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Granulomatous mastitis (GM) is an under-recognized and under-diagnosed disease. Patients with GM often present to the emergency room with a painful breast mass, nipple retraction, and skin changes. This pictorial essay will review the clinical presentation and imaging appearance of GM, BI-RADS reporting parameters, differential diagnoses, and diagnostic challenges posed by this disease. Early and accurate diagnosis is essential, as misdiagnosis can result in repeated core biopsies, leading to fistulae and sinus tract formation. A classic history and typical sonographic appearance allow the emergency radiologist to confidently make this diagnosis.

To effectively implement the Canadian Cardiovascular Society (CCS) guidelines for dyslipidemia management into clinical laboratories, clear recommendations for lipid reporting are essential. In this study, the Canadian Society of Clinical Chemists Working Group on Reference Interval Harmonisation surveyed Canadian laboratories on adult lipid reporting practices to set a foundation for the development and implementation of harmonised lipid reporting across Canada. Key aspects of the survey asked laboratories: what reporting parameters were in place to assess lipid results; what interpretative comments were provided; whether nonfasting lipids were permitted and, if so, what strategy was used to document fasting status; and whether there was interest in implementing a harmonised lipid report. A total of 101 laboratories were represented by 24 respondents, as many responses were submitted by laboratory networks that included more than 1 laboratory. There was at least 1 response from 9 Canadian provinces and representation across 5 testing platforms. Upper and lower limits for lipid parameters and referenced source of limits varied substantially across laboratories, with only 56% of laboratories (9 respondents) referencing the 2016 CCS guidelines. Eighty-six percent of laboratories (19 respondents) report nonfasting lipids, although the method of documenting nonfasting status varied. Overall, 36% of laboratories (8 respondents) reported interest in implementing a harmonised lipid report. Assessment of current lipid-reporting practices supports the need for harmonised lipid reporting across Canada. Development of a harmonised lipid report for the adult population, consistent with up-to-date Canadian guidelines, will improve continuity of lipid test interpretation across Canada and improve clinical decision making.

The aim of this study was to properly define the information regarding patient exposure to Ionizing Radiations in the radiological report, according to the European Directive 2013/59/EURATOM (EU 2013/59 art.58(b)). For this purpose, we evaluated the results from other Member States EU 2013/59 transpositions and from Guidelines recommendation published by International Organizations involved in diagnostic radiology. A practical way for implementing art.58 is also traced. Dosimetric quantities, such as exposure, absorbed dose and effective dose which may be included in radiological report, were first analyzed; then, in order to define international state of art of Member States EU 2013/59 transposition, a Web research using French, English, Spanish and German key words was performed. EU 2013/59 transposition for 5 Member States was reported. Especially regarding art.58, a European project reports that few European countries (11 of 28) have identified the dose metrics to be used in radiological report. Scientific organizations supporting clinical radiologists and medical physicists have published Guidelines reporting parameters useful to quantify the radiation output and to assess patient dose. Our research revealed that there is not a shared interpretation of patient exposure information to be included in radiological report. Nevertheless, according to scientific community, authors believe that the exposure is the most appropriate information that could be included in radiological report. Alternatively, but with more expensiveness, a risk index based on effective dose could be used. Moreover, the systematic exposure information recorded could be useful for dose estimates of population from medical exposure.

This results presented in this paper follow the basic principles and methodology developed for horizontal Single Hole Blast (SHB) testing using terrestrial laser scanning (TLS), introduced in Part 1, and shows specific SHB test applications as a mean to investigate rock blasting behavior. Part 1 introduced a detailed procedure for consistent and systematic SHB testing to provide the means for reproducible and comparable data collection and characterization. The concept of crater breakout angle was expanded to account for the observed non linear shape, based on measurements made at small increments along the blasthole to capture variability of the overall geometry. This paper describes SHB testing campaigns conducted at two underground salt mines. Traditional reporting parameters (e.g. breakout angle, crater area) are presented in an enhanced approach by capturing their variation along the blasthole, and with respect to measured burden dimensions. A new crater model is proposed to better capture and represent the observed crater shape, and avoid the simplification of best-fitting triangular crater shapes. Results from the field campaigns are presented in details using LiDAR point clouds and SHB characteristic plots of the crater geometry. The crater model is calibrated from the test results to obtain site-specific burden-dependent trends of the crater shape. Two methods are then proposed for implementing SHB test results into blast pattern designs using the proposed crater model.

The Hamburg Wheel Tracking (HWT) device is a laboratory-controlled rut depth test that uses loaded wheel(s) to apply a moving load on asphalt mixture specimens to simulate traffic loading on asphalt pavements. Currently, different machines with various degrees of compliance with the current AASHTO T 324-14 requirements are used by highway agencies. The objective of this study was to assess the capabilities of commercially available and representative HWT equipment in the US and to evaluate different analysis and reporting methods for rutting and stripping performance assessment from the HWT test. After performing a comprehensive evaluation of HWT devices from different vendors, considerable discrepancies among different equipment were identified. Furthermore, the available HWT machines do not meet all the requirements set forth in AASHTO T 324 including those for the wheel position waveform, the temperature range, and the reporting parameters. Evaluation of the analysis methods was conducted by applying six analysis procedures to the test data of two asphalt mixes with contrasting rutting resistance and moisture susceptibility. For the poor-performing mix, substantial differences were observed among the different methods, especially in the reporting of the Stripping Inflection Point (SIP). For the good-performing mix, only two of the six methods successfully identified this mix as a non-stripping mix. It is recommended that an approach similar to the one adopted by Iowa DOT be implemented in the revised AASHTO T 324 specification.

Background Global sagittal balance, describing the vertical alignment of the spine, is an important factor in the non-operative and operative management of back pain. However, the typical gold standard method of assessment, radiography, requires exposure to radiation and increased cost, making it unsuitable for repeated use. Non-radiologic methods of assessment are available, but their reliability and validity in the current literature have not been systematically assessed. Therefore, the aim of this systematic review was to synthesise and evaluate the reliability and validity of non-radiographic methods of assessing global sagittal balance. Methods Five electronic databases were searched and methodology evaluated by two independent reviewers using the13-item, reliability and validity, Brink and Louw critical appraisal tool. Results Fourteen articles describing six methodologies were identified from 3940 records. The six non-radiographic methodologies were biophotogrammetry, plumbline, surface topography, infra-red motion analysis, spinal mouse and ultrasound. Construct validity was evaluated for surface topography (R = 0.49 and R = 0.68, p

Brachytherapy (BT) for locally advanced cervical cancer is vital for optimal outcomes. There is heterogeneity in brachytherapy treatment practice for cervical cancer across India. In an attempt to standardize various processes involved in cervical cancer brachytherapy, the expert members of the Indian Brachytherapy Society (IBS) developed a document related to radiation therapy treatment of cervical cancer with special emphasis on brachytherapy. The guidelines are based on high quality clinical evidence, expert opinion and consensus wherever evidence was lacking. The document provides a guide for external beam radiation and details of all the processes involved in high-dose-rate (HDR) brachytherapy including patient selection, preparation, principles and technique of BT applications, target and normal tissue definition, dose prescriptions, BT planning, reporting parameters, common complications of BT and their management, scope for research, etc. In summary, we present here practical tips and tricks, recording and reporting of cervical cancer brachytherapy, which can be implemented in various clinical environments and forms the basis of this report.

Background: The growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis has a fundamental impact on glucose metabolism. Therefore, both untreated GH deficiency (GHD) and GH treatment (GHT) may be associated with some metabolic alterations, although the abnormalities of glucose metabolism have been investigated by relatively few studies as main outcomes. Aim: The present review summarizes the available data on glucose metabolism in children with GHD, providing an overview of the current state of the art in order better to clarify the real metabolic impact of GHD and GHT. Methods: Among all the existing studies, we evaluated all original studies that fulfilled our criteria for analysis reporting parameters of glucose metabolism as the primary or secondary objective. Results: The reported impact of GHD per se on glucose metabolism is quite homogeneous, with the majority of studies reporting no significant difference in metabolic parameters between GHD children and controls. Conversely, GHT proves to be more frequently associated with a subtle form of insulin resistance, while both fasting glucose and HbA1c levels remain almost always within the normal range. Conclusions: The different methods to study glucose metabolism, the heterogeneity of the populations evaluated, the different doses of GH used together with the variable duration of follow-up may be responsible for discrepancy in the results. Long-term longitudinal studies having glucose homeostasis as their primary outcome are still needed in order better to clarify the real metabolic impact of GHD and GHT in children.

The number of patients supported with left ventricular assist devices (LVADs) is rising rapidly, and noncardiac surgery (NCS) in these patients presents unique challenges. Given the controversy regarding the safety and timing of elective NCS, we performed a systematic review examining the perioperative morbidity and mortality of NCS in stable patients with LVADs. The published literature was searched using strategies created by a medical librarian. All reports involving five or more patients with implanted LVAD undergoing NCS were eligible for inclusion. One hundred and sixty one patients who underwent 252 surgeries were included from seven studies. Cohort size ranged from 8 to 47 patients undergoing 12 to 67 NCS. Median age ranged from 50.1 to 68 years and 75 to 100% were male. Thirty day postoperative mortality ranged from 6.4 to 16.7%, although four studies reported no deaths. Due to the small number of included studies with relative few patients and widely heterogeneous reporting of outcomes a formal quantitative meta-analysis was not performed. Noncardiac surgery in patients with LVADs appears to be safe and feasible in select patients. Future studies should use standard study design and reporting parameters to facilitate the systematic examination of safety and outcomes for elective NCS in LVAD patients.

Objective To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols. Material and methods A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7 – 10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted. Results A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group. Conclusions Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group.

Purpose To determine whether perioperative high-dose-rate brachytherapy (PHDRB) implants with larger high-dose regions produce increased locoregional control. Methods and Materials Patients ( n = 166) enrolled in several PHDRB prospective studies conducted at the University of Navarre were analyzed. The PHDRB was given to total doses of 16 Gy/4 b.i.d. or 24 Gy/6 b.i.d. treatments for negative or close/positive margins along with 45 Gy/25 Rx of external beam radiation therapy. The histogram-based generalized equivalent uniform dose (EUD) formulism was used to quantify and standardize the dose–volume histogram into 2-Gy equivalents. The region of interest analyzed included: tissue volume encompassed by the prescription isodose of 4 Gy ( TV 100 ). Routine dose reporting parameters such as physical dose and single-point 2-Gy equivalent dose were used for reference. Results After a median followup of 7.4 years (range, 3–12+), 50 patients have failed, and 116 remain controlled at last followup. Overall, EUD was not different in the patients who failed compared with controls (89.1 Gy vs. 86.5 Gy; p = not significant). When patients were stratified by risk using the University of Navarre Predictive Model, very high-risk patients (i.e., tumors ≥3 cm resected with close p = 0.028). This effect was not observed in low-, intermediate-, and high-risk University of Navarre Predictive Model categories. Conclusions In very high-risk patients, enlarged high-dose regions can produce a dose–response effect. Routine dose reporting methods such as physical dose and single-point 2-Gy equivalent dose may not show this effect, but it can be revealed by histogram-based EUD assessment.

It is regular practice for a clinical investigator to report the findings of any pertinent test. SEMG endeavors to investigate several aspects of skeletal muscular dysfunction. Dynamic SEMG evaluation reporting of the cervical musculature range of motion is the subject of this report. The report content and format is in line with the Daubert Rule of Evidence (Federal Rule 702). The format of the report allows the clinician to present the data in a manner that allows readily for court testimony or other presentation of objective evidence.

The Metabolomics Standards Initiative (MSI) has recently released documents describing minimum parameters for reporting metabolomics experiments, in order to validate metabolomic studies and to facilitate data exchange. The reporting parameters encompassed by MSI include the biological study design, sample preparation, data acquisition, data processing, data analysis and interpretation relative to the biological hypotheses being evaluated. Herein we exemplify how such metadata can be reported by using a small case study - the metabolite profiling by GC-TOF mass spectrometry of Arabidopsis thaliana leaves from a knockout allele of the gene At1g08510 in the Wassilewskija ecotype. Pitfalls in quality control are highlighted that can invalidate results even if MSI reporting standards are fulfilled, including reliable compound identification and integration of unknown metabolites. Standardized data processing methods are proposed for consistent data storage and dissemination via databases.

Background Proper utilization of resources is an important operational objective for clinical laboratories. To reduce unnecessary manual interventions on automated instruments, we conducted a workflow analysis that optimized dilution parameters and reporting of abnormally high chemistry results for the Beckman AU series of chemistry analyzers while maintaining clinically acceptable reportable ranges. Methods Workflow analysis for the Beckman AU680/5812 and DxC800 chemistry analyzers was performed using historical data. Clinical reportable ranges for 53 chemistry analytes were evaluated. Optimized dilution parameters and upper limit of reportable ranges for the AU680/5812 instruments were derived and validated to meet these reportable ranges. The number of specimens that required manual dilutions before and after optimization was determined for both the AU680/5812 and DxC800, with the DxC800 serving as the reference instrument. Results Retrospective data analysis revealed that 7700 specimens required manual dilutions on the DxC over a 2-y period. Using our optimized AU-specific dilution and reporting parameters, the data-driven simulation analysis showed a 61% reduction in manual dilutions. For the specimens that required manual dilutions on the AU680/5812, we developed standardized dilution procedures to further streamline workflow. Conclusions We provide a data-driven, practical outline for clinical laboratories to efficiently optimize their use of automated chemistry analyzers. The outcomes can be used to assist laboratories wishing to improve their existing procedures or to facilitate transitioning into a new line of instrumentation, regardless of the instrument model or manufacturer.

Objective. The objective was to evaluate the extent of geometric and positional variations of two different applicators during multiple high-dose-rate (HDR) intracavitary brachytherapy (ICBT) in carcinoma cervix and its implication on reporting as per International Commission on Radiation Units and Measurement (ICRU) Report 38. Methods. Fifty patients, following teletherapy, were randomly allocated to two groups of 25 each. They received a dose of 6 Gy to point A during each of the three HDR ICBT applications by either a flexible Ralstron or a rigid geometry Rotterdam applicator. The various applicator components related to its geometry and their Cartesian coordinates were evaluated from orthogonal films. The doses to ICRU bladder, rectal, pelvic, lymphatic trapezoid points, and dimensions of 6-Gy ICRU height, width, thickness, and volume were estimated for each application. Results. Significant variation was observed with the three HDR ICBT applications for each group, for all components and for both applicators, although it was relatively more with the flexible Ralstron applicator. The average shift in each of the coordinates of os, uterine tip, and ovoids was around 10 mm for both groups. These resulted in significant variations in all the ICRU Report 38 reporting parameters for three insertions in any given patient and across 25 patients of both groups. Conclusions. Multiple HDR ICBT applications led to significant variation in the applicator geometry and its positions in pelvis, irrespective of the applicator rigidity. This results in uncertainties in reporting as per ICRU Report 38 guidelines, and thus calls for its revision.

The helicity reporting parameters t/c and [theta](222) have been measured at 2, 25, and 60 degrees C in water for the solubilized polyalanine series Ac-Hel-A(n)-(t)LInp(2)K(4)W-NH(2) of length 4or = nor = 14 that bears the helix-initiating and monitoring N-cap Ac-Hel and the spaced solubilizer (t)LInp(2)K(4)W-NH(2) as a C-cap. Correlation of t/c with length shows that the helical propensity for nor = 6 is ca. 1.0, consistent with our early reports, but that a dramatic increase in temperature dependence and helical propensity occurs for nor = 8. A model based on hydrogen-bonding cooperativity is proposed to explain this finding, and both t/c and [theta](222) are modeled successfully by length-dependent alanine propensities at 2 degrees C of 1.03 for n = 6, 1.15, for 7or = nor = 9 and 1.26 for nor = 10. The implications of these results for the energetics of helix formation by alanine-rich peptide sequences are discussed.

Epidemic data often suffer from underreporting and delay in reporting. In this paper, we investigated the impact of delays and underreporting on estimates of reproduction number. We used a thinned version of the epidemic renewal equation to describe the epidemic process while accounting for the underlying reporting system. Assuming a constant reporting parameter, we used different delay patterns to represent the delay structure in our model. Instead of assuming a fixed delay distribution, we estimated the delay parameters while assuming a smooth function for the reproduction number over time. In order to estimate the parameters, we used a Bayesian semiparametric approach with penalized splines, allowing both flexibility and exact inference provided by MCMC. To show the performance of our method, we performed different simulation studies. We conducted sensitivity analyses to investigate the impact of misspecification of the delay pattern and the impact of assuming nonconstant reporting parameters on the estimates of the reproduction numbers. We showed that, whenever available, additional information about time-dependent underreporting can be taken into account. As an application of our method, we analyzed confirmed daily A(H1N1) v2009 cases made publicly available by the World Health Organization for Mexico and the USA. Copyright (c) 2013 John Wiley & Sons, Ltd.

With the demonstration of superior prognostic value of central blood pressure (CBP) beyond traditionally used brachial BP, there have been increasing interest in the development of novel devices reporting parameters of CBP. The emerging devices for non-invasive estimation of CBP, based on either tonometry-based or cuff-based techniques, were evaluated with various validation studies. Therefore, the research community and clinicians have been faced with challenges regarding the conduction and interpretation of the validation studies for the non-invasively obtained CBP. We summarize here the barriers to the clinical application of the CBP concept, which provide research opportunities to further the subsequent translation.

This paper discusses the need for the reporting of a variety of physical, chemical, climatic, geological, biological, and meteorological parameters along with the data required by various investigators on the performance of structural stormwater best management practices (BMPs) used to enhance stormwater quality. A standard list of minimum parameters is suggested. Such a list is needed if we want to exchange and transfer data between various studies being conducted throughout the world, or even within the United States. Transferability of performance results and consistency, or lack of it, in the performance of various BMPs, has been an ongoing problem. A mutually agreed upon minimum list of reporting parameters that can be used to relate the performance to some, or all, BMPs could begin to address this problem. Over time such standardization will conserve the resources being expended, not only by individual BMP investigations, but also in the selection and appropriate design of various BMPs.

Objective The purpose of the present systematic review was to evaluate the scientific literature regarding the professional assessment of aesthetics in implant dentistry. Material and Methods An electronic search of Medline database and Cochrane Central Register of Controlled Trials was performed, and complemented by a manual search. Clinical or validation studies (Part 1) and randomized-controlled trials (RCTs) (Part 2) reporting parameters and methods for the assessment of aesthetics were included. The information regarding the assessment of aesthetics was extracted. The methodological quality of RCTs was evaluated by means of the Cochrane Collaboration's Tool for assessing risk of bias. Results The search yielded 149 and 32 publications in Part 1 and Part 2, respectively. A great diversity with regard to parameters, methods and measurement units used for the assessment of aesthetics was found among the included studies. With respect to time points of assessment there were significant differences between the RCTs. Only two RCTs fulfilled all the criteria of the The Cochrane Collaboration's Tool for assessing risk of bias. Conclusions Due to the differences of the study designs, parameters and methods used for the assessment of aesthetics, comparisons between studies should be interpreted with caution. Only a limited number of RCTs offer sound evidence on aesthetic outcomes in implant dentistry.

In an effort to promote a uniform standard for reporting clinical results, the Consensus Meeting on Systems for Reporting Results in Acoustic Neuroma was convened in 2001, and the results of this meeting have been summarized by Kanzaki et al. in 2003. We describe publication compliance to these reporting parameters in a systematic analysis of publications obtained through a comprehensive literature search on patients with vestibular schwannoma (VS) treated with stereotactic radiosurgery (SRS). Each publication was scored based on whether it had properly reported each of eight elements described in the Consensus Meeting Reporting Guidelines (Guidelines). We compared the proportions of studies and cases that included each of the eight items prior to, and after, publication of the Guidelines. A significantly greater proportion of studies appropriately reported the size of the tumor after the release of the Guidelines (98% compared to 85%, p = 0.04). A significantly greater number of cases were reported properly adhering to the Guidelines in seven of the eight elements, with the exception of the cystic nature of the tumor. Report of post-treatment neurologic symptoms and complications saw the greatest degree of increase from before to after the publication of the Guidelines (47% to 68% of cases published, p < 0.001). Our findings suggest a potentially significant impact of the Guidelines on the quality of the information included in studies.

© 2009 Fernandes et al; licensee BioMed Central Ltd. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited., Background: Decisions about interim analysis and early stopping of clinical trials, as based on recommendations of Data Monitoring Committees (DMCs), have far reaching consequences for the scientific validity and clinical impact of a trial. Our aim was to evaluate the frequency and quality of the reporting on DMC composition and roles, interim analysis and early termination in pediatric trials. Methods: We conducted a systematic review of randomized controlled clinical trials published from 2005 to 2007 in a sample of four general and four pediatric journals. We used full-text databases to identify trials which reported on DMCs, interim analysis or early termination, and included children or adolescents. Information was extracted on general trial characteristics, risk of bias, and a set of parameters regarding DMC composition and roles, interim analysis and early termination. Results: 110 of the 648 pediatric trials in this sample (17%) reported on DMC or interim analysis or early stopping, and were included; 68 from general and 42 from pediatric journals. The presence of DMCs was reported in 89 of the 110 included trials (81%); 62 papers, including 46 of the 89 that reported on DMCs (52%), also presented information about interim analysis. No paper adequately reported all DMC parameters, and nine (15%) reported all interim analysis details. Of 32 trials which terminated early, 22 (69%) did not report predefined stopping guidelines and 15 (47%) did not provide information on statistical monitoring methods. Conclusions: Reporting on DMC composition and roles, on interim analysis results and on early termination of pediatric trials is incomplete and heterogeneous. We propose a minimal set of reporting parameters that will allow the reader to assess the validity of trial results.

from Unconventional Shale Gas Extraction Kyle J. Bibby,†,‡ Susan L. Brantley, Danny D. Reible, Karl G. Linden, Paula J. Mouser, Kelvin B. Gregory, Brian R. Ellis, and Radisav D. Vidic*,† †Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States ‡Department of Computational and Systems Biology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania 15261, United States Earth and Environmental Systems Institute and Department of Geosciences, Pennsylvania State University, University Park, Pennsylvania 16802, United States Department of Civil and Environmental Engineering, Texas Tech University, Lubbock, Texas 79409, United States Department of Civil, Environmental and Architectural Engineering, University of Colorado, UCB 428, Boulder, Colorado 80309, United States Department of Civil, Environmental and Geodetic Engineering, The Ohio State University, Columbus, Ohio 43210, United States Department of Civil and Environmental Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States

Problem: Adhesions are one of the most common causes for endoscopic sinus surgery (ESS) failures. Though meticulous postoperative debridement as well as various other interventions have commonly been undertaken partly to prevent the development of this complication, the basis behind these time-consuming and costly practices is largely empirical. We therefore set out to evaluate the evidence supporting postoperative debridement and other postoperative measures in preventing adhesion formation after ESS. Methods: The Cochrane Controlled Trials Register, MEDLINE, EMBASE, and the references of relevant articles were searched. Selection criteria included all randomized controlled trials that compared adhesion rates of adult ESS patients who were subjected to any form of postoperative intervention versus no or alternative intervention. Results: A total of 4 relevant research papers were identified. The interventions evaluated were all different and included postoperative debridement, 2 different types of hyaluronic acid sinus dressing and topical mitomycin-C application. All of the studies showed no significant difference in preventing adhesions, except for the study evaluating cross-linked hyaluronic acid dressing, which showed a statistically significant benefit in reducing adhesion formation (overall adhesion score 1.2 + 0.1 versus 2.1 + 0.1, P = 0.0001). Conclusion: The evidence available thus far seemed to suggest that the majority of current postoperative interventions, including the common practice of intensive postoperative sinus cleaning, did not significantly reduce adhesions. However, further evaluation to clarify the usefulness and role of these various measures is required. In addition, standardized intervention and outcome measures need to be devised to ensure quality data collection. Significance: This systematic review revealed that current post-ESS care regimens to reduce adhesion formation are not evidence based. It highlights the need for standardizing reporting parameters, and collecting more good quality data. Until then, postoperative care remains empirical. Support: None reported.

Implementation, Outcomes, and Evaluation In 2006, concern was raised by our neonatology department that all women at risk of preterm delivery were not receiving antenatal steroids. A team of nurses, physicians, and system analysts routinely met to evaluate performance and assess for improvement opportunities. Since 2005, findings from our neonatal information system showed that 77.8% of the women who gave birth between 24 and 32 weeks gestation received at least one dose of antenatal steroids. Staff was educated and protocols established with some improvement realized (83.9% in the year 2008). Efforts to develop a key performance indicator to facilitate concurrent review of missed opportunities were initiated. In 2009, the National Quality Forum released the Perinatal Consensus Standard (PC03) supporting the National Institutes of Health recommendations to give a full course of corticosteroids to all expectant women between 24 and 32 weeks gestation. On further evaluation, numerous challenges surfaced, including the collection and accurate reporting of data (due to definitional issues of successful treatment), identification of barriers to treatment, and the need to clarify reporting parameters.

Attempts to progress e-health in pathology in Australia have been hindered by a lack of standardisation in key requesting and reporting parameters, such as request codes, test panels, test names, units and reference intervals. Leverage off electronic health records (e.g., development and use of decision support systems) is difficult without agreement in these areas. The Royal College of Pathologists of Australasia (RCPA) led ‘Pathology Units and Terminology Standardisation’ (PUTS) project is showing leadership in these areas by bringing together pathologists, scientists and IT professionals to make recommendations on best practice. Working groups have been established to review request codes, recommended units, and reporting codes for seven pathology disciplines. Each group will also consider the terminology most applicable to that discipline (e.g., SNOMED-CT, LOINC, both, or possibly other) and where necessary highlight tests for which results should not be combined across pathology providers. Work on the ambitious Personally Controlled Electronic Health record program continues, with initial operation scheduled for mid 2012. Although participation will not initially be mandatory for patients or providers, Pathology reporting will be included. The pathology industry needs to be actively engaged in this rapidly changing landscape for optimal outcomes.