Search

AimsIn this study, we aim to determine whether combining multiple small colorectal polyps within a single specimen pot can reduce carbon footprint, without an associated deleterious clinical impact.MethodsThis was a retrospective observational study of colorectal polyps resected during 2019, within the Imperial College Healthcare Trust. The numbers of pots for polypectomy specimens were calculated and corresponding histology results were extracted. We modelled the potential reduction in carbon footprint if all less than 10 mm polyps were sent together and the number of advanced lesions we would not be able to locate if we adopted this strategy. Carbon footprint was estimated based on previous study using a life-cycle assessment, at 0.28 kgCO2e per pot.ResultsA total of 11 781 lower gastrointestinal endoscopies were performed. There were 5125 polyps removed and 4192 pots used, equating to a carbon footprint of 1174 kgCO2e. There were 4563 (89%) polyps measuring 0–10 mm. 6 (0.1%) of these polyps were cancers, while 12 (0.2%) demonstrated high-grade dysplasia. If we combined all small polyps in a single pot, total pot usage could be reduced by one-third (n=2779).ConclusionA change in practice by placing small polyps collectively in one pot would have resulted in reduction in carbon footprint equivalent to 396 kgCO2e (emissions from 982 miles driven by an average passenger car). The reduction in carbon footprint from judicious use of specimen pots would be amplified with a change in practice on a national level.

Polycystic ovary syndrome (PCOS) is a continuum of endocrine and reproductive disorders characterized by hyperandrogenism, antral follicle growth arrest, and chronic inflammation. Macrophages play key role in inflammation, and the balance between M1 (inflammatory) and M2 (anti-inflammatory) macrophages determines physiological/pathological outcomes. Here, we investigated if hyperandrogenism increases ovarian chemerin altering the balance of M1 and M2 macrophages and the granulosa cell death. Ovarian chemerin was upregulated by 5α-dihydrotestosterone (DHT) in lean and overweight rats; while increased serum chemerin levels were only evident in overweight rats, suggesting that the serum chemerin may be reflective of a systemic response and associated with obesity, whereas increased ovarian chemerin expression is a localized response independent of the metabolic status. DHT altered follicle dynamics while increased the M1: M2 macrophages ratio in antral and pre-ovulatory follicles. While ovarian M1 macrophages expressing chemokine-like receptor 1 (CMKLR1) were increased, CMKLR1+ monocytes, which migrated toward chemerin-rich environment, were markedly decreased after 15 days of DHT. Androgen-induced granulosa cell apoptosis was dependent on the presence of macrophages. In humans, chemerin levels in follicular fluid, but not in serum, were higher in lean PCOS patients compared to BMI-matched controls and were associated with increased M1: M2 ratio. Our results support the concept that in PCOS, hyperandrogenemia increases chemerin expression while promotes CMKLR1+ monocytes recruitment and deregulates the immunological niche of ovaries. This study established a new immunological perspective in PCOS at the ovarian level. Hyperandrogenism is associated with upregulation of chemerin and macrophage unbalance in the ovaries.

Introduction It has been established that a fast track management pathway for peri-ampullary malignancy with jaundice results in an increase in rate of surgery.1 We aimed to improve the resection rate in our HPB cancer patients referred with jaundice. All referrals are triaged on a daily basis by a Consultant Gastroenterologist. Previously, patients with jaundice were triaged to the next available gastroenterology clinic for further assessment. Such patients or those presenting to our Medical Assessment Unit were staged and fast tracked for early surgery. In March 2017 we introduced a new HPB Nurse led Jaundice clinic on our Ambulatory Assessment Area (AAA), referrals were triaged daily as usual and directed to the one of two HPB nurses to review the patients on AAA, perform a clinical assessment and organise a CT scan. Method We compared all the patients that were managed using the new strategy from March 2017 to December 2017 (10 months) to the patients referred and managed on traditional fast track pathway from March 2016 to February 2017 (12 months). We used the Somerset Cancer Registry and Electronic patient records (HIS Allscripts system). The mode of presentation, bilirubin level, cancer type and treatments were evaluated. Chi-square and t-test were used for data analysis. Results 21 patients with HPB malignancy presented with jaundice in 2016–17 compared to 22 patients referred since March 2017. Most patients had pancreatic cancer (13 in 2016 and 12 in 2017). 37 patients were referred to the AAA jaundice clinic; a cancer conversion rate of 59%. Assessment and investigation occurred more rapidly in patients triaged to the new jaundice clinic. Emergency presentations were reduced and more patients underwent surgical resection. Conclusion Despite the pre-existence of a fast track pathway in place with regional HPB surgeons, triaging patients daily and routing them to a clinic appointment within 7 days as happened previously is inferior to 5 day access for clinical assessment with early CT. This local organisational change within the currently available resources has had a tremendous impact on the quality of care that we have been able to offer our patients. This has also reduced the demand for emergency admissions and one would hope will translate into an increased longer term survival rate. Reference . Roberts, et al. A reduced time to surgery within a ‘fast track’ pathway for periampullary malignancy is associated with an increased rate of pancreatoduodenectomy HPBAugust 2017;713–720.

The Canadian Study of Health and Aging Clinical Frailty Scale (CFS) and the laboratory Frailty Index (FI-lab) are validated tools based on clinical and laboratory data, respectively. Their utility as predictors of geriatric trauma outcomes is unknown. Our primary objective was to determine whether pre-admission CFS is associated with adverse discharge destination. Secondary objectives were to evaluate the relationships between CFS and in-hospital complications and between admission FI-lab and discharge destination.We performed a 4-year (2011 to 2014) retrospective cohort study with patients 65 years and older admitted to a level I trauma center. Admission FI-lab was calculated using 23 variables collected within 48 hours of presentation. The primary outcome was discharge destination, either adverse (death or discharge to a long-term, chronic, or acute care facility) or favorable (home or rehabilitation). The secondary outcome was in-hospital complications. Multivariable logistic regression was used to evaluate the relationship between CFS or FI-lab and outcomes.There were 266 patients included. Mean age was 76.5 ± 7.8 years and median Injury Severity Score was 17 (interquartile range 13 to 24). There were 260 patients and 221 patients who had sufficient data to determine CFS and FI-lab scores, respectively. Pre-admission frailty as per the CFS (CFS 6 or 7) was independently associated with adverse discharge destination (odds ratio 5.1; 95% CI 2.0 to 13.2; p0.001). Severe frailty on admission, as determined by the FI-lab (FI-lab0.4), was not associated with adverse outcomes.Pre-admission clinical frailty independently predicts adverse discharge destination in geriatric trauma patients. The CFS may be used to triage resources to mitigate adverse outcomes in this population. The FI-lab determined on admission for trauma may not be useful.

Background Hydatidiform mole (HM) is a human pregnancy with excessive trophoblastic proliferation and abnormal embryonic development that may be sporadic or recurrent. In the sporadic form, the HM phenotype is driven by an abnormal ratio of paternal to maternal genomes, whereas in the recurrent form, the HM phenotype is caused by maternal-recessive mutations, mostly in NLRP7 , despite the diploid biparental origin of the HM tissues. In this study, we characterised the expression of the imprinted, maternally expressed gene, CDKN1C (p57 KIP2 ), the genotype, and the histopathology of 36 products of conception (POC) from patients with two defective alleles in NLRP7 and looked for potential correlations between the nature of the mutations in the patients and the various HM features. Methods/results We found that all the 36 POCs are diploid biparental and have the same parental contribution to their genomes. However, some of them expressed variable levels of p57 KIP2 and this expression was strongly associated with the presence of embryonic tissues of inner cell mass origin and mild trophoblastic proliferation, which are features of triploid partial HMs, and were associated with missense mutations. Negative p57 KIP2 expression was associated with the absence of embryonic tissues and excessive trophoblastic proliferation, which are features of androgenetic complete HMs and were associated with protein-truncating mutations. Conclusions Our data suggest that NLRP7 , depending on the severity of its mutations, regulates the imprinted expression of p57 KIP2 and consequently the balance between tissue differentiation and proliferation during early human development. This role is novel and could not have been revealed by any other approach on somatic cells.

185 Background: Cancer Care Ontario’s Drug Formulary is a web-based drug information resource. Patient information is currently provided as single-drug information sheets, with a limited number of multi-drug regimen information sheets (RIS) for breast and lung cancer treatments. Patients identified a need to create additional, high-quality, “user-friendly” RIS. Objectives of this project were to 1) engage patients and caregivers in RIS redesign; 2) evaluate the original vs a redesigned model RIS; and 3) use the model RIS template to create additional RIS across disease sites. Methods: The project team included a patient and family advisor (PFA) and clinical and research experts. This was a qualitative study between August 2017 to May 2019. A focus group (FG) was conducted with 5 PFAs to identify and prioritize drug information needs. A model RIS was designed, incorporating FG input and health literacy best practices. RIS were evaluated through blinded comparative cognitive interviews with 13 PFAs, to assess RIS for usability, understandability and content relevance. Evaluation informed iterative revisions. RIS were also evaluated by clinical and education experts using the Patient Education Materials Assessment Tool (PEMAT). An RIS style guide was developed to inform the creation of future RIS. Ethics approval was obtained from the University of Toronto. Results: The FG prioritized information on regimen details, Dos and Don’ts while on treatment, drug interactions, side effects and contact information. Guidance was provided on simplifying language, highlighting important information and aesthetics. Cognitive interviews consistently reported preference for model RIS over original RIS in most domains. PEMAT scores for original versus model RIS were 64% and 94% respectively (for understandability) and 60% and 82% respectively (for actionability). To date, the style guide has informed the creation of RIS for 10 high-use regimens. Conclusions: PFA and clinician co-design along with health literacy best practices informed measurable improvements in RIS. The style guide will enable the future creation and ongoing evaluation of high-quality RIS to enhance the cancer treatment experience for patients and caregivers.

Les programmes de cancerologie ontariens se sont fixes comme objectif de dispenser des soins infirmiers de haute qualite et des traitements securitaires a la fois pour les patients et pour le personnel. Dans le domaine de la sante, les contraintes financieres inherentes a la prestation des soins exigent que les mecanismes de financement rendent compte non seulement du cout des medicaments mais encore de facteurs tels que les couts des ressources humaines en pharmacie et en soins infirmiers. Alors que certaines organisations ont elabore des systemes de classification des patients afin de mesurer l’intensite des soins infirmiers et la charge de travail des infirmieres, ces systemes s’appliquent principalement aux clienteles hospitalisees et presentent de nombreux defis tels que la necessite pour les infirmieres de documenter la charge de travail exigee par les soins a des fins de justification. Cet article a pour but de tracer les grandes lignes de la methodologie et de l’implication des infirmieres en vue d’elaborer une ponderation de la consommation des ressources basee sur les protocoles pouvant etre appliquee aux salles de chimiotherapie ambulatoire. La methodologie inclut la determination de la charge de travail reliee au temps dont les infirmieres ont besoin pour preparer, conseiller et evaluer les patients et leur fournir l’enseignement requis ainsi que le temps necessaire pour rassembler les fournitures, acceder aux lignes de perfusion, surveiller, gerer les effets indesirables, gerer les symptomes et documenter les soins. La ponderation de la consommation des ressources fournit une meilleure mesure de la complexite des soins exiges par les patients atteints de cancer traites en milieu ambulatoire.

Aims and objectives. The aim was to explore healthcare workers’ duty concerns in the isolation wards during the novel H1N1 pandemic. Background. Healthcare workers’ willingness to work is a concern worldwide since SARS; Concerns related to work in the isolation wards among healthcare workers’ who continue to work during the novel H1N1 pandemic is unknown. In the light of possible staff shortages, healthcare workers’ duty concern is very important for planning the retention strategies. Method. The qualitative study with individual interview of 10 healthcare workers (four physicians, three nurses and three healthcare assistances) working in isolation wards were conducted in mid June 2009 where pandemic alert level 6 was raised by WHO. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach. Results. All participants who were still working in the isolation wards during the novel H1N1 pandemic showed professional senses that were strongly related to the willingness to work. Their concerns in their duty including appreciation from the employers, efficacy and side effects of vaccination, frequent policy changes, unclear criteria of case management, poor facility layout, duty role stress were highlighted. Conclusions. Further research should seek to provide in-depth specific concerns in each type of healthcare workers which is very important to keep adequate healthcare workers fighting against the infectious disease pandemic. Interesting results on the negative view towards the swine flu vaccination demonstrate more detailed evidence-based information about the vaccination is needed. Relevance to clinical practice. It is important for mangers to provide a support to healthcare workers during influenza pandemic by providing a clear guideline/policy for case management and demonstrating appreciation for the frontline healthcare workers to minimise the risk for high staff turnover rates.

To understand the mechanisms leading to hydatidiform mole formation in patients with NLRP7 mutations, we used a combination of various approaches to characterize five products of conception, from two patients, shown by flow cytometry to contain non-diploid cells. We demonstrate that four of these conceptions are triploid and two of them originated from fertilization with more than one sperm. We show that three of these triploid conceptions fulfill the histopathological criteria of partial hydatidiform mole and one fulfills the histopathological criteria of spontaneous abortion. Our data demonstrate that some oocytes from one patient with NLRP7 mutations are not able to prevent polyspermic fertilization and highlight the importance of using several approaches to characterize the genetic complexity of molar tissues and reproductive wastage. Altogether, our previous and current data show the association of NLRP7 mutations with several types of hydatidiform moles and with triploid spontaneous abortions.

Mucosal surfaces provide first-line defense against microbial invasion through their complex secretions. The antimicrobial activities of proteins in these secretions have been well delineated, but the contributions of lipids to mucosal defense have not been defined. We found that normal human nasal fluid contains all major lipid classes (in micrograms per milliliter), as well as lipoproteins and apolipoprotein A-I. The predominant less polar lipids were myristic, palmitic, palmitoleic, stearic, oleic, and linoleic acid, cholesterol, and cholesteryl palmitate, cholesteryl linoleate, and cholesteryl arachidonate. Normal human bronchioepithelial cell secretions exhibited a similar lipid composition. Removal of less-polar lipids significantly decreased the inherent antibacterial activity of nasal fluid against Pseudomonas aeruginosa, which was in part restored after replenishing the lipids. Furthermore, lipids extracted from nasal fluid exerted direct antibacterial activity in synergism with the antimicrobial human neutrophil peptide HNP-2 and liposomal formulations of cholesteryl linoleate and cholesteryl arachidonate were active against P. aeruginosa at physiological concentrations as found in nasal fluid and exerted inhibitory activity against other Gram-negative and Gram-positive bacteria. These data suggest that host-derived lipids contribute to mucosal defense. The emerging concept of host-derived antimicrobial lipids unveils novel roads to a better understanding of the immunology of infectious diseases.

Chromosomal instability (CIN) is a cytogenetic hallmark of human cancers. Increasing evidence suggests that impairment of mitotic checkpoint is causally associated with CIN. CHFR is one of the mitotic checkpoint regulators and it delays chromosome condensation in response to mitotic stress. Epigenetic inactivation of CHFR through promoter CpG hypermethylation may lead to CIN and has been reported in several human cancers. In this study, we investigated the CHFR gene expression in a panel of nasopharyngeal carcinoma (NPC), prostate, ovarian, and breast cancer cell lines. We found that the expression of CHFR mRNA was significantly decreased or undetectable in all eight NPC cell lines as well as three human NPC xenografts, whereas non-malignant nasopharyngeal cell lines and other cancer cell lines tested expressed CHFR at relatively high levels. Hypermethylation of CHFR promoter region was also strongly correlated with decreased CHFR expression in NPC cell lines and xenografts. Treatment with a methyltransferase inhibitor, 5-aza-2'-deoxycytidine, led to restoration of CHFR expression in NPC cell lines. More importantly, hypermethylation of CHFR promoter region was detected in 61.1% (22 out of 36) of primary NPC tumors while it was absent in non-malignant tissues. These findings suggest that downregulation of CHFR is a common event in NPC cells which may be due to hypermethylation of the gene promoter region.

With the increased mobility of peoples in a 21 st century global environment, many so-called traditional societies previously defined by homogeneous populations are becoming more multicultural and international in composition. Civic values and civil codes may therefore also be in flux as newcomers’ perspectives and interests interact with the traditional societal consensus. The operation of human rights within evolving societies is a clear example of the period of change and renegotiation that may arise within societies. When we contemplate human rights, we see a delicate balance between principles, for example, the Universal Declaration of Human Rights and the Canadian Charter of Rights and Freedoms, and practice as defined by, for example, national standards and civil codes, and the relative empowerment of NGOs. A useful comparison is illustrated by competing notions of fairness, which have come to dominate much political discourse. Fairness, whether it be in terms of equality of opportunity in economic life or in terms of acknowledgement of past injustices, can become a contentious issue between communities, and a challenge for policy leaders. Governments have long been subject to public scrutiny. Less enshrined is the notion that NGOs should also be accountable for their operations and for the implications of their activities. This accountability is not only internal but also to society at large. In the contemporary world, both human rights NGOs and governments assume responsibility to defend human rights. Both need to demonstrate and appeal to their constituencies and populations, with respect to their specific commitments. Together, the operation of NGOs and governments create checks and balances that will shape the quality of human rights experienced in the community. In so doing, they build trust and create dialogue. There must also be legitimate instruments and institutions for mediating human rights concerns and correcting social abuses and human behavior in a timely fashion that is responsive to evolving social needs and international norms. International NGOs can make a major contribution to society if they act in a careful, sensitive manner in promoting human rights, even if these activities place added pressure on the governance of host countries.

The aim was to explore healthcare workers' duty concerns in the isolation wards during the novel H1N1 pandemic.Healthcare workers' willingness to work is a concern worldwide since SARS; Concerns related to work in the isolation wards among healthcare workers' who continue to work during the novel H1N1 pandemic is unknown. In the light of possible staff shortages, healthcare workers' duty concern is very important for planning the retention strategies.The qualitative study with individual interview of 10 healthcare workers (four physicians, three nurses and three healthcare assistances) working in isolation wards were conducted in mid June 2009 where pandemic alert level 6 was raised by WHO. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.All participants who were still working in the isolation wards during the novel H1N1 pandemic showed professional senses that were strongly related to the willingness to work. Their concerns in their duty including appreciation from the employers, efficacy and side effects of vaccination, frequent policy changes, unclear criteria of case management, poor facility layout, duty role stress were highlighted.Further research should seek to provide in-depth specific concerns in each type of healthcare workers which is very important to keep adequate healthcare workers fighting against the infectious disease pandemic. Interesting results on the negative view towards the swine flu vaccination demonstrate more detailed evidence-based information about the vaccination is needed.It is important for mangers to provide a support to healthcare workers during influenza pandemic by providing a clear guideline/policy for case management and demonstrating appreciation for the frontline healthcare workers to minimise the risk for high staff turnover rates.

Background NLRP7 mutations are responsible for recurrent molar pregnancies and associated reproductive wastage. To investigate the role of NLRP7 in sporadic moles and other forms of reproductive wastage, the authors sequenced this gene in a cohort of 135 patients with at least one hydatidiform mole or three spontaneous abortions; 115 of these were new patients. Methods/Results All mutations were reviewed and their number, nature and locations correlated with the reproductive outcomes of the patients and histopathology of their products of conception. The presence of NLRP7 mutations was demonstrated in two patients with recurrent spontaneous abortions, and some rare non-synonymous variants (NSVs), present in the general population, were found to be associated with recurrent reproductive wastage. These rare NSVs were shown to be associated with lower secretion of interleukin 1b and tumour necrosis factor and therefore to have functional consequences similar to those seen in cells from patients with NLRP7 mutations. The authors also attempted to elucidate the cause of stillbirths observed in 13% of the patients with NLRP7 mutations by examining available placentas of the stillborn babies and live births from patients with mutations or rare NSVs. A number of severe to mild placental abnormalities were found, all of which are known risk factors for perinatal morbidity. Conclusions The authors recommend close follow-up of patients with NLRP7 mutations and rare NSVs to prevent the death of the rare or reduced number of babies that reach term.

SummaryFrom October 1987 to September 1991, frozen sections were performed on 159 ovarian lesions at the Queen Mary Hospital, Hong Kong, constituting 8–4 per cent of all frozen sections. The objective of the frozen section was assessment of the malignancy of the ovarian tumour (91 per cent), determination of the extent of metastatic disease (7 per cent) and exclusion of bilaterality in certain ovarian tumours to avoid castration (2 per cent). The overall accuracy of frozen sections was 92 per cent. There were 9 false negative diagnoses (6 per cent) and 3 grading errors (2 per cent). No false positive diagnoses were made. Among the incorrect diagnoses, 10 (6 per cent) were due to inappropriate sampling by the pathologist and 2 (1 per cent) were caused by misinterpretation. All errors involved the distinction between benign, borderline and malignant epithelial tumours. We believe that periodic assessments of frozen sections should be part of a quality assurance programme.

161 Background: In Ontario, 93% of outpatient IV chemotherapy is prescribed through Systemic Treatment Computerized Order Entry Systems (ST CPOE). To support this, Cancer Care Ontario (CCO) has developed guidelines, evaluation tools, a Community of Practice (COP) and quality indicators. Using data collected in ST CPOE systems a “Near Miss Indicator” is being developed. Methods: Clinical consensus indicated that intercepted order rate, a proxy for a near miss indicator, would further the provincial safety agenda. This is defined as the percent of course 1, day 1 intravenous (IV) chemotherapy drug orders that were changed post-first time prescribing a new regimen (excludes clinical trials). An extraction standard for dose adjustments was developed encompassing clinical and laboratory values and body surface area (BSA). Three months of data was collected from 3 centres using the same ST CPOE system. Results: A total of 6822 orders were reviewed for possible near misses; 1,446 (21.2%) were course 1 orders. For course 1, day 1 IV chemotherapy drug orders, 209 (3.2%) were changed. Most orders were changed several hours to days post prescribing and hence were not felt to represent normal clinical workflows. Physicians modified 65 and pharmacy modified 169 orders. “Other” was chosen as the reason for change in 95 (45.5%) of orders and despite multidisciplinary team review, these records were not interpretable. A near miss rate of 2.2% resulted (32/1,446). Clinical and laboratory values and BSA were equally responsible. A fourth category of “dose rounding for ease” by pharmacy was identified and felt to possibly represent poor regimen builds and pharmacy workload. Conclusions: A near miss indicator is under development via a process of identifying a need, exploration of data and socialization of the results through a COP. Initial results show a low near miss indicator rate of 2.2% which is felt to be clinically actionable. Future system modifications may facilitate capture of this indicator. The feasibility of extending the indicator to multiple vendor ST CPOEs is under study.

258 Background: It is important to demonstrate that delivery systems contribute to patient outcomes. Quality indicators provide a quantitative, evidence based (EB) foundation for clinicians, organizations, researchers, and administrators to monitor and evaluate performance of these systems. Technologies, such as ST CPOE systems are costly, impact clinician practice and therefore, would benefit from accountability through quality measures. The process for the identification of EB indicators for measuring the impacts of ST CPOE systems is described. Methods: The indicators were developed alongside the ST CPOE Best Practice Guideline. A multi-phased approach included the development of a conceptual framework, defining quality dimensions, literature review, environmental scans, and key informant interviews. An initial list of indicators was identified and aligned with the relevant quality dimensions (i.e. safety, effectiveness, efficiency, integration). A Modified Delphi methodology, involving internal and external content experts in oncology practice, technology, informatics, and human factors, was undertaken to obtain consensus on the vital few. Results: Three rounds of Modified Delphi exercises were conducted with the initial list of 118 indicators. 15 clinical practice indicators (CPI) were deemed as relevant for overall evaluation and research purposes specific to ST CPOE systems. Within this group, four indicators were identified as being valuable for reporting quality monitoring at the organizational, regional and provincial levels. In addition to CPI, 74 system functionality (e.g. usability, alert features, system integration) indicators were identified. Conclusions: Through engagement of experts and evidence review, we have identified a set of quality indicators for ST CPOE systems which will facilitate appropriate evaluation of systems and implementation processes. Operationalizing these indicators for automatic data flow through is planned in a large geographic area.

183 Background: Although information technology (IT) has the potential to improve the quality and safety of patient care, introduction into the clinical work flow may create unanticipated consequences. IT solutions such as computerized physician order entry (CPOE) are often designed and executed without end-user involvement. An evidence based guideline for systemic treatment (ST) CPOE was developed. The guideline looks at the features, functionalities and components of a ST CPOE system required to ensure safe and high-quality care. Methods: The guideline was developed by an interdisciplinary panel of physicians, nurses, pharmacists, methodologists, IT specialists, and human factors experts. A systematic review was conducted of the available clinical and technology literature and key informant interviews were conducted. Role-specific CPOE functionalities were process mapped for physicians, nurses and pharmacists. Two expert panels (i.e., clinical and supporting tools) were convened to review the information and provide feedback on guideline content. The guideline was also reviewed externally by content experts from provincial, national and international organizations. Results: The resulting evidence-based guideline focused on two distinct yet interconnected parts: clinical practice (e.g., error prevention, unanticipated consequences, impact on practice, clinical decision support), and technology requirements (e.g., usability features, system integration, effective alerts, audit logs, regimen building). The recommendations also highlight the importance of change management strategies and clinician engagement. Conclusions: This innovative guideline provides an approach to technology evaluation focusing on clinical practice needs driving IT solutions. Future research to help standardize design and usability of such systems is necessary. The non-vendor specific recommendations can be used as the foundation for evaluation of ST CPOE systems to reduce errors, improve safety, and support clinical practice. The application of the recommendations as an assessment of ST CPOE system guideline concordance will also be valuable.

This journal issue entitled: Abstracts of the 6th International Conference and Workshops on Molecular Morphology

This journal issue entitled: Abstracts of the 6th International Conference and Workshops on Molecular Morphology

Zinc ions have been demonstrated in the anterior pituitary of rat by autometallography (AMG) which involves in vivo exposure to sodium selenite leading to creation of zinc selenide crystal lattices that are later silver enhanced by AMG in the sections. In this study, autometallography is combined with immunohistochemistry in order to present the coexistence of zinc ions and hormones in endocrine cells of the rat pituitary. The results showed that the majority of zinc-enriched (ZEN) cells are somatotrophs. All the somatotrophs observed were loaded with AMG grains. Zinc ions were also found to be present in gonadotrophs, corticotrophs and thyrotrophs. A low density of AMG silver grains was found in about 60% of gonadotrophs, 8% of corticotrophs and less than 10% of thyrotrophs. Lactotrophs did not appear to contain zinc ions. The present observations may provide a clue to the physiological function of zinc ions in the rat pituitary.

Additional file 1: Table S1. Test lipid composition and particle size.

Additional file 1: Table S1. Test lipid composition and particle size.