Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumour with intermediate malignant potential. We report the case of a patient with local recurrence of AFH in two locations and lymph node metastases 18 months after primary surgical excision. The patient was treated with six cycles of ifosfamide and doxorubicin chemotherapy and a further three courses of ifosfamide monotherapy. Reassessment imaging showed a good response to chemotherapy with reduction in size of the two tumours of local recurrence and the lymph node metastases. This case demonstrates that AFH can respond to chemotherapy, even though it is rarely used.

AimTo increase the documented use of the Lifestart trolley to allow premature infants’ (<32 weeks’ gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.DesignA 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.ResultsDocumented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).Implications and relevanceBy undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.

The primary outcome measure was numbers of culture positive EOS cases where the calculator did not recommend empirical antibiotics. If the NICE guidelines would not have recommended treatment either this was not classified as a 'miss'. Risk of bias was assessed using QUADAS-2.Data were pooled using a random effect meta-analysis, quantifying heterogeneity using I². A subgroup analysis was performed using data from studies of babies exposed to chorioamnionitis. Results Eleven studies were eligible. There were 75 EOS cases and a minimum of 14, and a maximum of 22 cases where use of the calculator would have resulted in delayed or missed treatment, compared to if NICE guidelines were followed.The probability of 'calculator' delayed or missed treatment for an EOS case (additional to cases missed by following NICE guidelines) were best case 0.19 [95% confidence intervals 0.11 -0.29,I² 0%], worst case 0.31 [95% CI 0.17 -0.49, I² 37%].The probability of missing cases was significantly (p=0.03) more in babies exposed to chorioamnionitis, up to 0.56 [95% CI: [0.25, 0.82], I² 0%].All included studies had a low/moderate probability of bias. Conclusion A substantial proportion of EOS cases were missed by the calculator. Further evaluation of the calculator is recommended before it could be safely introduced into UK clinical practice.

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