Intra vitam trauma pattern: changing the paradigm of forensic anthropology?

International Journal of Legal Medicine - This study aims to improve a previous study that reported new traits to characterize a perimortem fracture pattern in human long bones. This second study...     

Academic radiology and the emergency department: does it need changing?

RATIONAL AND OBJECTIVES: The increasing importance of imaging for both diagnosis and management in patient care has resulted in a demand for radiology services 7 days a week, 24 hours a day, especially in the emergency department (ED). We hypothesized the resident preliminary reports were better than generalist radiology interpretations, although inferior to subspecialty interpretations. MATERIALS AND METHODS: Total radiology volume through our Level I pediatric and adult academic trauma ED was obtained from the radiology information system. We conducted a literature search for error and discordant rates between radiologists of varying experience. For a 2-week prospective period, all preliminary reports generated by the residents and final interpretations were collected. Significant changes in the report were tabulated. RESULTS: The ED requested 72,886 imaging studies in 2004 (16% of the total radiology department volume). In a 2-week period, 12 of 1929 (0.6%) preliminary reports by residents were discordant to the final subspecialty dictation. In the 15 peer-reviewed publications documenting error rates in radiology, the error rate between American Board of Radiology (ABR)-certified radiologists is greater than that between residents and subspecialists in the literature and in our study. However, the perceived error rate by clinicians outside radiology is significantly higher. CONCLUSION: Sixteen percent of the volume of imaging studies comes through the ED. The residents handle off-hours cases with a radiology-detected error rate below the error rate between ABR-certified radiologists. To decrease the perceived clinician-identified error rate, we need to change how academic radiology handles ED cases.     

Acute abdomen film: is there hope of changing referring patterns?

An abdomen radiograph (KUB) is frequently requested by ER physicians as part of the inital work-up of patients. However, other imaging studies are now routinely available in the acute setting that may make the KUB an obsolete and unnecessary examination. The first part of this study was to assess the current referral patterns for urgent KUB in our center; the improper referral pattern for KUB in terms of requests for unnecessary exams 48,5% as well as number of technical errors in terms of inadequate radiographic projection for the suspected pathology 47% were recorded. In a second part, the impact of corrective actions at one month, 2 months and 6 months was assessed and we observed a decrease of about 20% of the number of KUB scheduled by the ER physician. Our results confirm that it is possible to teach ER physicians to more appropriately order imaging studies, which should improve patient care and generate savings. Long term correction of referral patterns is possible if all actors remain involved in this process.     

Does changing the configuration of a motor racing circuit make it safer?

Objectives: To assess the pattern of injuries presenting to a racing circuit medical centre in two three-year periods before and after two chicanes were built into the track.

Methods: Medical centre records were used to identify all patients assessed during the two time periods. Those referred to hospital were categorised by injury severity into three groups.

Results: The proportions of those attending the medical centre that were referred and admitted to hospital were the same in both periods (12–13% and 3% respectively). During the two study periods, the risk of a severe injury for a car driver decreased from 0.1% to 0.03% (p<0.05). For a motorcyclist, similar values were 0% and 0.2% (not significant).

Conclusions: Chicanes have improved the safety of the racing circuit for car drivers, reducing the risk of injury.

     

Do changing patterns of heat and humidity influence thermoregulation and endurance performance?

The purpose of this project was to determine whether changing patterns of temperature and humidity, as expected in the morning versus afternoon, had a differential effect on thermoregulation and endurance performance. Eight male distance runners each participated in two heat pattern tests consisting of two hours treadmill running at 70%-maximum oxygen consumption. The mean heat load for each test was identical (22.2 degrees C wet bulb temperature) but either dry bulb temperature increased (24 to 27.5 degrees C) or decreased (27.5 to 24 degrees C) over the course of the two hour heat stress test. Whole body sweat rate was 10.7% higher (p<0.05) and there was greater plasma volume loss (2.7 versus 1.6%, p<0.05) in the cooling versus warming pattern test. Mean skin and body temperature changed in a significantly different (p<0.05) manner between the two patterns and closely followed ambient dry bulb temperature change. The thermoregulatory variables of heart rate and rectal temperature were not affected and performance did not differ between pattern tests. Ratings of perceived exertion (RPE) and oxygen consumption were also not significantly different between cooling and warming test. In summary, although some minor differences were noted, thermal homeostasis was maintained equally well during either warming or cooling for wet bulb temperatures between 24 and 27 degrees C. The mean heat load is therefore more important than changing patterns of temperature and humidity in determining an individual's physiological response to exercise in a warm environment.     

MRI resolution enhancement: How useful are shifted images obtained by changing the demodulation frequency?

Super‐resolution reconstruction is a process by which a set of different low resolution images of the same object are used to create an enhanced, higher resolution image of that object. Recently there has been debate amongst researchers whether it is possible to obtain in‐plane image enhancement using a set of low resolution magnetic resonance images, acquired by making small, independent changes to the demodulation frequency. We show that shifted low‐resolution images contain different information that can be used to obtain denser sampling, leading to image enhancement. We conclude this from specific phantom experiments, applying signal processing sampling theory and taking into consideration the relative sampling of the point spread function with respect to the location of signal sources. Furthermore, the maximum achievable resolution for Fourier encoded MRI data at a boundary or object feature is governed by the effective width of the point spread function or the Fourier pixel size determined by the extent of k‐space; this is verified experimentally. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.     

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

In the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives.     

An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: Is the tide changing due to adherence?

Objectives

The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research.

Methods

A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012.

Results

Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study.

Conclusions

CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening.