Royal College of Pathologists

There is a symbiotic relationship between the developers of AI services and the communities seeking to harness the benefits of AI. Some form of ecosystem governance is required if such relationships are to become mutually beneficial rather than parasitic, with one side deriving benefits at the expense of the other. This paper examines how a data trust framework can provide data sharing ecosystem governance to facilitate data flows and resolve information asymmetries between competitive entities. The EU Horizon-funded SPADE project case is discussed as an application scenario featuring agricultural drones, digital twins, and other data sharing challenges to explore this concept. We also examine how a club theory approach can help implement a sound business model with a data trust framework as a governance model.

The Sri Lanka Journal of Forensic Medicine, Science & Law (SLJFMSL) is a peer-reviewed, open-access journal published biannually in June and December each year by the Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.The mission of the SLJFMSL is to stimulate, encourage and empower researchers to publish high quality research in order to promote evidence based practice and provide a platform for researchers to share experiences and knowledge in the fields of forensic medicine, forensic sciences, medical ethics and relevant law. This journal publishes original research papers, reviews, points of view, case reports, technical notes and letters to the editor. The SLJFMSL is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.SLJFMSL was assessed by the Journal Publishing Practices and Standards framework and was placed at level five (of six) and is currently listed in SLJOL, DOAJ, IMSEAR, NLM Catalogue.

BackgroundSevere COVID-19 has a high mortality rate. Comprehensive pathological descriptions of COVID-19 are scarce and limited in scope. We aimed to describe the histopathological findings and viral tropism in patients who died of severe COVID-19.MethodsIn this case series, patients were considered eligible if they were older than 18 years, with premortem diagnosis of severe acute respiratory syndrome coronavirus 2 infection and COVID-19 listed clinically as the direct cause of death. Between March 1 and April 30, 2020, full post-mortem examinations were done on nine patients with confirmed COVID-19, including sampling of all major organs. A limited autopsy was done on one additional patient. Histochemical and immunohistochemical analyses were done, and histopathological findings were reported by subspecialist pathologists. Viral quantitative RT-PCR analysis was done on tissue samples from a subset of patients.FindingsThe median age at death of our cohort of ten patients was 73 years (IQR 52–79). Thrombotic features were observed in at least one major organ in all full autopsies, predominantly in the lung (eight [89%] of nine patients), heart (five [56%]), and kidney (four [44%]). Diffuse alveolar damage was the most consistent lung finding (all ten patients); however, organisation was noted in patients with a longer clinical course. We documented lymphocyte depletion (particularly CD8-positive T cells) in haematological organs and haemophagocytosis. Evidence of acute tubular injury was noted in all nine patients examined. Major unexpected findings were acute pancreatitis (two [22%] of nine patients), adrenal micro-infarction (three [33%]), pericarditis (two [22%]), disseminated mucormycosis (one [10%] of ten patients), aortic dissection (one [11%] of nine patients), and marantic endocarditis (one [11%]). Viral genomes were detected outside of the respiratory tract in four of five patients. The presence of subgenomic viral RNA transcripts provided evidence of active viral replication outside the respiratory tract in three of five patients.InterpretationOur series supports clinical data showing that the four dominant interrelated pathological processes in severe COVID-19 are diffuse alveolar damage, thrombosis, haemophagocytosis, and immune cell depletion. Additionally, we report here several novel autopsy findings including pancreatitis, pericarditis, adrenal micro-infarction, secondary disseminated mucormycosis, and brain microglial activation, which require additional investigation to understand their role in COVID-19.FundingImperial Biomedical Research Centre, Wellcome Trust, Biotechnology and Biological Sciences Research Council.

The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for 1year in the UK. To describe the causes and investigation of anaphylaxis in the NAP6cohort, in relation to published guidance and previous baseline survey results. We used a secure registry to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail. Panelconsensus diagnosis, reaction grade, review of investigations and clinic assessment are reported and compared to the prior NAP6 baseline clinic survey. A total of 266 cases met inclusion criteria between November 2015 and 2016, detailing reactions and investigations. One hundred and ninety-two of 266 (72%) had anaphylaxis with a trigger identified, of which 140/192 (75%) met NAP6 criteria for IgE-mediated allergic anaphylaxis, 13% lacking evidence of positive IgE tests were labelled "non-allergic anaphylaxis". 3% were non-IgE-mediated anaphylaxis. Adherence to guidance was similar to the baseline survey for waiting time for clinic assessment. However, lack of testing for chlorhexidine and latex, non-harmonized testing practices and poor coverage of all possible culprits was confirmed. Challenge testing may be underused and many have unacceptably delayed assessments, even in urgent cases. Communication or information provision for patients was insufficient, especially for avoidance advice and communication of test results. Insufficient detail regarding skin test methods was available to draw conclusions regarding techniques. Current clinical assessment in the UK is effective but harmonization of approach to testing, access to services and MHRA reporting is needed. Expert anaesthetist involvement should increase to optimize diagnostic yield and advice for future anaesthesia. Dynamic tryptase evaluation improves detection of tryptase release where peak tryptase is <14μg/L and should be adopted. Standardized clinic reports containing appropriate details of tests, conclusions, avoidance, cross-reactivity and suitable alternatives are required to ensure effective, safe future management options.

The National COPD Audit Programme ran an audit between February and April 2014: patient identifiers were used to link inpatient care of AECOPD to outcomes within 30/90 days of the index admission. <b>Aims:</b> We know that repeated hospital admission links to adverse patient outcomes. However, the relevance of previous hospital admission on COPD audit outcome data is not understood. We sought to assess effects of such events on our English audit cohort (n=12594). <b>Methods:</b> We obtained the number of COPD and non-COPD admissions for each of our cohort in the 90, 180 and 365 days prior to their index admission. We linked these prior admissions to the COPD audit index outcomes (mortality, length of stay [LoS] and readmission). <b>Results:</b> Previous/recent admissions were: - Common (19%, 27%, 36% had at least 1 COPD admission in the 3, 6 or 12 months prior to their index admission). - Associated more strongly with mortality after discharge (10.7% mortality for those with no admission in the 90 days prior to index admission versus 19.4% for those with five or more preadmissions [p&lt;0.001]) than during the index inpatient stay.&lt;br /&gt;- Associated with increased LoS of the index admission (23% of patients with no preadmissions versus 34% with five or more preadmissions had a LoS ˃ 7 days [p&lt;0.001]).&lt;br /&gt; - Related strongly to subsequent readmission, particularly for those who had an admission during the 90 days prior to their index event (21% of patients with no preadmissions versus 79% with five or more preadmissions were readmitted within 30 days [p&lt;0.001]). <b>Conclusion:</b> Particular attention should be given to the number and cause of previous admissions when managing patients with AECOPD.

BackgroundPrescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation.AimTo reduce prescribing errors in a UK hospital by improving feedback on prescribing errors.InterventionsWe developed three linked interventions using plan–do–study–act cycles: (1) name stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to provide feedback to doctors on individual prescribing errors and (3) fortnightly prescribing advice emails that addressed a common and/or serious error.Implementation and evaluationInterventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctors stated their name. Outcome measures were junior doctors' and pharmacists' perceptions of current feedback provision (evaluated using quantitative pre-questionnaires and post-questionnaires and qualitative focus groups) and the prevalence of erroneous medication orders written by junior doctors between August and December 2013.ResultsThe percentage of medication orders for which junior doctors stated their name increased from about 10% to 50%. Questionnaire responses revealed a significant improvement in pharmacists' perceptions but no significant change for doctors. Focus group findings suggested increased doctor engagement with safe prescribing. Interrupted time series analysis showed no difference in weekly prescribing error rates between baseline and intervention periods, compared with the control site.ConclusionFindings suggest improved experiences around feedback. However, attempts to produce a measurable reduction in prescribing errors are likely to need a multifaceted approach of which feedback should form part.

A GROUP of Scottish farm animal veterinary surgeons argue a cogent case against the proposed closure of the Inverness Surveillance Centre and the …