Proactively Monitoring Departmental Clinical IT Systems with an Open Source Availability System

The goal of all radiology information technology (IT) support organizations is excellent customer service through the availability of critical clinical information services, such as picture archiving communication systems and radiology information systems. Despite these goals, IT support personnel often act like firefighters, reacting to each problem, but unable to prevent or predict other problems. Proactive support is always more desirable than reactive support. Warning signs may exist well before a technical issue becomes system wide or the user is affected. The objective for IT support organizations in health care should be to maximize system uptime by using proactive monitoring systems for failures and to automatically detect failures through systems management tools. We report on the implementation of Nagios, an open source monitoring tool, as an availability management system in a diagnostic imaging department and on customized applications and protocols specific to radiology needs

A Rifted Margin Origin for the Crescent Basalts and Related Rocks in the Northern Coast Range Volcanic Province, Washington and British-Columbia

The remarkable early to middle Eocene volcanic sequence of the Crescent Formation exposed on the Olympic Peninsula consists predominantly of tholeiitic to minor transitional alkaline basalts with sparse sedimentary interbeds. A composite section measured in the vicinity of the Dosewallips River includes 8.4 km of pillowed to massive submarine basalts overlain by 7.8 km of subaerial flows. An upper limit of about 48 Ma on the age of the Crescent basalts is indicated by faunal assemblages in sediments interbedded with the uppermost flows in the sequence and a circa 50 Ma 40Ar/39Ar age on a leucogabbro from the presumably correlative Bremerton Igneous Complex. Stratigraphically controlled samples collected from throughout the Crescent basalt sequence show that two distinctly different chemical types exist. The lower part of the sequence originated from a relatively depleted mantle course resembling normal (N) to enriched (E)-MORB. The upper flows have a chemistry resembling E-MORB to oceanic island tholeiites. This difference could be due to either variable metasomatism of a single source domain, or influx of a separate enriched-mantle source component during the extrusion of the upper part of the sequence. Paleomagnetic measurements indicate that the Crescent basalts have not been significantly rotated, nor translated northwards since their extrusion. Paleotectonic reconstructions show that formation of the Crescent basalts and the Coast Range volcanic province as a whole coincided with a marked increase in the velocity of oblique convergence of the Kula plate with North America at about 60 Ma. Other geologic, geochemical, and paleomagnetic data are consistent with the interpretation that extrusion occurred in a basin or series of basins formed by a rift system along the continental margin of North America. Rifting might have been initiated by the influence of a hotspot, an increase in the rate of oblique convergence, or the kinematic effects of the Kula-Farallon ridge as it migrated along the margin. If extrusion is related to the passage of the triple junction, then the Coast Ranges can be considered to be an important tectonic marker for early to middle Eocene plate reconstructions

Communication of a mesothelioma diagnosis : developing recommendations to improve the patient experience

Background Malignant pleural mesothelioma (MPM) is an aggressive cancer linked to asbestos exposure and inhalation. As with other cancers, receiving a diagnosis of MPM is challenging and distressing. Particular challenges are associated with communicating a diagnosis of MPM, including explaining the disease and its prognosis, treatment options and legal and financial implications. Receiving A Diagnosis Of Mesothelioma (RADIO Meso) aimed to understand the experience of communicating a diagnosis of MPM from the perspective of patients, family carers and health professionals. Methods This qualitative study comprised 31 individual interviews with patients, family carers and health professionals. This was followed by two group interviews (n=42) and an electronic consultation exercise (n=39). Results This study provides unique insight into the mesothelioma diagnostic experience of patients, family carers and health professionals. Key findings include the importance of regarding diagnosis as a process, and provision of continuity and consistency. The clinical nurse specialist and effective multidisciplinary team working provided vital contributions to successful mesothelioma diagnostic communication. Facilitators to diagnostic communication included honesty and timeliness in communication, partnership working and maintaining a patient-centred approach. Challenges to enhancing mesothelioma diagnosis communication included accessing ongoing training, ensuring a suitable clinical environment and being able to allocate appropriate time. Conclusion The RADIO Meso study highlights factors that influence the communication of a diagnosis of MPM from the perspectives of individual patients and family carers. These findings provide the basis for a set of recommendations that can be used by health professionals to improve the MPM diagnostic experience

Nephropathy in males and females with Fabry disease: cross-sectional description of patients before treatment with enzyme replacement therapy

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Patient experiences of participation in a radical thoracic surgical trial : findings from the mesothelioma and radical surgery trial 2 (MARS 2)

Background The Mesothelioma and Radical Surgery Trial (MARS 2) aims to evaluate a surgical procedure by comparing chemotherapy and surgery against chemotherapy alone. The pilot study for MARS 2 evaluated the viability of recruitment. Challenges have been reported in conducting clinical research into thoracic surgical treatments and evidence is required to improve our understanding of patient experiences of trial procedures, trial treatments and the factors that influence participation. Methods This longitudinal qualitative study was nested within the MARS 2 pilot. Semi-structured telephone interviews were conducted with 15 participants in the MARS 2 trial. Interviews were conducted post-randomisation, post-surgery (surgery arm) and at 6 and 12 months. Altogether, 41 interviews were carried out. The data were analysed using framework techniques. Results Challenges were identified regarding the volume and complexity of information given to participants, and their understanding of clinical equipoise and randomisation. Factors influencing participation included having an opportunity to undergo surgery, a self-assessment of their ability to cope with trial treatments, maintaining a positive approach and altruism. Obstacles included the logistics of traveling for treatment in an unfamiliar setting. Negative consequences of trial participation included increased uncertainty amplified by multiple care providers and unclear transition arrangements after the trial. Conclusions Participants’ descriptions provided insights that have implications for care for mesothelioma trial patients. The need for healthcare staff to be alert to the potential for misunderstanding, particularly when presenting treatment options, was identified. Patients perceived and derived benefits from taking part in the trial but experienced some negative consequences. These should be anticipated and managed proactively