Online CPD.
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We studied the in vivo recovery, lifespan, and hemostatic effectiveness of CPDA-1 platelet concentrates stored for up to 72 hours at 4 C. A total of 120 CPDA-1 concentrates containing an average (+/- 1 S.D.) of 6.6 +/- 2.0 x 10(10) platelets were prepared. The pH of the units following storage at 4 C was 6.8 +/- 0.2; no unit had a pH below 6.3. Autologous transfusion of six normal volunteers showed that platelets stored at 4 C for 72 hours had an in vivo recovery of 40 +/- 18 per cent and a lifespan of 5.1 +/- 1.5 days. The hemostatic effectiveness of CPDA-1 platelets was determined by platelet counts and template bleeding time measurements in 10 thrombocytopenic patients. Patients receiving 48-hour-stored platelets had a four- to six-hour posttranfusion corrected platelet increment averaging 15,300 +/- 3,200/microliter which was 67 +/- 34 per cent of expected recovery. Four of the five patients transfused with this preparation showed an improved bleeding time. In contrast, three patients receiving 72-hour-stored platelets had a four- to six-hour posttransfusion increment of 5,800 +/- 2,400/microliter that was only 26 +/- 13 per cent of the expected recovery; furthermore, only one of these patients showed any correction of the bleeding time. These data indicate that CPDA-1 platelets are hemostatically effective when stored at 4 C for up to 48 hours.
Functional imaging plays a growing role in the clinical assessment and research investigation of patients with epilepsy. This article reviews the literature on functional MRI (fMRI) investigation of EEG activity, fMRI evaluation of cognitive and motor functions, magnetic resonance spectroscopy (MRS), single photon emission computed tomography (SPECT) and positron emission tomography (PET) in epilepsy. The place of these techniques in clinical evaluation and their contribution to a better neurobiological understanding of epilepsy are discussed.
Pregnancies in women with epilepsy are high risk and need careful management by both the medical and obstetric teams due to the increased incidence of complications and adverse outcomes of pregnancy. By the time a pregnant woman with epilepsy presents, the foetus is virtually fully formed and the opportunity for altering drug treatment has passed. Women need to be counselled and told to seek advice about their anticonvulsant therapy should they wish to become pregnant. All major anticonvulsant drugs are teratogenic but the main risk to the developing foetus appears to be when the mother is on polytherapy especially if sodium valproate forms part of the combination. Folate supplements (5 mg) before conception are advisable. There appears to be a minor but significant increased risk of maternal complications in women with epilepsy such as hyperemesis gravidarum, pre-eclampsia and eclampsia, vaginal bleeding and premature labour. In the majority of women seizure control will not alter during pregnancy. Oral vitamin K should be given to the mother receiving enzyme-inducing antiepileptic drugs. Post-natal infant development: there is an increased risk of prematurity (9-11%), stillbirth, neonatal and perinatal death, haemorrhagic disease of the newborn, low Apgar scores and low birth weight (7-10%). Breast feeding: virtually all the anticonvulsant drugs are excreted in breast milk in low concentrations. Feeding difficulties, irritability and lethargy can occur. However, the benefits of breast feeding usually far outweigh any minor risks to the baby.
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BACKGROUND: Conventional post-graduate meetings-typically 'lunchtime' meetings outside practices-have been heavily criticized. Revalidation is also impending, and there has been associated pressure for the widespread introduction of personal development plans (PDPs). However, there is very little empirical evidence about the usefulness to GPs of different kinds of educational meeting or of PDPs. OBJECTIVES: Our aim was to assess the utility to GPs of different types of post-graduate meeting and PDPs. METHODS: A postal questionnaire was sent to 921 GP principals in three health authorities, who were asked to recall their most recent post-graduate education-approved (PGEA) meetings (practice-based and 'outside') and the latest major learning 'undertaken' in their PDP. RESULTS: A total of 698 GPs (76%) returned questionnaires. A substantial minority (208; 30%) had a PDP. Most had undertaken education recently [median time elapsed (weeks): meeting 'outside' practice, 4; 'practice-based', 5; PDP, 3]. Education had not changed clinical practice for many GPs ('practice-based' 39% reported no change; 'outside' meetings 50% and PDPs 57%). A change in practice after a practice meeting was related to relevance to everyday practice [disagree/neutral, agree, strongly agree odds ratios: 1.00, 4.22 (95% CI 2.1-8.6) and 5.9 (2.6-13.3), respectively], to lecturer factors (enthusiasm, summarizing important points, handouts) and to social enjoyment. PDPs were less likely to be perceived relevant to practice (practice-based meeting, 'outside' meeting, PDPs: 89, 87 and 72%, respectively), as a break from practice (54,72 and 18%), good socially (63, 72 and 15%), good for professional networking (54, 70 and 19%) and glad to have done it (84, 86 and 44%). Being glad to use a PDP was more likely if the learning was clinically relevant, a break from practice, and incorporated professional networking. CONCLUSION: Changes in practice after post-graduate meetings are not only related to clinical relevance and lecturer factors, but also to professional and social factors. PDPs may not be providing better learning opportunities or enjoyment than traditional meetings, although GPs who are glad to use PDPs incorporate clinical relevance, a break from practice and networking. Post-graduate tutors should probably continue to support and monitor the lecturer quality and clinical relevance of a balanced portfolio of both practice-based and 'outside' meetings.
The extent of stability of MCV in whole blood samples used in UK NEQAS surveys has been demonstrated. There are differences in response by various blood counting systems and the relevance of these findings to performance assessment is discussed.
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