Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Development of guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy

AIM

The issue of medication safety is highly significant when anti-cancer therapy is used due to the high potential for harm from these agents and the disease context in which they are being used. This article reports on the development of multidisciplinary consensus guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy undertaken by a working group of the Clinical Oncological Society of Australia (COSA).

METHODS

A working group of pharmacists, nurses and medical oncologists was convened from the COSA membership. A draft set of guidelines was proposed and circulated to the COSA council and the wider membership of COSA for comment. The final version of the guidelines was then distributed to 25 key stakeholders in Australia for feedback and endorsement.

RESULTS

An initial draft was developed based on existing standards, evidence from the literature and consensus opinion of the group. It was agreed that published case studies would be used as evidence for a particular statement where related processes had resulted in patient harm. The group defined 13 areas where a guidance statement was applicable to all professional disciplines and three individual sections based on the processes and the professionals involved in the provision of cancer therapy.

CONCLUSION

The guidelines development represents a multidisciplinary collaboration to standardize the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. They should be seen as a point of reference for practitioners providing chemotherapy services.

The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy

The issue of medication safety is highly significant when anti-cancer therapy is used as a treatment modality due to the high potential for harm from these agents and the disease context in which they are being used. These guidelines provide recommendations on the safe prescribing, dispensing and administration of chemotherapy and related agents used in the treatment of cancer. The guidelines represent a multidisciplinary collaboration to standardise the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. The aim of these guidelines is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer. This guidance is intended for a multi-disciplinary audience and will have most relevance for medical, nursing and pharmacy staff involved in the complex processes of delivering chemotherapy and associated treatment. The scope of the guidelines includes; all patients and age groups receiving chemotherapy and targeted therapy for the treatment of cancer and cancer therapy administered by any route in both the hospital and home setting. These guidelines should be seen as point of reference for practitioners providing cancer chemotherapy services.

The genetic basis of colorectal cancer in a population-based incident cohort with a high rate of familial disease

BACKGROUND AND AIMS

Colorectal cancer (CRC) is the second most frequent cancer in developed countries. Newfoundland has the highest incidence of CRC in Canada and the highest rate of familial CRC yet reported in the world. To determine the impact of mutations in known CRC susceptibility genes and the contribution of the known pathways to the development of hereditary CRC, an incident cohort of 750 patients with CRC (708 different families) from the Newfoundland population was studied.

METHODS

Microsatellite instability (MSI) testing was performed on tumours, together with immunohistochemistry analysis for mismatch repair (MMR) genes. Where indicated, DNA sequencing and multiplex ligation-dependent probe amplifications of MMR genes and APC was undertaken. DNA from all patients was screened for MUTYH mutations. The presence of the BRAF variant, p.V600E, and of MLH1 promoter methylation was also tested in tumours.

RESULTS

4.6% of patients fulfilled the Amsterdam criteria (AC), and an additional 44.6% fulfilled the revised Bethesda criteria. MSI-high (MSI-H) was observed in 10.7% (n=78) of 732 tumours. In 3.6% (n=27) of patients, CRC was attributed to 12 different inherited mutations in six known CRC-related genes associated with chromosomal instability or MSI pathways. Seven patients (0.9%) carried a mutation in APC or biallelic mutations in MUTYH. Of 20 patients (2.7%) with mutations in MMR genes, 14 (70%) had one of two MSH2 founder mutations. 17 of 28 (61%) AC families did not have a genetic cause identified, of which 15 kindreds fulfilled the criteria for familial CRC type X (FCCTX).

CONCLUSIONS

Founder mutations accounted for only 2.1% of cases and this was insufficient to explain the high rate of familial CRC. Many of the families classified as FCCTX may have highly penetrant mutations segregating in a Mendelian-like manner. These families will be important for identifying additional CRC susceptibility loci.

Micropropagated bananas are more susceptible to fusarium wilt than plants grown from conventional material

The reaction of field-grown micropropagated bananas, Musa cv. Williams (AAA, Cavendish subgroup) and cv. Goldfinger (AAAB, FHIA-01), to subtropical race 4 Fusarium oxysporum f. sp. cubense (Foc) was compared with the reaction of plants grown from conventional planting material (sections of the rhizome, termed bits). Leaf gas exchange of plants was determined, and growth and dry matter accumulation were measured. Comparisons were made among these parameters from shortly after planting, throughout winter, and into spring when a high percentage of the plants started to show external symptoms of fusarium wilt. Micropropagated bananas were significantly more susceptible to race 4 Foc than plants derived from bits. This was irrespective of planting times, cultivars used, or whether the bits had first been established in containers in the glasshouse (as for micropropagated plants) or been planted directly in the field. This greater susceptibility does not appear to be a consequence of differences in maximum photoassimilation rates, greater photoassimilate demand, or lack of carbohydrate reserves once plants became established.

Photoemission Study of CO Adsorption on Gd

Angle-resolved UV photoemission spectroscopy has been used to investigate the interaction of CO with Gd films, grown on W(110). The results suggest the CO absorbs dissociatively, initially forming Gd(2)O(3), with subsequent catalytic oxidation of CO to form carbonate.

Genotypic variation in response to high temperature at flowering in common bean (Phaseolus vulgaris L.)

In controlled temperature glasshouses, 5 cultivars of Phaseolus vulgaris L. (cv. Actolac, and 4 Mexican cultivars: M 650, 659, 674, 685B) were subjected to super-optimal temperature (34/29�C day/night) stress pre-flowering (T2), pre- and post-flowering (T3), and post-flowering (T4). The stress treatments increased bud and flower production and dramatically increased abscission of buds, flowers, and pods compared with controls at 24-19�C. Actolac was the most sensitive to heat stress, while the Mexican cultivars displayed varying degrees of partial tolerance. For pod and seed production, M 674 was the most tolerant under T2, and M 685B the most tolerant under T4, with grain yields nearly equal to the control. This was achieved despite reduced seed weight, through increased seed set. Under T3 no cultivar produced seed. Cultivar M 659 was intermediate in stress reaction between Actolac and M 674 under T2, and M 650 was intermediate between Actolac and M 685B under T4. The data indicate that optimum growth temperatures for M 674 and M 685B may be greater than that for Actolac.

Human papillomavirus and epithelial ovarian neoplasia

In contrast to the strong association between human papillomavirus (HPV) and squamous cell carcinoma of the lower female genital tract, no viral DNA had been found in epithelial ovarian carcinoma. Recently, however, R. H. Kaufman, J. Bornstein, A. N. Gordon, E. Adam, A. L. Kaplan, and K. Adler-Storthy [Gynecol. Oncol. 27, 340-349 (1987)] reported the detection of HPV-6 DNA by in situ hybridization in 10 of 12 patients with advanced epithelial ovarian carcinoma. To further investigate the possible association between HPV and epithelial ovarian neoplasia, tumor from 12 patients with epithelial ovarian adenocarcinoma, 3 with epithelial ovarian tumors of low malignant potential, and 3 with epithelial ovarian tumors of low malignant potential, and 3 with epithelial ovarian adenomas was examined for HPV DNA by the Southern hybridization technique. All the tissues were tested under low stringency for HPV-6 and under high stringency for HPV-6, HPV-16, HPV-18, HPV-31, and HPV-35. In addition, all tissues were tested by polymerase chain reaction for the presence of HPV-6 and HPV-11. Of the 12 patients with adenocarcinoma, 5 were poorly differentiated, 4 serous, 1 endometrioid, 1 mucinous, and 1 mixed. The neoplasms were of grades 2-4 with a predominance of stages III and IV (83%). Of the 3 patients with tumors of low malignant potential, all were serous and stage I. Of the 3 patients with adenomas, 1 was mucinous, 1 serous, and 1 Brenner. We were unable to detect HPV-related sequences in any of the specimens. On the basis of these findings, there appears to be no association between HPV and epithelial ovarian neoplasia.

A conceptual model of the academic discipline nursing science

At their annual meeting during 1987, the heads of the Departments of Nursing at South African Universities discussed the sub-division of Nursing Science. They identified the following problems in this regard:

Nursing is the concern of all citizens (Sr. Henrietta Stockdale)

Today we remember, and give thanks for the work of Sister Henrietta Stockdale of the Anglican Sisterhood of St Michael and All Angels.

Nursing practice--reality or dream

For the purpose of this article, the term nursing practice excludes midwifery practice. The debate as to whether a nurse is a practitioner or not centres on the nurse and not on the midwife. Both legally and by customary practice, the midwife in South Africa has enjoyed the status of a practitioner since 1652, whilst the nurse has only been recognised as a legal practitioner since 1891.

Transient Brown's syndrome in juvenile chronic arthritis

A 9-year-old boy with systemic juvenile chronic arthritis and Brown's syndrome (limitation of elevation of the adducted eye due to limitation of movement of the superior oblique tendon) is described. The resolution in association with steroid treatment suggested a transient tenonsynovitis involving the superior oblique tendon as the cause.

New dimensions--nursing education in the post-secondary education system in the Republic of South Africa

On April 5, 1982 in her capacity as President of the South African Nursing Association, the author received a letter from the then Minister of Health. Dr. the Hon. L A P A Munnik to inform her that the Minister of Education had submitted the information to him that the Advisory Council of the Universities of South Africa had approved the principle whereby universities could develop an association with nursing colleges on the same lines as exist in respect of teacher training colleges, that is, as colleges external to the university but linked on an academic level to the university concerned.

The dependent, independent and interdependent functions of the nurse practitioner--a legal and ethical perspective

In general, contemporary nursing literature from Western countries does not take a bold stand on the very controversial issue of the dependent and independent functions of the nurse practitioner. The authors write as if they are skating on very thin ice. Text books on nursing imply a great deal about the practice potential of nurses but ever and anon there is a subtle reversion to the concept that nursing has certain dependent functions, meaning functions that require a doctor’s authorisation, and certain independent functions that are carried out on the nurse’s own initiative, and responsibility. In general the majority of authors consulted appear to subscribe to the concept postulated by Sarney when he says A good nursing practice act will separate the independent functions (what nurse can do on her own) from the dependent functions (what she can do only under the direction o f a doctor) (Sarney 1968 : 18).

The evolution of a profession

The word profession derives from the Latin profiteri - to make an open or public statement of one’s beliefs and intentions, one’s acknowledgement of a certain fact. In the modern sense the word has come to describe collectively the nature of an occupation, the practice of which requires certain advanced preparation in some liberal art or applied science. The practice is characterised by some form of exclusiveness (such as only those who are qualified in a certain area of study may practise the profession), by commitment, and by observances of an ethical nature.

UICC nursing education project: an established and ongoing activity

UICC has once again taken a lead in the campaign against cancer. It has established its Cancer Nursing Education Project as a continuing one. This is a momentous decision for cancer care and for the recognition of the contribution of nurses to the campaign against cancer.

The ward sister - Some aspects of her role and function

First-line manager, clinician, educator, custodian and advocate of the patient, professional colleague and team partner to the doctor and other members of the health team describes the multidimensional role of the ward sister.

Psychosocial aspects of mammary carcinoma

Malignant neoplastic diseases in man are as old as mankind itself. The Hindu epic, Ramayana, dating back to c 2500 B C, described tumours and their treatment. Since then Hippocrates (c 460 - 375 B C), Celsus (c 30 B C - A D 38), Galen (c 130 - 200 A D) and Leonides of Alexandria (c 180 A D), and numerous other scientists have studied and recorded these phenomena. Heller from the National Cancer Institute stressed that “Man’s attempt to understand cancer and to find ways of preventing, controlling and curing it began in ancient times”. (Heller, I960)

The criteria for professionalism in nursing in South Africa

The professional status of nursing has been questioned in some countries by some sociologists, and health service administrators and even by some nurses. This arises from the fact that there is much confused thinking about the criteria by which professional status is measured as well as from the incorrect use of the word “ profession” . Chief amongst the proponents of the concept that nursing (at least in the countries wiui wmcn they are familiar) is not a profession, but a semi-profession, are such authors as Buick-Constable (1969) who maintains that nursing in New Zealand is semi-professional, Etzioni (1969) and Bernard and Thompson (1969) in America who propound the same viewpoint about American nursing.