Abstract Aim To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months. Method QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022. Results In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion. Conclusions There has been significant improvement in all QPIs in the management of RCC in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.
Hemodynamic functions and blood volume were observed in patients with chronic uremia. Thirty-one patients had clinical features of circulatory congestion and 37 did not. The degree of anemia and acidosis was comparable in both groups. However, creatinine clearance was significantly lower in patients with circulatory congestion. Both groups of patients had greater blood pressure, heart rate, plasma volume, and total peripheral resistance than normal. Resting cardiac output was abnormally decreased in 19% of the patients with circulatory congestion and in 14% of patients without features of circulatory congestion. There was no correlation between blood volume and blood pressure. Intravenous digitalization of seven of the patients with circulatory congestion produced clinical and hemodynamic improvement in only two. Hemodialysis effected an increase in cardiac output and a decrease in total peripheral resistance in six patients with congestion. In seven patients without circulatory congestion after dialysis there was a fall in plasma and blood volume, associated with a slight decrease in cardiac output. It is suggested that congestion of the circulation in chronic uremia results from a variety of hemodynamic, myocardial, and metabolic alterations, rather than from any single abnormality.
In less than ten years teletherapy has progressed from the idea stage to successful commercial exploitation . About 350 sources from the United States and Canadian producers alone are now being used to treat patients, and this is only cobalt-60. This same rapid Cesium- 137 sources now are in the developmental stage. Preliminary work has shown that its long half life gives economic advantages; its half-million electron volt radiation does not cause great differences in clinical use but reduces the problem of radiation protection considerable. A third source material, strontium-90, is in the early stage of development. Many other radioisotopes have been used but have some practical disadous problem still remains: finding a practical and economical radioisotope in the quarter-million electronb volt range. The clinical program and with teletherapy has been outstanding. ng, decreased bone absorption, and increased depth dose.
BETWEEN September, 1964, and April, 1966, 720 patients with acute glomerulonephritis were admitted to the General Hospital in San Fernando from the rural areas of South Trinidad, West Indies. Previous outbreaks of nephritis had occurred in the same region in 1952 and 1958.1 The nephritis in the earlier outbreaks had conformed clinically to that usually associated with streptococcal infections in children. A large number of impetiginous sores in 1952, and of rash followed by desquamation in 1958, had further suggested a streptococcal origin. Bacterial cultures and streptococcal antibody studies were not obtained, however, and thus the cause was not determined. . . .
