fusion protein (r-bLf10/-70). Deletions of pN16b were cloned into the HindIII/NotI and BamHI/NotI restriction sites of expression vector pET 32 and expressed as thioredoxin fusion proteins, r-bLfT/-271 and r-bLfT/-310, respectively. r-bLf10/-70, r-bLfT/-271, and r-bLfT/-310 lacked, respectively, the NH2-terminal 70, 271, and 310 amino acids of Lf. Expression of recombinant proteins in Escherichia coli BL21-DE3 strain was monitored by denaturing gel electrophoresis or by immunoblot with anti-Lf antibodies. The yield of each of the soluble recombinant proteins was approximately 10 mg/L of BL21-DE3 suspension. r-bLf10/-70 and r-bLfT/-271 competed strongly with 125I-Lf for binding to hepatocytes but r-bLfT/-310 did not. Our findings are consistent with the conclusion that Lf binds to its Ca2+-dependent receptor on hepatocytes via noncarbohydrate determinants contained within its C-lobe.

Serological response to purified mycobacterial phosphatidylinositol mannoside in healthy controls and in patients with tuberculosis and leprosy

The serological response to a monoclonal antibody-defined phosphatidylinositol mannoside (L4-PIM) present in all mycobacteria was examined in patients with various mycobacterial diseases and healthy subjects from different populations. IgG but not IgM antibodies were detected in most patients with untreated lepromatous (84%) or borderline lepromatous (65%) leprosy, but in only a minority of those with disease at the tuberculoid end of the leprosy spectrum (< 17% positive). The response to L4-PIM was correlated with the IgM response to disaccharide octyl-bovine serum albumin (dBSA), and decreased with successful treatment. On the other hand, the test proved to be of little value in the diagnosis of untreated tuberculosis (4/15 positive) or atypical mycobacterial infection in patients with AIDS (0/11 positive). IgG antibodies to L4-PIM were also found in a significant proportion of healthy individuals, irrespective of their Mantoux status. These antibodies were shown to be specific for L4-PIM on immunoblotting, and their incidence increased with age in random donors from both urban Australia and rural Papua New Guinea. Despite the limited value of the assay in diagnosis of any particular mycobacterial disease, the presence of antibodies to L4-PIM appears to be a sensitive indicator of subclinical infection with environmental mycobacteria in subjects with an intact immune system.