Atypical reactive lymphoid hyperplasia : a 5 year study with analysis of 10 cases for latent Epstein-Barr virus infection by in situ hybridization and immunohistochemistry

AIMS OF THE STUDY: 1. To perform a retrospective, epidemiological analysis of cases of reactive lymphadenopathy and atypical reactive lymphoid hyperplasia (ARLH) received in the Department of Anatomical Pathology, UCT and GSH, over a 5 year period, in order to determine the number of cases of ARLH, and the frequency of the various subtypes of reactive lymphoid. hyperplasia, so as to provide base-line information for further studies. 2. To set up IN SITU HYBRIDIZATION (ISH) for detection of Epstein-Barr virus (EBV)-encoded RNA's (EBERs) in latently infected cells in selected cases, to determine if virus is present in ARLH. 3. To perform immunohistochemical analysis for the detection of EBY-derived latent membrane protein (LMP) in those cases subjected to ISH

Chemotherapy administration standards and guidelines: The development of a resource document

There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. The Independent Clinical Oncology Network’s Chemotherapy Administration Standards and Guidelines Resource Documentwas developed over 2 years and first introduced at a South African international oncology conference in 2017. A working group consisting of oncologists and oncology nurses was set up to address this deficiency. Pragmatic guidelines suitable to a wide range of local chemotherapy administration practices were developed using an iterative, multidisciplinary, collaborative process. The consensus was that these guidelines should be appropriate to the South African context. Safety, standard operational procedures, recommended professional competencies and training were central to the document. Guidelines for prescribing, storing, mixing, dispensing, administering and disposing of chemotherapy were included. Patient consent and involvement, patient and staff safety, recommended professional competencies, management of accidents and errors, error reporting and local legal requirements are dealt with in detail. The hope is that these guidelines will be used as a resource document for South African chemotherapy practices, both public and private. The document is supported by standard operating procedures and action steps. These were developed to promote the use of the guidelines and to support pragmatic quality assurance measures at practice level. These standards and guidelines will be regularly updated, based on needs identified and deficiencies noted

How important is on-site adequacy assessment for thyroid FNA? An evaluation of 883 cases

Immediate adequacy assessment (IADA) during fine-needle aspiration (FNA) is not universal and the optimal numberof passes has not been well determined. The aim of this study was to evaluate the nondiagnostic rates (NDR) with and without the IADA forthyroid aspirates. Subsequent cytological and surgical follow-upwere reviewed for nondiagnostic cases. In addition, we evaluated the numberof passes performed in each FNA to determine the optimal number. Retrospective analysis of NDR was performed on 883 thyroid FNA specimens retrievedthrough a Computer SNOMED Search from our files between January 2001 toDecember 2003. For FNAs with IADA, one Diff-Quick and one fixedsmear for each pass were prepared, and the needle was rinsed in CytoLytsolution for a ThinPrep and/or a cell-block. FNAs without IADAwere received in CytoLyt solution, from which a ThinPrep and a cell-block were prepared for each case. Of the total 883 cases, 443 wereperformed with IADA, of which 417 cases were diagnostic. The remaining440 cases were performed without IADA, of which 300 cases were diagnostic.NDR for IADA was 5.9% (26 cases-group-I)compared to 31.8% (140 cases-group-II)without IADA. In group-I, 5 cases were followed-upby repeat FNA, 10 cases by surgical resection, and 11 cases received notissue follow-up. In group-II, 23 cases were followed-up by repeat FNA, 36 by surgical resection, and 82 cases received notissue follow-up. Interestingly, follow-up in group-Idid not reveal any missed malignancy, while that in group-II resultedin a malignant diagnosis in 13.8% (8 cases). We alsofound that the optimal number of passes with least NDR was 4–6 passes.NDR was 25% for < 3 passes, 11% for 4 passes, 5.2% for 5 passes, 1.4% for 6 passes, and 2.5% for 7 passesor more. IADA significantly reduces the NDR and increases the sample adequacy for diagnosis. Optimal number of passes is 4–6 passes, and additionalpasses did not improve the diagnostic rate. Our study also emphasizesthe significance of repeat FNA or histological follow-up for nondiagnostic cases, especially for those without IADA. Diagn. Cytopathol. 2007;35:183–186. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55982/1/20552_ftp.pd

The clinical and diagnostic impact of using standard criteria of adequacy assessment and diagnostic terminology on thyroid nodule fine needle aspiration

The study was aimed to investigate the impact of using standard criteria for assessing specimen adequacy and diagnostic terminology (CAST) on fine-needle aspiration (FNA) diagnosis and clinical management of thyroid nodules. The study included similar numbers of FNAs performed in 2 year before (group A) and 1.5 year after (group B) implementing the standard CAST. In comparison to group A, group B showed a significantly lower rate of nondiagnostic specimens (RND) (16.1% vs. 21.6%, P ≤ 0.01) and rate of descriptive diagnoses (RDD) (3.8% vs. 14.5%, P ≤ 0.001) and greater non-neoplastic (70.0% vs. 64.1%, P < 0.05) and follicular cell lesions (7.4% vs. 4.3%, P < 0.05) but a similar percentage of neoplastic diagnoses. The rate of surgical follow-up (RSF) was significantly higher in group B than in group A, overall (21.6% vs. 17.0%, P < 0.05), or in subgroups of non-neoplastic (12.6% vs. 5.4%, P < 0.01) and neoplastic categories (81.0% vs. 61.0%, P < 0.05). The rate of cytohistologic concordance was higher in group B although the difference was not statistically significant. We concluded that use of the standard CAST on FNA diagnosis of thyroid nodules significantly reduced RND and RDD, providing more consistent diagnoses among the pathologists as well as better and more uniform communication between the pathologists and the clinicians. Furthermore, the cytohistological concordance was slightly better after CAST implementation, indicating that the improvement of diagnostic consistency among pathologists did not sacrifice the diagnostic accuracy. Diagn. Cytopathol. 2008;36:161–166. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58042/1/20762_ftp.pd

Audits of oncology units – an effective and pragmatic approach

CITATION: Abratt, R. P., et al. 2017. Audits of oncology units – an effective and pragmatic approach. South African Medical Journal, 107(6):493-496, doi:10.7196/SAMJ.2017.v107i6.12356.The original publication is available at http://www.samj.org.za/index.php/samjBackground. Audits of oncology units are part of all quality-assurance programmes. However, they do not always come across as pragmatic and helpful to staff. Objective. To report on the results of an online survey on the usefulness and impact of an audit process for oncology units. Methods. Staff in oncology units who were part of the audit process completed the audit self-assessment form for the unit. This was followed by a visit to each unit by an assessor, and then subsequent personal contact, usually via telephone. The audit self-assessment document listed quality-assurance measures or items in the physical and functional areas of the oncology unit. There were a total of 153 items included in the audit. The online survey took place in October 2016. The invitation to participate was sent to 59 oncology units at which staff members had completed the audit process. Results. The online survey was completed by 54 (41%) of the 132 potential respondents. The online survey found that the audit was very or extremely useful in maintaining personal professional standards in 89% of responses. The audit process and feedback was rated as very or extremely satisfactory in 80% and 81%, respectively. The self-assessment audit document was scored by survey respondents as very or extremely practical in 63% of responses. The feedback on the audit was that it was very or extremely helpful in formulating improvement plans in oncology units in 82% of responses. Major and minor changes that occurred as a result of the audit process were reported as 8% and 88%, respectively. Conclusion. The survey findings show that the audit process and its self- assessment document meet the aims of being helpful and pragmatic.http://www.samj.org.za/index.php/samj/article/view/11919Publisher's versio

Book Review: Being Mortal – Illness, Medicine, and What Matters in the End

Title: Being Mortal – Illness, Medicine, and What Matters in the EndAuthor: Atul GawandeNewton, MA: Wellcome Collection, 2014. ISBN 978-1-84668-582-