Apical hypertrophic cardiomyopathy with left ventricular apical aneurysm: Importance of multi‐modality imaging

Apical hypertrophic cardiomyopathy (HCM) is an uncommon variant of HCM characterized by apical hypertrophy without the septal predominance seen in the majority of HCM cases. In 2% of patients, a concomitant left ventricular apical aneurysm is observed, which increases the risk of sudden death and adverse HCM‐related events. Multimodality imaging is helpful for appropriate identification of this particular morphologic pattern. Herein, we present a case of apical HCM with a left ventricular apical aneurysm, exemplifying the utility of a multimodality approach from resting electrocardiogram, transthoracic echocardiogram, left ventriculography, and cardiac magnetic resonance imaging, for proper risk stratification and treatment planning.     

Qui sont les élèves à besoins éducatifs particuliers ? La part d’aléatoire du signalement pour une mesure d’aide renforcée de pédagogie spécialisée dans un canton suisse

In this article, we begin by questioning the notion of special educational needs, which is used today in Switzerland, by going back over its historical foundations and developing the main issues and problems it raises. We then present the results of a comprehensive research aimed at uncovering the factors at work in the process of designating certain students for an enhanced special education support measure during their compulsory schooling. On the basis of a content analysis of the reports for an enhanced special education support measure produced during the 2016–2017 school year in a Swiss canton, as well as comprehensive interviews conducted with permanent teachers, we highlight various factors that can lead to the designation of a student for an enhanced special education support measure. We show how there is a degree of randomness in being designated for a special education support measure and critically discuss the role of the school institution and its actors in this process.     

To screen or not to screen: How to find and identify very early arthritis

There is accumulating evidence demonstrating that early treatment leads to better outcomes in rheumatoid arthritis. In order to be treated early, patients thus need to be identified at the earliest possible stage. This means identifying patients with rheumatoid arthritis at their earliest clinical signs but it could also mean screening for healthy individuals at high risk of developing rheumatoid arthritis. The different tools available to screen for these individuals are reviewed here and their relevance is discussed.     

Rapid identification of nonblood sterile site broth cultures using the FilmArray blood culture identification panel

The FilmArray Blood Culture Identification Panel was validated for nonblood sterile site specimens with clinical impact of rapid identification compared to conventional diagnostics. The panel accurately identified target organisms from 98% of positive broth cultures a median 1.1?day faster than conventional techniques (P?<?0.0001) with potential clinical impact in 22% of cases.     

Reverse engineering techniques applied to a human skull,for CAD 3D reconstruction and physical replication by rapid prototyping

The production of a copy of an existing object of complex shape is one of the typical applications of the integration between two modern computer-based technologies, reverse engineering (RE) and rapid prototyping (RP). The method is extremely versatile and can be used in various applicative domains (e.g. replacement of anatomical parts with artificial prostheses, replication of skeletal remains). Two different acquisition techniques of images of a skull, by laser and by CT scan, were compared to ascertain which enabled more accurate reproduction of the original specimen. The skull was chosen due to it being the body part most often used in medico-legal investigations (for personal identification, skull-photo superimposition techniques, forensic art, etc). Comparison between the copy and the original yielded satisfactory results for both techniques. However, CT scanning demonstrated some advantages over the laser technique, as it provided a cleaner point cloud, enabling shorter pre-reproduction processing times, as well as data on the internal parts, which resulted in the reproduction of a more faithful copy.     

Prediction of Oncotype Dx recurrence score using clinical parameters: A comparison of available tools and a simple predictor based on grade and progesterone receptor

Objective/BackgroundThe Oncotype Dx test is a genomic test currently used in clinical practice to predict the risk of disease recurrence in estrogen receptor (ER)-positive, HER2-negative breast cancer patients with axillary lymph node-negative or micrometastatic disease. The test is one of several similar genomically based tests available. Although it has a good predictive value, it is expensive and thus constitutes a significant financial burden for health systems. Thus, several attempts have been made to devise low-cost tools that could predict the recurrence score derived from the genomic evaluation using easily obtainable clinical parameters.MethodsTwo previously proposed predictive tools were evaluated in a cohort of 201 patients that had undergone the Oncotype Dx test for their efficacy in predicting the Oncotype Dx Recurrence Score (RS). A simple predictor, named GR-PR, based on two available pathologic parameters, grade and progesterone receptor status was devised and also evaluated.ResultsThe sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of all three tools were compared and found to be similar for all cutoff points of Oncotype Dx RS. The accuracy of GR-PR was comparable to the best performing of the two other prediction tools for all four cutoff points.ConclusionThe simple GR-PR predictor proposed in this study seems to be at least as accurate as more complex tools and should be the preferred tool for the prediction of Oncotype Dx RS from clinicopathologic parameters when the Oncotype Dx test is not available.     

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review

Objective: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context.

Study Design and Setting: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of prede?ned inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure.

Conclusion: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.     

Using Winnicott or Finding Winnicott?

The author suggests, in the title, a difference between using Winnicott's ideas, as in applying them, and finding Winnicott in clinical work. It is in finding examples that resonate to his ideas that we can see most directly what Winnicott had been writing about. And it is at those times of finding Winnicott that his ideas most vividly come alive.     

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

Background: With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments.

Method: An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR?=?36%)

Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%).

Conclusion: The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.