%0 Journal Article %J Eur J Ophthalmol %D 2019 %T Eye injuries in children - incidence and outcomes: An observational study at a dedicated children's eye casualty. %A Jolly, Rohit %A Arjunan, Mousindha %A Theodorou, Maria %A Dahlmann-Noor, Annegret H %K Adolescent %K Child %K Child, Preschool %K Emergency Service, Hospital %K Eye Injuries %K Female %K Humans %K Incidence %K Infant %K Male %K Prognosis %K Quality of Life %K Retrospective Studies %K Treatment Outcome %K Vision Disorders %K Visual Acuity %X

PURPOSE: Trauma is an important cause of visual loss in children and may affect their quality of life. Prevention and legislation can reduce the incidence of trauma, and appropriate and timely treatment can improve prognosis. We aimed to describe incidence of eye injuries in children and the adherence to national and local management guidelines.

METHODS: Retrospective service evaluation at a tertiary hospital (Moorfields Eye Hospital, London, UK) which operates a dedicated children's eye casualty. The electronic patient administration system and electronic patient record system (Openeyes) were used to identify children who presented with eye injuries between January 2015 and December 2015.

RESULTS: Of 2397 first-time attendances to our children's casualty, 508 were for injuries (estimated incidence 21.1%, 95% confidence interval: 19.5%-22.7%). Mean age at presentation was 7.51 (standard deviation: 7.97) years; boys were more commonly affected than girls (69%). The most common injury was corneal abrasion, followed by blunt and chemical injury; severe injuries such as penetrating trauma were rare. Injuries were sustained mostly during play or sports. Two children sustained permanent loss of vision in the affected eye.

CONCLUSION: Our findings are comparable to other published reports. Adherence to management guidelines is high, but documentation of advice given to families can be improved. Regular training of staff and collaboration with organisations outside the hospital can increase awareness of eye injuries in children.

%B Eur J Ophthalmol %V 29 %P 499-503 %8 2019 Sep %G eng %N 5 %R 10.1177/1120672118803512 %0 Journal Article %J PLoS One %D 2019 %T Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria. %A Bhattacharya, Antoinette Alas %A Umar, Nasir %A Audu, Ahmed %A Felix, Habila %A Allen, Elizabeth %A Schellenberg, Joanna R M %A Marchant, Tanya %K Adolescent %K Adult %K Female %K Guidelines as Topic %K Health information systems %K Humans %K Infant Health %K Infant, Newborn %K Maternal Health %K Middle Aged %K Nigeria %K Pregnancy %K Quality Indicators, Health Care %K Young Adult %X

INTRODUCTION: Routine health information systems are critical for monitoring service delivery. District Heath Information System, version 2 (DHIS2) is an open source software platform used in more than 60 countries, on which global initiatives increasingly rely for such monitoring. We used facility-reported data in DHIS2 for Gombe State, north-eastern Nigeria, to present a case study of data quality to monitor priority maternal and neonatal health indicators.

METHODS: For all health facilities in DHIS2 offering antenatal and postnatal care services (n = 497) and labor and delivery services (n = 486), we assessed the quality of data for July 2016-June 2017 according to the World Health Organization data quality review guidance. Using data from DHIS2 as well as external facility-level and population-level household surveys, we reviewed three data quality dimensions-completeness and timeliness, internal consistency, and external consistency-and considered the opportunities for improvement.

RESULTS: Of 14 priority maternal and neonatal health indicators that could be tracked through facility-based data, 12 were included in Gombe's DHIS2. During July 2016-June 2017, facility-reported data in DHIS2 were incomplete at least 40% of the time, under-reported 10%-60% of the events documented in facility registers, and showed inconsistencies over time, between related indicators, and with an external data source. The best quality data elements were those that aligned with Gombe's health program priorities, particularly older health programs, and those that reflected contact indicators rather than indicators related to the provision of commodities or content of care.

CONCLUSION: This case study from Gombe State, Nigeria, demonstrates the high potential for effective monitoring of maternal and neonatal health using DHIS2. However, coordinated action at multiple levels of the health system is needed to maximize reporting of existing data; rationalize data flow; routinize data quality review, feedback, and supervision; and ensure ongoing maintenance of DHIS2.

%B PLoS One %V 14 %P e0211265 %8 2019 %G eng %N 1 %R 10.1371/journal.pone.0211265 %0 Journal Article %J Acta Cytol %D 2014 %T Making cytological diagnoses on digital images using the iPath network. %A Dalquen, Peter %A Savic Prince, Spasenija %A Spieler, Peter %A Kunze, Dietmar %A Neumann, Heinrich %A Eppenberger-Castori, Serenella %A Adams, Heiner %A Glatz, Katharina %A Bubendorf, Lukas %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Child %K Child, Preschool %K Computers, Handheld %K Cytodiagnosis %K Diagnosis, Differential %K Female %K Humans %K Hyperplasia %K Infant %K Male %K Metaplasia %K Middle Aged %K Neoplasms %K Observer Variation %K Reproducibility of Results %K Sensitivity and Specificity %K Telemedicine %X

BACKGROUND: The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool.

AIM: To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set.

METHOD: Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant.

RESULTS: For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93%, respectively; the overall accuracy was 88-90%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions.

CONCLUSION: Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.

%B Acta Cytol %V 58 %P 453-60 %8 2014 %G eng %N 5 %R 10.1159/000369241 %0 Journal Article %J J Telemed Telecare %D 2013 %T A hybrid approach to telepathology in Cambodia. %A Kadaba, Varsha %A Ly, Tho %A Noor, Saqib %A Chhut, Serey V %A Hinsch, Nora %A Stauch, Gerhard %A Gollogly, James %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Cambodia %K Child %K Child, Preschool %K Female %K Humans %K Internet %K Male %K Middle Aged %K Remote Consultation %K Retrospective Studies %K Surgical Procedures, Operative %K telepathology %K Videoconferencing %K Young Adult %X

We established a hybrid telepathology network at the Children's Surgical Centre (CSC) in Cambodia, based on store-and-forward communication using iPATH and videoconferencing using Skype. We retrospectively analysed all data from the CSC stored on the iPATH server and reviewed the patient notes over an 8-month period. Of 115 patients for histopathology diagnosis during the study period, 38 cases were uploaded onto iPATH for further telemedicine discussion. The median number of days it took a specialist, other than the local one, to comment on the case on iPATH was 5 days (range 0-15). In three cases (8%) there was no reply from a specialist on iPATH. During the study period, seven clinical conferences were held, with an average of 6 cases (range 4-7) discussed at each conference. All 38 cases discussed had a final agreed diagnosis and firm management plans were made. Of the 24 cases where proactive management was advised, 17 patients followed through with the recommendations. Although the combination of video consultations and store-and-forward communication has not been used much before in the developing world, it has benefited patient care and outcomes at the CSC.

%B J Telemed Telecare %V 19 %P 475-8 %8 2013 Dec %G eng %N 8 %R 10.1177/1357633X13512071 %0 Journal Article %J J Clin Pathol %D 2013 %T Physiological states and functional relation between thyrotropin and free thyroxine in thyroid health and disease: in vivo and in silico data suggest a hierarchical model. %A Midgley, John E M %A Hoermann, Rudolf %A Larisch, Rolf %A Dietrich, Johannes W %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Autoantibodies %K Autoantigens %K Biological Markers %K Computer Simulation %K Feedback, Physiological %K Humans %K Hyperthyroidism %K Hypothyroidism %K Iodide Peroxidase %K Iron-Binding Proteins %K Linear Models %K Middle Aged %K Models, Biological %K Multivariate Analysis %K Nonlinear Dynamics %K Predictive Value of Tests %K Retrospective Studies %K Thyroid Diseases %K Thyroid Function Tests %K Thyroid Gland %K Thyrotropin %K Thyroxine %K Young Adult %X

AIMS: Understanding the exact relationship between serum thyrotropin/thyroid stimulating hormone (TSH) and free thyroxine (FT(4)) is a prerequisite for improving diagnostic reliability and clinical decision making.

METHODS: We (1) retrospectively studied the relationship between TSH and FT(4) in a large unselected clinical sample (n=6641) of primary hypothyroid, euthyroid and hyperthyroid subjects, and (2) applied a mathematical model of thyroid hormone feedback control to assess the relation between structural parameters and TSH levels in the different functional states.

RESULTS: When separately analysing total sample and untreated subjects, the correlation slope for logTSH versus FT(4) for hypothyroid subjects was significantly different from that of the euthyroid panel and hyperthyroid subjects (the latter being compromised by reaching the TSH assay's lower detection limit). As trends between functional states changed, each functional segment appeared to become differently regulated. Theoretical modelling and sensitivity analysis revealed that the influence of various structural parameters on TSH levels also depends on the overall function of the feedback loop.

CONCLUSIONS: Our data suggest that the states of hypothyroidism, euthyroidism and hyperthyroidism can be regarded as differently regulated entities. The apparent complexity could be replicated by mathematical modelling suggesting a hierarchical type of feedback regulation involving patterns of operative mechanisms unique to each condition. For clinical purposes and assay evaluation, neither the standard model relating logTSH with FT(4), nor an alternative model based on non-competitive inhibition can be reliably represented by a single correlation comparing all samples for both hormones in one all-inclusive group.

%B J Clin Pathol %V 66 %P 335-42 %8 2013 Apr %G eng %N 4 %R 10.1136/jclinpath-2012-201213