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Southend-on-Sea, United Kingdom

Sai-Giridhar P.,Breast Care Unit | Al-Ramadhani S.,Barts and the Royal London Hospital | George D.,Princess Alexandra Hospital NHS Trust | Gopinath P.,Princess Alexandra Hospital NHS Trust | And 30 more authors.

Aims: Treatment strategies for breast cancer continue to evolve. No uniformity exists in the UK for the management of node-positive breast cancer patients. Most centres continue to use conventional histopathology of sampled sentinel lymph nodes (SLNs), which requires delayed axillary clearance in up to 25% of patients. Some use touch imprint cytology or frozen section for intraoperative testing, although both have inherent sensitivity issues. An intraoperative molecular diagnostic approach helps to overcome some of these limitations. The aim of this study was to assess the clinical effectiveness of Metasin, a molecular method for the intraoperative evaluation of SLNs. Methods and results: RNA from 3296 lymph nodes from 1836 patients undergoing SLN assessment was analysed with Metasin. Alternate slices of tissue were examined in parallel by histology. Cases deemed to be discordant were analysed by protein gel electrophoresis. There was concordance between Metasin and histology in 94.1% of cases, with a sensitivity of 92% [95% confidence interval (CI) 88-94%] and a specificity of 97% (95% CI 95-97%). Positive and negative predictive values were 88% and 98%, respectively. Over half of the discordant cases (4.4%) were ascribed to tissue allocation bias (TAB). Conclusions: Clinical validation of the Metasin assay suggests that it is sufficiently sensitive and specific to make it fit for purpose in the intraoperative setting. © 2016 John Wiley & Sons Ltd. Source

Hanna-Jumma S.,Southend University Hospital Trust | Higgins D.,Southend University Hospital Trust | Kinnear J.,Southend University Hospital Trust | Wright M.,Care Network
Journal of the Intensive Care Society

Percutaneous tracheostomy (PT) is a commonly-performed invasive procedure in intensive care units. Infections (including bacteraemia and nosocomial pneumonia) are recognised complications that occur following PT. The recently published document 'Standards for care of adult patients with temporary tracheostomies' produced by the Intensive Care Society UK (ICS) made no recommendations regarding antibiotic prophylaxis (AP) for PT, and we were unaware of whether AP is used for this procedure in the UK. We therefore conducted a survey of the current practice in 130 critical care units; 65 responded. None gave antibiotics for routine PT, but in the presence of known colonisation with methicillin-resistant Staphyloccocus aureus (MRSA), six units (9%) would give antibiotic prophylaxis. Only three units (5%) had a policy for antibiotic prophylaxis. Twenty-six critical care units (40%) reported infectious complications occurring following PT. Despite a high level of awareness among clinicians that PT is associated with a significant risk of infective complications, only a small number administer AP prior to PT insertion even in patients colonised with MRSA and those with positive sputum cultures. The majority of units do not have a policy or guidelines for administration of AP prior to PT despite the fact that administration of appropriate antibiotics has been shown to reduce perioperative infectious complications for this procedure. © The Intensive Care Society 2010. Source

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