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PubMed1994

Alternating radiotherapy and chemotherapy in limited small cell lung cancer: the IGR protocols. French FNCLCC Lung Cancer Study Group.

Two-hundred two patients with limited small cell lung cancer were tested by four consecutive alternating radiotherapy and chemotherapy protocols. The alternating schedule consisted of six cycles of chemotherapy (doxorubicin, etoposide, and cyclophosphamide, plus methotrexate in the first protocol; cisplatin replaced methotrexate in the other three protocols) and three courses of thoracic radiotherapy at a total dose of 45, 55, 65 and 61 Gy in the four consecutive protocols, respectively. A 1-week rest followed each chemotherapy cycle and each course of radiotherapy. Seventy-six percent of patients were in complete remission at the end of the induction treatment. Overall results showed a 2-year cumulative incidence rate of failure of 75%. The first cause of failure was local recurrence only, 33%; distant only, 25%; distant and local simultaneously, 9%; and intercurrent death, 8%. Overall survival rate at 5 years was 16%. No significant differences were observed between the four treatment groups. Alternating radio-chemotherapy approaches are feasible and currently included in Phase III trials.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1995

A protocol for the management of failed alloplastic temporomandibular joint disc implants.

PURPOSE: This is a retrospective evaluation of a protocol for management of failed alloplastic temporomandibular joint (TMJ) disc implants. PATIENTS AND METHODS: The criteria for implant failure were defined as any one or combination of the following symptoms and signs: TMJ pain, jaw hypomobility, occlusal changes, and radiographic evidence of bone pathology related to the implant. The protocol consisted of removal of the implant, aggressive joint debridement, recontouring of the articulating surfaces, and placement of a pedicled temporalis muscle/fascia flap (TF) for joint lining. Arch bars and maxillomandibular guiding elastics were used if extensive condylar recontouring was necessary. No attempt was made to reconstruct the condyle or correct occlusal abnormalities at the time of implant removal. All 27 patients (42 joints) treated by this protocol during the study period were included for evaluation. There were 24 Proplast/Teflon (PTI) (Vitek, Inc, Houston, TX), 11 Silastic (SI) (Dow Corning, Midland, MI), and 7 Christensen Fossa implants (CFI) (TMJ Implants, Golden, CO) implants removed. RESULTS: The mean follow-up period was 38.3 months (range, 3 to 65 months). Pain was well controlled in 24 of 27 patients (88.9%). Preoperative and postoperative mean maximal incisal opening (MIO) was 32.1 mm and 39.8 mm, respectively. Two patients (7.4%) required a second TMJ operation for persistent pain and limitation of opening. To date, 7 patients (25.9%) have required a secondary procedure (unilateral vertical ramus osteotomy, n = 1; Le Fort I osteotomy, n = 6) to correct occlusal prematurity on the operated side or bilateral open bite. The remaining patients have required no additional surgical treatment. CONCLUSIONS: The results of this study indicate that a proposed protocol is an effective means of controlling pain and improving jaw motion in patients with failed alloplastic TMJ disc implants.

Adult↗

PubMed1993

Glucose effects in an ovarian cancer protocol of exceptional activity.

A French multidrug protocol for stage III ovarian cancer has achieved 77% pathologic complete response, 100% total response, and 81% actuarial 4-year survival. Our analysis indicates that these rates exceed typical with very high statistical significance. Yet neither the drugs, the combined intravenous and intraperitoneal mode of delivery, nor potential bias in the predominantly suboptimal patient population appear to explain the protocol's exceptional results. Here we propose that the atypical administration of intraperitoneal glucose prior to drugs underlies the unusual activity of this protocol. We review studies demonstrating that high-dose glucose has pronounced effects on cancer cells, most notably, substantial potentiation of certain antineoplastic agents. We consider possible mechanisms of such glucose potentiation, including hypothesized osmotic effects that would be especially strong under intraperitoneal administration. We conclude that the French ovarian cancer protocol may represent a significant advance and that glucose potentiation may be more widely applicable as an adjunct to cancer chemotherapy.

Actuarial Analysis↗

PubMed2006

Propofol by infusion protocol for ED procedural sedation.

INTRODUCTION: Propofol is an effective agent for use in procedural sedation and analgesia (PSA). Most ED studies have used a bolus-dosed protocol. We evaluated the efficacy, complication rate, and satisfaction among caregivers and patients while using an infusion-dosed protocol of propofol for PSA in our ED. METHODS: A prospective, observational study was performed in our academic ED. Propofol use was at the discretion of the ordering physician and dosed by predetermined infusion protocol. Variables measured included adverse events, times of sedation, procedure, and recovery. Patient and provider satisfaction were measured using a 10-cm visual analog scale. RESULTS: Fifty patients were enrolled over 18 months. Procedures were varied, and all were successfully completed. The mean propofol dose was 174 mg (SD = 164 mg). Average times to sedation (4.6 minutes, SD = 2.6 minutes) and recovery (8.2 minutes, SD = 5.8 minutes) were short. Complications included 8 patients with respiratory depression and 6 with hypotension, all easily reversible. Satisfaction scores were uniformly high. Only 34% of patients had any memory of the procedure, and 94% would agree to use it again if necessary. CONCLUSIONS: Infusion-dosed propofol is effective for ED PSA. Total doses, effectiveness, satisfaction rates, and complications of infusion-dosed propofol are comparable to findings from studies using bolus-dosed protocols.

Adolescent↗

PubMed2004

Comparison of the amblyopia treatment study HOTV and electronic-early treatment of diabetic retinopathy study visual acuity protocols in children aged 5 to 12 years.

PURPOSE: To compare two established visual acuity protocols: the Amblyopia Treatment Study HOTV (ATS HOTV) visual acuity protocol and the Electronic-Early Treatment of Diabetic Retinopathy Study (E-ETDRS) protocol, in children aged 5 to 12 years. DESIGN: Prospective cohort study. METHODS: Crowded HOTV optotypes and crowded ETDRS optotypes were presented to 236 consecutive children aged 5 to 12 years using an electronic visual acuity tester (Palm handheld, personal computer, and monitor). Twenty-three percent of the children were classified as amblyopic, 35% as having uncorrected refractive error, 36% as normal, and 6% as other. Visual acuity test results were converted to logarithm of minimal angle of resolution (logMAR) units for analysis. RESULTS: In developmentally normal children (n = 230), testability was 100% for HOTV in 5- to 12-year-olds and 100% for E-ETDRS in 7- to 12-year-olds. The E-ETDRS testing could be completed in 52% of 5-year-olds and in 87% of 6-year-olds. Visual acuity performance was better when measured by HOTV compared with E-ETDRS (median difference 0.06 logMAR [three letters on a chart with five letters/line], P =.0001), and the difference was found in normal eyes, eyes with refractive error, and amblyopic eyes. CONCLUSIONS: The ATS HOTV protocol yields slightly better visual acuity performance compared with E-ETDRS in 5- to 12-year-olds, but on average by less than a logMAR level. This systematic difference is important when a physician changes testing modality as a child matures and should be considered when interpreting the results of recent and ongoing clinical trials in amblyopia.

Amblyopia↗

PubMed2006

A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery.

OBJECTIVE: The Siemens servo 300 A ventilator has an automode function that allows automated weaning of patients from mechanical ventilation. Spontaneous breathing triggers the ventilator. After two spontaneously triggered breaths, the ventilator automatically changes from mandatory mechanical ventilation to spontaneous ventilation. If spontaneous breathing or triggering does not occur, the Siemens servo 300 A ventilator changes from spontaneous ventilation back to mandatory mechanical ventilation. We compared the effects of automated versus conventional protocol-driven weaning on the time until extubation in patients undergoing coronary artery bypass graft (CABG) surgery. In addition, we studied the effects of the mode of weaning on hemodynamic and physiologic parameters. METHODS: Twenty consecutive male patients without respiratory disease scheduled for CABG at the University Hospital of Regensburg were entered into the study. Patients were randomized to postoperative ventilation with the Siemens 300 A/automode ventilator (group A, n = 10) or with the Siemens 300 ventilator (group B, n = 10). All patients were weaned from ventilation according to a standardized protocol. RESULTS: On average, patients in group A were younger and had lower pulmonary artery pressure (PAP) and higher cardiac output compared to patients in group B. However, patients in group A had longer ischemic and bypass times compared to patients in group B. Postoperative use of analgesia and sedation were similar in both groups. Time from tracheal intubation until extubation was 2 h shorter in patients assigned to automode ventilation compared to patients assigned to conventional ventilation (mean time group A 7.9 h, group B 10.0 h; p = 0.069). Peak airway pressure was reduced by 2 cm H2O at the beginning of spontaneous ventilation in group A compared to group B. After extubation, cardiac index showed a greater increase in patients assigned to group A compared to those in group B. CONCLUSIONS: Automode ventilator weaning trended toward more rapid extubation than did conventional protocol-driven ventilation in conjunction with a standardized weaning protocol. Physiologic and hemodynamic factors were better in patients using automode ventilation compared to patients using conventional ventilation. Automode ventilation was well tolerated and did not induce significant adverse effects.

Adult↗

PubMed2006

Quantitative sensory testing: a comprehensive protocol for clinical trials.

We have compiled a comprehensive QST protocol as part of the German Research Network on Neuropathic Pain (DFNS) using well established tests for nearly all aspects of somatosensation. This protocol encompasses thermal as well as mechanical testing procedures. Our rationale was to test for patterns of sensory loss (small and large nerve fiber functions) or gain (hyperalgesia, allodynia, hyperpathia), and to assess both cutaneous and deep pain sensitivity. The practicality of the QST protocol was tested in 18 healthy subjects, 21-58 years, half of them female. All subjects were tested bilaterally over face, hand and foot. We determined thermal detection and pain thresholds including a test for the presence of paradoxical heat sensations, mechanical detection thresholds to von Frey filaments and a 64-Hz tuning fork, mechanical pain thresholds to pinprick stimuli and blunt pressure, stimulus-response-functions for pinprick and dynamic mechanical allodynia (pain to light touch), and pain summation (wind-up ratio) using repetitive pinprick stimulation. The full protocol took 27+/-2.3 min per test area. The majority of QST parameters were normally distributed only after logarithmic transformation (secondary normalization) except for the frequency of paradoxical heat sensations, cold and heat pain thresholds, and for vibration detection thresholds. Thresholds were usually lowest over face, followed by hand, and then foot. Only thermal pain thresholds, wind-up ratio and vibration detection thresholds were not significantly dependent on the body region. There was no significant right-to-left difference for any of the QST parameters; left-to-right correlation coefficients ranged between 0.78 and 0.97, thus explaining between 61% and 94% of the variance. This study has shown that a complete somatosensory profile of one affected area and one unaffected control area, which will be necessary to characterize patients with a variety of diseases, can be obtained within 1 h. Case examples of selected patients illustrate the value of z-transformed QST data for an easy survey of individual symptom profiles.

Adult↗

PubMed2006

3.5-Year follow-up of intralesional cidofovir protocol for pediatric recurrent respiratory papillomatosis.

OBJECTIVES: Intralesional injection of cidofovir has been described as an adjunctive treatment for pediatric recurrent respiratory papillomatosis (RRP). However, questions remain regarding the optimal dosing schedule and side-effect profile. The objective of this study was to describe patient outcomes following a standardized cidofovir protocol. METHODS: Eleven pediatric patients originally treated with a standardized stepped-dose protocol of intralesional cidofovir for RRP were followed for an extended observational period. Additional interventions, disease severity, and adverse outcomes were recorded. RESULTS: Five of 11 patients have required no further treatments following the original cidofovir protocol. Two patients initially achieved remission but have subsequently required additional treatment for recurrent disease. Four patients never achieved remission and have undergone multiple additional interventions. Mean follow-up time for all patients from the conclusion of the original study was 30.2 months (10-45). No adverse outcomes were noted. CONCLUSIONS: Intralesional injection of cidofovir may have some potential as an adjunct in the treatment of RRP. Response to cidofovir is unpredictable. Further study of cidofovir is necessary to more clearly define whether the favorable responses observed represent a true treatment effect or simply reflect the natural history of the disease. Perhaps as important is to refine treatment protocols and informed consents that reflect the concern about the carcinogenic potential of cidofovir and to better characterize the drug's side-effect profile.

Adolescent↗

PubMed2003

The accuracy of the amblyopia treatment study visual acuity testing protocol.

PURPOSE: To study the accuracy of the newly proposed Amblyopia Treatment Study (ATS) visual acuity testing protocol for 3- to 6-year-old children. Because no "gold standard" is available for acuity testing in pediatric patients, accuracy was evaluated using computer simulations based on a psychometric model. METHODS: Monte Carlo simulations of ATS acuity data were generated using a psychometric model that accounts for true acuity, noise in the visual system, and the rate of inadvertent misses. We varied true acuity from 20/15 to 20/400 (-0.1 to 1.3 logMAR). Visual system noise was represented by the slope beta of the psychometric function and ranged from 1 (noisy) to 8 (not noisy). The rate of inadvertent misses ranged from 0% to 10%. Accuracy of the ATS protocol was evaluated in terms of precision, bias, and stimulus range limitations. The same model was fitted to experimental ATS acuity data, thus allowing us to study the distributions of acuity, visual system noise, and level of attentiveness in 126 children ages 3 to <7 years. RESULTS: For conditions with little noise in the visual system (beta > 2), precision was well within 0.1 logMAR (corresponding to one line on a logMAR letter chart), except for acuities worse than 1.2 logMAR, and decreased to 0.15 to 0.2 logMAR for beta = 1. Bias was negligible, except in noisy conditions, where the ATS protocol tended to overestimate acuity by one line at the poor end of the true acuity range and underestimate acuity at the good end of the true acuity range. Effects of the rate of inadvertent misses were small. Fits to the real data showed a wide range of slope parameters, but only 11% had beta < or = 2. The rate of inadvertent misses was < or = 2% in 89% of cases. CONCLUSION: The simulations suggest that the ATS protocol offers an accurate method for assessing visual acuity in children in the range of 3 to 6 years of age with both precision and bias within 0.1 logMAR for typical values of the psychometric parameters.

Amblyopia↗

PubMed2006

The atlas of complication incidence: a proposal for a new standard for reporting the results of radiotherapy protocols.

We present a new method of reporting the results of radiotherapy protocols. The dose-volume atlas of complication incidence is a comprehensive and unbiased summary of the dose-volume exposures and complications occurring in patients after treatment. This new tool provides clear and systematic information about the safety of regions of dose-volume exposure previously treated that can be used when considering new treatments. Actuarial and model-dependent versions of the atlas are described. By using the raw data in the appropriate forms of the atlas, logistic regression, Kaplan-Meier, and Cox proportional hazards analysis can be performed, allowing for the independent calculation of dose-volume response. The data required are simple enough that provided compatible definitions of dose, volume, and complications are used, atlases from different protocols are potentially additive, facilitating the meta-analysis of inter-interinstitutional data. If this method were adopted as a standard for reporting the outcome of treatment protocols, a potentially synergistic increase in the utility of each protocol could result.

Clinical Protocols↗

PubMed1994

Group B streptococci: results of a protocol of antepartum screening and intrapartum treatment.

OBJECTIVE: Our purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers. STUDY DESIGN: In 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals. Cultures were obtained from the lower third of the vagina and rectum at 24 to 28 weeks' gestation. Women with positive cultures were treated with intravenous antibiotics in labor. Women with signs of chorioamnionitis (through intrapartum assessment) were also treated in labor, regardless of carrier status. RESULTS: During the first 2 years of this protocol 1681 women were delivered. Forty percent of the women were from the private practice, 32% were black, and 62% were married. The group B streptococcal carriage rate was 14%. During the period of evaluation there were no infants infected with group B streptococci and no adverse reactions or complications among women who were treated with antibiotics. CONCLUSION: We found antepartum screening and intrapartum chemoprophylaxis of all group B streptococcal carriers to be an acceptable and effective protocol for reducing perinatal group B streptococcal infections.

Ampicillin↗

PubMed1999

Preliminary results of a bone marrow magnetic resonance imaging protocol for patients with high-risk prostate cancer.

OBJECTIVES: To compare the accuracy of a bone marrow magnetic resonance imaging (MRI) protocol in patients at high risk of metastatic disease with radioisotopic bone scans, the standard method for detection of bony metastases in patients with prostate cancer. METHODS: The study group consisted of 19 men with prostate cancer who underwent a bone marrow MRI between November 1993 and February 1996. This protocol images the marrow of the thoracolumbar spine, sacrum, pelvis, and femurs. Indications for MRI included an equivocal bone scan and/or staging of locally advanced or recurrent disease. The findings on MRI and bone scan were compared and the results correlated with the subsequent clinical patient outcome. RESULTS: The bone marrow MRI protocol detected metastatic disease in 1 (7%) of 13 patients with negative bone scans. Four patients had an indeterminate bone scan: 2 had true-positive MRIs, 1 a true-negative MRI, and 1 a false-positive MRI on the basis of subsequent clinical follow-up. Two patients with positive bone scans had true-positive MRIs. CONCLUSIONS: Although not recommended for routine staging, MRI was useful in this study for clarifying an equivocal bone scan. The bone marrow MRI protocol images a high yield volume of the bony skeleton and is fast and economical compared with obtaining many focused MRI scans of these areas separately. These preliminary data suggest that further investigation of its clinical utility for staging locally advanced or recurrent disease is justified.

Adenocarcinoma↗

PubMed1991

Monitoring EMS protocol deviations: a useful quality assurance tool.

STUDY OBJECTIVE: To determine the incidence, type, and outcome of protocol deviations in an emergency medical services (EMS) system. DESIGN: Retrospective consecutive case series. SETTING: Seven advanced life support ambulance services servicing five area hospital emergency departments. PATIENTS: 1,246 patients requiring advanced life support care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Advanced life support ambulance runs during a two-month period were examined for protocol deviations. Of 1,246 runs examined, 16% had deviations. Approximately 55% of these deviations were minor, 38% were serious, and 7% were very serious in nature. The effects of the errors were evaluated using hospital records. Results showed that 89.5% of patients were unaffected, 5.0% improved, and 5.5% suffered complications from deviations. Emergency medical technicians committed 69% of the deviations without the consent of medical control, medical control committed an additional 18%, and both were responsible in 13% of cases. Incomplete histories were found in 8% of cases. CONCLUSION: Protocol deviations committed in prehospital care do not usually cause direct harm to patients. On review of these deviations, however, several disturbing trends were uncovered, including misconceptions in the use of IV therapy, a number of serious deviations in advanced cardiac life support protocols, and lack of communication with medical control. This type of quality assurance study has the ability to identify areas of strength and weakness in an EMS system, allowing planning of ongoing educational efforts in the system.

Clinical Protocols↗

PubMed1999

Comparison between chemoradiation protocol intended for organ preservation and conventional surgery for clinical T1-T2 esophageal carcinoma.

PURPOSE: This retrospective study was designed to compare treatment results of the chemoradiation protocol with conventional surgery for thoracic T1-T2 esophageal squamous cell carcinoma. METHODS AND MATERIALS: Sixty-six patients with esophageal carcinoma, clinically diagnosed as T1 (tumor invading lamina propria or submucosa) or T2 (tumor invading muscularis propria) were treated for 12 consecutive years, from July 1986 to January 1998. The conventional surgery group included 30 patients who underwent esophagectomy with regional lymph node dissection. Twenty-one of them received postoperative radiotherapy. Thirty-six patients were assigned to the chemoradiation protocol, consisting of neoadjuvant chemoradiotherapy (44 Gy; CDDP: 60 mg/m2, day 1, bolus; 5-FU: 400 mg/m2, day 1-4, continuous), followed by either definitive radiotherapy with high-dose-rate intraluminal brachytherapy (total 70 Gy) for responders or surgery for nonresponders as in the conventional surgery group. Surgical candidates in both groups received intraoperative radiotherapy for abdominal lymphatics since 1991. RESULTS: In the protocol group, 4 patients underwent radical surgery after neoadjuvant chemoradiotherapy, and the remaining 32 underwent definitive chemoradiotherapy. Local control rates at 1 and 3 years were 85% and 70% in the T1/protocol group versus 91% and 80% in the T1/surgery group, and 83% and 83% in the T2/protocol group versus 94% and 80% in the T2/surgery group, respectively. There was no statistical significance. Overall 1- and 3-year survival rates were 100% and 83% in the T1/protocol group versus 82% and 72% in the T1/surgery group (p = 0.36), and 100% and 51% in the T2/protocol group, versus 95% and 68% in the T2/surgery group p = 0.61), respectively. There was no treatment-related mortality in either group. The rates of esophageal conservation were 92% in the T1/protocol group and 58% in the T2/protocol group. CONCLUSION: The chemoradiation protocol can result in comparable survival with conventional surgery for patients with T1-T2 esophageal carcinoma. A randomized trial between definitive chemoradiotherapy and surgery is required.

Aged↗

PubMed1988

A protocol for the treatment of severe infections of the hand.

A protocol for the treatment of hand infections was used for 69 patients in a university teaching hospital. The protocol prescribes incision and drainage under optimal conditions (in the operating room) when the patient is first seen and intravenous antibacterial therapy effective against anaerobic and aerobic bacteria initiated immediately after obtaining aerobic and anaerobic cultures. Results of bacteria studies confirmed the significant frequency (nearly 30%) of mixed aerobic and anaerobic infection. Use of the protocol resulted in a shorter hospital stay, faster healing, and fewer complications (recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis) when compared with 107 patients who were treated before institution of the protocol.

Adolescent↗

PubMed2001

Effects of a pediatric emergency department febrile infant protocol on time to antibiotic therapy.

The purpose of this study was to examine the effect of an Emergency Department (ED) protocol to reduce time to antibiotic administration in the febrile infant less than 3 months of age with a rectal temperature > or =38.0 degrees C. We conducted a before-after study of a febrile infant quality improvement initiative in an urban pediatric ED with approximately 35,000 patient visits per year. Records of infants less than 3 months of age presenting with a rectal temperature > or =38.0 degrees C, who underwent a full septic work-up (blood, urine, and cerebrospinal fluid studies, and possibly chest radiography), were identified by using daily ED logs. This review was performed in the month before and then 12 months after institution of the "Septic Infant Work-up Sheet" and a set of interventions (Febrile Infant Protocol) designed to streamline care of the febrile infant and to reduce the time to antibiotic administration. Data were analyzed by using the Kaplan-Meier survival estimate and the log-rank test. Patient demographic characteristics and severity of illness were similar across months; however, ED process of care was significantly changed. Initial analysis revealed a median time to antibiotics of 142 min. Subsequent analysis after implementation of the Febrile Infant Protocol revealed a median time to antibiotics of 105 min. This represents an overall time reduction of 25% from time of presentation to antibiotic administration. In conclusion, a guideline-based ED febrile infant protocol changed clinical practice and improved time to antibiotics.

Anti-Bacterial Agents↗

PubMed1997

Euthanatics: implementation of a protocol to standardise euthanatics among pharmacists and GPs.

The purpose of this study was to evaluate the implementation of a protocol to standardise euthanatics among pharmacists and general practitioners (GPs). Data over 1993 and 1994 were collected by means of an anonymous postal questionnaire sent to all pharmacists (n = 37) and all GPs (n = 283) working in the area in which the protocol was implemented. In total, 76% of the pharmacists and 63% of the GPs responded. All pharmacists and 65% of the GPs were aware of the existence of the protocol and all pharmacists and 42% of the GPs were also familiar with the content of the protocol. Both pharmacists and GPs had fairly positive attitudes towards the importance and possibility of the standardisation of euthanatics. Of the GPs who performed euthanasia or assisted with suicide during the research period, 59% made use of one or more standard packages. The majority of pharmacists and GPs were satisfied with the standard packages, and all GPs indicated that they intend to use the packages again in the future. This study shows that the implementation of standardised euthanatics was quite successful.

Adult↗

PubMed1991

Endophthalmitis investigative protocol: a plan for source identification and patient protection.

A survey of randomly selected ophthalmic outpatient surgical facilities revealed a lack of established investigative protocols to follow when postoperative endophthalmitis occurs. The survey also provided information about the incidence of endophthalmitis, the microorganisms encountered, and the precautions used to prevent postoperative infections. We present an endophthalmitis investigative protocol which provides a task list, investigation forms, incidence log, and quality assurance measures to identify patients at risk and to minimize the risk of recurrence of this rare but serious complication of ophthalmic surgery. This standardized protocol will also assist in source identification when aseptic iritis occurs postoperatively. The purpose of this paper is to stimulate a dialogue which may result in an international standard for an endophthalmitis investigative protocol.

Ambulatory Surgical Procedures↗