Clinical Bulletins
D-News
Information Guides
2012 Cervical Cytology Bulletin
We are pleased to advise that the latest edition of
the DML Cervical Cytology Bulletin is now available. The Bulletin
updates our 2007 edition and gives background information on
cervical cytology, emphasising the important role regular screening
plays in reducing the incidence of cervical cancers. The advantages
of using ThinPrep® are discussed and we describe up-to-date
specimen collection techniques. The Bulletin also outlines the DML
automated primary screening process using the ThinPrep® Imager
system, explains issues of clinical importance related to reporting
and focuses on the importance of HPV and the future of cevical
screening.
DML provides a Cervical Cytology Service under our
National Screening Unit contract for women and health professionals
across the greater Auckland region. We work in partnership with
LabPLUS to ensure that Auckland retains significant expertise,
consistency of service and ongoing educational opportunities in
cervical cytology. Both laboratories use the ThinPrep® PreservCyt
Solution method.
Additional copies of the Bulletin are available on
request by emailing us or you can download a
copy by clicking here.
Melanoma
Bulletin Download PDF
With over 2,000 new melanoma, and
70,000 new non-melanoma cases reported in New Zealand each year the
diagnosis and management of skin cancers is an important part of
general practice.
Although most skin cancers are
easily treated, about 200 people a year in New Zealand die from
melanoma, and approximately 60 people a year die from non-melanoma
cutaneous malignancies, mainly squamous cell carcinoma. Although
basal cell carcinoma does not have the same metastatic potential as
squamous cell carcinoma, it can also cause significant morbidity -
especially in those cancers occurring around the head and
neck.
This Bulletin summarises
information on melanoma and the current recommendations for
excision of these lesions. Rarer tumours such as Merkel cell
carcinoma, skin appendage carcinomas, cutaneous sarcomas and
lymphomas will not be discussed.
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Travel Advice
Bulletin Download PDF
Many travellers believe a few
injections a couple of days before departure will ensure them a
healthy trouble free trip. This is far from the truth
with traveller's diarrhoea and respiratory tract infections being
the major causes of morbidity and cardiovascular disease and injury
the major causes of death in travellers. Simple commonsense
advice such as the need for insurance is probably more important
than vaccines for uncommon diseases. Such advice is outlined in
this bulletin.
Travel medicine cannot be reduced
to a chart. Recommendations need to be individualized and depend on
the traveller, their itinerary and activities. Those who travel to
visit friends and relations have documented higher rates of
numerous diseases such as malaria, typhoid, tuberculosis and
influenza. If you have such patients in your practice who may
return home to a developing or tropical country suggest that they
see you before such a trip. They will often not think to seek
pre-travel advice as they lived there before without vaccinations
or tablets. They need to understand that their risk of
illness from infections such as malaria will have increased during
their absence.
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Travel
Information Sheets Download PDF
Note: This PDF is
1.5Mb.
To assist you in providing general travel advice we have
included a series of Traveller Information Sheets.
These cover:
- General travel advice
- Travelling with children
- Malaria
- Travel at altitude
- Travel related DVT
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FNA
Bulletin Download
PDF
Note: This PDF is
5.2Mb.
Fine-Needle Aspiration biopsy (FNA,
FNAB) is a procedure involving the sampling of mass lesions for
cytological examination and diagnosis. These lesions may be
superficial or deep. Deep lesions such as lung, mediastinal and
intra-abdominal tumours require radiological localisation
techniques such as ultrasound and CT to accurately direct the
needle to the lesions; these fine needle aspiration procedures are
performed in radiology rooms with the appropriate equipment.
This bulletin refers solely to the
aspiration biopsy of superficial lesions that can be palpated,
localised and immobilised by hand, and are therefore able to be
performed in the outpatient setting.
Management
of Occupational Exposure to Blood or Body
Fluid Download PDF
The blood borne viruses that pose a
risk in the health care setting are Human Immunodeficiency virus
(HIV), Hepatitis B virus (HBV) and Hepatitis C virus
(HCV).
Exposures occur through needlesticks
or cuts from other sharp contaminated instruments or through
contact of the eye, nose, mouth or open skin with blood or body
fluids.
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Disinfection and Sterilization of
Reuseable Medical Devices in General
Practice Download PDF
Transmission of infection through
reused medical devices is well documented. This bulletin provides
general information about cleaning, disinfection and sterilization
to assist those responsible for these functions in General
Practice.
For the disinfection and
sterilization of reusable devices to be effective, meticulous
attention to detail is essential. Staff must be properly trained
and equipped to perform these duties in a safe and responsible
manner.
There is now a joint
Australian/New Zealand Standard document (AS/NZS 4815:2001) that
provides detailed information on the requirements for disinfection
and sterilization of reusable items in office based practice. The
AS/NZ Standard also details the requirements for sterilizing
wrapped instruments.
Some portable steam sterilizers
(bench top sterilizers) have a drying phase that is not associated
with a vacuum. Without a vacuum, the drying inside the wrapping may
be incomplete. The AS/NZ Standard stipulates that a drying
phase is necessary for items that are to be stored as sterile
packs. The contents of packs must be dry immediately on completion
of the cycle. There is no accepted method for measuring the
complete removal of steam remaining on the enclosed items, so the
claim that a drying cycle without a vacuum is sufficient for 100%
drying cannot be substantiated. If steam remains inside the
package, then the process is compromised.
The British standard (BS 3970:
Part 4: 1990) for transportable steam sterilizers states: "The
absence of a forced air removal stage and a post sterilization
vacuum drying stage precludes the use of such machines for
wrapped instruments or porous goods." Porous goods include
dressings.
Flexible endoscopes and heat
sensitive equipment require special methods for sterilization.
Readers should refer to the NZ Standards Guideline for
Microbiological Surveillance of Flexible Hollow Endoscopes and
the Australian Standards document AS 4187.
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D-News
August 2012 Download PDF
Our latest D-News is now available and offers
information on resistant organisms causing UTIs, in particular for
those living in residential care. Also featured is comprehensive
information on tests which have restricted referrals, an update on
new collection points and the latest on test requirements for
Immigration Medicals.
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D-News April
2011 Download
PDF
This issue focuses on the Cervical
Cytology Service we provide for women and health professionals
across the greater Auckland region and outlines our commitment to
the National Cervical Screening Programme.A key highlight is the
partnership arrangement between DML and LabPLUS which has been
established to ensure that Auckland retains significant expertise,
consistency of service and ongoing educational opportunities in
cervical cytology. This issue includes an outline of the launch of
automated primary screening of ThinPrep® cytology smears at DML
using the new ThinPrep® Imager system. D-News also provides
important information related to unsatisfactory results on cervical
smears and explains the clinical relevance for the patient and
smeartaker.
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NewsBrief
August 2010 Download PDF
This two page NewsBrief introduces
the roll out of structured pathology reporting at DML and outlines
the reporting protocols of the RCPA. Major advances in the
diagnosis and treatment of cancers over the past decades, along
with the need to consider other information about the patient, has
resulted in the need to standardize reporting. The NewsBrief also
announces the move to a new version of the Roche Troponin T assay,
which due to its increased sensitivity is called 'high sensitivity
Troponin T' (or hsTnT).
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D-News
March 2010 Download
PDF
The first issue of D-News for 2010
features clinical articles and information on High Risk HPV, PSA
testing, eGFR (estimated Glomerular Filtration Rate), fasting
glucoses and rate of abnormal GTTs. Also included is an updated Key
Contacts list, information on new access points and information on
paying for tests.
Also now
available is the Antibiotic Susceptibility Chart
2009.
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D-News
August 2009 Download PDF
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D-News March 2009 Download PDF
In the
first issue of DNews for 2009 Paul Ockelford's editorial focuses on
the Supreme Court Judgment. Clinical articles are Screening for
Colorectal Cancer and Its Precursors, Dr Mee Ling Yeong, Dengue
Fever, Dr Joan Ingram, and Neutropenia Drs Nicola Eaddy and Anna
Ruskova. The Collection Centre Update includes new opening hours as
well as a Collection Centre relocation.
Specialised Procedures
Download PDF
Information about specialised tests and locations performing the
testing or procedure. Please note that specialised tests and
procedures require an appointment.
Specimen
Labeling, Storage and Transport
Download PDF
Guidelines
for specimen labeling, storage and
transport.
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HPV Testing
Guidelines Download PDF
The testing of cytology smear samples for
high risk Human Papilloma Virus (HrHPV) is funded by the National
Cervical Screening Programme (NCSP) for women eligible under the
"Guidelines for Cervical Screening in New Zealand". Any HrHPV
testing outside the guidelines is not funded by the NCSP. The test
can however be performed for a fee of $74.00 at the request of the
patient or the clinician. A cytology smear sample collected in the
ThinPrep vial and sent to DML will be processed and interpreted by
a team of trained scientists and cytopathologists. The HrHPV
testing is also performed on-site at DML. The cytology and HrHPV
results will then form parts of a single report and the
recommendation will be based on the combined results which will be
reported at the same time. The HrHPV test will be reported as
"detected", "not detected" or "invalid".Please note that the HrHPV
test available through DML detects whether HrHPV genital material
(DNA) from any of the 13 high risk types of HPV most commonly
associated with cervical cancer is present in the specimen
submitted and does not indicate the specific
subtype.
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