WorldWideScience

Sample records for patients methodological pitfalls

  1. Methodological pitfalls of the Unconscious Thought paradigm

    NARCIS (Netherlands)

    Waroquier, Laurent; Marchiori, David; Klein, Olivier; Cleeremans, Axel

    2009-01-01

    According to Unconscious Thought Theory (UTT: Dijksterhuis & Nordgren, 2006), complex decisions are best made after a period of distraction assumed to elicit "unconscious thought". Over three studies, respectively offering a conceptual, an identical and a methodologically improved replication of

  2. Methodological pitfalls in early detection studies–the NAPE Lecture 2002

    DEFF Research Database (Denmark)

    Svein, Friis; Tor Ketil, Larsen; Melle, Ingrid

    2003-01-01

    Identifies and discusses methodological pitfalls that may help explain why many questions around early detection (ED) and duration of untreated psychosis (DUP) are still unsolved. This paper concentrates on pitfalls in sampling, measurement, and data analyses. The main problems seem to be: (1) Sa...... to identify the pitfalls, and to estimate and discuss their influence. (PsycINFO Database Record (c) 2016 APA, all rights reserved)...

  3. Addressing the “It Is Just Placebo” Pitfall in CAM: Methodology of a Project to Develop Patient-Reported Measures of Nonspecific Factors in Healing

    Directory of Open Access Journals (Sweden)

    Carol M. Greco

    2013-01-01

    Full Text Available CAM therapies are often dismissed as “no better than placebo;” however, this belief may be overcome through careful analysis of nonspecific factors in healing. To improve trial methodology, we propose that CAM (and conventional RCTs should evaluate and adjust for the effects of intrapersonal, interpersonal, and environmental factors on outcomes. However, measurement of these is challenging, and there are no brief, precise instruments that are suitable for widespread use in trials and clinical settings. This paper describes the methodology of a project to develop a set of patient-reported instruments that will quantify the nonspecific or “placebo” effects that are in fact specific and active ingredients in healing. The project uses the rigorous instrument-development methodology of the NIH-PROMIS initiative. The methods include (1 integration of patients’ and clinicians’ opinions with existing literature; (2 development of relevant items; (3 calibration of items on large samples; (4 classical test theory and modern psychometric methods to select the most useful items; (5 development of computerized adaptive tests (CATs that maximize information while minimizing patient burden; and (6 initial validation studies. The instruments will have the potential to revolutionize clinical trials in both CAM and conventional medicine through quantifying contextual factors that contribute to healing.

  4. Whole body imaging in the abdominal cancer patient: pitfalls of PET-CT.

    LENUS (Irish Health Repository)

    McDermott, Shaunagh

    2012-02-01

    Proper interpretation of PET-CT images requires knowledge of the normal physiological distribution of the tracer, frequently encountered physiological variants, and benign pathological causes of FDG uptake that can be confused with a malignant neoplasm. In addition, not all malignant processes are associated with avid tracer uptake. A basic knowledge of the technique of image acquisition is also required to avoid pitfalls such as misregistration of anatomical and scintigraphic data. This article reviews these potential pitfalls as they apply to the abdomen and pelvis of patients with cancer.

  5. Variants and pitfalls on radioiodine scans in pediatric patients with differentiated thyroid carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Mostafa, Mohamed; Vali, Reza; Chan, Jeffrey; Omarkhail, Yusuaf; Shammas, Amer [University of Toronto, Nuclear Medicine Division, Department of Medical Imaging, The Hospital for Sick Children, Toronto, Ontario (Canada)

    2016-10-15

    Potentially false-positive findings on radioiodine scans in children with differentiated thyroid carcinoma can mimic functioning thyroid tissue and functioning thyroid carcinomatous tissue. Such false-positive findings comprise variants and pitfalls that can vary slightly in children as compared with adults. To determine the patterns and frequency of these potential false-positive findings on radioiodine scans in children with differentiated thyroid carcinoma. We reviewed a total of 223 radioiodine scans from 53 pediatric patients (mean age 13.3 years, 37 girls) with differentiated thyroid carcinoma. Focal or regional activity that likely did not represent functioning thyroid tissue or functioning thyroid carcinomatous tissue were categorized as variants or pitfalls. The final diagnosis was confirmed by reviewing the concurrent and follow-up clinical data, correlative ultrasonography, CT scanning, serum thyroglobulin and antithyroglobulin antibody levels. We calculated the frequency of these variants and pitfalls from diagnostic and post-therapy radioiodine scans. The most common variant on the radioiodine scans was the thymic activity (24/223, 10.8%) followed by the cardiac activity (8/223, 3.6%). Salivary contamination and star artifact, caused by prominent thyroid remnant, were the most important observed pitfalls. Variants and pitfalls that mimic functioning thyroid tissue or functioning thyroid carcinomatous tissue on radioiodine scan in children with differentiated thyroid carcinoma are not infrequent, but they decrease in frequency on successive radioiodine scans. Potential false-positive findings can be minimized with proper knowledge of the common variants and pitfalls in children and correlation with clinical, laboratory and imaging data. (orig.)

  6. Inernational research in health care management: its need in the 21st century, methodological challenges, ethical issues, pitfalls, and practicalities.

    Science.gov (United States)

    Buttigieg, Sandra C; Rathert, Cheryl; D'Aunno, Thomas A; Savage, Grant T

    2015-01-01

    This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them. The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research. International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success. This commentary addresses salient issues pertaining to international research in one comprehensive account.

  7. Disease management programs for CKD patients: the potential and pitfalls.

    Science.gov (United States)

    Rocco, Michael V

    2009-03-01

    Disease management describes the use of a number of approaches to identify and treat patients with chronic health conditions, especially those that are expensive to treat. Disease management programs have grown rapidly in the United States in the past several years. These programs have been established for patients with chronic kidney disease (CKD), but some have been discontinued because of the high cost of the program. Disease management programs for CKD face unique challenges. Identification of patients with CKD is hampered by incomplete use of the International Classification of Diseases, Ninth Revision (ICD-9) codes for CKD by physicians and the less than universal use of estimated glomerular filtration rate from serum creatinine measurements to identify patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2). CKD affects multiple organ systems. Thus, a comprehensive disease management program will need to manage each of these aspects of CKD. These multiple interventions likely will make a CKD disease management program more costly than similar disease management programs designed for patients with diabetes mellitus, congestive heart failure, or other chronic diseases. The lack of data that can be used to develop effective disease management programs in CKD makes it difficult to determine goals for the management of each organ system affected by CKD. Finally, long periods of observation will be needed to determine whether a particular disease management program is effective in not only improving patient outcomes, but also decreasing both resource use and health care dollars. This long-term observation period is contrary to how most disease management contracts are written, which usually are based on meeting goals during a 1- to 3-year period. Until these challenges are resolved, it likely will be difficult to maintain effective disease management programs for CKD.

  8. Pitfalls of nonstandardized photography in facial plastic surgery patients.

    Science.gov (United States)

    Sommer, Doron D; Mendelsohn, Martyn

    2004-07-01

    The authors tested the hypothesis that certain maneuvers (neck flexion/extension and head protrusion/retrusion) alter the appearance of the submental area, jawline, and melolabial groove. They used a questionnaire survey of 20 naïve judges who assessed a standardized photograph album of three subjects. The subjects' faces (frontal and lateral views) were photographed in neutral, neck flexion/extension, and head protrusion/retrusion positions. High Kendall coefficients of correlation were observed in 10 of 12 questions evaluating an improvement in jawline definition with neck extension or head protrusion, as well as in 11 of 12 questions assessing decreased submental soft tissue. All questions relating to the melolabial groove had a correlation coefficient of less than 0.70. Small changes in patient positioning during photodocumentation for facial plastic surgical procedures can cause dramatic changes in the appearance of certain parameters. Standardizing patient positioning for preoperative and postoperative photographs is imperative.

  9. On the hunt for the gene of perspective taking: pitfalls in methodology.

    Science.gov (United States)

    Miklósi, Adám; Topál, József

    2011-12-01

    In this commentary, we evaluate the methodology of Udell, Dorey, and Wynne's (Learning & Behavior, in press) experiment in controlling for environmental factors and argue that their conclusion is not supported. In particular, we emphasise that comparative studies on dogs and wolves need to ensure that both species enjoyed the same rearing history, are comparable in age, and have the same experience with the testing conditions. We also argue that the utilisation of shelter dogs does not control for genetic effects on social behaviour. Finally, we propose a synergetic model to account for both genetic and environmental effects on interspecific social behaviour in dogs and wolves.

  10. Common methodologies in the evaluation of food allergy: pitfalls and prospects of food allergy prevalence studies.

    Science.gov (United States)

    Shu, Shang-an; Chang, Christopher; Leung, Patrick S C

    2014-06-01

    Global and regional studies on the prevalence of food allergies are plagued by inconsistent methodologies, variations in interpretation of results, and non-standardized study design. Hence, it becomes difficult to compare the prevalence of food allergies in different communities. This information would be useful in providing critical data that will enhance research to elucidate the nature of food allergies, and the role of gene-environment interactions in the sensitization of children and adults to foods. Testing methodologies range from questionnaires to objective in vitro and in vivo testing, to the gold standard, double-blind placebo-controlled food challenge (DBPCFC). Although considered the most accurate and reliable method in detecting the prevalence of food allergy, DBPCFC is not always practical in epidemiological studies of food allergy. On the other hand, multiple logistic regression studies have been done to determine predictability of the outcome of food challenges, and it appears that skin prick testing and in vitro-specific serum IgE are the best predictors. Future studies directed towards confirming the validity of these methods as well as developing algorithms to predict the food challenge outcomes are required, as they may someday become accessory tools to complement DBPCFC.

  11. Retroperitoneal Inflammatory Liposarcoma in a Patient with Non-Hodgkin Lymphoma: A Report Highlighting Diagnostic Pitfalls

    Directory of Open Access Journals (Sweden)

    Cathy S. Lim

    2010-01-01

    Full Text Available Well differentiated liposarcoma (WDLS is the commonest subtype of liposarcoma. Recognised subtypes of WDLSs are lipoma-like, sclerosing, spindle cell and inflammatory. The inflammatory variant of WDLS also known as “lymphocyte-rich liposarcoma” is rare. We present a case of inflammatory WDLS occurring in the retroperitoneum, in a patient with a past history of non-Hodgkin lymphoma. We outline the histological features, discuss the differential diagnoses and highlight the diagnostic pitfalls in interpretation of this lesion on fine needle biopsy.

  12. Epidemiological studies in idiopathic pulmonary fibrosis: pitfalls in methodologies and data interpretation

    Directory of Open Access Journals (Sweden)

    Antonella Caminati

    2015-09-01

    Full Text Available Data on incidence, prevalence and mortality of idiopathic pulmonary fibrosis (IPF are sparse and vary across studies. The true incidence and prevalence of the disease are unknown. In general, the overall prevalence and incidence reported in European and Asian countries are lower than those reported in American studies. In recent years, the epidemiological approach to IPF has been difficult for many reasons. First, the diagnostic criteria of the disease have changed over time. Secondly, the coding system used for IPF in administrative databases, the most common data source used to study this aspect of the disease, has been modified in the past few years. Finally, the study design, the methodology and the population selected in each of the studies are very different. All these aspects make comparisons among studies very difficult or impossible. In this review, we list the main issues that might arise when comparing different studies and that should be taken into consideration when describing the state of epidemiological knowledge concerning this pathology.

  13. Imaging Spectrum and Pitfalls of (11)C-Methionine Positron Emission Tomography in a Series of Patients with Intracranial Lesions.

    Science.gov (United States)

    Ito, Kimiteru; Matsuda, Hiroshi; Kubota, Kazoo

    2016-01-01

    (11)C-methionine (Met) positron emission tomography (PET) is one of the most commonly used PET tracers for evaluating brain tumors. However, few reports have described tips and pitfalls of (11)C-Met PET for general practitioners. Physiological (11)C-Met uptake, anatomical variations, vascular disorders, non-tumorous lesions such as inflammation or dysplasia, benign brain tumors and patient condition during (11)C-Met PET examination can potentially affect the image interpretation and cause false positives and negatives. These pitfalls in the interpretation of (11)C-Met PET images are important for not only nuclear medicine physicians but also general radiologists. Familiarity with the spectrum and pitfalls of (11)C-Met images could help prevent unfavorable clinical results caused by misdiagnoses.

  14. Imaging spectrum and pitfalls of 11C-methionine position emission tomography in a series of patients with intracranial lesions

    International Nuclear Information System (INIS)

    Ito, Kimiteru; Matsuda, Hiroshi; Kubota, Kazoo

    2016-01-01

    11 C-methionine (Met) positron emission tomography (PET) is one of the most commonly used PET tracers for evaluating brain tumors. However, few reports have described tips and pitfalls of 11 C-Met PET for general practitioners. Physiological 11 C-Met uptake, anatomical variations, vascular disorders, non-tumorous lesions such as inflammation or dysplasia, benign brain tumors and patient condition during 11 C-Met PET examination can potentially affect the image interpretation and cause false positives and negatives. These pitfalls in the interpretation of 11 C-Met PET images are important for not only nuclear medicine physicians but also general radiologists. Familiarity with the spectrum and pitfalls of 11 C-Met images could help prevent unfavorable clinical results caused by misdiagnoses

  15. Pitfalls of fluorodeoxyglucose positron-emission tomography-CT in tuberculosis mimicking malignancy in 60 patients

    International Nuclear Information System (INIS)

    Wang Xinlu; Yin Jilin; Zhang Jinhe; Ou Yangxi; Zhou Zheng; Quan Jiangtao; Zhang Weibiao; Zheng Hui

    2013-01-01

    Objective: To analyze the pitfalls of "1"8F fluorodeoxyglucose (FDG) positron emission tomography/computer tomography (PET-CT) scan in the diagnosis of 60 patients of tuberculosis mimicking malignancy. Methods: The study included 60 patients with PET-CT diagnosis of probable malignancy. Fifty patients were proved to be tuberculosis by pathological examinations and 10 were diagnosed by clinical followup. The images of whole body were acquired at 60 min after administration of 222-555 MBq "1"8F-FDG. The PET-CT imaging characteristics and clinical data, including lesion size, distribution, standardized uptake value (SUV) were retrospectively analyzed. After the whole body scan of PET-CT, each patient had a chest spiral CT scan for detailed observation of lung lesions. Contrast enhanced CT (CECT) was performed in 8 patients. Results: (1)Thirty patients were misdiagnosed as lung cancer, 14 patients as malignant lymphoma, 6 patients as malignant mesothelioma, 3 as intestine carcinoma, 2 as bone malignancy, 1 patient as hepatocarcinoma, spleen malignancy, ovarian cancer, laryngocarcinoma and nasopharyngeal carcinoma respectively. (2) 90.9% (20/22) of patients showed normal level of serum CEA and 100% (13/13) of patients showed normal level of CA199. Increasing serum CA125 was found in all patients (6/6) with active TB patients accompanied with ascites, pleural fluid and (or) pericardial effusion. (3) 93.3% (28/30) active tuberculosis showed accumulated "1"8F-FDG which was incorrectly interpreted as malignancy. The most common sites of TB lymphadenopathy were bilateral cervical tissues, which was accounted for 85.7% (12/14). CECT revealed characteristics of peripheral enhancement and central necrosis in tubercular lymphadenopathy, which was 87.5% (7/8). Conclusions: The diverse manifestations of TB on imaging and high uptake of "1"8F-FDG on PET imaging result in misdiagnosis of malignancy. It is important for radiologists and nuclear medicine physicians to identify the

  16. More than just noise: Inter-individual differences in fear acquisition, extinction and return of fear in humans - Biological, experiential, temperamental factors, and methodological pitfalls.

    Science.gov (United States)

    Lonsdorf, Tina B; Merz, Christian J

    2017-09-01

    Why do only some individuals develop pathological anxiety following adverse events? Fear acquisition, extinction and return of fear paradigms serve as experimental learning models for the development, treatment and relapse of anxiety. Individual differences in experimental performance were however mostly regarded as 'noise' by researchers interested in basic associative learning principles. Our work for the first time presents a comprehensive literature overview and methodological discussion on inter-individual differences in fear acquisition, extinction and return of fear. We tell a story from noise that steadily develops into a meaningful tune and converges to a model of mechanisms contributing to individual risk/resilience with respect to fear and anxiety-related behavior. Furthermore, in light of the present 'replicability crisis' we identify methodological pitfalls and provide suggestions for study design and analyses tailored to individual difference research in fear conditioning. Ultimately, synergistic transdisciplinary and collaborative efforts hold promise to not only improve our mechanistic understanding but can also be expected to contribute to the development of specifically tailored ('individualized') intervention and targeted prevention programs in the future. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Imaging spectrum and pitfalls of {sup 11}C-methionine position emission tomography in a series of patients with intracranial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kimiteru [Dept. of Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo (Japan); Matsuda, Hiroshi [Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo (Japan); Kubota, Kazoo [Div. of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo (Japan)

    2016-06-15

    {sup 11}C-methionine (Met) positron emission tomography (PET) is one of the most commonly used PET tracers for evaluating brain tumors. However, few reports have described tips and pitfalls of {sup 11}C-Met PET for general practitioners. Physiological {sup 11}C-Met uptake, anatomical variations, vascular disorders, non-tumorous lesions such as inflammation or dysplasia, benign brain tumors and patient condition during {sup 11}C-Met PET examination can potentially affect the image interpretation and cause false positives and negatives. These pitfalls in the interpretation of {sup 11}C-Met PET images are important for not only nuclear medicine physicians but also general radiologists. Familiarity with the spectrum and pitfalls of {sup 11}C-Met images could help prevent unfavorable clinical results caused by misdiagnoses.

  18. Pitfalls when implementing nurse-led annual telephone calls to replace outpatient visits for Inflammatory Bowel Disease patients

    DEFF Research Database (Denmark)

    Jakobsen, Dorrit; Bager, Palle; Hentze, Runa

    Background: In Denmark, patients with Inflammatory Bowel Disease (IBD) and disease in remission are mainly seen on a regularly basis in outpatient clinics, by gastroenterologists. Replacing the regular visits with annual telephone calls performed by IBD nurses seems beneficial, both for the patie......Background: In Denmark, patients with Inflammatory Bowel Disease (IBD) and disease in remission are mainly seen on a regularly basis in outpatient clinics, by gastroenterologists. Replacing the regular visits with annual telephone calls performed by IBD nurses seems beneficial, both...... for the patients and for the outpatient clinic. The purpose of this study was to identify potential barriers and pitfalls in the planning and implementation phase of a nurse-led telephone service. Methods: Preparations prior to introducing the annual telephone calls were done in 2010. From January 2011 all...... eligible IBD patients were shifted from regularly visits to annual telephone calls performed by an IBD nurse. As the intervention contained of several sub-elements and the elements were subject to adjustment during implementation, the intervention was regarded as a Complex Intervention. All the elements...

  19. PET/CT with 18F-choline: Physiological whole bio-distribution in male and female subjects and diagnostic pitfalls on 1000 prostate cancer patients: 18F-choline PET/CT bio-distribution and pitfalls. A southern Italian experience.

    Science.gov (United States)

    Calabria, Ferdinando; Chiaravalloti, Agostino; Cicciò, Carmelo; Gangemi, Vincenzo; Gullà, Domenico; Rocca, Federico; Gallo, Gianpasquale; Cascini, Giuseppe Lucio; Schillaci, Orazio

    2017-08-01

    The 11 C/ 18 F-choline is a PET/CT radiopharmaceutical useful in detecting tumors with high lipogenesis. 11 C/ 18 F-choline uptake can occur in physiological conditions or tumors. The knowledge of its bio-distribution is essential to recognize physiologic variants or diagnostic pitfalls. Moreover, few information are available on the bio-distribution of this tracer in female patients. Our aim was to discuss some documented 18 F-choline PET/CT pitfalls in prostate cancer patients. Our secondary aim was to describe the 18 F-choline bio-distribution in the female body. We collected diagnostic pitfalls in three PET centers examining 1000 prostate cancer by 18 F-choline PET/CT. All pitfalls were ensured by follow-up, imaging and/or histology. We also performed whole body 18 F-choline PET/CT in 5 female patients. 169/1000 (16.9%) patients showed pitfalls not owing to prostate cancer. These findings were due to inflammation, benign tumors while, in 1% of examined patients, a concomitant neoplasm was found. In the female body, the breast showed low physiological uptake. The accurate knowledge of 18 F-choline PET/CT bio-distribution and diagnostic pitfalls is essential. Correlative imaging and histological exam are often necessary to depict pitfalls. In women, the uptake in the breast is due to the physiological gradient of 18 F-choline uptake in the exocrine glands. Our results confirm the possibility of 18 F-choline uptake in several diseases other than prostate cancer. However, our experience was acquired on a large population and shows that a conspicuous amount of 18 F-choline diagnostic pitfalls are easily recognizable and attributable to inflammation. A new advance in knowledge is the minimal difference in terms of physiological tracer bio-distribution between male and female patients. The knowledge of the physiological bio-distribution and of the potential pitfalls linked of a tracer could help physicians to choose the best diagnostic and therapeutic approaches for a

  20. Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Tschoeke Sven K

    2008-06-01

    Full Text Available Abstract Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.

  1. 18F-DOPA PET/CT Physiological Distribution and Pitfalls: Experience in 215 Patients.

    Science.gov (United States)

    Calabria, Ferdinando F; Chiaravalloti, Agostino; Jaffrain-Rea, Marielise L; Zinzi, Maddalena; Sannino, Pasqualina; Minniti, Giuseppe; Rubello, Domenico; Schillaci, Orazio

    2016-10-01

    F-DOPA PET/CT is potentially helpful in the management of patients with low-grade brain tumors, movement disorders, and somatic neuroendocrine tumors. We describe the whole-body physiological distribution of F-DOPA uptake. We examined 215 patients with F-DOPA PET/CT. Among these, 161 had brain scans and 54 had whole-body scans. Physiological distribution was negligible in the brain, with the exception of basal ganglia, whereas greatest activity was noted in the liver, pancreas, other exocrine glands, and the urinary system. Incidental tracer uptake sites were identified in 5.5% of patients. Some of these findings were due to inflammation, whereas in most cases, uptake was seen in benign tumors of the brain or in the endocrine or exocrine glands. F-DOPA uptake may be seen in inflammatory tissue or benign tumors. Correlations with history, physical examination, laboratory examination, CT, MRI, and histology are necessary for optimal diagnosis.

  2. Ascending colon rotation following patient positional change during CT colonography: a potential pitfall in interpretation

    International Nuclear Information System (INIS)

    Kim, Ji Yeon; Park, Seong Ho; Lee, Seung Soo; Kim, Ah Young; Ha, Hyun Kwon

    2011-01-01

    To investigate the degree and pattern of ascending colonic rotation as patients moved from supine to prone positions during CTC. A search of our CTC and colonoscopy database found 37 patients (43 eligible lesions) who fulfilled the following criteria: colonoscopy-proven sessile polyps ≥6 mm in the straight mid-ascending colon, lesion visualisation in both supine and prone CTC, and optimal colonic distension. A coordinate system was developed to designate the polyp radial location ( ) along the luminal circumference, unaffected by rotation of the torso. The degree/direction of polyp radial location change (i.e. ascending colonic rotation) between supine and prone positions correlated with anthropometric measurements. Movement from supine to prone positions resulted in a change in the radial polyp location of between -23 and 79 (median, 21 ), demonstrating external rotation of the ascending colon in almost all cases (2 to 79 in 36/37 patients and 42/43 lesions). The degree/direction of rotation mildly correlated with the degree of abdominal compression in the anterior-posterior direction in prone position (r = 0.427 [P = 0.004] and r = 0.404 [P = 0.007]). The ascending colon was usually found to rotate externally as patients moved from supine to prone positions, partly dependent on the degree of abdominal compression. (orig.)

  3. Pitfall in metabolic screening in a patient with fatal peroxisomal beta-oxidation defect

    NARCIS (Netherlands)

    Rosewich, H.; Waterham, H. R.; Wanders, R. J. A.; Ferdinandusse, S.; Henneke, M.; Hunneman, D.; Gärtner, J.

    2006-01-01

    We present a rare case of peroxisomal acyl-CoA oxidase deficiency that was not detected by the common metabolic screening program for peroxisomal disorders. The patient presented with a typical MRI pattern showing pachygyria, perisylvian polymicrogyria, cerebral and cerebellar white matter

  4. Lead and cadmium in public health in Nigeria: physicians neglect and pitfall in patient management.

    Science.gov (United States)

    Orisakwe, Orish Ebere

    2014-02-01

    Low-level heavy metals exposure may contribute much more toward the causation of chronic disease and impaired functioning than previously thought. Among the suggested preventive and intervention measures for the control of renal diseases are the reduction in the exposure to heavy metals. Although these indicate knowledge and awareness of possible role of some heavy metals in the etiogenesis of some chronic diseases by Nigerian Physicians, heavy metal assay as diagnostic guide in patient management is often omitted in most healthcare settings. This is a synoptic capture of the increased incidence and prevalence of some metabolic disorders where heavy metals may be implicated. A search of the terms heavy metal exposure, source, toxicity, metabolic disorders, poisoning in Nigeria, in bibliographical databases (in English language) such as PubMed, Scopus, Google Scholar, and Africa Journal Online (AJOL) digital library was conducted. Leaded gasoline, refuse dumping, absence of poison information centers, and poor record keeping characterize environmental health in Nigeria. Lead and cadmium are of most significant public health importance in Nigeria. The recognition and inclusion of heavy metals assays in the diagnosis of metabolic disorders may ensure early diagnosis and improve management.

  5. Imaging spectrum and pitfalls of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with tuberculosis.

    Science.gov (United States)

    Ito, Kimiteru; Morooka, Miyako; Minamimoto, Ryogo; Miyata, Yoko; Okasaki, Momoko; Kubota, Kazuo

    2013-08-01

    Mycobacterium tuberculosis (TB) is one of the most prominant diseases frequently causing false positive lesions in oncologic surveys using (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), since TB granulomas are composed of activated macrophages and lymphocytes with high affinity for glucose. These pitfalls of (18)F-FDG PET/CT are important for radiologists. Being familiar with (18)F-FDG images of TB could assist in preventing unfavorable clinical results based on misdiagnoses. In addition, (18)F-FDG PET/CT has the advantage of being able to screen the whole body, and can clearly detect harboring TB lesions as high uptake foci. This article details the spectrum and pitfalls of (18)F-FDG PET/CT imaging in TB.

  6. Pitfalls in diagnostic radiology

    Energy Technology Data Exchange (ETDEWEB)

    Peh, Wilfred C.G. (ed.) [Khoo Teck Puat Hospital (Singapore). Dept. of Diagnostic Radiology

    2015-04-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  7. Pitfalls in diagnostic radiology

    International Nuclear Information System (INIS)

    Peh, Wilfred C.G.

    2015-01-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  8. A systematic review of studies on psychosocial late effects of childhood cancer: structures of society and methodological pitfalls may challenge the conclusions

    DEFF Research Database (Denmark)

    Lund, Lasse Wegener; Schmiegelow, Kjeld; Rechnitzer, Catherine

    2011-01-01

    High survival rates after childhood cancer raise attention to possible psychosocial late effects. We focus on predictors of psychosocial outcomes based on diagnosis, treatment, demography, somatic disease, and methodological problems. Overall, survivors evaluate their health-related quality of life...

  9. Probable Diagnosis of a Patient with Niemann-Pick Disease Type C: Managing Pitfalls of Exome Sequencing.

    Science.gov (United States)

    Zeiger, William A; Jamal, Nasheed I; Scheuner, Maren T; Pittman, Patricia; Raymond, Kimiyo M; Morra, Massimo; Mishra, Shri K

    2018-02-17

    Here, we present a case of a 31-year-old man with progressive cognitive decline, ataxia, and dystonia. Extensive laboratory, radiographic, and targeted genetic studies over the course of several years failed to yield a diagnosis. Initial whole exome sequencing through a commercial laboratory identified several variants of uncertain significance; however, follow-up clinical examination and testing ruled each of these out. Eventually, repeat whole exome sequencing identified a known pathogenic intronic variant in the NPC1 gene (NM_000271.4, c.1554-1009G>A) and an additional heterozygous exonic variant of uncertain significance in the NPC1 gene (NM_000271.4, c.2524T>C). Follow-up biochemical testing was consistent with a diagnosis of probable Niemann-Pick disease Type C (NP-C). This case illustrates the potential of whole exome sequencing for diagnosing rare complex neurologic diseases. It also identifies several potential common pitfalls that must be navigated by clinicians when interpreting commercial whole exome sequencing results.

  10. Pitfalls in liver imaging

    Energy Technology Data Exchange (ETDEWEB)

    Itai, Yuji; Saida, Yukihisa [Department of Radiology, Institute of Clinical Medicine, University of Tsukuba (Japan)

    2002-05-01

    Localized, abnormal attenuation/intensity areas on unenhanced and/or enhanced study of CT/MR imaging do not necessarily correspond to tumors themselves or real tumor size. Pitfalls in the diagnosis of liver tumor are described dividing into enhanced study (vascular variants, vascular abnormalities, hyperplastic nodules, around the tumor, and miscellaneous) and unenhanced study (fatty change, focal spared area of diffuse fatty liver, and miscellaneous). (orig.)

  11. Pitfalls in liver imaging

    International Nuclear Information System (INIS)

    Itai, Yuji; Saida, Yukihisa

    2002-01-01

    Localized, abnormal attenuation/intensity areas on unenhanced and/or enhanced study of CT/MR imaging do not necessarily correspond to tumors themselves or real tumor size. Pitfalls in the diagnosis of liver tumor are described dividing into enhanced study (vascular variants, vascular abnormalities, hyperplastic nodules, around the tumor, and miscellaneous) and unenhanced study (fatty change, focal spared area of diffuse fatty liver, and miscellaneous). (orig.)

  12. Detection of paroxysmal nocturnal hemoglobinuria clones in patients with myelodysplastic syndromes and related bone marrow diseases, with emphasis on diagnostic pitfalls and caveats.

    Science.gov (United States)

    Wang, Sa A; Pozdnyakova, Olga; Jorgensen, Jeffrey L; Medeiros, L Jeffrey; Stachurski, Dariusz; Anderson, Mary; Raza, Azra; Woda, Bruce A

    2009-01-01

    The presence of paroxysmal nocturnal hemoglobinuria clones in the setting of aplastic anemia or myelodysplastic syndrome has been shown to have prognostic and therapeutic implications. However, the status of paroxysmal nocturnal hemoglobinuria clones in various categories of myelodysplastic syndrome and in other bone marrow disorders is not well-studied. By using multiparameter flow cytometry immunophenotypic analysis with antibodies specific for four glycosylphosphatidylinositol-anchored proteins (CD55, CD59, CD16, CD66b) and performing an aerolysin lysis confirmatory test in representative cases, we assessed the paroxysmal nocturnal hemoglobinuria-phenotype granulocytes in 110 patients with myelodysplastic syndrome, 15 with myelodysplastic/myeloproliferative disease, 5 with idiopathic myelofibrosis and 6 with acute myeloid leukemia. Paroxysmal nocturnal hemoglobinuria-phenotype granulocytes were detected in nine patients with low grade myelodysplastic syndrome who showed clinicopathological features of bone marrow failure, similar to aplastic anemia. All paroxysmal nocturnal hemoglobinuria-positive cases demonstrated loss of the four glycosylphosphatidylinositol-anchored proteins, with CD16(-)CD66b(-) clones being larger than those of CD55(-)CD59(-) (p<0.05). Altered glycosylphosphatidylinositol-anchored protein expression secondary to granulocytic hypogranulation, immaturity, and/or immunophenotypic abnormalities was present in a substantial number of cases and diagnostically challenging. These results show that routine screening for paroxysmal nocturnal hemoglobinuria clones in patients with an intrinsic bone marrow disease who show no clinical evidence of hemolysis has an appreciable yield in patients with low grade myelodysplastic syndromes. The recognition of diagnostic caveats and pitfalls associated with the underlying intrinsic bone marrow disease is essential in interpreting paroxysmal nocturnal hemoglobinuria testing correctly. In our experience, the CD

  13. Investigating patients' experiences: methodological usefulness of interpretive interactionism.

    Science.gov (United States)

    Tower, Marion; Rowe, Jennifer; Wallis, Marianne

    2012-01-01

    To demonstrate the methodological usefulness of interpretive interactionism by applying it to the example of a study investigating healthcare experiences of women affected by domestic violence. Understanding patients' experiences of health, illness and health care is important to nurses. For many years, biomedical discourse has prevailed in healthcare language and research, and has influenced healthcare responses. Contemporary nursing scholarship can be developed by engaging with new ways of understanding therapeutic interactions with patients. Research that uses qualitative methods of inquiry is an important paradigm for nurses who seek to explain and understand or describe experiences rather than predict outcomes. Interpretive interactionism is an interpretive form of inquiry for conducting studies of social or personal problems that have healthcare policy implications. It puts the patient at the centre of the research process and makes visible the experiences of patients as they interact with the healthcare and social systems that surround them. Interpretive interactionism draws on concepts of symbolic interactionism, phenomenology and hermeneutics. Interpretive interactionism is a patient-centred methodology that provides an alternative way of understanding patients' experiences. It can contribute to policy and practice development by drawing on the perspectives and experiences of patients, who are central to the research process. It also allows research findings to be situated in and linked to healthcare policy, professional ethics and organisational approaches to care. Interpretive interactionism has methodological utility because it can contribute to policy and practice development by drawing on the perspectives and experiences of patients who are central to the research process. Interpretive interactionism allows research findings to be situated in and linked to health policy, professional ethics and organisational approaches to caring.

  14. Assessing patient preferences in heart failure using conjoint methodology

    Directory of Open Access Journals (Sweden)

    Pisa G

    2015-08-01

    Full Text Available Giovanni Pisa,1 Florian Eichmann,1 Stephan Hupfer21Kantar Health GmbH, Munich, Germany; 2Novartis Pharma GmbH, Nuernberg, GermanyAim: The course of heart failure (HF is characterized by frequent hospitalizations, a high mortality rate, as well as a severely impaired health-related quality of life (HRQoL. To optimize disease management, understanding of patient preferences is crucial. We aimed to assess patient preferences using conjoint methodology and HRQoL in patients with HF.Methods: Two modules were applied: an initial qualitative module, consisting of in-depth interviews with 12 HF patients, and the main quantitative module in 300 HF patients from across Germany. Patients were stratified according to the time of their last HF hospitalization. Each patient was presented with ten different scenarios during the conjoint exercise. Additionally, patients completed the generic HRQoL instrument, EuroQol health questionnaire (EQ-5D™.Results: The attribute with the highest relative importance was dyspnea (44%, followed by physical capacity (18%. Of similar importance were exhaustion during mental activities (13%, fear due to HF (13%, and autonomy (12%. The most affected HRQoL dimensions according to the EQ-5D questionnaire were anxiety/depression (23% with severe problems, pain/discomfort (19%, and usual activities (15%. Overall average EQ-5D score was 0.39 with stable, chronic patients (never hospitalized having a significantly better health state vs the rest of the cohort.Conclusion: This paper analyzed patient preference in HF using a conjoint methodology. The preference weights resulting from the conjoint analysis could be used in future to design HRQoL questionnaires which could better assess patient preferences in HF care.Keywords: heart failure, quality of life, conjoint analysis, utility, patient preference

  15. Application of Bow-tie methodology to improve patient safety.

    Science.gov (United States)

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-09

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

  16. Pitfalls in neck imaging

    International Nuclear Information System (INIS)

    Gay, S.B.; Phillips, C.D.; Cornett, J.B.

    1991-01-01

    CT and MR imaging have become effective imaging modalities in the evaluation of primary head and neck neoplasms. As radiologists have gained experience in head and neck imaging, certain pitfalls have become evident. Identification of pathologic lymph nodes is the critical element in staging neoplasms of the head and neck. The diagnosis of cervical lymphadenopathy may be complicated by confusion with normal structures, inadequate contrast opacification of vascular structures, and poor scanning technique. This paper illustrates these potential problem areas on both CT and MR images and offers the authors' approach to further evaluation in problem cases

  17. [Nursing methodology applicated in patients with pressure ulcers. Clinical report].

    Science.gov (United States)

    Galvez Romero, Carmen

    2014-05-01

    The application of functional patterns lets us to make a systematic and premeditated nursing assessment, with which we obtain a lot of relevant patient data in an organized way, making easier to analize them. In our case, we use Marjory Gordon's functional health patterns and NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Intervention Classification) taxonomy. The overall objective of this paper is to present the experience of implementation and development of nursing methodology in the care of patients with pressure ulcers. In this article it's reported a case of a 52-year-old female who presented necrosis of phalanxes in upper and lower limbs and suffered amputations of them after being hospitalized in an Intensive Care Unit. She was discharged with pressure ulcers on both heels. GENERAL ASSESSMENT: It was implemented the nursing theory known as "Gordon's functional health patterns" and the affected patterns were identified. The Second Pattern (Nutritional-Metabolic) was considered as reference, since this was the pattern which altered the rest. EVOLUTION OF THE PATIENT: The patient had a favourable evolution, improving all the altered patterns. The infections symptoms disappeared and the pressure ulcers of both heels healed completely. The application of nursing methodology to care patients with pressure ulcers using clinical practice guidelines, standardized procedures and rating scales of assessment improves the evaluation of results and the performance of nurses.

  18. Suicide and patients with neurologic diseases. Methodologic problems

    DEFF Research Database (Denmark)

    Stenager, E N; Stenager, Egon

    1992-01-01

    OBJECTIVE: The suicide risk in patients with many neurologic diseases has been reported to be greater than that in the general population. Studies on the subject are, however, often encumbered with methodologic problems. We appraised these problems and, based on an evaluation, reappraised knowledge...... of the suicide risk in patients with specific neurologic diseases. DATA SOURCE: Using the computerized database MEDLINE, we identified all published reports with the key words suicide, attempted suicide, and neurologic diseases. STUDY SELECTION: We assessed and reviewed studies concerning the most common...... of the studies, the methods used gave rise to uncertainty about the conclusion presented. CONCLUSION: An increased suicide risk was found in patients suffering from multiple sclerosis and spinal cord lesions as well as in selected groups of patients with epilepsy. In other neurologic diseases, the suicide risk...

  19. Limitations and pitfalls of using family letters to communicate genetic risk: a qualitative study with patients and healthcare professionals

    OpenAIRE

    Dheensa, Sandeep; Lucassen, Anneke; Fenwick, Angela

    2017-01-01

    European genetic testing guidelines recommend that healthcare professionals (HCPs) discuss the familial implications of any test with a patient and offer written material to help them share the information with family members. Giving patients these “family letters” to alert any relatives of their risk has become part of standard practice and has gone relatively unquestioned over the years. Communication with at-risk relatives will become an increasingly pressing issue as mainstream and routin...

  20. Limitations and Pitfalls of Using Family Letters to Communicate Genetic Risk: a Qualitative Study with Patients and Healthcare Professionals.

    Science.gov (United States)

    Dheensa, Sandi; Lucassen, Anneke; Fenwick, Angela

    2018-06-01

    European genetic testing guidelines recommend that healthcare professionals (HCPs) discuss the familial implications of any test with a patient and offer written material to help them share the information with family members. Giving patients these "family letters" to alert any relatives of their risk has become part of standard practice and has gone relatively unquestioned over the years. Communication with at-risk relatives will become an increasingly pressing issue as mainstream and routine practice incorporates broad genome tests and as the number of findings potentially relevant to relatives increases. This study therefore explores problems around the use of family letters to communicate about genetic risk. We conducted 16 focus groups with 80 HCPs, and 35 interviews with patients, recruited from across the UK. Data were analyzed thematically and we constructed four themes: 1) HCPs writing family letters: how to write them and why?, 2) Patients' issues with handing out family letters, 3) Dissemination becomes an uncontrolled form of communication, and 4) When the relative has the letter, is the patient's and HCP's duty discharged? We conclude by suggesting alternative and supplementary methods of communication, for example through digital tools, and propose that in comparison to communication by family letter, direct contact by HCPs might be a more appropriate and successful option.

  1. A cross sectional review of patient information available in the World Wide Web on CyberKnife: fallacies and pitfalls.

    Science.gov (United States)

    Menon, Durgapoorna; Chelakkot, Prameela G; Sunil, Devika; Lakshmaiah, Ashwini

    2017-12-01

    The purpose of this study is to assess the quality of videos available in YouTube on CyberKnife. The term "CyberKnife" was input into the search window of www.youtube.com on a specific date and the first 50 videos were assessed for technical and content issues. The data was tabulated and analysed. The search yielded 32,300 videos in 0.33 s. Among the first 50 analysed, most were professional videos, mostly on CyberKnife in general and for brain tumours. Most of the videos did not mention anything about patient selection or lesion size. The other technical details were covered by most although they seemed muffled by the animations. Many patient videos were recordings of one entire treatment, thus giving future patients an insight on what to expect. Almost half the videos projected glorified views about the treatment technique. The company videos were reasonably accurate and well presented as were many institutional videos, although there was a tendency to gloss over a few points. The glorification of the treatment technique was a disturbing finding. The profound trust of the patients on the health care system is humbling.

  2. (18)F-choline PET/CT pitfalls in image interpretation: an update on 300 examined patients with prostate cancer.

    Science.gov (United States)

    Calabria, Ferdinando; Chiaravalloti, Agostino; Schillaci, Orazio

    2014-02-01

    F-choline PET/CT is an important diagnostic tool in the management of patients with prostate cancer (PC). The aim of this study was to describe and discuss some abnormal sites of uptake that we observed, not due to PC recurrence. Three hundred patients were submitted to F-choline PET/CT for staging or restaging of PC. Whole-body PET/CT was acquired 40 minutes after the F-choline administration. We found abnormal uptake of the tracer, not related to PC, in 48/300 patients (16%). Most of these findings were due to inflammatory processes. Furthermore, some malignant conditions, such as a case of colon cancer, a case of bladder carcinoma, and a multiple myeloma, were diagnosed. Mild uptake was also detected in some benign diseases, such as thymoma, adrenal adenoma, and sarcoidosis. Six patients showed focal brain uptake in correspondence to a meningioma. It is necessary for nuclear physicians, during clinical practice, to consider the possibility of F-choline uptake in some benign or malignant conditions for the intrinsic pharmacologic property of the tracer. An accurate medical investigation, correlative imaging with CT and/or MRI with contrast agents, laboratory data, and above all, histologic examination are often necessary for correct diagnosis.

  3. Sonographic screening for urinary tract abnormalities in patients with Schistosoma haematobium infection: pitfalls in examining pregnant women.

    OpenAIRE

    Richter, J.; Wagatsuma, Y.; Aryeetey, M.; Feldmeier, H.

    1996-01-01

    In areas where Schistosoma haematobium is endemic, urinary schistosomiasis and pregnancy are frequently concomitant; however, both these conditions may produce similar urinary tract changes in ultrasound scans and hence their differential diagnosis may be difficult. In patients with urinary schistosomiasis, focal and/or diffuse urinary bladder wall changes are frequently detected ultrasonically. Dilatation of one or both ureters and progressive hydronephrosis may be observed in more severe ca...

  4. Pitfalls of insulin pump clocks: technical glitches that may potentially affect medical care in patients with diabetes.

    Science.gov (United States)

    Aldasouqi, Saleh A; Reed, Amy J

    2014-11-01

    The objective was to raise awareness about the importance of ensuring that insulin pumps internal clocks are set up correctly at all times. This is a very important safety issue because all commercially available insulin pumps are not GPS-enabled (though this is controversial), nor equipped with automatically adjusting internal clocks. Special attention is paid to how basal and bolus dose errors can be introduced by daylight savings time changes, travel across time zones, and am-pm clock errors. Correct setting of insulin pump internal clock is crucial for appropriate insulin delivery. A comprehensive literature review is provided, as are illustrative cases. Incorrect setting can potentially result in incorrect insulin delivery, with potential harmful consequences, if too much or too little insulin is delivered. Daylight saving time changes may not significantly affect basal insulin delivery, given the triviality of the time difference. However, bolus insulin doses can be dramatically affected. Such problems may occur when pump wearers have large variations in their insulin to carb ratio, especially if they forget to change their pump clock in the spring. More worrisome than daylight saving time change is the am-pm clock setting. If this setting is set up incorrectly, both basal rates and bolus doses will be affected. Appropriate insulin delivery through insulin pumps requires correct correlation between dose settings and internal clock time settings. Because insulin pumps are not GPS-enabled or automatically time-adjusting, extra caution should be practiced by patients to ensure correct time settings at all times. Clinicians and diabetes educators should verify the date/time of insulin pumps during patients' visits, and should remind their patients to always verify these settings. © 2014 Diabetes Technology Society.

  5. Thyroid ultrasonography: Pitfalls and techniques

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seon hyeong; Kim, Eun Kyung; Kim, Soo Jin; Kwak, Jin Young [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-04-15

    Thyroid ultrasonography (US) plays a key role in the diagnosis and management of thyroid-related diseases. The aim of this article was to illustrate various pitfalls that can occur in utilizing thyroid US and techniques to prevent them. In this article, we present cases demonstrating the common pitfalls associated with US equipment, performance, normal thyroid structures, misinterpretations, and surrounding structures. Knowledge of these areas is essential to avoid misdiagnosis or improper disease management.

  6. Patients with Testicular Cancer Undergoing CT Surveillance Demonstrate a Pitfall of Radiation-induced Cancer Risk Estimates: The Timing Paradox

    Science.gov (United States)

    Eisenberg, Jonathan D.; Lee, Richard J.; Gilmore, Michael E.; Turan, Ekin A.; Singh, Sarabjeet; Kalra, Mannudeep K.; Liu, Bob; Kong, Chung Yin; Gazelle, G. Scott

    2013-01-01

    Purpose: To demonstrate a limitation of lifetime radiation-induced cancer risk metrics in the setting of testicular cancer surveillance—in particular, their failure to capture the delayed timing of radiation-induced cancers over the course of a patient’s lifetime. Materials and Methods: Institutional review board approval was obtained for the use of computed tomographic (CT) dosimetry data in this study. Informed consent was waived. This study was HIPAA compliant. A Markov model was developed to project outcomes in patients with testicular cancer who were undergoing CT surveillance in the decade after orchiectomy. To quantify effects of early versus delayed risks, life expectancy losses and lifetime mortality risks due to testicular cancer were compared with life expectancy losses and lifetime mortality risks due to radiation-induced cancers from CT. Projections of life expectancy loss, unlike lifetime risk estimates, account for the timing of risks over the course of a lifetime, which enabled evaluation of the described limitation of lifetime risk estimates. Markov chain Monte Carlo methods were used to estimate the uncertainty of the results. Results: As an example of evidence yielded, 33-year-old men with stage I seminoma who were undergoing CT surveillance were projected to incur a slightly higher lifetime mortality risk from testicular cancer (598 per 100 000; 95% uncertainty interval [UI]: 302, 894) than from radiation-induced cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy loss attributable to testicular cancer (83 days; 95% UI: 42, 124) was more than three times greater than life expectancy loss attributable to radiation-induced cancers (24 days; 95% UI: 13, 35). Trends were consistent across modeled scenarios. Conclusion: Lifetime radiation risk estimates, when used for decision making, may overemphasize radiation-induced cancer risks relative to short-term health risks. © RSNA, 2012 Supplemental material: http

  7. Pitfalls in the statistical examination and interpretation of the correspondence between physician and patient satisfaction ratings and their relevance for shared decision making research

    Science.gov (United States)

    2011-01-01

    Background The correspondence of satisfaction ratings between physicians and patients can be assessed on different dimensions. One may examine whether they differ between the two groups or focus on measures of association or agreement. The aim of our study was to evaluate methodological difficulties in calculating the correspondence between patient and physician satisfaction ratings and to show the relevance for shared decision making research. Methods We utilised a structured tool for cardiovascular prevention (arriba™) in a pragmatic cluster-randomised controlled trial. Correspondence between patient and physician satisfaction ratings after individual primary care consultations was assessed using the Patient Participation Scale (PPS). We used the Wilcoxon signed-rank test, the marginal homogeneity test, Kendall's tau-b, weighted kappa, percentage of agreement, and the Bland-Altman method to measure differences, associations, and agreement between physicians and patients. Results Statistical measures signal large differences between patient and physician satisfaction ratings with more favourable ratings provided by patients and a low correspondence regardless of group allocation. Closer examination of the raw data revealed a high ceiling effect of satisfaction ratings and only slight disagreement regarding the distributions of differences between physicians' and patients' ratings. Conclusions Traditional statistical measures of association and agreement are not able to capture a clinically relevant appreciation of the physician-patient relationship by both parties in skewed satisfaction ratings. Only the Bland-Altman method for assessing agreement augmented by bar charts of differences was able to indicate this. Trial registration ISRCTN: ISRCT71348772 PMID:21592337

  8. Research methodology and epidemiology of relevance in recurrent pregnancy loss

    DEFF Research Database (Denmark)

    Christiansen, Ole B; Nielsen, Henriette Svarre; Kolte, Astrid

    2006-01-01

    With respect to recurrent pregnancy loss (RPL), unfortunately there is very little consensus about which investigations are useful for identifying causes and evaluating the prognosis, and also about which treatments are effective. In this review, arguments are given for the claim that this lack...... background for most of the RPL cases and the importance of matching/adjusting for a series of prognostic variables when groups are mutually compared). Furthermore, many studies in RPL contain methodological flaws that are sometimes severe. A series of important epidemiological features of RPL is highlighted...... in the review and the most important methodological pitfalls, many of them specific for RPL research, are discussed. Advice is given about to how to avoid the pitfalls in order that the validity of the studies can improve for the benefit of the patients....

  9. Medical Abortion in Primary Care : Pitfalls and Benefits

    NARCIS (Netherlands)

    Boersma, A. A.; Meyboom-de Jong, B.

    2009-01-01

    We describe jive pitfalls of medical abortion: ectopic pregnancy not terminated after misoprostol, but without negative side-effects; long-term vaginal blood loss with suspicious retained products which disappeared spontaneously; a patient with uterus myomatatosus with severe pain and retained

  10. Parents' common pitfalls of discipline.

    Science.gov (United States)

    Witoonchart, Chatree; Fangsa-ard, Thitiporn; Chaoaree, Supamit; Ketumarn, Panom; Kaewpornsawan, Titawee; Phatthrayuttawat, Sucheera

    2005-11-01

    Problems of discipline are common among parents. These may be the results of the parents' pitfalls in disciplining their children. To find out common pitfalls of parents in disciplining their children. Parents of students with ages ranged between 60-72 months old in Bangkok-Noi district, Bangkok, were selected by random sampling. Total number of 1947 children ages between 60-72 months were recruited. Parents of these children were interviewed with a questionnaire designed to probe into problems in child rearing. There hindered and fifty questionnaires were used for data analyses. Parents had high concerns about problems in discipline their children and needed support from professional personnel. They had limited knowledge and possessed lots of wrong attitude towards discipline. Common pitfalls on the topics were problems in, 1) limit setting 2) rewarding and punishment 3) supervision on children watching TV and bedtime routines. Parents of children with ages 60-72 months old in Bangkok-Noi district, Bangkok, had several common pitfalls in disciplining their children, including attitude, knowledge and practice.

  11. The pitfalls of container production

    Science.gov (United States)

    Wayne Bell

    2013-01-01

    This paper summarizes ten of the biggest “pitfalls” or challenges I have encountered in my experience growing southern pine seedlings in containers over the past 30 years. Learning from challenges is an important part of growing successful nursery operations.

  12. Ultrasonography of the shoulder: pitfalls and variants

    International Nuclear Information System (INIS)

    Friedman, L.; Finlay, K.; Popowich, T.; Jurriaans, E.

    2002-01-01

    Ultrasonography (US) of the shoulder, particularly the evaluation of the rotator cuff, is the most common examination of the musculoskeletal system performed in most practices. Despite this, it remains one of the most difficult examinations to learn. There are many pitfalls and errors that can occur initially, but once mastered, US of the rotator cuff is one of the best methods available for diagnosing rotator cuff disease. The literature reports a 91%-95% sensitivity and close to 90% specificity and accuracy in the assessment of both partial and full thickness tears. This compares favourably with magnetic resonance imaging (MRI), where a more recent study reported an 84% sensitivity, 97% specificity and an accuracy of 93% for combined partial and full thickness tears of the rotator cuff. Advantages of US include low cost, easy access, high degree of accuracy in expert hands, ease of comparison with the opposite side, dynamic real-time examination, ability to focus on the exact site of the patient's pain and graded compression availability. It is for these reasons that we hope to outline the various pitfalls and common errors that can occur during the examination in a systematic fashion. It must also be pointed out that computed tomographic arthrography and magnetic resonance arthrography remain the investigations of choice for assessing labral disorders. (author)

  13. Pitfalls in multidetector row CT colonography

    International Nuclear Information System (INIS)

    Stoyneva, V.

    2009-01-01

    Full text:MDCT colonography is a reliable method for detection and identification of type of the colon lesions. At every step of the examination an error could be made and that would be lead to an incorrect diagnosis. Problems and pitfalls can be overcome with various useful techniques. The relatively clean and dry colon after careful preparation, allows avoiding problems of residual fluid and faeces. The knowledge about the structure and thickness characteristics of lesions of the colon and artefacts can to be useful in distinction of the polypoidal lesions from normal findings. The aim of this lecture is to describe common and less common pitfalls in CT colonography and to clarify features and CT criteria to distinction of organic formations from pseudo lesions. Inadequate preparation of the patient, weaknesses into the protocol, gaps and errors in interpretation are responsible for false positive and false negative results. The training which reduces the residual solids and liquid, marking, protocols elaboration and CAD allows achieving higher sensitivity and specificity. The 2D and 3D application techniques and solid knowledge about CT characteristic of the colon organic findings and pseudo lesions will reduce the rate of false positive results

  14. 75 FR 59720 - Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI)

    Science.gov (United States)

    2010-09-28

    ... GOVERNMENT ACCOUNTABILITY OFFICE Methodology Committee of the Patient-Centered Outcomes Research... responsibility for appointing not more than 15 members to a Methodology Committee of the Patient- Centered Outcomes Research Institute. In addition, the Directors of the Agency for Healthcare Research and Quality...

  15. Limitations and pitfalls of 99mTc-EDDA/HYNIC-TOC (Tektrotyd) scintigraphy.

    Science.gov (United States)

    Garai, Ildikó; Barna, Sandor; Nagy, Gabor; Forgacs, Attila

    2016-01-01

    Tektrotyd kit was developed by Polatom company for 99mTc labeling to make an alternative tracer of somatostatin receptor scintigraphy available. Since 2005, 99mTc-EDDA/HYNIC-Tyr3-Octreotide has been used in clinical imaging and achieved high impact in management of patients with neuroendocrine tumors. Knowing the limitations and pitfalls is essential to provide ac-curate diagnosis. Therefore, the potential pitfalls associated with the use of 99mTc-EDDA/HYNIC-TOC are reviewed on the basis of own experience. Data were analyzed of 310 patients who underwent somatostatin receptor scintigraphy with 99mTc-Tektrotyd. Pitfalls during radiolabeling process or acquisition can worsen the sensitivity of SRS (somatostatin receptor scintigraphy). Recognizing physi-ological and clinical pitfalls, the diagnostic accuracy will improve.

  16. Cannabidiol: Promise and Pitfalls

    OpenAIRE

    Welty, Timothy E.; Luebke, Adrienne; Gidal, Barry E.

    2014-01-01

    Over the past few years, increasing public and political pressure has supported legalization of medical marijuana. One of the main thrusts in this effort has related to the treatment of refractory epilepsy—especially in children with Dravet syndrome—using cannabidiol (CBD). Despite initiatives in numerous states to at least legalize possession of CBD oil for treating epilepsy, little published evidence is available to prove or disprove the efficacy and safety of CBD in patients with epilepsy....

  17. Avoiding Pitfalls in the Statistical Analysis of Heterogeneous Tumors

    Directory of Open Access Journals (Sweden)

    Judith-Anne W. Chapman

    2009-01-01

    Full Text Available Information about tumors is usually obtained from a single assessment of a tumor sample, performed at some point in the course of the development and progression of the tumor, with patient characteristics being surrogates for natural history context. Differences between cells within individual tumors (intratumor heterogeneity and between tumors of different patients (intertumor heterogeneity may mean that a small sample is not representative of the tumor as a whole, particularly for solid tumors which are the focus of this paper. This issue is of increasing importance as high-throughput technologies generate large multi-feature data sets in the areas of genomics, proteomics, and image analysis. Three potential pitfalls in statistical analysis are discussed (sampling, cut-points, and validation and suggestions are made about how to avoid these pitfalls.

  18. Advantages and pitfalls of South Africa-Angola strategic alliances

    Directory of Open Access Journals (Sweden)

    A. J. Vogel

    2010-12-01

    Full Text Available Purpose: Owing to a shortage of South African research focusing on international strategic alliances, this study aimed to determine whether the advantages and pitfalls of international strategic alliances referred to in international business publications are also applicable to South African international strategic alliances. Design/Methodology/Approach: This was a formal, empirical study that targeted the 163 South African enterprises which were members of the South African-Angolan Chamber of Commerce in 2005 and 2006. Findings: The results identified joint ventures as the most prominent mode of entry when expanding into developing countries and, with few exceptions, the findings support the advantages and pitfalls of international strategic alliances identified in other international publications. Value of the research: A great deal of international management research over the years has been focused on the importance of strategic alliances as a mode of entry, as well as on the pitfalls experienced by alliance partners, particularly in developed countries. However, the lack of such research in Africa in general and South Africa in particular means that South African enterprises must base their entry mode selection on non-South African research findings, and although this sample size was small, the lack of other Africa-specific research makes this research significant. Implications: With South Africa being the largest source of FDI into the rest of Africa, the findings of this paper show that South African enterprises can attain the advantages associated with international strategic alliances when using this mode of entry into Africa. In terms of pitfalls, the findings highlight the need for multinational enterprises to pay specific attention to the role of governments when forming strategic alliances.

  19. Cannabidiol: promise and pitfalls.

    Science.gov (United States)

    Welty, Timothy E; Luebke, Adrienne; Gidal, Barry E

    2014-09-01

    Over the past few years, increasing public and political pressure has supported legalization of medical marijuana. One of the main thrusts in this effort has related to the treatment of refractory epilepsy-especially in children with Dravet syndrome-using cannabidiol (CBD). Despite initiatives in numerous states to at least legalize possession of CBD oil for treating epilepsy, little published evidence is available to prove or disprove the efficacy and safety of CBD in patients with epilepsy. This review highlights some of the basic science theory behind the use of CBD, summarizes published data on clinical use of CBD for epilepsy, and highlights issues related to the use of currently available CBD products. Cannabidiol is the major nonpsychoactive component of Cannabis sativa. Over the centuries, a number of medicinal preparations derived from C. sativa have been employed for a variety of disorders, including gout, rheumatism, malaria, pain, and fever. These preparations were widely employed as analgesics by Western medical practitioners in the 19(th) century (1). More recently, there is clinical evidence suggesting efficacy in HIV-associated neuropathic pain, as well as spasms associated with multiple sclerosis (1).

  20. The seven common pitfalls of customer service in hospitals.

    Science.gov (United States)

    Domingo, Rene T

    2015-01-01

    Operating simultaneously like a repair shop, prison, and hotel, hospitals are prone to seven common pitfalls in customer service. Patient care is often fragmented, inscrutable, inflexible, insensitive, reactive, myopic, and unsafe. Hospitals are vying to be more high-tech, rather than high-touch even though staff engagement with patients rather than facilities and equipment strongly influence patient satisfaction. Unless processes, policies, and people are made customer-centered, the high quality of the hospital's human and hardware resources will not translate into high patient satisfaction and patient loyalty.

  1. Myasthenia Gravis: Unusual Presentations and Diagnostic Pitfalls.

    Science.gov (United States)

    Rodolico, Carmelo; Parisi, Daniela; Portaro, Simona; Biasini, Fiammetta; Sinicropi, Stefano; Ciranni, Annamaria; Toscano, Antonio; Messina, Sonia; Musumeci, Olimpia; Vita, Giuseppe; Girlanda, Paolo

    2016-08-30

    Myasthenia gravis (MG) is an autoimmune disorder presenting with fluctuating, fatigable muscle weakness. Initial symptoms classically involve ocular and proximal limb muscles. Rarely, MG may onset with unusual features, so it can be misdiagnosed with other neuromuscular diseases. To describe unusual and atypical presentations of MG in a large cohort of patients, considering and discussing diagnostic difficulties and pitfalls. We report on 21 out of 508 MG patients, coming to our department in the last 27 years and presenting with atypical or unusual features. The diagnosis was achieved performing a careful clinical examination, a proper neurophysiological assessment, the neostigmine test, the AChR and MuSK antibodies assay and chest CT-scan. Patients with atypical/unusual MG onset were the 4.4% of all MG patients population. We describe seven different clinical categories: asymmetric distal upper limbs weakness, foot drop, isolated triceps brachii weakness and foot drop, post exertional axial weakness with dropped head, acute facial dyplegia, limb-girdle MG and MG with sudden lower limbs weakness and recurrent falls. Atypical and unusual presentations may increase the risk to misdiagnose or delay MG diagnosis. Isolated limb-girdle presentation is the most frequent atypical form in our series.

  2. METHODOLOGY OF PROSTHETIC TREATMENT IN PATIENTS WITH MAXILLECTOMY

    Directory of Open Access Journals (Sweden)

    Ivan Gerdzhikov

    2018-06-01

    Full Text Available Aim: The aim of the described method is to present the main stages in the prosthetic treatment with hollow bulb obturator, which provides optimum defect hermetization and restoration of the damaged functions. Materials and methods: The clinical case, described is on a 70-years-old patient with edentulous jaws and maxillary defect in the right half of the upper jaw. The preliminary impressions were taken with irreversible hydrocolloid impression material, and the final impressions were taken with additive silicone material. The occlusion height and the centric relations were registered as the classical technique. After the successful trial denture appointment, the surface of the plaster master model was covered by isolation polish. After this procedure, the master model was covered by even wax layer with 5mm thickness. It was designed to be thinner in the area of the resection line. The designed cavity was filled in with silicone impression material and covered with the folio. The base plate with the arranged teeth was fixed to the model, packed in the cuvette and finished from heat-cured acrylic resin with low quantity of residual monomer. After the polymerization process, the silicone material was removed, and the obturators cap was fixed to the denture’s base plate with cold cured acrylic resin. The obturator and the complete denture of the mandible were adjusted and articulated in patient’s mouth in the final clinical stage. Results: The applied prosthetic method allowed successful defect hermetization and helped for the restoration of the speech, feeding and patient’s self-esteem. Conclusion: Prosthetic rehabilitation of patients with maxillary resection is possible only with the application of specific treatment methods.

  3. Avoiding pitfalls in interdisciplinary education

    DEFF Research Database (Denmark)

    Holt, R. E.; Woods, P. J.; Ferreira, Ana Sofia

    2017-01-01

    education, illustrating approaches towards solutions using the Nordic Centre for Research on Marine Ecosystems and Resources under Climate Change (NorMER) research network as a case study. We provide insights and detailed examples of how to overcome some of the challenges of conducting interdisciplinary......As the world’s social-environmental problems increasingly extend across boundaries, both disciplinary and political, there is a growing need for interdisciplinarity, not only in research per se, but also in doctoral education. We present the common pitfalls of interdisciplinary research in doctoral...... research within doctoral studies that can be applied within any doctoral/postdoctoral education programme, and beyond. Results from a selfevaluation survey indicate that early-career workshops, annual meetings and research visits to other institutions were the most effective learning mechanisms, whereas...

  4. Spins, Stalls, and Shutdowns: Pitfalls of Qualitative Policing and Security Research

    Directory of Open Access Journals (Sweden)

    Randy K. Lippert

    2015-11-01

    Full Text Available This article explores key elements of qualitative research on policing and security agencies, including barriers encountered and strategies to prevent them. While it is oft-assumed that policing/security agencies are difficult to access due to their clandestine or bureaucratic nature, this article demonstrates this is not necessarily the case, as access was gained for three distinct qualitative research projects. Yet, access and subsequent research were not without pitfalls, which we term security spins, security stalls, and security shutdowns. We illustrate how each was encountered and argue these pitfalls are akin to researchers falling into risk categories, not unlike those used by policing/security agents in their work. Before concluding we discuss methodological strategies for scholars to avoid these pitfalls and to advance research that critically interrogates the immense policing/security realm. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1601108

  5. Notes on methodology and pitfalls in science and research and on communication of results. Some aspects related to EMF; Synpunkter paa metodik och fallgropar inom vetenskap och forskning samt hur resultaten kommuniceras. Naagra aspekter relaterade till EMF

    Energy Technology Data Exchange (ETDEWEB)

    Cedervall, Bjoern (Unit of Med. Radiation Physics and Med. Radiation Biology, Dept. Oncology and Pathology, Karolinska Inst., Stockholm (Sweden))

    2009-06-15

    There are many aspects of the controversy around EMF and potential risks that are largely unknown to the wider audience. Such aspects form the basis for the topics discussed in this report. More specifically focus has been on arguments related to possible cause-effect where linguistic barriers and societal 'filters' (for instance by uncritical media) may constitute a problem. Regardless of whether scientists are working with for example molecular biology or epidemiology they are confronted with a number of methodological problems that may be difficult or even impossible to master. Such difficulties are seldom seen in press releases, news media and so on but they may still be part of many scientists' daily challenges. The most difficult communication challenge is probably that if something is absolutely safe it cannot be proven. An unknown virus, bacterium, or chemical contaminant may completely ruin experiments in a molecular biology experiment but at least the experiments can be repeated and often measures can be taken once such a contamination has been found. For epidemiological studies there is always a specific challenge in that the investigations cannot be repeated as people never do the same things under the same conditions and in a predictable manner. It is with this background and context that the author has chosen to treat some methodological problems in science as well as the so-called Hill's criteria for cause-effects. A shorter comment has been made with reference to various aspects of the precautionary principle as it is often referred to in the EMF debate but most often, however, it has seldom been clarified what is meant by precautionary practices or actions. Precaution is closely related to human fear and therefore a corresponding chapter has been included. This report ends with a few looks into the historical rear-view mirror which illuminates the anticipated benefits with the invisible and mystical rather than the potential

  6. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution.

    Science.gov (United States)

    Cooper, Zara; Courtwright, Andrew; Karlage, Ami; Gawande, Atul; Block, Susan

    2014-12-01

    To provide a description of communication breakdowns and to identify interventions to improve surgical decision making for elderly patients with serious illness and acute, life-threatening surgical conditions. Communication between surgeons, patients, and surrogates about goals of treatment plays an important and understudied role in determining the surgical interventions elderly patients with serious illness receive. Communication breakdowns may lead to nonbeneficial procedures in acute events near the end of life. We review the available literature on factors that lead to communication challenges and nonbeneficial surgery at the end of life. We use this review to identify solutions for navigating surgical decision making for seriously ill elderly patients with acute surgical conditions. Surgeon, patient, surrogate, and systemic factors-including time constraints, inadequate provider communication skills and training, uncertainty about prognosis, patient and surrogate anxiety and fear of inaction, and limitations in advance care planning-contribute to communication challenges and nonbeneficial surgery at the end of life. Surgeons could accomplish more effective communication with seriously ill elderly patients if they had a structured, standardized approach to exploring patients' preferences and to integrating those preferences into surgical decisions in the acute setting. Improved communication among surgeons, patients, and surrogates is necessary to ensure that patients receive the care that they want and to avoid nonbeneficial treatment. Further research is needed to learn how to best structure these conversations in the emergency surgical setting.

  7. Gallium uptake in myositis ossificans. Potential pitfalls in diagnosis

    International Nuclear Information System (INIS)

    Salzman, L.; Lee, V.W.; Grant, P.

    1987-01-01

    Seven cases of gallium uptake in myositis ossificans are described. Gallium scans are done frequently in paraplegics, quadriplegics, and comatose patients to look for occult infection. It is important to be aware of possible gallium uptake in myositis ossificans, particularly in the extremities, which is frequent in these patients. Gallium uptake may be present prior to any abnormalities seen on plain films or CT scans. It is important to correlate roentgenograms with abnormal gallium scans, particularly in the extremities, to avoid potential pitfalls in diagnosis and prevent unnecessary antibiotic treatment. A bone scan should be obtained whenever possible, particularly when roentgenograms are negative, to confirm the diagnosis

  8. Assessment of seasonal influenza vaccine effectiveness in patients from a central Italy reference hospital: pitfalls and intricacies from a pilot case-control study

    Directory of Open Access Journals (Sweden)

    Katleen de Gaetano Donati

    2014-07-01

    Full Text Available Objectives: Influenza vaccination protects high-risk populations from severe outcomes. We assessed the feasibility of testing influenza vaccine effectiveness against hospitalization with laboratory-confirmed influenza.Methods: All hospitalized patients with influenza-like illness within 14 days, were swabbed. Cases were positive at RT-PCR for influenza A/B. Results: AtRome “GemelliHospital” (Season 2011-2012 104 patients were contacted and 62 recruited. Considering total sample and target group (n= 47, 76%, only 29% and 38% had been vaccinated. Eighteen patients were laboratory-confirmed for influenza.Conclusions: RecruitedILI patients and prevalence of vaccinated subjects were less than expected. Larger numbers are warranted to study vaccine effectiveness against severe influenza outcomes.  

  9. Methodology of clinical measures of healthcare quality delivered to patients with cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Posnenkova O.M.

    2014-03-01

    Full Text Available The results of implementation the methodology proposed by American Colleague of Cardiology and American Heart Association (ACC/AHA for development of Russian clinical quality measures for patients with arterial hypertension, coronary heart disease and chronic heart failure. Created quality measures cover the key elements of medical care influencing directly on clinical outcomes of treatment.

  10. A systematic review of the methodology of telemedicine evaluation in patients with postural and movement disorders

    NARCIS (Netherlands)

    Huis in 't Veld, M.H.A.; van Dijk, H; Hermens, Hermanus J.; Vollenbroek-Hutten, Miriam Marie Rosé

    2006-01-01

    We reviewed the methodology used in telemedicine research concerning patients with postural and movement disorders. Literature searches were performed using various computerized databases through to October 2005. Twenty-two studies met the criteria for review. Two broad models of telemedicine

  11. Pitfalls in magnetic resonance imaging of the hip; ``Pitfalls`` in der Kernspintomographie der Hueftgelenke

    Energy Technology Data Exchange (ETDEWEB)

    Schedel, H [Strahlenklinik und Poliklinik, Universtaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Wicht, L [Strahlenklinik und Poliklinik, Universtaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Kern, A [Strahlenklinik und Poliklinik, Universtaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Vogl, T [Strahlenklinik und Poliklinik, Universtaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Felix, R [Strahlenklinik und Poliklinik, Universtaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

    1994-12-31

    In the differential diagnosis of unspecific hip pain MRI becomes increasing importance. In particular it is useful in the diagnosis of avascular necrosis, primary and secondary bone tumors, osteomyelitis and synovial processes. According to the higher frequence of MR-examinations of the hip the number of nonpathological incidental findings rises. These `pitfalls` which were found in MRI of 152 patients with unspecific hip pain are demonstrated. Soft tissue penetrating cortical lesions of the femoral neck (herniation pit), physiological changes of bone marrow, synovial proliferation of the hip capsule, epiphyseal scares of the femoral head and the transient osteoporosis are some of the morphological changes of the hip, which may cause difficulties and misinterpretations in MRI of the hip. The knowledge of their radiological characteristics in MRI is important, especially in cases of unspecific hip pain. (orig.) [Deutsch] Die Magnetresonanztomographie gewinnt bei der Differentialdiagnose unspezifischer Hueftbeschwerden zunehmend an Bedeutung. Vor allem die avaskulaere Hueftkopfnekrose, primaere und sekundaere Knochentumoren, Osteomyelitis und synoviale Prozesse lassen sich kernspintomographisch gut differenzieren. Durch den haeufigeren Einsatz der Kernspintomographie im Hueftbereich werden aber auch vermehrt morphologische Veraenderungen nichtpathologischer Genese gefunden, die als physiologische Normvarianten bzw. benigne Veraenderungen von pathologischen Befunden abzugrenzen sind. In dieser Arbeit werden die bei der kernspintomographischen Untersuchung von 152 Patienten mit unklaren Hueftschmerzen gefundenen `pitfalls` vorgestellt. Durch kortikale Defekte des Schenkelhalses penetrierendes Weichteilgewebe (herniation pit), physiologische Knochenmarksveraenderungen der Acetabulum- und Femurregion, synoviale Proliferationen der Hueftgelenkskapsel, epiphysaere Narben des Femurkopfes und die transitorische Osteoporose sind einige der morphologischen Veraenderungen im

  12. Diffusion-weighted MRI to assess response to chemoradiotherapy in rectal cancer: main interpretation pitfalls and their use for teaching

    Energy Technology Data Exchange (ETDEWEB)

    Lambregts, Doenja M.J.; Lahaye, Max J.; Maas, Monique [The Netherlands Cancer Institute, Department of Radiology, Amsterdam (Netherlands); Heeswijk, Miriam M. van [The Netherlands Cancer Institute, Department of Radiology, Amsterdam (Netherlands); Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Delli Pizzi, Andrea [Gabriele d' Annunzio University, SS. Annunziate Hospital, Department of Neuroscience and Imaging, Chieti (Italy); Elderen, Saskia G.C. van [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Andrade, Luisa [Hospitais da Universidade de Coimbra, Department of Radiology, Coimbra (Portugal); Peters, Nicky H.G.M.; Osinga-de Jong, Margreet [Zuyderland Medical Center, location Heerlen, Heerlen (Netherlands); Kint, Peter A.M. [Amphia Hospital, Department of Radiology, Breda (Netherlands); Bipat, Shandra [Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Ooms, Rik [Maxima Medical Centre, Department of Radiology, Eindhoven-Veldhoven (Netherlands); Beets, Geerard L. [The Netherlands Cancer Institute, Department of Surgery, Amsterdam (Netherlands); Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Bakers, Frans C.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Beets-Tan, Regina G.H. [The Netherlands Cancer Institute, Department of Radiology, Amsterdam (Netherlands); Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht (Netherlands)

    2017-10-15

    To establish the most common image interpretation pitfalls for non-expert readers using diffusion-weighted imaging (DWI) to assess response to chemoradiotherapy in patients with rectal cancer and to explore the use of these pitfalls in an expert teaching setting. Two independent non-expert readers (R1 and R2) scored the restaging DW MRI scans (b1,000 DWI, in conjunction with ADC maps and T2-W MRI scans for anatomical reference) in 100 patients for the likelihood of a complete response versus residual tumour using a five-point confidence score. The readers received expert feedback and the final response outcome for each case. The supervising expert documented any potential interpretation errors/pitfalls discussed for each case to identify the most common pitfalls. The most common pitfalls were the interpretation of low signal on the ADC map, small susceptibility artefacts, T2 shine-through effects, suboptimal sequence angulation and collapsed rectal wall. Diagnostic performance (area under the ROC curve) was 0.78 (R1) and 0.77 (R2) in the first 50 patients and 0.85 (R1) and 0.85 (R2) in the final 50 patients. Five main image interpretation pitfalls were identified and used for teaching and feedback. Both readers achieved a good diagnostic performance with an AUC of 0.85. (orig.)

  13. Diffusion-weighted MRI to assess response to chemoradiotherapy in rectal cancer: main interpretation pitfalls and their use for teaching

    International Nuclear Information System (INIS)

    Lambregts, Doenja M.J.; Lahaye, Max J.; Maas, Monique; Heeswijk, Miriam M. van; Delli Pizzi, Andrea; Elderen, Saskia G.C. van; Andrade, Luisa; Peters, Nicky H.G.M.; Osinga-de Jong, Margreet; Kint, Peter A.M.; Bipat, Shandra; Ooms, Rik; Beets, Geerard L.; Bakers, Frans C.H.; Beets-Tan, Regina G.H.

    2017-01-01

    To establish the most common image interpretation pitfalls for non-expert readers using diffusion-weighted imaging (DWI) to assess response to chemoradiotherapy in patients with rectal cancer and to explore the use of these pitfalls in an expert teaching setting. Two independent non-expert readers (R1 and R2) scored the restaging DW MRI scans (b1,000 DWI, in conjunction with ADC maps and T2-W MRI scans for anatomical reference) in 100 patients for the likelihood of a complete response versus residual tumour using a five-point confidence score. The readers received expert feedback and the final response outcome for each case. The supervising expert documented any potential interpretation errors/pitfalls discussed for each case to identify the most common pitfalls. The most common pitfalls were the interpretation of low signal on the ADC map, small susceptibility artefacts, T2 shine-through effects, suboptimal sequence angulation and collapsed rectal wall. Diagnostic performance (area under the ROC curve) was 0.78 (R1) and 0.77 (R2) in the first 50 patients and 0.85 (R1) and 0.85 (R2) in the final 50 patients. Five main image interpretation pitfalls were identified and used for teaching and feedback. Both readers achieved a good diagnostic performance with an AUC of 0.85. (orig.)

  14. Using soft systems methodology to develop a simulation of out-patient services.

    Science.gov (United States)

    Lehaney, B; Paul, R J

    1994-10-01

    Discrete event simulation is an approach to modelling a system in the form of a set of mathematical equations and logical relationships, usually used for complex problems, which are difficult to address by using analytical or numerical methods. Managing out-patient services is such a problem. However, simulation is not in itself a systemic approach, in that it provides no methodology by which system boundaries and system activities may be identified. The investigation considers the use of soft systems methodology as an aid to drawing system boundaries and identifying system activities, for the purpose of simulating the outpatients' department at a local hospital. The long term aims are to examine the effects that the participative nature of soft systems methodology has on the acceptability of the simulation model, and to provide analysts and managers with a process that may assist in planning strategies for health care.

  15. Methodological issues and pitfalls of short safety culture questionnaires

    NARCIS (Netherlands)

    Jagtman, H.M.; Koornneef, F.; Akselsson, R.; Stewart, S.

    2013-01-01

    Safety culture surveys have been fielded in many different sectors of industrial activities. Many of these surveys consist of a long list of questions which is time consuming for the respondents. As part of the FP6 HILAS project a shorter survey has been developed, which aimed at getting a high

  16. Early recovery of circulating immature B cells in B-lymphoblastic leukemia patients after CD19 targeted CAR T cell therapy: A pitfall for minimal residual disease detection.

    Science.gov (United States)

    Xiao, Wenbin; Salem, Dalia; McCoy, Catharine S; Lee, Daniel; Shah, Nirali N; Stetler-Stevenson, Maryalice; Yuan, Constance M

    2017-09-09

    CD19-targeted chimeric-antigen receptor-modified T-cells (CAR-T) are promising in the treatment of refractory B-lymphoblastic leukemia (B-ALL). Minimal residual disease (MRD) detection by multicolor flow cytometry (FCM) is critical to distinguish B-ALL MRD from regenerating, non-neoplastic B-cell populations. FCM was performed on samples from 9 patients with B-ALL treated with CAR-T. All 9 patients showed response to CAR-T. Additionally, FCM revealed circulating CD10 + B cells, potentially mimicking MRD. Circulating CD10+ B-cells were detected in blood from 3 days to 3 months after CAR-T, comprising 73% (median) of B-cells (52-83%, 95%CI). They expressed CD19, CD10, CD20, bright CD9, CD22, CD24, moderate CD38 and dim CD58, but were CD34 (-), with bright CD45 and polyclonal surface light chain immunoglobulin (sIg) expression. A similar CD10 + B-cell subpopulation was detected by marrow FCM, amidst abundant B-cell precursors. These circulating CD10 + B-cells are compatible with immature B-cells, and are a reflection of B-cell recovery within the marrow. They are immunophenotypically distinguishable from residual B-ALL. Expression of light chain sIg and key surface antigens characterizing regenerating B-cell precursors can distinguish immature B-cells from B-ALL MRD and prevent misdiagnosis. © 2017 International Clinical Cytometry Society. © 2017 International Clinical Cytometry Society.

  17. Patient-centered outcomes research in radiology: trends in funding and methodology.

    Science.gov (United States)

    Lee, Christoph I; Jarvik, Jeffrey G

    2014-09-01

    The creation of the Patient-Centered Outcomes Research Trust Fund and the Patient-Centered Outcomes Research Institute (PCORI) through the Patient Protection and Affordable Care Act of 2010 presents new opportunities for funding patient-centered comparative effectiveness research (CER) in radiology. We provide an overview of the evolution of federal funding and priorities for CER with a focus on radiology-related priority topics over the last two decades, and discuss the funding processes and methodological standards outlined by PCORI. We introduce key paradigm shifts in research methodology that will be required on the part of radiology health services researchers to obtain competitive federal grant funding in patient-centered outcomes research. These paradigm shifts include direct engagement of patients and other stakeholders at every stage of the research process, from initial conception to dissemination of results. We will also discuss the increasing use of mixed methods and novel trial designs. One of these trial designs, the pragmatic trial, has the potential to be readily applied to evaluating the effectiveness of diagnostic imaging procedures and imaging-based interventions among diverse patient populations in real-world settings. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  18. Disseminated Acanthamoeba Infection Presenting With Cutaneous Lesions in an Immunocompromised Patient: A Case Report, Review of Histomorphologic Findings, and Potential Diagnostic Pitfalls.

    Science.gov (United States)

    Morrison, Annie O; Morris, Robert; Shannon, Amie; Lauer, Scott R; Guarner, Jeannette; Kraft, Colleen S

    2016-02-01

    Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights. A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation. The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two well-demarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalin-fixed, paraffin-embedded tissue. Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of free-living amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Attitudes towards medication non-adherence in elderly kidney transplant patients: A Q methodology study

    OpenAIRE

    Moors-Tielen, Mirjam; Exel, Job; Buren, M.C.; Maasdam, L.; Weimar, Willem

    2011-01-01

    textabstractBackground. Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing population of elderly kidney recipients.Methods. Q methodology was used to explore attitude profiles. Participants (> 65 years) were asked to rank-order opinion statements on issues associated with (non-)ad...

  20. Self-administration of cocaine, cannabis and heroin in the human laboratory: benefits and pitfalls

    OpenAIRE

    Haney, Margaret

    2008-01-01

    The objective of this review is to describe self-administration procedures for modeling addiction to cocaine, cannabis and heroin in the human laboratory, the benefits and pitfalls of the approach, and the methodological issues unique to each drug. In addition, the predictive validity of the model for testing treatment medications will be addressed. The results show that all three drugs of abuse are reliably and robustly self-administered by non-treatment-seeking research volunteers. In terms...

  1. The neuroaesthetics of prose fiction: pitfalls, parameters and prospects.

    Science.gov (United States)

    Burke, Michael

    2015-01-01

    There is a paucity of neuroaesthetic studies on prose fiction. This is in contrast to the very many impressive studies that have been conducted in recent times on the neuroaesthetics of sister arts such as painting, music and dance. Why might this be the case, what are its causes and, of greatest importance, how can it best be resolved? In this article, the pitfalls, parameters and prospects of a neuroaesthetics of prose fiction will be explored. The article itself is part critical review, part methodological proposal and part opinion paper. Its aim is simple: to stimulate, excite and energize thinking in the discipline as to how prose fiction might be fully integrated in the canon of neuroaesthetics and to point to opportunities where neuroimaging studies on literary discourse processing might be conducted in collaborative work bringing humanists and scientists together.

  2. Methodological Challenges in Examining the Impact of Healthcare Predictive Analytics on Nursing-Sensitive Patient Outcomes.

    Science.gov (United States)

    Jeffery, Alvin D

    2015-06-01

    The expansion of real-time analytic abilities within current electronic health records has led to innovations in predictive modeling and clinical decision support systems. However, the ability of these systems to influence patient outcomes is currently unknown. Even though nurses are the largest profession within the healthcare workforce, little research has been performed to explore the impact of clinical decision support on their decisions and the patient outcomes associated with them. A scoping literature review explored the impact clinical decision support systems containing healthcare predictive analytics have on four nursing-sensitive patient outcomes (pressure ulcers, failure to rescue, falls, and infections). While many articles discussed variable selection and predictive model development/validation, only four articles examined the impact on patient outcomes. The novelty of predictive analytics and the inherent methodological challenges in studying clinical decision support impact are likely responsible for this paucity of literature. Major methodological challenges include (1) multilevel nature of intervention, (2) treatment fidelity, and (3) adequacy of clinicians' subsequent behavior. There is currently insufficient evidence to demonstrate efficacy of healthcare predictive analytics-enhanced clinical decision support systems on nursing-sensitive patient outcomes. Innovative research methods and a greater emphasis on studying this phenomenon are needed.

  3. SCIRehab uses practice-based evidence methodology to associate patient and treatment characteristics with outcomes.

    Science.gov (United States)

    Whiteneck, Gale G; Gassaway, Julie

    2013-04-01

    To describe the application of practice-based evidence (PBE) methodology to spinal cord injury (SCI) rehabilitation in the SCIRehab study, and to summarize associations of patient characteristics and treatment interventions to outcomes. Prospective observational study. Six SCI rehabilitation centers. Patients with traumatic SCI (N=1376) admitted for first rehabilitation. Not applicable. FIM and residence at discharge, and FIM, residence, Craig Handicap Assessment and Reporting Technique, work/school status, Patient Health Questionnaire-9, Diener Satisfaction with Life Scale, rehospitalization, and presence of pressure ulcers at 1 year postinjury. Patient demographic and injury characteristics explained significant variation in rehabilitation outcomes, particularly functional outcomes. Regression modeling also identified a large number of significant associations with outcomes when total time in each discipline was modeled and when models were developed for each discipline, examining time spent in the many specific interventions provided by each discipline. The application of PBE methodology in the SCIRehab study provided extensive information about the process of inpatient SCI rehabilitation. While patient demographic and injury characteristics explain substantial variation in rehabilitation outcomes, particularly functional outcomes, significant relations also were found between the type and quantity of treatment interventions delivered by each rehabilitation discipline and a broad range of outcomes. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Medical Prescription Pitfalls of Uncomplicated Urinary Tract ...

    African Journals Online (AJOL)

    Objectives: The aim of this evaluation was to identify pitfalls in medical prescriptions of uncomplicated urinary tract infections in government healthcare facilities in Zambia. Design: This was a cross sectional and government healthcare facilities were conveniently sampled. Main outcome measures: Rate of compliance to ...

  5. Pearls and pitfalls in neural CGRP immunohistochemistry

    DEFF Research Database (Denmark)

    Warfvinge, Karin; Edvinsson, Lars

    2013-01-01

    This review outlines the pearls and pitfalls of calcitonin-gene related protein (CGRP) immunohistochemistry of the brain. PEARLS: In 1985, CGRP was first described in cerebral arteries using immunohistochemistry. Since then, cerebral CGRP (and, using novel antibodies, its receptor components) has...

  6. The Effects of FOCUS-PDCA Methodology on Emergency Department Patient Disposition Index

    Directory of Open Access Journals (Sweden)

    Hossien Jabbari beirami

    2015-05-01

    Full Text Available Introduction: Hospital emergency is an important and unique department and prolonged stay of the patients in this ward leads to a decrease in the ability to serve other patients in need. Therefore, this study aimed to evaluate the ability of FOCUS-PDCA methodology to decrease waiting time of the procedures and improve index of decision-making within 6 hours in emergency department (ED. Methods: In this interventional before-after study, the effect of FOCUS-PDCA methodology on waiting time of the procedures and decision-making was evaluated in the ED of Sina Hospital, Tabriz, Iran in a 5-month period. Initially, a team of procedure definers defined the problematic procedures and suggested practical solutions to relieve them. Then, these solutions were practiced using appropriate programming, and finally the effects of these measures were analyzed using SPSS version 11.5 and independent t-test. Results: 5 months after intervention, mean waiting time for receiving consultation was reduced from 28.1 to 17 minutes (p < 0.001 and mean time for the results of a laboratory test to be ready was reduced from 70.26 to 37.66 minutes (p = 0.006. The number of patients who stayed in the ED for more than 6 hours, which was 101 in April, decreased to 52 in November (p = 0.002. The index of patient disposition in less than 6 hours increased from 94.71% in April to 96.87% in November. Conclusion: Based on the results of this study, it seems that carrying out FOCUS-PDCA methodology can decrease waiting time of the procedures and improve patient disposition index in the ED.

  7. Pitfalls in �Biblical� leadership

    Directory of Open Access Journals (Sweden)

    Volker Kessler

    2013-02-01

    Full Text Available This article is about the pitfalls involved in writing a Christian handbook on leadership. By analysing some elements of the Rule of Benedict it is argued that it is impossible to write such a handbook without using non-Biblical sources. Moreover, there are typical pitfalls when authors attempt to develop a pure Biblical leadership theory. The first pitfall is typical of Christians representing Niebuhr�s type of �Christ against Culture�. As early as 1951, Niebuhr claimed that in the field of leadership in particular the radical exclusive Christians reintroduced rules from non-Christian cultures. Examples from the last decade support Niebuhr�s observation. The second pitfall, referred to as reconstruction, is typical of those authors who are open to secular sources but who seek to give Biblical evidence for their leadership theory. This pitfall is illustrated by analysing the process in which the secular concepts of transforming leadership and vision statements found their way into evangelical books on Christian leadership. Reconstruction typically consists of four steps: Perception (a secular model of leadership becomes popular, Acceptance (this model is examined and accepted for the context of the church Assimilation (it is claimed that leaders in the Bible worked exactly as described in the model, books are written about Biblical leadership, exemplifying the model. The secular source becomes obsolete. and Standardisation (this model of leadership is declared to be the Biblical norm for every Christian leader. I argue that step 3 is at least problematic and step 4 is a fatal error.

  8. The influence of patient portals on users' decision making is insufficiently investigated: A systematic methodological review.

    Science.gov (United States)

    Fraccaro, Paolo; Vigo, Markel; Balatsoukas, Panagiotis; Buchan, Iain E; Peek, Niels; van der Veer, Sabine N

    2018-03-01

    Patient portals are considered valuable conduits for supporting patients' self-management. However, it is unknown why they often fail to impact on health care processes and outcomes. This may be due to a scarcity of robust studies focusing on the steps that are required to induce improvement: users need to effectively interact with the portal (step 1) in order to receive information (step 2), which might influence their decision-making (step 3). We aimed to explore this potential knowledge gap by investigating to what extent each step has been investigated for patient portals, and explore the methodological approaches used. We performed a systematic literature review using Coiera's information value chain as a guiding theoretical framework. We searched MEDLINE and Scopus by combining terms related to patient portals and evaluation methodologies. Two reviewers selected relevant papers through duplicate screening, and one extracted data from the included papers. We included 115 articles. The large majority (n = 104) evaluated aspects related to interaction with patient portals (step 1). Usage was most often assessed (n = 61), mainly by analysing system interaction data (n = 50), with most authors considering participants as active users if they logged in at least once. Overall usability (n = 57) was commonly assessed through non-validated questionnaires (n = 44). Step 2 (information received) was investigated in 58 studies, primarily by analysing interaction data to evaluate usage of specific system functionalities (n = 34). Eleven studies explicitly assessed the influence of patient portals on patients' and clinicians' decisions (step 3). Whereas interaction with patient portals has been extensively studied, their influence on users' decision-making remains under-investigated. Methodological approaches to evaluating usage and usability of portals showed room for improvement. To unlock the potential of patient portals, more (robust) research

  9. Methodology for comprehensive patient, worker and public radiation protection considerations while introducing new medical procedures

    International Nuclear Information System (INIS)

    Neeman, E.; Keren, M.

    2001-01-01

    Patient protection is a major consideration while introducing new medical procedure. But protection of the workers and the public should be considered too. A methodology of combining non-patient radiation protection considerations with the introduction of new medical procedures is described. The new medical procedure was the Intracoronary Gamma Irradiation for the Prevention of Restenosis by using Iridium 192 gamma radiation sources. The usual authors' responsibility is the licensing of the use of radioactive materials while keeping public protection. According to this responsibility, the methodology's original orientation is public protection. As a result of coordination between several competent authorities, managed by the authors, the methodology was adopted for patient and worker protection too. Applicants, actually possible users (hospitals) of the new procedure, were obliged to plan medical procedures and working area according to dose limits and constrains as recommended by the International Atomic Energy Agency and local competent authorities. Exposure calculations had to consider the usual parameters as sources types and activity, dose rate and dose levels, duration and number of treatments. Special attention was given to the presence workers and public by chance presence in or near treatment area. A usual condition to give a license was the installation of continuous (during treatment) radiation monitoring systems. But a special attention was given to physical barriers and procedures in order to stop unauthorized personal to arrive near to working area. Satisfactory staff training for normal operation and emergency situations are essential, including appropriate safety procedures and the presence of safety assistance team while executing treatment. (author)

  10. Human rhabdomyosarcoma cell lines for rhabdomyosarcoma research: Utility and pitfalls

    Directory of Open Access Journals (Sweden)

    Ashley R.P. Hinson

    2013-07-01

    Full Text Available Rhabdomyosarcoma (RMS is the most common soft tissue sarcoma of childhood and adolescence. Despite intergroup clinical trials conducted in Europe and North America, outcomes for high risk patients with this disease have not significantly improved in the last several decades, and survival of metastatic or relapsed disease remains extremely poor. Accrual into new clinical trials is slow and difficult, so in vitro cell line research and in vivo xenograft models present an attractive alternative for preclinical research for this cancer type. Currently, 30 commonly used human RMS cell lines exist, with differing origins, karyotypes, histologies, and methods of validation. Selecting an appropriate cell line for RMS research has important implications for outcomes. There are also potential pitfalls in using certain cell lines including contamination with murine stromal cells, cross-contamination between cell lines, discordance between the cell line and its associated original tumor, imposter cell lines, and nomenclature errors that result in the circulation of two or more presumed unique cell lines that are actually from the same origin. These pitfalls can be avoided by testing for species-specific isoenzymes, microarray analysis, assays for subtype-specific fusion products, and short tandem repeat analysis.

  11. Human Rhabdomyosarcoma Cell Lines for Rhabdomyosarcoma Research: Utility and Pitfalls

    Science.gov (United States)

    Hinson, Ashley R. P.; Jones, Rosanne; Crose, Lisa E. S.; Belyea, Brian C.; Barr, Frederic G.; Linardic, Corinne M.

    2013-01-01

    Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood and adolescence. Despite intergroup clinical trials conducted in Europe and North America, outcomes for high risk patients with this disease have not significantly improved in the last several decades, and survival of metastatic or relapsed disease remains extremely poor. Accrual into new clinical trials is slow and difficult, so in vitro cell-line research and in vivo xenograft models present an attractive alternative for preclinical research for this cancer type. Currently, 30 commonly used human RMS cell lines exist, with differing origins, karyotypes, histologies, and methods of validation. Selecting an appropriate cell line for RMS research has important implications for outcomes. There are also potential pitfalls in using certain cell lines including contamination with murine stromal cells, cross-contamination between cell lines, discordance between the cell line and its associated original tumor, imposter cell lines, and nomenclature errors that result in the circulation of two or more presumed unique cell lines that are actually from the same origin. These pitfalls can be avoided by testing for species-specific isoenzymes, microarray analysis, assays for subtype-specific fusion products, and short tandem repeat analysis. PMID:23882450

  12. Tax Multipliers: Pitfalls in Measurement and Identification

    OpenAIRE

    Daniel Riera-Crichton; Carlos A. Vegh; Guillermo Vuletin

    2012-01-01

    We contribute to the literature on tax multipliers by analyzing the pitfalls in identification and measurement of tax shocks. Our main focus is on disentangling the discussion regarding the identification of exogenous tax policy shocks (i.e., changes in tax policy that are not the result of policymakers responding to output fluctuations) from the discussion related to the measurement of tax policy (i.e., finding a tax policy variable under the direct control of the policymaker). For this purp...

  13. Adapting nurse competence to future patient needs using Checkland's Soft Systems Methodology.

    Science.gov (United States)

    Železnik, Danica; Kokol, Peter; Blažun Vošner, Helena

    2017-01-01

    New emerging technologies, health globalization, demographic change, new healthcare paradigms, advances in healthcare delivery and social networking will change the needs of patients in the future and consequently will require that new knowledge, competence and skill sets be acquired by nurses. Checkland's Soft Systems Methodology, focusing on the enriched CATWOE and PQR elements of the root definitions, combined with our own developed "Too much - Too little constraint" approach was used to devise impending knowledge, competence and skill sets. The analysis revealed ten needs among patients of the future, 63 constraints and 18 knowledge, competence and skill sets for the future nurse. The completed study showed that SSM is an appropriate tool for high level structuring of a "messy" real-world problem situation to meet prospective nursing challenges. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Training and Action for Patient Safety: Embedding Interprofessional Education for Patient Safety within an Improvement Methodology

    Science.gov (United States)

    Slater, Beverley L.; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

    2012-01-01

    Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based…

  15. Proposal of a methodology for individualized iodine-131 therapy for Graves' disease in patients with hyperthyroidism

    International Nuclear Information System (INIS)

    Araujo, Francisco de; Melo, Rossana Corbo de; Rebelo, Ana Maria de Oliveira; Dantas, Bernardo Maranhao; Dantas, Ana Leticia A.; Lucena, Eder Augusto de

    2007-01-01

    Objective: Several methods are utilized for determining the radioiodine activity in the treatment of Graves' disease (hyperthyroidism). Some of this methods do not take into consideration the thyroid absorbed dose or the necessary parameters for this estimation. The association between absorbed dose and administered activity depends on effective half-life, iodine uptake and thyroid mass of each patient. The present study was aimed at developing a methodology for individualized 131 I therapy for Graves' disease in patients with hyperthyroidism of the Graves' disease. Materials and methods: A neck-thyroid phantom developed at Instituto de Radioprotecao e Dosimetria, containing a standard solution of 131 I, was utilized for calibrating the scintillation gamma camera and uptake probe installed in the Department of Nuclear Medicine of the Hospital Universitario Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Results: The view angle of the collimator/detector assembly presented values compatible with the thyroid gland size for distances of 25 cm (uptake probe) and 45.8 cm (scintillation gamma camera). Calibration factors were 39.3 ± 0.78 and 4.3 ± 0.17 cpm/kBq, respectively. The 14-30-hour interval in the retention curve allows the estimation of activity between two points for determining the effective iodine half-life in the thyroid. Conclusion: The utilization of equipment usually available in nuclear medicine clinics is feasible, so this is a simple, effective and low cost methodology. (author)

  16. Priorities for methodological research on patient and public involvement in clinical trials: A modified Delphi process.

    Science.gov (United States)

    Kearney, Anna; Williamson, Paula; Young, Bridget; Bagley, Heather; Gamble, Carrol; Denegri, Simon; Muir, Delia; Simon, Natalie A; Thomas, Stephen; Elliot, Jim T; Bulbeck, Helen; Crocker, Joanna C; Planner, Claire; Vale, Claire; Clarke, Mike; Sprosen, Tim; Woolfall, Kerry

    2017-12-01

    Despite increasing international interest, there is a lack of evidence about the most efficient, effective and acceptable ways to implement patient and public involvement (PPI) in clinical trials. To identify the priorities of UK PPI stakeholders for methodological research to help resolve uncertainties about PPI in clinical trials. A modified Delphi process including a two round online survey and a stakeholder consensus meeting. In total, 237 people registered of whom 219 (92%) completed the first round. One hundred and eighty-seven of 219 (85%) completed the second; 25 stakeholders attended the consensus meeting. Round 1 of the survey comprised 36 topics; 42 topics were considered in round 2 and at the consensus meeting. Approximately 96% of meeting participants rated the top three topics as equally important. These were as follows: developing strong and productive working relationships between researchers and PPI contributors; exploring PPI practices in selecting trial outcomes of importance to patients; and a systematic review of PPI activity to improve the accessibility and usefulness of trial information (eg participant information sheets) for participants. The prioritized methodological research topics indicate important areas of uncertainty about PPI in trials. Addressing these uncertainties will be critical to enhancing PPI. Our findings should be used in the planning and funding of PPI in clinical trials to help focus research efforts and minimize waste. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  17. Using PICO Methodology to Answer Questions About Smoking in COPD Patients.

    Science.gov (United States)

    Jiménez Ruiz, Carlos A; Buljubasich, Daniel; Riesco Miranda, Juan Antonio; Acuña Izcaray, Agustín; de Granda Orive, José Ignacio; Chatkin, José Miguel; Zabert, Gustavo; Guerreros Benavides, Alfredo; Paez Espinel, Nelson; Noé, Valeri; Sánchez-Angarita, Efraín; Núñez-Sánchez, Ingrid; Sansores, Raúl H; Casas, Alejandro; Palomar Lever, Andrés; Alfageme Michavila, Inmaculada

    2017-11-01

    The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (i)moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (ii)high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (iii)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (iv)high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Using Six Sigma methodology to reduce patient transfer times from floor to critical-care beds.

    Science.gov (United States)

    Silich, Stephan J; Wetz, Robert V; Riebling, Nancy; Coleman, Christine; Khoueiry, Georges; Abi Rafeh, Nidal; Bagon, Emma; Szerszen, Anita

    2012-01-01

    In response to concerns regarding delays in transferring critically ill patients to intensive care units (ICU), a quality improvement project, using the Six Sigma process, was undertaken to correct issues leading to transfer delay. To test the efficacy of a Six Sigma intervention to reduce transfer time and establish a patient transfer process that would effectively enhance communication between hospital caregivers and improve the continuum of care for patients. The project was conducted at a 714-bed tertiary care hospital in Staten Island, New York. A Six Sigma multidisciplinary team was assembled to assess areas that needed improvement, manage the intervention, and analyze the results. The Six Sigma process identified eight key steps in the transfer of patients from general medical floors to critical care areas. Preintervention data and a root-cause analysis helped to establish the goal transfer-time limits of 3 h for any individual transfer and 90 min for the average of all transfers. The Six Sigma approach is a problem-solving methodology that resulted in almost a 60% reduction in patient transfer time from a general medical floor to a critical care area. The Six Sigma process is a feasible method for implementing healthcare related quality of care projects, especially those that are complex. © 2011 National Association for Healthcare Quality.

  19. Diuresis renography in children: methodological aspects

    International Nuclear Information System (INIS)

    Bonnin, F.; Le Stanc, E.; Busquet, G.; Saidi, L.; Lyonnet, F.

    1995-01-01

    In paediatrics, diuresis renography is used as a method to guide clinical management of hydronephrosis or hydro-uretero-nephrosis. Various pitfalls in the technique and other errors exist and may lead to a misinterpretation of the test. The methodology for performing and interpreting the diuresis renography is discussed. (authors). 12 refs., 4 figs

  20. Auxological criteria for the diagnosis of GH-dependent short stature and prescription of rGH: problems and pitfalls

    Directory of Open Access Journals (Sweden)

    Giulio Gilli

    2007-12-01

    Full Text Available Recombinant growth hormone (rGH administration is a cornerstone in the treatment of short stature secondary to GH deficit. Since its introduction in the 80s, the population of short patients with an indication to rGH therapy has clearly broadened, probably because of increased awareness by patients and physicians. Since rGH therapy is demanding for patients and expensive, the Italian National Health Service, like other third payers and regulatory authorities, regulates its prescription according to criteria listed in the Nota AIFA 39. This paper illustrates pitfalls and difficulties paediatricians may encounter when assessing short stature patients in order to decide upon the opportunity and possibility to initiate rGH therapy through the exposition of four emblematic, though hypothetical, clinical histories. In the discussion, the Authors highlight some of the most critical points in the formulation of the Nota 39, among which are the lack of clear reference values, neglecting of parental height targets and therapeutic responses, as well as some omissions in methodology specifications.

  1. Pitfalls in diagnostic gastrin measurements

    DEFF Research Database (Denmark)

    Rehfeld, Jens F; Bardram, Linda; Hilsted, Linda

    2012-01-01

    Gastrin measurements are performed primarily for the diagnosis of gastrin-producing tumors, gastrinomas, which cause the Zollinger-Ellison syndrome (ZES). Gastrin circulates as several bioactive peptides, however, and the peptide pattern in gastrinoma patients often deviates from normal. Therefor...

  2. Attitudes towards medication non-adherence in elderly kidney transplant patients: a Q methodology study.

    Science.gov (United States)

    Tielen, Mirjam; van Exel, N Job A; van Buren, Marleen C; Maasdam, Louise; Weimar, Willem

    2011-05-01

    Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing population of elderly kidney recipients. Q methodology was used to explore attitude profiles. Participants (> 65 years) were asked to rank-order opinion statements on issues associated with (non-)adherence. The rankings were subject to by-person factor analysis, and the resulting factors were interpreted and described as attitudes. Twenty-six elderly renal transplant recipients participated in the study. All passed the Mini-Mental State Examination. Two attitude profiles were found: (i) satisfied and easy-going (attitude A), and (ii) reserved and concerned (attitude B). Elderly patients with attitude A want to enjoy the new life following their kidney transplant, are not very concerned about having to recommence dialysis, now and then even forget their regime, and do not really worry about it. Elderly patients with attitude B feel more insecure about their kidney transplant, are fairly concerned over issues like rejection or going back on dialysis, and try to adapt their way of life to the regime. One-third of these elderly patients forget their medication at least once a month, but there was no difference between attitude groups. Attitudes about the post-transplant regime differ among elderly patients, implying different needs for assistance, monitoring and risk of non-adherence to the regime. The proportion of elderly patients who forget their medication is considerable, but may be much higher among those with mild and severe cognitive limitations.

  3. Evaluation of an interprofessional clinician-patient communication workshop utilizing standardized patient methodology.

    Science.gov (United States)

    Lagan, Casey; Wehbe-Janek, Hania; Waldo, Kim; Fox, Amy; Jo, Chanhee; Rahm, Mark

    2013-01-01

    Communication and interpersonal skills (CIS) are one of the 6 general competencies required by the Accreditation Council for Graduate Medical Education (ACGME). The clinician-patient communication (CPC) workshop, developed by the Institute for Healthcare Communication, provides an interactive opportunity to practice and develop CIS. The objectives of this study were to (1) determine the impact of a CPC workshop on orthopedic surgery residents' CIS (2) determine the impact of physician alone or incorporation of nursing participation in the workshop, and (3) incorporate standardized patients (SPs) in resident training and assessment of CIS. Stratified by training year, 18 residents of an Orthopaedic Surgery Residency Program were randomized to a CPC workshop with only residents (group A, n = 9) or a CPC workshop with nurse participants (group B, n = 9). Data included residents' (1) CIS scores as evaluated by SPs and (2) self-reports from a 25-question survey on perception of CIS. Data were collected at baseline and 3 weeks following the workshop. Following the workshop, the combined group (group A and B) felt more strongly that the ACGME should require a communication training and evaluation curriculum (post mean = 52.7, post-pre difference = 15.94, p = 0.026). Group A residents felt more strongly that communication is a learned behavior (post mean = 82.7, post-pre difference = 17.67, p = 0.028), and the addition of SPs was a valuable experience (post mean = 59.3, post-pre difference = 16.44, p = 0.038). Group B residents reported less willingness to improve on their communication skills (post-mean = 79.7, post-pre difference = -7.44, p = 0.049) and less improvement in professional satisfaction in effective communication than group A (post mean group A = 81.9, group B = 83.6, post-pre difference group A = 7.11, group B = 1.89, p = 0.047). Few differences between groups regarding CIS scores were detected. While there was no demonstrable difference regarding CIS, our

  4. MRI in Glioma Immunotherapy: Evidence, Pitfalls, and Perspectives

    Directory of Open Access Journals (Sweden)

    Domenico Aquino

    2017-01-01

    Full Text Available Pseudophenomena, that is, imaging alterations due to therapy rather than tumor evolution, have an important impact on the management of glioma patients and the results of clinical trials. RANO (response assessment in neurooncology criteria, including conventional MRI (cMRI, addressed the issues of pseudoprogression after radiotherapy and concomitant chemotherapy and pseudoresponse during antiangiogenic therapy of glioblastomas (GBM and other gliomas. The development of cancer immunotherapy forced the identification of further relevant response criteria, summarized by the iRANO working group in 2015. In spite of this, the unequivocal definition of glioma progression by cMRI remains difficult particularly in the setting of immunotherapy approaches provided by checkpoint inhibitors and dendritic cells. Advanced MRI (aMRI may in principle address this unmet clinical need. Here, we discuss the potential contribution of different aMRI techniques and their indications and pitfalls in relation to biological and imaging features of glioma and immune system interactions.

  5. Survival analysis of colorectal cancer patients with tumor recurrence using global score test methodology

    Energy Technology Data Exchange (ETDEWEB)

    Zain, Zakiyah, E-mail: zac@uum.edu.my; Ahmad, Yuhaniz, E-mail: yuhaniz@uum.edu.my [School of Quantitative Sciences, Universiti Utara Malaysia, UUM Sintok 06010, Kedah (Malaysia); Azwan, Zairul, E-mail: zairulazwan@gmail.com, E-mail: farhanaraduan@gmail.com, E-mail: drisagap@yahoo.com; Raduan, Farhana, E-mail: zairulazwan@gmail.com, E-mail: farhanaraduan@gmail.com, E-mail: drisagap@yahoo.com; Sagap, Ismail, E-mail: zairulazwan@gmail.com, E-mail: farhanaraduan@gmail.com, E-mail: drisagap@yahoo.com [Surgery Department, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Bandar Tun Razak, Kuala Lumpur (Malaysia); Aziz, Nazrina, E-mail: nazrina@uum.edu.my

    2014-12-04

    Colorectal cancer is the third and the second most common cancer worldwide in men and women respectively, and the second in Malaysia for both genders. Surgery, chemotherapy and radiotherapy are among the options available for treatment of patients with colorectal cancer. In clinical trials, the main purpose is often to compare efficacy between experimental and control treatments. Treatment comparisons often involve several responses or endpoints, and this situation complicates the analysis. In the case of colorectal cancer, sets of responses concerned with survival times include: times from tumor removal until the first, the second and the third tumor recurrences, and time to death. For a patient, the time to recurrence is correlated to the overall survival. In this study, global score test methodology is used in combining the univariate score statistics for comparing treatments with respect to each survival endpoint into a single statistic. The data of tumor recurrence and overall survival of colorectal cancer patients are taken from a Malaysian hospital. The results are found to be similar to those computed using the established Wei, Lin and Weissfeld method. Key factors such as ethnic, gender, age and stage at diagnose are also reported.

  6. Methods and pitfalls of measuring thermal preference and tolerance in lizards.

    Science.gov (United States)

    Camacho, Agustín; Rusch, Travis W

    2017-08-01

    Understanding methodological and biological sources of bias during the measurement of thermal parameters is essential for the advancement of thermal biology. For more than a century, studies on lizards have deepened our understanding of thermal ecophysiology, employing multiple methods to measure thermal preferences and tolerances. We reviewed 129 articles concerned with measuring preferred body temperature (PBT), voluntary thermal tolerance, and critical temperatures of lizards to offer: a) an overview of the methods used to measure and report these parameters, b) a summary of the methodological and biological factors affecting thermal preference and tolerance, c) recommendations to avoid identified pitfalls, and d) directions for continued progress in our application and understanding of these thermal parameters. We emphasize the need for more methodological and comparative studies. Lastly, we urge researchers to provide more detailed methodological descriptions and suggest ways to make their raw data more informative to increase the utility of thermal biology studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Applied statistics in ecology: common pitfalls and simple solutions

    Science.gov (United States)

    E. Ashley Steel; Maureen C. Kennedy; Patrick G. Cunningham; John S. Stanovick

    2013-01-01

    The most common statistical pitfalls in ecological research are those associated with data exploration, the logic of sampling and design, and the interpretation of statistical results. Although one can find published errors in calculations, the majority of statistical pitfalls result from incorrect logic or interpretation despite correct numerical calculations. There...

  8. Research Methodology in Recurrent Pregnancy Loss

    DEFF Research Database (Denmark)

    Christiansen, Ole B

    2014-01-01

    The aim of this article is to highlight pitfalls in research methodology that may explain why studies in recurrent pregnancy loss (RPL) often provide very divergent results. It is hoped that insight into this issue may help clinicians decide which published studies are the most valid. It may help...... researchers to eliminate methodological flaws in future studies, which may hopefully come to some kind of agreement about the usefulness of diagnostic tests and treatments in RPL....

  9. Pitfalls of Insulin Pump Clocks

    Science.gov (United States)

    Reed, Amy J.

    2014-01-01

    The objective was to raise awareness about the importance of ensuring that insulin pumps internal clocks are set up correctly at all times. This is a very important safety issue because all commercially available insulin pumps are not GPS-enabled (though this is controversial), nor equipped with automatically adjusting internal clocks. Special attention is paid to how basal and bolus dose errors can be introduced by daylight savings time changes, travel across time zones, and am-pm clock errors. Correct setting of insulin pump internal clock is crucial for appropriate insulin delivery. A comprehensive literature review is provided, as are illustrative cases. Incorrect setting can potentially result in incorrect insulin delivery, with potential harmful consequences, if too much or too little insulin is delivered. Daylight saving time changes may not significantly affect basal insulin delivery, given the triviality of the time difference. However, bolus insulin doses can be dramatically affected. Such problems may occur when pump wearers have large variations in their insulin to carb ratio, especially if they forget to change their pump clock in the spring. More worrisome than daylight saving time change is the am-pm clock setting. If this setting is set up incorrectly, both basal rates and bolus doses will be affected. Appropriate insulin delivery through insulin pumps requires correct correlation between dose settings and internal clock time settings. Because insulin pumps are not GPS-enabled or automatically time-adjusting, extra caution should be practiced by patients to ensure correct time settings at all times. Clinicians and diabetes educators should verify the date/time of insulin pumps during patients’ visits, and should remind their patients to always verify these settings. PMID:25355713

  10. The current landscape of pitfalls in Ontologies

    CSIR Research Space (South Africa)

    Keet, CM

    2013-09-01

    Full Text Available 2Ontology Engineering Group, Departamento de Inteligencia Artificial, Universidad Polite´cnica de Madrid, Madrid, Spain keet@ukzn.ac.za, {mcsuarez,mpoveda}@fi.upm.es Keywords: Ontology Development : Ontology Quality : Pitfall Abstract: A growing... in Ontologies C. Maria Keet1, Mari Carmen Sua´rez-Figueroa2 and Marı´a Poveda-Villalo´n2 1School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, and UKZN/CSIR-Meraka Centre for Artificial Intelligence Research, Durban, South Africa...

  11. Genomics for paediatricians: promises and pitfalls.

    Science.gov (United States)

    Hammond, Carrie Louise; Willoughby, Josh Matthew; Parker, Michael James

    2018-03-24

    In recent years, there have been significant advances in genetic technologies, evolving the field of genomics from genetics. This has huge diagnostic potential, as genomic testing increasingly becomes part of mainstream medicine. However, there are numerous potential pitfalls in the interpretation of genomic data. It is therefore essential that we educate clinicians more widely about the appropriate interpretation and utilisation of genomic testing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Pitfalls in colour photography of choroidal tumours

    Science.gov (United States)

    Schalenbourg, A; Zografos, L

    2013-01-01

    Colour imaging of fundus tumours has been transformed by the development of digital and confocal scanning laser photography. These advances provide numerous benefits, such as panoramic images, increased contrast, non-contact wide-angle imaging, non-mydriatic photography, and simultaneous angiography. False tumour colour representation can, however, cause serious diagnostic errors. Large choroidal tumours can be totally invisible on angiography. Pseudogrowth can occur because of artefacts caused by different methods of fundus illumination, movement of reference blood vessels, and flattening of Bruch's membrane and sclera when tumour regression occurs. Awareness of these pitfalls should prevent the clinician from misdiagnosing tumours and wrongfully concluding that a tumour has grown. PMID:23238442

  13. Pitfalls in colour photography of choroidal tumours.

    Science.gov (United States)

    Schalenbourg, A; Zografos, L

    2013-02-01

    Colour imaging of fundus tumours has been transformed by the development of digital and confocal scanning laser photography. These advances provide numerous benefits, such as panoramic images, increased contrast, non-contact wide-angle imaging, non-mydriatic photography, and simultaneous angiography. False tumour colour representation can, however, cause serious diagnostic errors. Large choroidal tumours can be totally invisible on angiography. Pseudogrowth can occur because of artefacts caused by different methods of fundus illumination, movement of reference blood vessels, and flattening of Bruch's membrane and sclera when tumour regression occurs. Awareness of these pitfalls should prevent the clinician from misdiagnosing tumours and wrongfully concluding that a tumour has grown.

  14. Development and Evaluation of a Training Program for Organ Procurement Coordinators Using Standardized Patient Methodology.

    Science.gov (United States)

    Odabasi, Orhan; Elcin, Melih; Uzun Basusta, Bilge; Gulkaya Anik, Esin; Aki, Tuncay F; Bozoklar, Ata

    2015-12-01

    The low rate of consent by next of kin of donor-eligible patients is a major limiting factor in organ transplant. Educating health care professionals about their role may lead to measurable improvements in the process. Our aim was to describe the developmental steps of a communication skills training program for health care professionals using standardized patients and to evaluate the results. We developed a rubric and 5 cases for standardized family interviews. The 20 participants interviewed standardized families at the beginning and at the end of the training course, with interviews followed by debriefing sessions. Participants also provided feedback before and after the course. The performance of each participant was assessed by his or her peers using the rubric. We calculated the generalizability coefficient to measure the reliability of the rubric and used the Wilcoxon signed rank test to compare achievement among participants. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 17.0, IBM Corporation, Armonk, NY, USA). All participants received higher scores in their second interview, including novice participants who expressed great discomfort during their first interview. The participants rated the scenarios and the standardized patients as very representative of real-life situations, with feedback forms showing that the interviews, the video recording sessions, and the debriefing sessions contributed to their learning. Our program was designed to meet the current expectations and implications in the field of donor consent from next of kin. Results showed that our training program developed using standardized patient methodology was effective in obtaining the communication skills needed for family interviews during the consent process. The rubric developed during the study was a valid and reliable assessment tool that could be used in further educational activities. The participants showed significant improvements in

  15. Attitudes of elderly Korean patients toward death and dying: an application of Q-methodology.

    Science.gov (United States)

    Yeun, Eunja

    2005-11-01

    The aim of this study was to identify the attitudes of elderly Korean patients toward death and dying using Q-methodology to aid in the development of basic strategies for nursing care of elderly Koreans. Thirty participants at a university hospital sorted 40 selected Q-statements on a nine-point scale. Data analysis identified three types of attitudes toward death and dying in elderly patients in Korea: religion-dependent, science-adherent, and sardonic. Religion-dependent elders are highly dependent upon religion as evidenced by their reply that they would like to rely on God and a minister the most. Science-adherent elders have great affection for life and believe in modern medical advancements. The sardonic elders regard death as the dispensation of nature so there is no need to be afraid of death and dying. This study will contribute to the understanding that nurses and other health professionals have of the perceptions of elderly Koreans about death and dying. Also, the findings may provide the basis for the development of more appropriate strategies to improve death and dying education programs of health professionals.

  16. Clean Development Mechanism PDD Guidebook: Navigating the Pitfalls; 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    2008-04-15

    This guidebook is designed to help readers navigate the pitfalls of preparing a Project Design Document (PDD) for Clean Development Mechanism (CDM) projects. This second edition also aims at helping project developers to navigate the pitfalls of preparing a Monitoring Report and be better prepared to face the verification process. The purpose of a PDD is to prepare project information for relevant stakeholders. These stakeholders include the investment community, the Designated Operating Entity (DOE) performing validation of the project, the CDM Executive Board (EB), the Designated National Authorities (DNA) of the involved countries and the local population. The PDD, together with the validation report and the approval letter of the DNA, are the basis for the registration of the project and its recognition as a credible CDM project. The PDD is about the project's design--that is, how the project intends to reduce greenhouse gas (GHG) emissions below those levels that would otherwise have been emitted1. Each and every CDM project is unique, from the project design to the application of even the simplest baseline methodology. Some of the projects submitted for validation may be very efficient in reducing emissions and score well in terms of economic, social and environmental benefits, but may still not qualify as CDM projects. Experience has shown that the information needed to judge the suitability of a project for the CDM is vast and can take months to assemble. Also, the time required to assemble relevant information increases with the number and diversity of stakeholders involved and the complexity of the information itself. The objective of the verification of emissions reduction is the review and ex post determination of the monitored emission reductions that have occurred during a specified verification period. The verification is about the project's reality--that is, how the project has been implemented as described in the registered PDD and is

  17. Why do pregnant women participate in research? A patient participation investigation using Q-Methodology.

    Science.gov (United States)

    Meshaka, Riwa; Jeffares, Stephen; Sadrudin, Farah; Huisman, Nicole; Saravanan, Ponnusamy

    2017-04-01

    Patient participation in study design is paramount to design studies that are acceptable to patients. Despite an increase in research involving pregnant women, relatively little is known about the motivational factors that govern their decision to be involved in a clinical trial, compared to other patient groups. To better understand the viewpoints of pregnant women who take part in clinical trials. We chose to use Q-Methodology, a method of exploring the structure of opinions surrounding a topic. We developed a set of 40 statements that encompassed the reasons why pregnant women might want to take part in research and 30 research participants from the PRiDE study (an observational trial investigating the role of micronutrients in gestational diabetes) were asked to rank them in order of agreement. The finished matrices from each participant were compared and analysed to produce capturing viewpoints. About 30 women aged 19-40 involved in the PRiDE study completed the questionnaire. There were two overarching motivators that emerged: a willingness to help medical research and improve our knowledge of medical science, and having a personal connection to the disease, therefore a potential fear of being affected by it. A third, less significant viewpoint, was that of a lack of inconvenience being a motivating factor. Understanding what motivates pregnant women to decide to take part in a research study is valuable and helps researchers maximize their uptake and retention rates when designing a trial involving pregnant women. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  18. Exploring Qualitatively-Derived Concepts: Inductive—Deductive Pitfalls

    Directory of Open Access Journals (Sweden)

    Janice M. Morse

    2002-12-01

    Full Text Available Analytic induction is a sacred tenet of qualitative inquiry. 1 Therefore, when one begins a project focusing on concept of interest (rather than allowing the concepts to emerge from the data per se, how does one maintain a valid approach? When commencing inquiry with a chosen concept or phenomena of interest, rather than with a question from the data per se about what is going on, how does one control deductive tendencies to see what one desires to see and which threaten validity? Difficulties stem from the nature of induction itself – Is analytic induction an impossible operation in qualitative research, as Popper (1963/65 suggests? In this section, we first discuss Popper's concern, followed by a discussion of two major threats that may prevent an inductive approach in qualitative research.2 The first threat is the “pink elephant paradox;? the second is the avoidance of conceptual tunnel vision or, specifically, how does the researcher decontextualize the concept of interest from the surrounding context and thereby avoid the tendency to consider all data to be pertinent to the concept of interest? As we explore each of these pitfalls, and we present methodological strategies to maintain both the integrity of the concept and the integrity of the research.

  19. Demonstration of a software design and statistical analysis methodology with application to patient outcomes data sets.

    Science.gov (United States)

    Mayo, Charles; Conners, Steve; Warren, Christopher; Miller, Robert; Court, Laurence; Popple, Richard

    2013-11-01

    With emergence of clinical outcomes databases as tools utilized routinely within institutions, comes need for software tools to support automated statistical analysis of these large data sets and intrainstitutional exchange from independent federated databases to support data pooling. In this paper, the authors present a design approach and analysis methodology that addresses both issues. A software application was constructed to automate analysis of patient outcomes data using a wide range of statistical metrics, by combining use of C#.Net and R code. The accuracy and speed of the code was evaluated using benchmark data sets. The approach provides data needed to evaluate combinations of statistical measurements for ability to identify patterns of interest in the data. Through application of the tools to a benchmark data set for dose-response threshold and to SBRT lung data sets, an algorithm was developed that uses receiver operator characteristic curves to identify a threshold value and combines use of contingency tables, Fisher exact tests, Welch t-tests, and Kolmogorov-Smirnov tests to filter the large data set to identify values demonstrating dose-response. Kullback-Leibler divergences were used to provide additional confirmation. The work demonstrates the viability of the design approach and the software tool for analysis of large data sets.

  20. Clean development mechanism PDD guidebook: Navigating the pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Kamel, S. (ed.)

    2005-11-01

    This guidebook is designed to help readers navigate the pitfalls of preparing a Project Design Document (PDD) for Clean Development Mechanism (CDM) projects. The purpose of a PDD is to prepare project information for relevant stakeholders. These stakeholders include the investment community, the Designated Operating Entity (DOE) performing validation of the project, the CDM Executive Board (EB), the Designated National Authorities (DNA) of the involved countries and the local population. The PDD, together with the validation report and the approval letter of the DNA, are the basis for the registration of the project and its recognition as a credible CDM project. The PDD is about the project's design that is, how the project intends to reduce greenhouse gas (GHG) emissions below those levels that would otherwise have been emitted. Each and every CDM project is unique, from the project design to the application of even the simplest baseline methodology. Some of the projects submitted for validation may be very efficient in reducing emissions and score well in terms of economic, social and environmental benefits, but may still not qualify as CDM projects. Experience has shown that the information needed to judge a suitability of a project for the CDM is vast and can take months to assemble. Also, the time required to assemble relevant information increases with the number and diversity of stakeholders involved and the complexity of the information itself. This guidebook is based on a review of all PDDs submitted to DNV for validation. The advice given and the pitfalls described in this guidebook are, therefore, based on day-to-day, hands-on experience and real instances of mistakes made in submissions. In summary, then, this guidebook takes a practical stance: it is concerned with the practical issues of how to get projects through the validation process. It will help those submitting a PDD by: 1) Describing the most common and costly mistakes made in the process

  1. Single Subject Prediction of Brain Disorders in Neuroimaging: Promises and Pitfalls

    Science.gov (United States)

    Arbabshirani, Mohammad R.; Plis, Sergey; Sui, Jing; Calhoun, Vince D.

    2016-01-01

    Neuroimaging-based single subject prediction of brain disorders has gained increasing attention in recent years. Using a variety of neuroimaging modalities such as structural, functional and diffusion MRI, along with machine learning techniques, hundreds of studies have been carried out for accurate classification of patients with heterogeneous mental and neurodegenerative disorders such as schizophrenia and Alzheimer's disease. More than 500 studies have been published during the past quarter century on single subject prediction focused on a multiple brain disorders. In the first part of this study, we provide a survey of more than 200 reports in this field with a focus on schizophrenia, mild cognitive impairment (MCI), Alzheimer's disease (AD), depressive disorders, autism spectrum disease (ASD) and attention-deficit hyperactivity disorder (ADHD). Detailed information about those studies such as sample size, type and number of extracted features and reported accuracy are summarized and discussed. To our knowledge, this is by far the most comprehensive review of neuroimaging-based single subject prediction of brain disorders. In the second part, we present our opinion on major pitfalls of those studies from a machine learning point of view. Common biases are discussed and suggestions are provided. Moreover, emerging trends such as decentralized data sharing, multimodal brain imaging, differential diagnosis, disease subtype classification and deep learning are also discussed. Based on this survey, there are extensive evidences showing the great potential of neuroimaging data for single subject prediction of various disorders. However, the main bottleneck of this exciting field is still the limited sample size, which could be potentially addressed by modern data sharing models such as the ones discussed in this paper. Emerging big data technologies and advanced data-intensive machine learning methodologies such as deep learning have coincided with an increasing need

  2. Pitfalls associated with open reduction and internal fixation of fractured ribs.

    Science.gov (United States)

    Sarani, Babak; Schulte, Leah; Diaz, Jose J

    2015-12-01

    Rib fracture is exceedingly common and remains a leading cause of death in patients with chest injury. Probability of death increases by 19% with each broken rib, and the probability of death increases further with age. Treatment is centered on pain control and early mobilization to provide adequate pulmonary hygiene. Multimodality interventions, such as incentive spirometry, postural changes, and coughing, are pivotal in minimizing the risk of pneumonia and death. Recently, many studies have found mortality benefit to operation fixation (ORIF) of ribs in select patients. However, this procedure remains underutilized partly due to lack of familiarity with its technique and pitfalls by trauma surgeons, in particular. Whereas there are publications on operative technique, there are no studies describing pitfalls associated with this procedure. The purpose of this paper is to describe pitfalls on the technical aspects of ORIF of the ribs based on the medical literature where possible and based on our experience in instances where peer reviewed evidence is lacking. The paper is not meant to serve as a protocol for managing rib fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. [Methodological aspects of a study of medical service satisfaction in patients with borderline mental disorders].

    Science.gov (United States)

    Malygin, Ya V; Tsygankov, B D

    The authors discussed a methodology of the study of medical service satisfaction and it's factors: moment of assessment, methodology of data collection, format of data, bench-marking, principles of inclusion of questions into a questionnaire, organizing and frequency of conducting studies.

  4. Predictors of clinical outcome in total hip and knee replacement : a methodological appraisal of implants and patient factors

    NARCIS (Netherlands)

    Keurentjes, Johan Christiaan

    2014-01-01

    In this thesis, we studied both implants and patient and surgeon factors as predictors of clinical outcome after total hip and knee replacement. Additionally, we studied a number of methodological aspects of orthopaedic research, such as competing risks in estimating the probability of revision

  5. Identification of novel mutations in the α-galactosidase A gene in patients with Fabry disease: pitfalls of mutation analyses in patients with low α-galactosidase A activity.

    Science.gov (United States)

    Yoshimitsu, Makoto; Higuchi, Koji; Miyata, Masaaki; Devine, Sean; Mattman, Andre; Sirrs, Sandra; Medin, Jeffrey A; Tei, Chuwa; Takenaka, Toshihiro

    2011-05-01

    Fabry disease is an X-linked lysosomal storage disorder caused by mutations of the α-galactosidase A (GLA) gene, and the disease is a relatively prevalent cause of left ventricular hypertrophy followed by conduction abnormalities and arrhythmias. Mutation analysis of the GLA gene is a valuable tool for accurate diagnosis of affected families. In this study, we carried out molecular studies of 10 unrelated families diagnosed with Fabry disease. Genetic analysis of the GLA gene using conventional genomic sequencing was performed in 9 hemizygous males and 6 heterozygous females. In patients with no mutations in coding DNA sequence, multiplex ligation-dependent probe amplification (MLPA) and/or cDNA sequencing were performed. We identified a novel exon 2 deletion (IVS1_IVS2) in a heterozygous female by MLPA, which was undetectable by conventional sequencing methods. In addition, the g.9331G>A mutation that has previously been found only in patients with cardiac Fabry disease was found in 3 unrelated, newly-diagnosed, cardiac Fabry patients by sequencing GLA genomic DNA and cDNA. Two other novel mutations, g.8319A>G and 832delA were also found in addition to 4 previously reported mutations (R112C, C142Y, M296I, and G373D) in 6 other families. We could identify GLA gene mutations in all hemizygotes and heterozygotes from 10 families with Fabry disease. Mutations in 4 out of 10 families could not be identified by classical genomic analysis, which focuses on exons and the flanking region. Instead, these data suggest that MLPA analysis and cDNA sequence should be considered in genetic testing surveys of patients with Fabry disease. Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  6. Common pitfalls in preclinical cancer target validation.

    Science.gov (United States)

    Kaelin, William G

    2017-07-01

    An alarming number of papers from laboratories nominating new cancer drug targets contain findings that cannot be reproduced by others or are simply not robust enough to justify drug discovery efforts. This problem probably has many causes, including an underappreciation of the danger of being misled by off-target effects when using pharmacological or genetic perturbants in complex biological assays. This danger is particularly acute when, as is often the case in cancer pharmacology, the biological phenotype being measured is a 'down' readout (such as decreased proliferation, decreased viability or decreased tumour growth) that could simply reflect a nonspecific loss of cellular fitness. These problems are compounded by multiple hypothesis testing, such as when candidate targets emerge from high-throughput screens that interrogate multiple targets in parallel, and by a publication and promotion system that preferentially rewards positive findings. In this Perspective, I outline some of the common pitfalls in preclinical cancer target identification and some potential approaches to mitigate them.

  7. Cross wavelet analysis: significance testing and pitfalls

    Directory of Open Access Journals (Sweden)

    D. Maraun

    2004-01-01

    Full Text Available In this paper, we present a detailed evaluation of cross wavelet analysis of bivariate time series. We develop a statistical test for zero wavelet coherency based on Monte Carlo simulations. If at least one of the two processes considered is Gaussian white noise, an approximative formula for the critical value can be utilized. In a second part, typical pitfalls of wavelet cross spectra and wavelet coherency are discussed. The wavelet cross spectrum appears to be not suitable for significance testing the interrelation between two processes. Instead, one should rather apply wavelet coherency. Furthermore we investigate problems due to multiple testing. Based on these results, we show that coherency between ENSO and NAO is an artefact for most of the time from 1900 to 1995. However, during a distinct period from around 1920 to 1940, significant coherency between the two phenomena occurs.

  8. Distal biceps brachii tendon repair: a systematic review of patient outcome determination using modified Coleman methodology score criteria.

    Science.gov (United States)

    Nyland, John; Causey, Brandon; Wera, Jeff; Krupp, Ryan; Tate, David; Gupta, Amit

    2017-07-01

    This systematic literature review evaluated the methodological research design quality of studies that evaluated patient outcomes following distal biceps brachii tendon repair and developed evidence-based recommendations for future patient clinical outcomes research. Following the preferred reporting items for systematic reviews and meta-analyses criteria, and using "biceps brachii", "tendon", "repair" and "outcome assessment" search terms, the CINAHL, Academic Search Premier and MEDLINE databases were searched from January 1960-October 2015. The modified Coleman methodology score (MCMS) served as the primary outcome measure. Descriptive statistical analysis was performed for composite and component MCMS and for patient outcome assessment methodology use frequency. A total of 93 studies were evaluated. Overall MCMS was low (57.1 ± 14). Only 12 (12.9 %) had prospective cohort or randomized controlled trial designs. There was a moderate relationship between publication year and MCMS (r = 0.53, P research study methodological scores improved on average since 2008, generally low MCMS scores, retrospective designs, lack of eccentric elbow flexor or supinator strength testing, and poorly described surgical and rehabilitation descriptions remain commonplace. These findings decrease clinical study validity and generalizability. III.

  9. Potential pitfalls in the anorectal region during CT colonography: A ...

    African Journals Online (AJOL)

    2017-02-28

    Feb 28, 2017 ... smart phone or ... require further investigation and may require just a digital rectal ... pathology-related pitfalls (internal haemorrhoids, polyps, cancer, ... interpretation problems.12 It is preferable to use a small gauge (25 Fr.

  10. Dual-energy CT for the evaluation of urinary calculi: Image interpretation, pitfalls and stone mimics

    International Nuclear Information System (INIS)

    Jepperson, M.A.; Cernigliaro, J.G.; Sella, D.; Ibrahim, E.; Thiel, D.D.; Leng, S.; Haley, W.E.

    2013-01-01

    Urolithiasis is a common disease with a reported prevalence between 4% and 20% in developed countries. Determination of urinary calculi composition is a key factor in preoperative evaluation, treatment, and stone recurrence prevention. Prior to the introduction of dual-energy computed tomography (DECT), available methods for determining urinary stone composition were only available after stone extraction, and thereby unable to aid in optimized stone management prior to intervention. DECT utilizes the attenuation difference produced by two different x-ray energy spectra to quantify urinary calculi composition as uric acid or non-uric acid (with likely further classification in the future) while still providing the information attained with a conventional CT. Knowledge of DECT imaging pitfalls and stone mimics is important, as the added benefit of dual-energy analysis is the determination of stone composition, which in turn affects all aspects of stone management. This review briefly describes DECT principles, scanner types and acquisition protocols for the evaluation of urinary calculi as they relate to imaging pitfalls (inconsistent characterization of small stones, small dual-energy field of view, and mischaracterization from surrounding material) and stone mimics (drainage devices) that may adversely impact clinical decisions. We utilize our clinical experience from scanning over 1200 patients with this new imaging technique to present clinically relevant examples of imaging pitfalls and possible mechanisms for resolution

  11. Pitfalls in CT diagnosis of appendicitis: pictorial essay

    International Nuclear Information System (INIS)

    Shademan, Ashkan; Tappouni, Rafel F.R.

    2013-01-01

    Despite the high diagnostic accuracy of CT for appendicitis, numerous pitfalls exist that may result in a misdiagnosis. This pictorial review outlines the potential pitfalls in the CT diagnosis of appendicitis that includes atypical position of the appendix and coexisting pathologies. Various mimickers of appendicitis and clinical dilemmas will be highlighted. Upon completion, the reviewer should have an improved ability to recognise appendicitis mimickers and identify equivocal or atypical findings.

  12. Logistic regression modelling: procedures and pitfalls in developing and interpreting prediction models

    Directory of Open Access Journals (Sweden)

    Nataša Šarlija

    2017-01-01

    Full Text Available This study sheds light on the most common issues related to applying logistic regression in prediction models for company growth. The purpose of the paper is 1 to provide a detailed demonstration of the steps in developing a growth prediction model based on logistic regression analysis, 2 to discuss common pitfalls and methodological errors in developing a model, and 3 to provide solutions and possible ways of overcoming these issues. Special attention is devoted to the question of satisfying logistic regression assumptions, selecting and defining dependent and independent variables, using classification tables and ROC curves, for reporting model strength, interpreting odds ratios as effect measures and evaluating performance of the prediction model. Development of a logistic regression model in this paper focuses on a prediction model of company growth. The analysis is based on predominantly financial data from a sample of 1471 small and medium-sized Croatian companies active between 2009 and 2014. The financial data is presented in the form of financial ratios divided into nine main groups depicting following areas of business: liquidity, leverage, activity, profitability, research and development, investing and export. The growth prediction model indicates aspects of a business critical for achieving high growth. In that respect, the contribution of this paper is twofold. First, methodological, in terms of pointing out pitfalls and potential solutions in logistic regression modelling, and secondly, theoretical, in terms of identifying factors responsible for high growth of small and medium-sized companies.

  13. Options and pitfalls of normal tissues complication probability models

    International Nuclear Information System (INIS)

    Dorr, Wolfgang

    2011-01-01

    impaired by accompanying (e. g. vascular) diseases or the life-style of the patient (lung/smoking, liver/alcohol consumption). All these pitfalls are (of course) considered by experienced radiation oncologists and medical physicists. However, less experienced users of DYH constraints may be less aware of these pitfalls, and may be confident with the 'numbers' they receive from NTCP modeling modules integrated in modern planning systems. In conclusion, DYH-based dose constraints, and even NTCP modeling can be regarded as (very) useful tools in assisting treatment planning, but should be used with some/great care.

  14. Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

    Directory of Open Access Journals (Sweden)

    Bruno Zanotti

    2015-03-01

    Full Text Available Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure. Available bone substitutes include porous hydroxyapatite (HA and polymethylmethacrylate. Whichever material is used, however, prosthetic cranial implants are susceptible to intra- and postsurgical complications and even failure. The aim of this study was to investigate such occurrences in HA cranioplasty implants, seeking not only to determine the likely causes (whether correlated or not with the device itself but also, where possible, to suggest countermeasures. Methods: We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants (Custom Bone Service Fin-Ceramica Faenza, Italy in the period 1997-2013. Results: The two most common complications were implant fractures (84 cases, 2.9% of the total fitted and infections (51 cases, 1.77%. Conclusion: Although cranioplasties are superficial and not difficult types of surgery, and use of custom-made implants are often considered the "easy" option from a surgical perspective, these procedures are nonetheless plagued by potential pitfalls. If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon, but lack of appropriate care can open the door to numerous potential sources of failure, which can compromise-even irreparably-the ability to heal.

  15. Application of validity theory and methodology to patient-reported outcome measures (PROMs): building an argument for validity.

    Science.gov (United States)

    Hawkins, Melanie; Elsworth, Gerald R; Osborne, Richard H

    2018-07-01

    Data from subjective patient-reported outcome measures (PROMs) are now being used in the health sector to make or support decisions about individuals, groups and populations. Contemporary validity theorists define validity not as a statistical property of the test but as the extent to which empirical evidence supports the interpretation of test scores for an intended use. However, validity testing theory and methodology are rarely evident in the PROM validation literature. Application of this theory and methodology would provide structure for comprehensive validation planning to support improved PROM development and sound arguments for the validity of PROM score interpretation and use in each new context. This paper proposes the application of contemporary validity theory and methodology to PROM validity testing. The validity testing principles will be applied to a hypothetical case study with a focus on the interpretation and use of scores from a translated PROM that measures health literacy (the Health Literacy Questionnaire or HLQ). Although robust psychometric properties of a PROM are a pre-condition to its use, a PROM's validity lies in the sound argument that a network of empirical evidence supports the intended interpretation and use of PROM scores for decision making in a particular context. The health sector is yet to apply contemporary theory and methodology to PROM development and validation. The theoretical and methodological processes in this paper are offered as an advancement of the theory and practice of PROM validity testing in the health sector.

  16. A Proposed Methodology to Assess the Accuracy of 3D Scanners and Casts and Monitor Tooth Wear Progression in Patients.

    Science.gov (United States)

    Ahmed, Khaled E; Whitters, John; Ju, Xiangyang; Pierce, S Gareth; MacLeod, Charles N; Murray, Colin A

    2016-01-01

    The aim of this study was to detail and assess the capability of a novel methodology to 3D-quantify tooth wear progression in a patient over a period of 12 months. A calibrated stainless steel model was used to identify the accuracy of the scanning system by assessing the accuracy and precision of the contact scanner and the dimensional accuracy and stability of casts fabricated from three different types of impression materials. Thereafter, the overall accuracy of the 3D scanning system (scanner and casts) was ascertained. Clinically, polyether impressions were made of the patient's dentition at the initial examination and at the 12-month review, then poured in type IV dental stone to assess the tooth wear. The anterior teeth on the resultant casts were scanned, and images were analyzed using 3D matching software to detect dimensional variations between the patient's impressions. The accuracy of the 3D scanning system was established to be 33 μm. 3D clinical analysis demonstrated localized wear on the incisal and palatal surfaces of the patient's maxillary central incisors. The identified wear extended to a depth of 500 μm with a distribution of 4% to 7% of affected tooth surfaces. The newly developed 3D scanning methodology was found to be capable of assessing and accounting for the various factors affecting tooth wear scanning. Initial clinical evaluation of the methodology demonstrates successful monitoring of tooth wear progression. However, further clinical assessment is needed.

  17. Pitfalls in training simulated patients to respond appropriately to questions from medical students in family history-taking activities: the current situation surrounding the training of simulated patients for learning activities at Nippon Medical School.

    Science.gov (United States)

    Aso, Ryoko; Inoue, Chikako; Yoshimura, Akinobu; Shimura, Toshiro

    2013-01-01

    Our goal was to train simulated patients (SPs) to respond appropriately to questions about family history from medical students in simulated medical interviews. To this end, we carried out a survey of 91 SPs and 76 4th-year medical students to investigate their notions of what constitutes a family. All of the SPs and students surveyed deemed parents and children living together to be members of a family. In a situation where one spouse's parents live together with the basic family unit, 93% of the SPs considered them to be members of the family, whereas only 79% of the students did. Married children living apart from their parents were considered members of the family by 18% of the SPs and 39% of the students. These results indicate clear differences between the SPs and students in their notions of the family. To verify the level of understanding of the definitions of family and blood relatives in particular scenarios used in simulated medical interviews, we administered a written test to 14 SPs who were training to assist in the nationwide common achievement test in medicine, the Objective Structured Clinical Examination (OSCE). The overall score of the SPs was 93.5%; the incorrect answers were "a sibling is not a blood relative" and "a spouse is a blood relative." We analyzed the performance of these 14 SPs in medical interviews carried out after training for the OSCE, in which they were asked questions that required them to reveal their understanding of blood relatives, cohabiting relatives, and the family. All of the SPs responded appropriately to the students' questions about family history. After the OSCE, we asked the SPs to assess themselves on how well they had given their family histories and to evaluate the usefulness of the SP training they had received. Their mean self-assessment score on providing a family history was 3.6 (scale: 1-4); on the usefulness of training, it was 3.4 (scale: 1-4). In conclusion, training SPs to respond appropriately to

  18. Computer-assisted detection (CAD) methodology for early detection of response to pharmaceutical therapy in tuberculosis patients

    Science.gov (United States)

    Lieberman, Robert; Kwong, Heston; Liu, Brent; Huang, H. K.

    2009-02-01

    The chest x-ray radiological features of tuberculosis patients are well documented, and the radiological features that change in response to successful pharmaceutical therapy can be followed with longitudinal studies over time. The patients can also be classified as either responsive or resistant to pharmaceutical therapy based on clinical improvement. We have retrospectively collected time series chest x-ray images of 200 patients diagnosed with tuberculosis receiving the standard pharmaceutical treatment. Computer algorithms can be created to utilize image texture features to assess the temporal changes in the chest x-rays of the tuberculosis patients. This methodology provides a framework for a computer-assisted detection (CAD) system that may provide physicians with the ability to detect poor treatment response earlier in pharmaceutical therapy. Early detection allows physicians to respond with more timely treatment alternatives and improved outcomes. Such a system has the potential to increase treatment efficacy for millions of patients each year.

  19. Planning Strabismus Surgery: How to Avoid Pitfalls and Complications.

    Science.gov (United States)

    Aroichane, Maryam

    2016-01-01

    Good surgical results following strabismus surgery depend on several factors. In this article, detailed steps for planning strabismus surgery will be reviewed for basic horizontal strabismus surgery, vertical, and oblique muscle surgeries. The thought process behind each case will be presented to help in selecting the best surgical approach to optimize postoperative results. The surgical planning for strabismus will be developed with clinical examples from easy cases to more complex ones. Preoperative pictures of the ocular alignment are an integral part of planning surgery and help in documenting the strabismus before and after surgery. Three cases of strabismus cases will be reviewed with several key factors for planning surgery, including visual acuity, refractive error, potential for stereovision, and risk of postoperative diplopia. The most important factor is accurate orthoptic measurements. The surgical planning for each patient is detailed along with preoperative pictures. Strabismus surgery results can be improved by careful preoperative planning. The surgeon has the ability to discern potential pitfalls that can alter the surgical outcome. Surgical planning allows a dedicated time of reflection before surgery, foreseeing potential problems, and avoiding them during the surgery. © 2016 Board of regents of the University of Wisconsin System, American Orthoptic Journal, Volume 66, 2016, ISSN 0065-955X, E-ISSN 1553-4448.

  20. FDG-PET/CT in Skeletal Muscle: Pitfalls and Pathologies.

    Science.gov (United States)

    Parida, Girish Kumar; Roy, Shambo Guha; Kumar, Rakesh

    2017-07-01

    FDG-PET/CT is an integral part of modern-day practice of medicine. By detecting increased cellular metabolism, FDG-PET/CT can help us detect infection, inflammatory disorders, or tumors, and also help us in prognostication of patients. However, one of the most important challenges is to correctly differentiate the abnormal uptake that is potentially pathologic from the physiological uptake. So while interpreting a PET/CT, one must be aware of normal biodistribution and different physiological variants of FDG uptake. Skeletal muscles constitute a large part of our body mass and one of the major users of glucose. Naturally, they are often the site of increased FDG uptake in a PET study. We as a nuclear medicine physician must be aware of all the pitfalls of increased skeletal muscle uptake to differentiate between physiological and pathologic causes. In this review, we have discussed the different causes and patterns of physiological FDG uptake in skeletal muscles. This knowledge of normal physiological variants of FDG uptake in the skeletal muscles is essential for differentiating pathologic uptake from the physiological ones. Also, we reviewed the role of FDG-PET/CT in various benign and malignant diseases involving skeletal muscle. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Core biopsies of the breast: Diagnostic pitfalls

    Directory of Open Access Journals (Sweden)

    Megha Joshi

    2011-01-01

    Full Text Available The incidence of breast cancer is increasing worldwide. In this review article, the authors compare and contrast the incidence of breast cancer, and the inherent differences in the United States (US and India in screening techniques used for diagnosing breast cancer. In spite of these differences, core biopsies of the breast are common for diagnosis of breast cancer in both countries. The authors describe "Best Practices" in the reporting and processing of core biopsies and in the analysis of estrogen receptor (ER, progesterone receptor (PR, and human epidermal growth factor Receptor 2 (Her2/neu. The pitfalls in the diagnosis of fibroepithelial lesions of the breast on core biopsy are discussed, as also the significance of pseudoangiomatous stromal hyperplasia of the breast (PASH is discussed in core biopsy. In this review, the management and diagnosis of flat epithelial atypia and radiation atypia are elaborated and the use of immunohistochemistry (IHC in papillary lesions, phyllodes tumor, and complex sclerosing lesions (radial scars is illustrated. Rarer lesions such as mucinous and histiocytoid carcinoma are also discussed.

  2. Avoiding legal pitfalls in surrogacy arrangements.

    Science.gov (United States)

    James, Summer; Chilvers, Rebecca; Havemann, Dara; Phelps, John Y

    2010-12-01

    The goal of this article is to discuss the legal pitfalls that reproductive endocrinologists face when participating in gestational surrogacy contracts. This paper was composed using Westlaw and LexisNexis commercial legal search engines to perform a review of statutes and cases pertaining to gestational surrogacy. The search results demonstrated that in the absence of suitable preparation, there is significant potential for litigation while participating in gestational agreements. Providers caring for gestational carriers have been named as parties in lawsuits for failure to provide psychological screening, failure to screen for infectious disease and participation in gestational contracts that are not compliant with state law. There is great disparity in state laws and court rulings pertaining to gestational agreements. When legal disputes arise, individual state laws and court rulings are controlling over the Uniform Parentage Act. Likewise, recommendations by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine do not supersede state laws. The failure to abide by individual state laws unnecessarily exposes reproductive endocrinologists and their IVF facilities to potential litigation. In order to lessen exposure to litigation, an understanding of individual state legislation or historical court rulings is advised. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Pitfalls in the Assessment, Analysis, and Interpretation of Routine Outcome Monitoring (ROM) Data : Results from an Outpatient Clinic for Integrative Mental Health

    NARCIS (Netherlands)

    Hoenders, Rogier H. J.; Bos, Elisabeth H.; Bartels-Velthuis, Agna A.; Vollbehr, Nina K.; van der Ploeg, Karen; de Jonge, Peter; de Jong, Joop T. V. M.

    There is considerable debate about routine outcome monitoring (ROM) for scientific or benchmarking purposes. We discuss pitfalls associated with the assessment, analysis, and interpretation of ROM data, using data of 376 patients. 206 patients (55 %) completed one or more follow-up measurements.

  4. Usefulness of ceruloplasmin testing as a screening methodology for geriatric patients with osteoporosis

    OpenAIRE

    Karakas, Emel Yigit; Yetisgin, Alpaslan; Cadirci, Dursun; Sezen, Hatice; Altunbas, R?za; Kas, Fehmi; Demir, Mehmet; Ulas, Turgay

    2016-01-01

    [Purpose] To evaluate serum ceruloplasmin levels in geriatric patients with osteoporosis. [Subjects and Methods] Seventy geriatric patients over 65?years of age were recruited. Patients were divided into two groups: group 1 (?OP?, n=35) consisted of patients with osteoporosis, and group 2 (n=35) consisted of patients without osteoporosis. Dual-energy X-ray absorptiometry scanning was used in the measurement of bone mineral density in all cases. Inflammatory parameters, including C-reactive pr...

  5. Patients at the centre: methodological considerations for evaluating evidence from health interventions involving patients use of web-based information systems.

    Science.gov (United States)

    Cummings, Elizabeth; Turner, Paul

    2010-09-15

    Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions.Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences.Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the 'patient at the centre' by engaging them in their own care and/or 'empowering' them through the use of information systems.This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients' interests and outcomes are measured, defined and evaluated within health interventions that involve them using web-based information systems

  6. Orthotopic neobladder reconstrution: postoperative CT appearance, complications and potential pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Su Lim; Jung, Seung Eun; Im, Yeon Soo; Lee, Jae Mun; Lee, Ji Youl; Yoon, Moon Soo; Hahn, Seong Tai [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2003-08-01

    To evaluate the postoperative CT appearance, complications and potential pitfalls of radical cystectomy with orthotopic neobladder reconstruction. We examined 46 patients [43 men and 3 women aged 34-72 (mean, 56.7) years] who had undergone neobladder reconstruction (ileocolic neobladder in 25 patients and ileal-W neobladder in 21). The CT scans were assessed in terms of their depiction of normal anatomy, namely the shape, location and internal architecture of the neobladder, the location of bladder bases, and the ureteral course. Early and late complications were also assessed. The characteristics of ileocolic neobadder were a right-side location, a lobulated outer margin, interal projections due to haustra or plication, a base in the retropubis, and right-side insertion of both ureters. In contrast, the characteristics of an ileal-W neobladder were a central location, an ovoid shape, nodular thickening at the ureteral insertion site, internal projections due to plication, and a retropubic bladder base. Early complications included hematoma with abscess formation (n=2), and postoperative peritonitis (n=1), while late complications were hydronephrosis due to stricture ar the ureteral anastomotic site (n=16), tumor recurrence at this site (n=1), distal ureteral stone (n=1), mucus urinary retention (n=1), incisional hernia (n=2), tumor recurrence in the pelvic side wall (n=1), carcinomatosis peritonei (n=1), and liver metastasis (n=2). A knowledge of normal anatomic changes is essential for the accurate interpretation of CT scans. CT is a useful modality of the evaluation of postoperative change and the complications occurring in patients who have undergone radial cystectomy with othotopic neobladder reconstruction.

  7. Patients at the Centre: Methodological Considerations for Evaluating Evidence from Health Interventions Involving Patients Use of Web-Based Information Systems

    Science.gov (United States)

    Cummings, Elizabeth; Turner, Paul

    2010-01-01

    Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions. Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences. Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the ‘patient at the centre’ by engaging them in their own care and/or ‘empowering’ them through the use of information systems. This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients’ interests and outcomes are measured, defined and evaluated within health interventions that involve them using web

  8. Illusory consolidation of the left lower lobe: A pitfall of portable radiography

    International Nuclear Information System (INIS)

    Zylak, C.J.; Litteton, J.T.; Lighter, M.D.; Zurizch, M.L.

    1986-01-01

    A frequent finding on a portable chest radiography is obscuration of the left hemidiaphragm. Experimental evidence based on radiography of a frozen unembalmed human chest phantom corroborated the hypothesis that this finding can be the result of tube angulation. Clinical examples are provided that supplement the experimental evidence. To avoid this potential pitfall it is essential that the patient be imaged in a position which will ensure that the hemidiaphragm is tangent to the beam. To do otherwise can mislead, creating the false impression of disease in the left lower lobe or pleural space

  9. Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest

    Energy Technology Data Exchange (ETDEWEB)

    Meirelles, Gustavo de Souza Portes; Capobianco, Julia; Oliveira, Marco Antonio Conde de, E-mail: gustavo.meirelles@grupofleury.com.br [Grupo Fleury, Sao Paulo, SP (Brazil)

    2017-01-15

    PET/CT is widely used for the evaluation of patients with thoracic malignancies. Although the levels of {sup 18}F-fluorodeoxyglucose (FDG) uptake are usually high in neoplastic diseases, they can also be physiological, due to artifacts. In addition, FDG uptake can occur in benign conditions such as infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate the main pitfalls and artifacts in the interpretation of the results of oncologic PET/CT of the chest, outlining strategies for avoiding misinterpretation. (author)

  10. Strong transthyretin immunostaining: potential pitfall in cardiac amyloid typing.

    Science.gov (United States)

    Satoskar, Anjali A; Efebera, Yvonne; Hasan, Ayesha; Brodsky, Sergey; Nadasdy, Gyongyi; Dogan, Ahmet; Nadasdy, Tibor

    2011-11-01

    Although systemic amyloidosis commonly presents with renal disease, cardiac involvement usually determines the patient's prognosis. Cardiac involvement is seen in light chain amyloid and transthyretin amyloidosis. Distinguishing between these two is critical because prognosis and treatment differ. Our study demonstrates the unreliability of transthyretin immunostaining in subtyping cardiac amyloid. Between January 2003 and August 2010, we retrieved 229 native endomyocardial biopsies, of which 24 had amyloid. Immunohistochemistry for κ, λ, transthyretin, and serum amyloid A protein was performed on formalin-fixed, paraffin-embedded sections. Staining was graded as weak (trace to 1+) or strong (2 to 3+). Mass spectrometry (MS)-based proteomic typing of microdissected amyloid material was performed on selected cases. Fifteen patients had monoclonal gammopathy/plasma cell dyscrasia with cardiac amyloid. Eight of them (53%) showed strong transthyretin staining in the cardiac amyloid deposits. MS was performed in 5 of these 8 biopsies, and all 5 biopsies revealed light chain amyloid-type amyloid. Two of these 5 light chain amyloid biopsies did not even have concomitant strong staining for the appropriate light chain. Among the 15 cases with plasma cell dyscrasia, only 7 biopsies showed strong staining for the corresponding monoclonal light chain. Strong, false-positive immunostaining for transthyretin in cardiac amyloid is a potential pitfall, augmented by the frequent lack of staining for immunoglobulin light chains. Therefore, the presence of amyloid in the cardiac biopsy should prompt a search for plasma cell dyscrasia irrespective of transthyretin staining. Confirmation with MS should be sought, particularly if there is any discrepancy between κ/λ staining and serum immunofixation results.

  11. Patient-reported Outcomes in Randomised Controlled Trials of Prostate Cancer: Methodological Quality and Impact on Clinical Decision Making

    Science.gov (United States)

    Efficace, Fabio; Feuerstein, Michael; Fayers, Peter; Cafaro, Valentina; Eastham, James; Pusic, Andrea; Blazeby, Jane

    2014-01-01

    Context Patient-reported outcomes (PRO) data from randomised controlled trials (RCTs) are increasingly used to inform patient-centred care as well as clinical and health policy decisions. Objective The main objective of this study was to investigate the methodological quality of PRO assessment in RCTs of prostate cancer (PCa) and to estimate the likely impact of these studies on clinical decision making. Evidence acquisition A systematic literature search of studies was undertaken on main electronic databases to retrieve articles published between January 2004 and March 2012. RCTs were evaluated on a predetermined extraction form, including (1) basic trial demographics and clinical and PRO characteristics; (2) level of PRO reporting based on the recently published recommendations by the International Society for Quality of Life Research; and (3) bias, assessed using the Cochrane Risk of Bias tool. Studies were systematically analysed to evaluate their relevance for supporting clinical decision making. Evidence synthesis Sixty-five RCTs enrolling a total of 22 071 patients were evaluated, with 31 (48%) in patients with nonmetastatic disease. When a PRO difference between treatments was found, it related in most cases to symptoms only (n = 29, 58%). Although the extent of missing data was generally documented (72% of RCTs), few reported details on statistical handling of this data (18%) and reasons for dropout (35%). Improvements in key methodological aspects over time were found. Thirteen (20%) RCTs were judged as likely to be robust in informing clinical decision making. Higher-quality PRO studies were generally associated with those RCTs that had higher internal validity. Conclusions Including PRO in RCTs of PCa patients is critical for better evaluating the treatment effectiveness of new therapeutic approaches. Marked improvements in PRO quality reporting over time were found, and it is estimated that at least one-fifth of PRO RCTs have provided sufficient

  12. Rational manipulation of digital EEG: pearls and pitfalls.

    Science.gov (United States)

    Seneviratne, Udaya

    2014-12-01

    The advent of digital EEG has provided greater flexibility and more opportunities in data analysis to optimize the diagnostic yield. Changing the filter settings, sensitivity, montages, and time-base are possible rational manipulations to achieve this goal. The options to use polygraphy, video, and quantification are additional useful features. Aliasing and loss of data are potential pitfalls in the use of digital EEG. This review illustrates some common clinical scenarios where rational manipulations can enhance the diagnostic EEG yield and potential pitfalls in the process.

  13. Pitfalls in the ankle-brachial index and brachial-ankle pulse wave velocity

    Directory of Open Access Journals (Sweden)

    Ato D

    2018-04-01

    Full Text Available Dai Ato Gakujutsu Shien Co., Ltd., Tokyo, Japan Background: The ankle-brachial index (ABI and pulse wave velocity (PWV are indices of atherosclerosis and arterial stiffness. The Japan-made measuring devices of those indices have spread widely because of their convenience and the significance of the parameters. However, studies that comprehensively discuss the various pitfalls in using these indices are not available.Methods: This study presents several representative pitfalls in using the ABI and brachial-ankle PWV (baPWV by showing the result sheets of the device, “the Vascular Profiler”. Furthermore, some considerations when utilizing these indices in the future are also discussed.Results: Several diseases such as arteriosclerosis obliterans (ASO, arterial calcification in the lower limb, arterial stenosis in the right upper-limb, aortic valve diseases, arterial stenosis in the upper-limb of the contralateral side of the hemodialysis access, are the representative pitfalls when evaluating ABI and baPWV. Moreover, a measurement error is found to actually exist. Furthermore, same phenomena are considered most likely to occur when using other similar indices and devices.Conclusion: The ABI and baPWV are the useful and significant biomarkers. Nevertheless, caution is sometimes necessary when interpreting them. Moreover, rigorous patient exclusion criteria should be considered when using those indices in the severely conditioned patient population. And the results of this study can be applied to enhance the literacy using other indices, such as the cardio-ankle vascular index and other similar devices. Keywords: ankle-brachial index, pulse wave velocity, peripheral arterial disease, aortic valve disease, hemodialysis

  14. Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator (ICD A systematic review

    Directory of Open Access Journals (Sweden)

    Ockene Ira S

    2009-12-01

    Full Text Available Abstract Background Despite the potentially life-saving benefits of the implantable cardioverter-defibrillator (ICD, a significant group of patients experiences emotional distress after ICD implantation. Different psychosocial interventions have been employed to improve this condition, but previous reviews have suggested that methodological issues may limit the validity of such interventions. Aim: To review the methodology of previously published studies of psychosocial interventions in ICD patients, according to CONSORT statement guidelines for non-pharmacological interventions, and provide recommendations for future research. Methods We electronically searched the PubMed, PsycInfo and Cochrane databases. To be included, studies needed to be published in a peer-reviewed journal between 1980 and 2008, to involve a human population aged 18+ years and to have an experimental design. Results Twelve studies met the eligibility criteria. Samples were generally small. Interventions were very heterogeneous; most studies used cognitive behavioural therapy (CBT and exercise programs either as unique interventions or as part of a multi-component program. Overall, studies showed a favourable effect on anxiety (6/9 and depression (4/8. CBT appeared to be the most effective intervention. There was no effect on the number of shocks and arrhythmic events, probably because studies were not powered to detect such an effect. Physical functioning improved in the three studies evaluating this outcome. Lack of information about the indication for ICD implantation (primary vs. secondary prevention, limited or no information regarding use of anti-arrhythmic (9/12 and psychotropic (10/12 treatment, lack of assessments of providers' treatment fidelity (12/12 and patients' adherence to the intervention (11/12 were the most common methodological limitations. Conclusions Overall, this review supports preliminary evidence of a positive effect of psychosocial interventions

  15. Time Perception in Severe Traumatic Brain Injury Patients: A Study Comparing Different Methodologies

    Science.gov (United States)

    Mioni, G.; Mattalia, G.; Stablum, F.

    2013-01-01

    In this study, we investigated time perception in patients with traumatic brain injury (TBI). Fifteen TBI patients and 15 matched healthy controls participated in the study. Participants were tested with durations above and below 1s on three different temporal tasks that involved time reproduction, production, and discrimination tasks. Data…

  16. Research methodology in recurrent pregnancy loss.

    Science.gov (United States)

    Christiansen, Ole B

    2014-03-01

    The aim of this article is to highlight pitfalls in research methodology that may explain why studies in recurrent pregnancy loss (RPL) often provide very divergent results. It is hoped that insight into this issue may help clinicians decide which published studies are the most valid. It may help researchers to eliminate methodological flaws in future studies, which may hopefully come to some kind of agreement about the usefulness of diagnostic tests and treatments in RPL. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Comparison of methodologies to define hemodialysis patients hyporesponsive to epoetin and impact on counts and characteristics

    Directory of Open Access Journals (Sweden)

    Gilbertson David T

    2013-02-01

    Full Text Available Abstract Background Some hemodialysis patients require large doses of erythropoiesis-stimulating agents (ESAs to manage anemia. These patients, termed “ESA hyporesponsive,” have been characterized using various definitions. We applied three definitions of hyporesponsiveness to a large, national cohort of hemodialysis patients to assess the impact of definition on counts and on characteristics associated with hyporesponsiveness. Methods We studied point-prevalent hemodialysis patients on May 1, 2008, with Medicare as primary payer, who survived through December 31, 2008. Included patients received recombinant human erythropoietin (EPO in each month, August-December. Hyporesponsiveness definitions were: above the ninetieth percentile of total monthly EPO dose; above the ninetieth percentile of total monthly EPO dose divided by weight in kg; above the ninetieth percentile of total monthly EPO dose divided by hemoglobin level. Hyporesponsiveness was further classified as chronic, acute, or other. Comorbid conditions were assessed before and concurrent with the hyporesponsive period. Results Women, African Americans, and patients aged Conclusions As associations were similar between patient characteristics and three methods of characterizing EPO hyporesponsiveness, the simplest definition using EPO dose can be used.

  18. Analysis of Combined Data from Heterogeneous Study Designs: A Methodological Proposal from the Patient Navigation Research program

    Science.gov (United States)

    Roetzheim, Richard G.; Freund, Karen M.; Corle, Don K.; Murray, David M.; Snyder, Frederick R.; Kronman, Andrea C.; Jean-Pierre, Pascal; Raich, Peter C.; Holden, Alan E. C.; Darnell, Julie S.; Warren-Mears, Victoria; Patierno, Steven; Design, PNRP; Committee, Analysis

    2013-01-01

    Background The Patient Navigation Research Program (PNRP) is a cooperative effort of nine research projects, each employing its own unique study design. To evaluate projects such as PNRP, it is desirable to perform a pooled analysis to increase power relative to the individual projects. There is no agreed upon prospective methodology, however, for analyzing combined data arising from different study designs. Expert opinions were thus solicited from members of the PNRP Design and Analysis Committee Purpose To review possible methodologies for analyzing combined data arising from heterogeneous study designs. Methods The Design and Analysis Committee critically reviewed the pros and cons of five potential methods for analyzing combined PNRP project data. Conclusions were based on simple consensus. The five approaches reviewed included: 1) Analyzing and reporting each project separately, 2) Combining data from all projects and performing an individual-level analysis, 3) Pooling data from projects having similar study designs, 4) Analyzing pooled data using a prospective meta analytic technique, 5) Analyzing pooled data utilizing a novel simulated group randomized design. Results Methodologies varied in their ability to incorporate data from all PNRP projects, to appropriately account for differing study designs, and in their impact from differing project sample sizes. Limitations The conclusions reached were based on expert opinion and not derived from actual analyses performed. Conclusions The ability to analyze pooled data arising from differing study designs may provide pertinent information to inform programmatic, budgetary, and policy perspectives. Multi-site community-based research may not lend itself well to the more stringent explanatory and pragmatic standards of a randomized controlled trial design. Given our growing interest in community-based population research, the challenges inherent in the analysis of heterogeneous study design are likely to become

  19. Patient's radioprotection and analysis of DPC practices and certification of health facilities - Methodological guide

    International Nuclear Information System (INIS)

    Bataillon, Remy; Lafont, Marielle; Rousse, Carole; Vuillez, Jean-Philippe; Ducou Le Pointe, Hubert; Grenier, Nicolas; Lartigau, Eric; Orcel, Philippe; Dujarric, Francis; Beaupin, Alain; Bar, Olivier; Blondet, Emmanuelle; Combe, Valerie; Pages, Frederique

    2012-11-01

    This methodological guide has been published in compliance with French and European regulatory texts to define the modalities of implementation of the assessment of clinical practices resulting in exposure to ionizing radiation in medical environment (radiotherapy, radio-surgery, interventional radiology, nuclear medicine), to promote clinical audits, and to ease the implementation of programs of continuous professional development in radiotherapy, radiology and nuclear medicine. This guide proposes an analysis of professional practices through analysis sheets which address several aspects: scope, practice data, objectives in terms of improvement of radiation protection, regulatory and institutional references, operational objectives, methods, approaches and tools, follow-up indicators, actions to improve practices, professional target, collective approach, program organisation, and program valorisation in existing arrangements. It also gives 20 program proposals which notably aim at a continuous professional development, 5 of them dealing with diagnosis-oriented imagery-based examinations, 9 with radiology and risk management, 4 with radiotherapy, and 2 with nuclear medicine

  20. Improving patient care in cardiac surgery using Toyota production system based methodology.

    Science.gov (United States)

    Culig, Michael H; Kunkle, Richard F; Frndak, Diane C; Grunden, Naida; Maher, Thomas D; Magovern, George J

    2011-02-01

    A new cardiac surgery program was developed in a community hospital setting using the operational excellence (OE) method, which is based on the principles of the Toyota production system. The initial results of the first 409 heart operations, performed over the 28 months between March 1, 2008, and June 30, 2010, are presented. Operational excellence methodology was taught to the cardiac surgery team. Coaching started 2 months before the opening of the program and continued for 24 months. Of the 409 cases presented, 253 were isolated coronary artery bypass graft operations. One operative death occurred. According to the database maintained by The Society of Thoracic Surgeons, the risk-adjusted operative mortality rate was 61% lower than the regional rate. Likewise, the risk-adjusted rate of major complications was 57% lower than The Society of Thoracic Surgeons regional rate. Daily solution to determine cause was attempted on 923 distinct perioperative problems by all team members. Using the cost of complications as described by Speir and coworkers, avoiding predicted complications resulted in a savings of at least $884,900 as compared with the regional average. By the systematic use of a real time, highly formatted problem-solving methodology, processes of care improved daily. Using carefully disciplined teamwork, reliable implementation of evidence-based protocols was realized by empowering the front line to make improvements. Low rates of complications were observed, and a cost savings of $3,497 per each case of isolated coronary artery bypass graft was realized. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Pitfalls in penetrating thoracic trauma (lessons we learned the hard way...).

    Science.gov (United States)

    Degiannis, Elias; Zinn, Richard Joseph

    2008-10-01

    The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.

  2. [Organization and methodology of early rehabilitation of the patients with cardioembolic stroke complicated by cardiac insufficiency].

    Science.gov (United States)

    Isaeva, T V

    2013-01-01

    The present work was focused on the safety and effectiveness of the combined rehabilitative treatment in the case of pre-acute and acute cardioembolic stroke in 45 patients with varying degree of cardiac decompensation. The study showed that the use of "passive" remediation, such as the postural treatment, breathing exercises, selective massage, neuromuscular electrical stimulation, is safe and can be recommended to the patients with stroke and cardiac decompensation of different severity (II and III FC of chronic cardiac insufficiency). The introduction of such active measures as verticalization into the program of comprehensive rehabilitation may cause decompensation of cardiac insufficiency. The rehabilitation strategy used in the present study improved performance and exercise tolerance in the majority of the patients. Moreover, it resulted in the significant reduction of the severity of stroke, improved the motor function, and increased functional independence of the patients.

  3. Optimization of the pharmaceutical care system for diabetes patients using modern pharmaceutical informatics methodology

    Directory of Open Access Journals (Sweden)

    Андрій Ігорович Бойко

    2016-04-01

    Full Text Available Aim. Implementation of pharmaceutical informatics methods in the system of pharmaceutical care for diabetes patients in Ukraine.Methods. System method was used for the analysis of status and reforming the pharmaceutical care for patients with diabetes; program-oriented management at informatization project realization; pharmaceutical informatics in the creation of computer pharmaceutical knowledge bases; methods of data synthesis and summarizing.Results. System analysis of the basic directions of reforming the pharmaceutical care for patients with diabetes in Ukraine was carried out. Ways of it’s of optimization were processed: establishment of specialized pharmacies with implementation of modern information technologies and special postgraduate education for pharmacists. Structure and information providing of computer knowledge base “Pharmaceutical care for patients with diabetes” was substantiated.Conclusion. Based on the regional project “Informatization of prescription antidiabetic drugs circulation in Ukraine” realization, the necessity of establishment of specialized pharmacies providing pharmaceutical care for patients with diabetes was substantiated. Ways for optimization of postgraduate education for pharmacists of the specialized pharmacies by implementation of special thematic improvement cycles were proceed. Computer knowledge base as an effective tool for optimization of pharmaceutical care for patients with diabetes was realized

  4. Patients' views on early sensory relearning following nerve repair-a Q-methodology study.

    Science.gov (United States)

    Vikström, Pernilla; Carlsson, Ingela; Rosén, Birgitta; Björkman, Anders

    2017-09-26

    Descriptive study. Early sensory relearning where the dynamic capacity of the brain is used has been shown to improve sensory outcome after nerve repair. However, no previous studies have examined how patients experience early sensory relearning. To describe patient's views on early sensory relearning. Statements' scores were analyzed by factor analysis. Thirty-seven consecutive adult patients with median and/or ulnar nerve repair who completed early sensory relearning were included. Three factors were identified, explaining 45% of the variance: (1) "Believe sensory relearning is meaningful, manage to get an illusion of touch and complete the sensory relearning"; (2) "Do not get an illusion of touch easily and need support in their sensory relearning" (3) "Are not motivated, manage to get an illusion of touch but do not complete sensory relearning". Many patients succeed in implementing their sensory relearning. However, a substantial part of the patient population need more support, have difficulties to create illusion of touch, and lack motivation to complete the sensory relearning. To enhance motivation and meaningfulness by relating the training clearly to everyday occupations and to the patient's life situation is a suggested way to proceed. The three unique factors indicate motivation and sense of meaningfulness as key components which should be taken into consideration in developing programs for person-centered early sensory relearning. 3. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  5. Towards an in-plane methodology to track breast lesions using mammograms and patient-specific finite-element simulations

    Science.gov (United States)

    Lapuebla-Ferri, Andrés; Cegoñino-Banzo, José; Jiménez-Mocholí, Antonio-José; Pérez del Palomar, Amaya

    2017-11-01

    In breast cancer screening or diagnosis, it is usual to combine different images in order to locate a lesion as accurately as possible. These images are generated using a single or several imaging techniques. As x-ray-based mammography is widely used, a breast lesion is located in the same plane of the image (mammogram), but tracking it across mammograms corresponding to different views is a challenging task for medical physicians. Accordingly, simulation tools and methodologies that use patient-specific numerical models can facilitate the task of fusing information from different images. Additionally, these tools need to be as straightforward as possible to facilitate their translation to the clinical area. This paper presents a patient-specific, finite-element-based and semi-automated simulation methodology to track breast lesions across mammograms. A realistic three-dimensional computer model of a patient’s breast was generated from magnetic resonance imaging to simulate mammographic compressions in cranio-caudal (CC, head-to-toe) and medio-lateral oblique (MLO, shoulder-to-opposite hip) directions. For each compression being simulated, a virtual mammogram was obtained and posteriorly superimposed to the corresponding real mammogram, by sharing the nipple as a common feature. Two-dimensional rigid-body transformations were applied, and the error distance measured between the centroids of the tumors previously located on each image was 3.84 mm and 2.41 mm for CC and MLO compression, respectively. Considering that the scope of this work is to conceive a methodology translatable to clinical practice, the results indicate that it could be helpful in supporting the tracking of breast lesions.

  6. Health services research in the public healthcare system in Hong Kong: an analysis of over 1 million antihypertensive prescriptions between 2004-2007 as an example of the potential and pitfalls of using routinely collected electronic patient data.

    Science.gov (United States)

    Wong, Martin C S; Jiang, Johnny Y; Tang, Jin-ling; Lam, Augustine; Fung, Hong; Mercer, Stewart W

    2008-06-25

    Increasing use is being made of routinely collected electronic patient data in health services research. The aim of the present study was to evaluate the potential usefulness of a comprehensive database used routinely in the public healthcare system in Hong Kong, using antihypertensive drug prescriptions in primary care as an example. Data on antihypertensive drug prescriptions were retrieved from the electronic Clinical Management System (e-CMS) of all primary care clinics run by the Health Authority (HA) in the New Territory East (NTE) cluster of Hong Kong between January 2004 and June 2007. Information was also retrieved on patients' demographic and socioeconomic characteristics, visit type (new or follow-up), and relevant diseases (International Classification of Primary Care, ICPC codes). 1,096,282 visit episodes were accessed, representing 93,450 patients. Patients' demographic and socio-economic details were recorded in all cases. Prescription details for anti-hypertensive drugs were missing in only 18 patients (0.02%). However, ICPC-code was missing for 36,409 patients (39%). Significant independent predictors of whether disease codes were applied included patient age > or = 70 years (OR 2.18), female gender (OR 1.20), district of residence (range of ORs in more rural districts; 0.32-0.41), type of clinic (OR in Family Medicine Specialist Clinics; 1.45) and type of visit (OR follow-up visit; 2.39). In the 57,041 patients with an ICPC-code, uncomplicated hypertension (ICPC K86) was recorded in 45,859 patients (82.1%). The characteristics of these patients were very similar to those of the non-coded group, suggesting that most non-coded patients on antihypertensive drugs are likely to have uncomplicated hypertension. The e-CMS database of the HA in Hong Kong varies in quality in terms of recorded information. Potential future health services research using demographic and prescription information is highly feasible but for disease-specific research dependant

  7. Proposal of a methodology for individualized iodine-131 therapy for Graves' disease in patients with hyperthyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Araujo, Francisco de [Instituto de Radioprotecao e Dosimetria (IRD), Rio de Janeiro, RJ (Brazil)]. E-mail: faraujo@ird.gov.br; Melo, Rossana Corbo de [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); Rebelo, Ana Maria de Oliveira [Universidade Federal, Rio de Janeiro, RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE); Dantas, Bernardo Maranhao; Dantas, Ana Leticia A.; Lucena, Eder Augusto de [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil)

    2007-11-15

    Objective: Several methods are utilized for determining the radioiodine activity in the treatment of Graves' disease (hyperthyroidism). Some of this methods do not take into consideration the thyroid absorbed dose or the necessary parameters for this estimation. The association between absorbed dose and administered activity depends on effective half-life, iodine uptake and thyroid mass of each patient. The present study was aimed at developing a methodology for individualized {sup 131}I therapy for Graves' disease in patients with hyperthyroidism of the Graves' disease. Materials and methods: A neck-thyroid phantom developed at Instituto de Radioprotecao e Dosimetria, containing a standard solution of {sup 131}I, was utilized for calibrating the scintillation gamma camera and uptake probe installed in the Department of Nuclear Medicine of the Hospital Universitario Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Results: The view angle of the collimator/detector assembly presented values compatible with the thyroid gland size for distances of 25 cm (uptake probe) and 45.8 cm (scintillation gamma camera). Calibration factors were 39.3 {+-} 0.78 and 4.3 {+-} 0.17 cpm/kBq, respectively. The 14-30-hour interval in the retention curve allows the estimation of activity between two points for determining the effective iodine half-life in the thyroid. Conclusion: The utilization of equipment usually available in nuclear medicine clinics is feasible, so this is a simple, effective and low cost methodology. (author)

  8. Limitations and pitfalls of climate change impact analysis on urban rainfall extremes

    DEFF Research Database (Denmark)

    Willems, P.; Olsson, J.; Arnbjerg-Nielsen, Karsten

    Under the umbrella of the IWA/IAHR Joint Committee on Urban Drainage, the International Working Group on Urban Rainfall (IGUR) has reviewed existing methodologies for the analysis of long-term historical and future trends in urban rainfall extremes and their effects on urban drainage systems, due...... to anthropogenic climate change. Current practices have several limitations and pitfalls, which are important to be considered by trend or climate change impact modellers and users of trend/impact results. Climate change may well be the driver that ensures that changes in urban drainage paradigms are identified...... and suitable solutions implemented. Design and optimization of urban drainage infrastructure considering climate change impacts and co-optimizing with other objectives will become ever more important to keep our cities liveable into the future....

  9. Conducting interdisciplinary research to promote healthy and safe employment in health care: promises and pitfalls.

    Science.gov (United States)

    Slatin, Craig; Galizzi, Monica; Melillo, Karen Devereaux; Mawn, Barbara

    2004-01-01

    Due to the complexity of human health, emphasis is increasingly being placed on the need for and conduct of multidisciplinary and/or interdisciplinary health research. Yet many academic and research organizations--and the discipline-specific associations and journals--may not yet be prepared to adopt changes necessary to optimally support interdisciplinary work. This article presents an ongoing interdisciplinary research project's efforts to investigate mechanisms and pathways that lead to occupational health disparities among healthcare workers. It describes the promises and pitfalls encountered during the research,and outlines effective strategies that emerged as a result. Lessons learned include: conflict resolution regarding theoretical and methodological differences; establishing a sense of intellectual ownership of the research, as well as guidelines for multiple authorship; and development and utilization of protocols, communication systems, and tools. This experience suggests a need for the establishment of supportive structures and processes to promote successful interdisciplinary research.

  10. Common pitfalls in statistical analysis: Linear regression analysis

    Directory of Open Access Journals (Sweden)

    Rakesh Aggarwal

    2017-01-01

    Full Text Available In a previous article in this series, we explained correlation analysis which describes the strength of relationship between two continuous variables. In this article, we deal with linear regression analysis which predicts the value of one continuous variable from another. We also discuss the assumptions and pitfalls associated with this analysis.

  11. Medical prescription pitfalls of uncomplicated urinary tract infections ...

    African Journals Online (AJOL)

    user

    1Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia. C. S. ABSTRACT. Objectives: The aim of this evaluation was to identify pitfalls in medical prescriptions of uncomplicated urinary ... competences such as principles of clinical pharmacology, knowledge, skill and critical. 1 judgement, among ...

  12. Estimation dose in patients of nuclear medicine. Implementation of a calculi program and methodology

    International Nuclear Information System (INIS)

    Prieto, C.; Espana, M.L.; Tomasi, L.; Lopez Franco, P.

    1998-01-01

    Our hospital is developing a nuclear medicine quality assurance program in order to comply with medical exposure Directive 97/43 EURATOM and the legal requirements established in our legislation. This program includes the quality control of equipment and, in addition, the dose estimation in patients undergoing nuclear medicine examinations. This paper is focused in the second aspect, and presents a new computer program, developed in our Department, in order to estimate the absorbed dose in different organs and the effective dose to the patients, based upon the data from the ICRP publication 53 and its addendum. (Author) 16 refs

  13. Attitudes towards medication non-adherence in elderly kidney transplant patients: A Q methodology study

    NARCIS (Netherlands)

    M. Moors-Tielen (Mirjam); N.J.A. van Exel (Job); M.C. Buren; L. Maasdam; W. Weimar (Willem)

    2011-01-01

    textabstractBackground. Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing

  14. Study methodology and diabetes control in patients from the non-English diabetes management project (NEDMP).

    Science.gov (United States)

    Dirani, Mohamed; Dang, Trung M; Xie, Jing; Gnanasekaran, Sivashanth; Nicolaou, Theona; Rees, Gwyneth; Fenwick, Eva; Lamoureux, Ecosse L

    2017-03-01

    To describe the clinical characteristics of non-English speaking patients from the Diabetes Management Project (NEDMP), and compare their diabetes management and severity of diabetic retinopathy (DR) with the English-speaking DMP sample (EDMP). A prospective study was conducted on non-English speaking adults with diabetes who attended the Royal Victorian Eye and Ear Hospital. 136 (90.1%) non-English speaking adults were assessed, with a mean age of 72.2 years (range: 50-88 years); 74 (54.4%) were male. Participants completed interviewer-administered questionnaires and underwent visual acuity, fundus photography, optical coherence tomography, biochemistry and anthropometric measurements. The EDMP assessed 609 patients in 2009 using a similar protocol. Type and duration of diabetes, diabetes control and diabetic retinopathy. A total of 127 (93.4%) and 8 (5.9%) participants reported having type 2 and type 1 diabetes, respectively, with a median (IQR) duration of 17 (14) years. The proportion of patients with poor diabetes control (HbA1c ≥ 7%) in the NEDMP was similar to the EDMP (64.0% and 68.2%, respectively; P = 0.411). A significantly higher proportion of patients with DR in the NEDMP were found to have poor diabetes control (HbA1c ≥ 7%) compared to those without DR (80.9% vs. 50.0%, P = 0.003). Almost two-thirds of NEDMP patients (74/118) had DR and 23% (27/115) had diabetic macular edema. The prevalence of DR was similar between the NEDMP and EDMP studies, ranging from 25-30% and 28-29%. The clinical characteristics, diabetes control, and DR severity of English and non-English-speaking patients were similar. The high proportion of poor diabetes management in non-English speaking patients with DR suggests educational and behavioural interventions to improve glycaemic control are warranted. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  15. Pitfalls in the diagnosis and management of Cushing's syndrome.

    Science.gov (United States)

    Bansal, Vivek; El Asmar, Nadine; Selman, Warren R; Arafah, Baha M

    2015-02-01

    .g., malabsorption, celiac disease) and by the concurrent use of medications that interfere with its metabolism (e.g., inducers and inhibitors of the P450 enzyme system). In this review, the authors aim to review the pitfalls commonly encountered in the workup of patients suspected to have hypercortisolism. The optimal diagnosis and therapy for patients with Cushing's disease require the thorough and close coordination and involvement of all members of the management team.

  16. Metabolic tumour volumes measured at staging in lymphoma: methodological evaluation on phantom experiments and patients

    International Nuclear Information System (INIS)

    Meignan, Michel; Sasanelli, Myriam; Itti, Emmanuel; Casasnovas, Rene Olivier; Luminari, Stefano; Fioroni, Federica; Coriani, Chiara; Masset, Helene; Gobbi, Paolo G.; Merli, Francesco; Versari, Annibale

    2014-01-01

    The presence of a bulky tumour at staging on CT is an independent prognostic factor in malignant lymphomas. However, its prognostic value is limited in diffuse disease. Total metabolic tumour volume (TMTV) determined on 18 F-FDG PET/CT could give a better evaluation of the total tumour burden and may help patient stratification. Different methods of TMTV measurement established in phantoms simulating lymphoma tumours were investigated and validated in 40 patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. Data were processed by two nuclear medicine physicians in Reggio Emilia and Creteil. Nineteen phantoms filled with 18 F-saline were scanned; these comprised spherical or irregular volumes from 0.5 to 650 cm 3 with tumour-to-background ratios from 1.65 to 40. Volumes were measured with different SUVmax thresholds. In patients, TMTV was measured on PET at staging by two methods: volumes of individual lesions were measured using a fixed 41 % SUVmax threshold (TMTV 41 ) and a variable visually adjusted SUVmax threshold (TMTV var ). In phantoms, the 41 % threshold gave the best concordance between measured and actual volumes. Interobserver agreement was almost perfect. In patients, the agreement between the reviewers for TMTV 41 measurement was substantial (ρ c = 0.986, CI 0.97 - 0.99) and the difference between the means was not significant (212 ± 218 cm 3 for Creteil vs. 206 ± 219 cm 3 for Reggio Emilia, P = 0.65). By contrast the agreement was poor for TMTV var . There was a significant direct correlation between TMTV 41 and normalized LDH (r = 0.652, CI 0.42 - 0.8, P 41 , but high TMTV 41 could be found in patients with stage 1/2 or nonbulky tumour. Measurement of baseline TMTV in lymphoma using a fixed 41% SUVmax threshold is reproducible and correlates with the other parameters for tumour mass evaluation. It should be evaluated in prospective studies. (orig.)

  17. MIRD methodology

    International Nuclear Information System (INIS)

    Rojo, Ana M.; Gomez Parada, Ines

    2004-01-01

    The MIRD (Medical Internal Radiation Dose) system was established by the Society of Nuclear Medicine of USA in 1960 to assist the medical community in the estimation of the dose in organs and tissues due to the incorporation of radioactive materials. Since then, 'MIRD Dose Estimate Report' (from the 1 to 12) and 'Pamphlets', of great utility for the dose calculations, were published. The MIRD system was planned essentially for the calculation of doses received by the patients during nuclear medicine diagnostic procedures. The MIRD methodology for the absorbed doses calculations in different tissues is explained

  18. Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations.

    Science.gov (United States)

    Matusik, P S; Matusik, P T; Stein, P K

    2018-07-01

    Aim The aim of this review was to summarize current knowledge about the scientific findings and potential clinical utility of heart rate variability measures in patients with systemic lupus erythematosus. Methods PubMed, Embase and Scopus databases were searched for the terms associated with systemic lupus erythematosus and heart rate variability, including controlled vocabulary, when appropriate. Articles published in English and available in full text were considered. Finally, 11 publications were selected, according to the systematic review protocol and were analyzed. Results In general, heart rate variability, measured in the time and frequency domains, was reported to be decreased in patients with systemic lupus erythematosus compared with controls. In some systemic lupus erythematosus studies, heart rate variability was found to correlate with inflammatory markers and albumin levels. A novel heart rate variability measure, heart rate turbulence onset, was shown to be increased, while heart rate turbulence slope was decreased in systemic lupus erythematosus patients. Reports of associations of changes in heart rate variability parameters with increasing systemic lupus erythematosus activity were inconsistent, showing decreasing heart rate variability or no relationship. However, the low/high frequency ratio was, in some studies, reported to increase with increasing disease activity or to be inversely correlated with albumin levels. Conclusions Patients with systemic lupus erythematosus have abnormal heart rate variability, which reflects cardiac autonomic dysfunction and may be related to inflammatory cytokines but not necessarily to disease activity. Thus measurement of heart rate variability could be a useful clinical tool for monitoring autonomic dysfunction in systemic lupus erythematosus, and may potentially provide prognostic information.

  19. Predicting activities of daily living for cancer patients using an ontology-guided machine learning methodology.

    Science.gov (United States)

    Min, Hua; Mobahi, Hedyeh; Irvin, Katherine; Avramovic, Sanja; Wojtusiak, Janusz

    2017-09-16

    Bio-ontologies are becoming increasingly important in knowledge representation and in the machine learning (ML) fields. This paper presents a ML approach that incorporates bio-ontologies and its application to the SEER-MHOS dataset to discover patterns of patient characteristics that impact the ability to perform activities of daily living (ADLs). Bio-ontologies are used to provide computable knowledge for ML methods to "understand" biomedical data. This retrospective study included 723 cancer patients from the SEER-MHOS dataset. Two ML methods were applied to create predictive models for ADL disabilities for the first year after a patient's cancer diagnosis. The first method is a standard rule learning algorithm; the second is that same algorithm additionally equipped with methods for reasoning with ontologies. The models showed that a patient's race, ethnicity, smoking preference, treatment plan and tumor characteristics including histology, staging, cancer site, and morphology were predictors for ADL performance levels one year after cancer diagnosis. The ontology-guided ML method was more accurate at predicting ADL performance levels (P ontologies. This study demonstrated that bio-ontologies can be harnessed to provide medical knowledge for ML algorithms. The presented method demonstrates that encoding specific types of hierarchical relationships to guide rule learning is possible, and can be extended to other types of semantic relationships present in biomedical ontologies. The ontology-guided ML method achieved better performance than the method without ontologies. The presented method can also be used to promote the effectiveness and efficiency of ML in healthcare, in which use of background knowledge and consistency with existing clinical expertise is critical.

  20. A proposed methodology to control body temperature in patients at risk of hypothermia by means of active rewarming systems.

    Science.gov (United States)

    Costanzo, Silvia; Cusumano, Alessia; Giaconia, Carlo; Mazzacane, Sante

    2014-01-01

    Hypothermia is a common complication in patients undergoing surgery under general anesthesia. It has been noted that, during the first hour of surgery, the patient's internal temperature (Tcore) decreases by 0.5-1.5°C due to the vasodilatory effect of anesthetic gases, which affect the body's thermoregulatory system by inhibiting vasoconstriction. Thus a continuous check on patient temperature must be carried out. The currently most used methods to avoid hypothermia are based on passive systems (such as blankets reducing body heat loss) and on active ones (thermal blankets, electric or hot-water mattresses, forced hot air, warming lamps, etc.). Within a broader research upon the environmental conditions, pollution, heat stress, and hypothermia risk in operating theatres, the authors set up an experimental investigation by using a warming blanket chosen from several types on sale. Their aim was to identify times and ways the human body reacts to the heat flowing from the blanket and the blanket's effect on the average temperature Tskin and, as a consequence, on Tcore temperature of the patient. The here proposed methodology could allow surgeons to fix in advance the thermal power to supply through a warming blanket for reaching, in a prescribed time, the desired body temperature starting from a given state of hypothermia.

  1. Metabolic tumour volumes measured at staging in lymphoma: methodological evaluation on phantom experiments and patients

    Energy Technology Data Exchange (ETDEWEB)

    Meignan, Michel [Hopital Henri Mondor and Paris-Est University, Department of Nuclear Medicine, Creteil (France); Paris-Est University, Service de Medecine Nucleaire, EAC CNRS 7054, Hopital Henri Mondor AP-HP, Creteil (France); Sasanelli, Myriam; Itti, Emmanuel [Hopital Henri Mondor and Paris-Est University, Department of Nuclear Medicine, Creteil (France); Casasnovas, Rene Olivier [CHU Le Bocage, Department of Hematology, Dijon (France); Luminari, Stefano [University of Modena and Reggio Emilia, Department of Diagnostic, Clinic and Public Health Medicine, Modena (Italy); Fioroni, Federica [Santa Maria Nuova Hospital-IRCCS, Department of Medical Physics, Reggio Emilia (Italy); Coriani, Chiara [Santa Maria Nuova Hospital-IRCCS, Department of Radiology, Reggio Emilia (Italy); Masset, Helene [Henri Mondor Hospital, Department of Radiophysics, Creteil (France); Gobbi, Paolo G. [University of Pavia, Department of Internal Medicine and Gastroenterology, Fondazione IRCCS Policlinico San Matteo, Pavia (Italy); Merli, Francesco [Santa Maria Nuova Hospital-IRCCS, Department of Hematology, Reggio Emilia (Italy); Versari, Annibale [Santa Maria Nuova Hospital-IRCCS, Department of Nuclear Medicine, Reggio Emilia (Italy)

    2014-06-15

    The presence of a bulky tumour at staging on CT is an independent prognostic factor in malignant lymphomas. However, its prognostic value is limited in diffuse disease. Total metabolic tumour volume (TMTV) determined on {sup 18}F-FDG PET/CT could give a better evaluation of the total tumour burden and may help patient stratification. Different methods of TMTV measurement established in phantoms simulating lymphoma tumours were investigated and validated in 40 patients with Hodgkin lymphoma and diffuse large B-cell lymphoma. Data were processed by two nuclear medicine physicians in Reggio Emilia and Creteil. Nineteen phantoms filled with {sup 18}F-saline were scanned; these comprised spherical or irregular volumes from 0.5 to 650 cm{sup 3} with tumour-to-background ratios from 1.65 to 40. Volumes were measured with different SUVmax thresholds. In patients, TMTV was measured on PET at staging by two methods: volumes of individual lesions were measured using a fixed 41 % SUVmax threshold (TMTV{sub 41}) and a variable visually adjusted SUVmax threshold (TMTV{sub var}). In phantoms, the 41 % threshold gave the best concordance between measured and actual volumes. Interobserver agreement was almost perfect. In patients, the agreement between the reviewers for TMTV{sub 41} measurement was substantial (ρ {sub c} = 0.986, CI 0.97 - 0.99) and the difference between the means was not significant (212 ± 218 cm{sup 3} for Creteil vs. 206 ± 219 cm{sup 3} for Reggio Emilia, P = 0.65). By contrast the agreement was poor for TMTV{sub var}. There was a significant direct correlation between TMTV{sub 41} and normalized LDH (r = 0.652, CI 0.42 - 0.8, P <0.001). Higher disease stages and bulky tumour were associated with higher TMTV{sub 41}, but high TMTV{sub 41} could be found in patients with stage 1/2 or nonbulky tumour. Measurement of baseline TMTV in lymphoma using a fixed 41% SUVmax threshold is reproducible and correlates with the other parameters for tumour mass evaluation

  2. PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

    Science.gov (United States)

    ORSARIA, PAOLO; CHIARAVALLOTI, AGOSTINO; FIORENTINI, ALESSANDRO; PISTOLESE, CHIARA; VANNI, GIANLUCA; VITTORIA GRANAI, ALESSANDRA; VARVARAS, DIMITRIOS; DANIELI, ROBERTA; SCHILLACI, ORAZIO; PETRELLA, GIUSEPPE; CLAUDIO BUONOMO, ORESTE

    2017-01-01

    Background: Although it is valuable for detecting distant metastases, identifying recurrence, and evaluating responses to chemotherapy, the role of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in assessing locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. In the current report, we describe a new PET probe-based clinical approach, with evaluation of the technical performance of a handheld high-energy gamma probe for intraoperative localization of breast carcinomas, and evaluation of lymph node metastases during radio-guided oncological surgery. Patients and Methods: Three patients underwent a PET/CT scan immediately prior to surgery following the standard clinical protocol. Intraoperatively, tumors were localized and resected with the assistance of a hand-held gamma probe. PET-guided assessment of the presence or absence of regional nodal spread of malignancy was compared with the reference standard of histopathological examination. Results: In all three cases, perioperative 18F-FDG PET/CT imaging and intraoperative gamma probe detection verified complete resection of the hypermetabolic lesions and demonstrated no additional suspicious occult disease. Conclusion: This innovative approach demonstrates great promise for providing real-time access to metabolic and morphological tumor information that may lead to an optimal disease-tailored approach. In carefully selected indications, a PET probe can be a useful adjunct in surgical practice, but further trials with a larger number of patients need to be performed to verify these findings. PMID:28064227

  3. Methodologic principles of regulation of patient irradiation during X-ray investigations

    International Nuclear Information System (INIS)

    Vorob'ev, E.I.; Knizhnikov, V.A.; Stavitskij, R.V.; Barkhudarov, R.M.; Lyass, F.M.; Lebedev, L.A.

    1986-01-01

    Attention is paid to the regulation of radiation doses in biomedical radiography on the basis of cost-benefit concept i.e. using optimization principle. Conceptual bases and main dose limits for roentgenological investigations are suggested. Radiation doses and information value from the application of roentgenological investigations for different patients are unequal and depend on the desease type and nature. Three categories of patients subjected to roentgenological examinations are separated: Asub(d)-persons having oncologic desease or with suspicion for it, Bsub(d)-persons which are examined to define diagnosis and to select thrapeutic method in connection with nononcologic deseases, Csub(d)-persons which are subjected to procedures both with preventive and investigative purpose. For Asub(d) category persons radiation doses to all organs should not exceed 0.5 Sv (to eye lens-0.3 Sv), for Bsub(d) category-1/3 of maximum permissible dose to personel envisaged in radiation protection guides (RPG-76), for Csub(d) category-0.5 Sv/year. Control level of dose equivalents limiting different organs exposure due to routine roentgenological procedures, which were obtained by means of dosimetric investigations using tissue-equivalent phantom of a reference man, are presented

  4. A methodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices

    International Nuclear Information System (INIS)

    Prisciandaro, Joann I.; Frechette, Christina M.; Herman, Michael G.; Brown, Paul D.; Garces, Yolanda I.; Foote, Robert L.

    2004-01-01

    Assessment of clinic and site specific margins are essential for the effective use of three-dimensional and intensity modulated radiation therapy. An electronic portal imaging device (EPID) based methodology is introduced which allows individual and population based CTV-to-PTV margins to be determined and compared with traditional margins prescribed during treatment. This method was applied to a patient cohort receiving external beam head and neck radiotherapy under an IRB approved protocol. Although the full study involved the use of an EPID-based method to assess the impact of (1) simulation technique (2) immobilization, and (3) surgical intervention on inter- and intrafraction variations of individual and population-based CTV-to-PTV margins, the focus of the paper is on the technique. As an illustration, the methodology is utilized to examine the influence of two immobilization devices, the UON TM thermoplastic mask and the Type-S TM head/neck shoulder immobilization system on margins. Daily through port images were acquired for selected fields for each patient with an EPID. To analyze these images, simulation films or digitally reconstructed radiographs (DRR's) were imported into the EPID software. Up to five anatomical landmarks were identified and outlined by the clinician and up to three of these structures were matched for each reference image. Once the individual based errors were quantified, the patient results were grouped into populations by matched anatomical structures and immobilization device. The variation within the subgroup was quantified by calculating the systematic and random errors (Σ sub and σ sub ). Individual patient margins were approximated as 1.65 times the individual-based random error and ranged from 1.1 to 6.3 mm (A-P) and 1.1 to 12.3 mm (S-I) for fields matched on skull and cervical structures, and 1.7 to 10.2 mm (L-R) and 2.0 to 13.8 mm (S-I) for supraclavicular fields. Population-based margins ranging from 5.1 to 6.6 mm (A

  5. Pitfalls in genetic testing: the story of missed SCN1A mutations.

    Science.gov (United States)

    Djémié, Tania; Weckhuysen, Sarah; von Spiczak, Sarah; Carvill, Gemma L; Jaehn, Johanna; Anttonen, Anna-Kaisa; Brilstra, Eva; Caglayan, Hande S; de Kovel, Carolien G; Depienne, Christel; Gaily, Eija; Gennaro, Elena; Giraldez, Beatriz G; Gormley, Padhraig; Guerrero-López, Rosa; Guerrini, Renzo; Hämäläinen, Eija; Hartmann, Corinna; Hernandez-Hernandez, Laura; Hjalgrim, Helle; Koeleman, Bobby P C; Leguern, Eric; Lehesjoki, Anna-Elina; Lemke, Johannes R; Leu, Costin; Marini, Carla; McMahon, Jacinta M; Mei, Davide; Møller, Rikke S; Muhle, Hiltrud; Myers, Candace T; Nava, Caroline; Serratosa, Jose M; Sisodiya, Sanjay M; Stephani, Ulrich; Striano, Pasquale; van Kempen, Marjan J A; Verbeek, Nienke E; Usluer, Sunay; Zara, Federico; Palotie, Aarno; Mefford, Heather C; Scheffer, Ingrid E; De Jonghe, Peter; Helbig, Ingo; Suls, Arvid

    2016-07-01

    Sanger sequencing, still the standard technique for genetic testing in most diagnostic laboratories and until recently widely used in research, is gradually being complemented by next-generation sequencing (NGS). No single mutation detection technique is however perfect in identifying all mutations. Therefore, we wondered to what extent inconsistencies between Sanger sequencing and NGS affect the molecular diagnosis of patients. Since mutations in SCN1A, the major gene implicated in epilepsy, are found in the majority of Dravet syndrome (DS) patients, we focused on missed SCN1A mutations. We sent out a survey to 16 genetic centers performing SCN1A testing. We collected data on 28 mutations initially missed using Sanger sequencing. All patients were falsely reported as SCN1A mutation-negative, both due to technical limitations and human errors. We illustrate the pitfalls of Sanger sequencing and most importantly provide evidence that SCN1A mutations are an even more frequent cause of DS than already anticipated.

  6. Introducing a change in hospital policy using FMEA methodology as a tool to reduce patient hazards.

    Science.gov (United States)

    Ofek, Fanny; Magnezi, Racheli; Kurzweil, Yaffa; Gazit, Inbal; Berkovitch, Sofia; Tal, Orna

    2016-01-01

    Intravenous potassium chloride (IV KCl) solutions are widely used in hospitals for treatment of hypokalemia. As ampoules of concentrated KCL must be diluted before use, critical incidents have been associated with its preparation and administration. Currently, we have introduced ready-to-use diluted KCl infusion solutions to minimize the use of high-alert concentrated KCl. Since this process may be associated with considerable risks, we embraced a proactive hazard analysis as a tool to implement a change in high-alert drug usage in a hospital setting. Failure mode and effect analysis (FMEA) is a systematic tool to analyze and identify risks in system operations. We used FMEA to examine the hazards associated with the implementation of the ready-to-use solutions. A multidisciplinary team analyzed the risks by identifying failure modes, conducting a hazard analysis and calculating the criticality index (CI) for each failure mode. A 1-day survey was performed as an evaluation step after a trial run period of approximately 4 months. Six major possible risks were identified. The most severe risks were prioritized and specific recommendations were formulated. Out of 28 patients receiving IV KCl on the day of the survey, 22 received the ready-to-use solutions and 6 received the concentrated solutions as instructed. Only 1 patient received inappropriate ready-to-use KCl. Using the FMEA tool in our study has proven once again that by creating a gradient of severity of potential vulnerable elements, we are able to proactively promote safer and more efficient processes in health care systems. This article presents a utilization of this method for implementing a change in hospital policy regarding the routine use of IV KCl.

  7. Potential pitfalls of steatopygia on bone imaging using Tc99m MDP and role of SPECT

    International Nuclear Information System (INIS)

    Elgazzar, H; Elsaid, M; Omar, A; Al-Maskery, IB

    2004-01-01

    Body habbitus influence the quality of bone scintigraphy. Steatopygia (steato: fat, pygia: buttocks) may affect the quality of bone scan since it may lead to diagnostic pitfalls. Objective: The objective of this prospective study is to evaluate the effects of steatopygia on the appearance of the lumbar spine on bone scan and the role of SPECT in overcoming fat attenuation artifact if present. Method: Bone scintigraphy, including whole body bone scan, spot views and SPECT of the lumber spine, using a dual head gamma camera, were performed on thirty adult obese patients (13 males, 17 females) with an average weight of 90 kg. referred to the department for routine bone scan. Each patient was injected intravenously with 0.25 mCi/kg (9.25 Mbq of Tc-99m MDP, and their weight and height of each patient were recorded. Whole body scan was performed using 256 X 1024 matrix size and 8 min/meter speed. SPECT was performed using 128 X 128 matrix size, 20 second-32 projections and elliptical orbit around the lumbar spine. Spot views were acquired using 256X256 matrix size for 1000 Kcounts. Results: Twenty patients (67%) (6 males, 14 females) showed steatopygia with attenuation at the lower lumber vertebrae. Diminished uptake in the lower lumbar spine and edge effect artifacts were noted on planar images mimicking abnormalities. SPECT, especially in the sagittal axis, resolved these artifacts. Conclusion: Steatopygia should be considered in the interpretation of bone scans of obese patients to avoid diagnostic pitfalls. Adding SPECT of the lumber spine to the planar imaging improves the diagnostic accuracy in obese patients by overcoming the steatopygia effect seen on whole body and spot planar images. (authors)

  8. The value and pitfalls of speculation about science and technology in bioethics: the case of cognitive enhancement.

    Science.gov (United States)

    Racine, Eric; Martin Rubio, Tristana; Chandler, Jennifer; Forlini, Cynthia; Lucke, Jayne

    2014-08-01

    In the debate on the ethics of the non-medical use of pharmaceuticals for cognitive performance enhancement in healthy individuals there is a clear division between those who view "cognitive enhancement" as ethically unproblematic and those who see such practices as fraught with ethical problems. Yet another, more subtle issue, relates to the relevance and quality of the contribution of scholarly bioethics to this debate. More specifically, how have various forms of speculation, anticipatory ethics, and methods to predict scientific trends and societal responses augmented or diminished this contribution? In this paper, we use the discussion of the ethics of cognitive enhancement to explore the positive and negative contribution of speculation in bioethics scholarship. First, we review and discuss how speculation has relied on different sets of assumptions regarding the non-medical use of stimulants, namely: (1) terminology and framing; (2) scientific aspects such as efficacy and safety; (3) estimates of prevalence and consequent normalization; and (4) the need for normative reflection and regulatory guidelines. Second, three methodological guideposts are proposed to alleviate some of the pitfalls of speculation: (1) acknowledge assumptions more explicitly and identify the value attributed to assumptions; (2) validate assumptions with interdisciplinary literature; and (3) adopt a broad perspective to promote more comprehensive reflection. We conclude that, through the examination of the controversy about cognitive enhancement, we can employ these methodological guideposts to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.

  9. Machine learning techniques to examine large patient databases.

    Science.gov (United States)

    Meyfroidt, Geert; Güiza, Fabian; Ramon, Jan; Bruynooghe, Maurice

    2009-03-01

    Computerization in healthcare in general, and in the operating room (OR) and intensive care unit (ICU) in particular, is on the rise. This leads to large patient databases, with specific properties. Machine learning techniques are able to examine and to extract knowledge from large databases in an automatic way. Although the number of potential applications for these techniques in medicine is large, few medical doctors are familiar with their methodology, advantages and pitfalls. A general overview of machine learning techniques, with a more detailed discussion of some of these algorithms, is presented in this review.

  10. Methodologies for Development of Patient Specific Bone Models from Human Body CT Scans

    Science.gov (United States)

    Chougule, Vikas Narayan; Mulay, Arati Vinayak; Ahuja, Bharatkumar Bhagatraj

    2016-06-01

    This work deals with development of algorithm for physical replication of patient specific human bone and construction of corresponding implants/inserts RP models by using Reverse Engineering approach from non-invasive medical images for surgical purpose. In medical field, the volumetric data i.e. voxel and triangular facet based models are primarily used for bio-modelling and visualization, which requires huge memory space. On the other side, recent advances in Computer Aided Design (CAD) technology provides additional facilities/functions for design, prototyping and manufacturing of any object having freeform surfaces based on boundary representation techniques. This work presents a process to physical replication of 3D rapid prototyping (RP) physical models of human bone from various CAD modeling techniques developed by using 3D point cloud data which is obtained from non-invasive CT/MRI scans in DICOM 3.0 format. This point cloud data is used for construction of 3D CAD model by fitting B-spline curves through these points and then fitting surface between these curve networks by using swept blend techniques. This process also can be achieved by generating the triangular mesh directly from 3D point cloud data without developing any surface model using any commercial CAD software. The generated STL file from 3D point cloud data is used as a basic input for RP process. The Delaunay tetrahedralization approach is used to process the 3D point cloud data to obtain STL file. CT scan data of Metacarpus (human bone) is used as the case study for the generation of the 3D RP model. A 3D physical model of the human bone is generated on rapid prototyping machine and its virtual reality model is presented for visualization. The generated CAD model by different techniques is compared for the accuracy and reliability. The results of this research work are assessed for clinical reliability in replication of human bone in medical field.

  11. Herpetological Monitoring Using a Pitfall Trapping Design in Southern California

    Science.gov (United States)

    Fisher, Robert; Stokes, Drew; Rochester, Carlton; Brehme, Cheryl; Hathaway, Stacie; Case, Ted

    2008-01-01

    The steps necessary to conduct a pitfall trapping survey for small terrestrial vertebrates are presented. Descriptions of the materials needed and the methods to build trapping equipment from raw materials are discussed. Recommended data collection techniques are given along with suggested data fields. Animal specimen processing procedures, including toe- and scale-clipping, are described for lizards, snakes, frogs, and salamanders. Methods are presented for conducting vegetation surveys that can be used to classify the environment associated with each pitfall trap array. Techniques for data storage and presentation are given based on commonly use computer applications. As with any study, much consideration should be given to the study design and methods before beginning any data collection effort.

  12. Methodology for perceptual assessment of speech in patients with cleft palate: a critical review of the literature.

    Science.gov (United States)

    Lohmander, Anette; Olsson, Maria

    2004-01-01

    This review of 88 articles in three international journals was undertaken for the purpose of investigating the methodology for perceptual speech assessment in patients with cleft palate. The articles were published between 1980 and 2000 in the Cleft Palate-Craniofacial Journal, the International Journal of Language and Communication Disorders, and Folia Phoniatrica et Logopaedica. The majority of articles (76) were published in the Cleft Palate-Craniofacial Journal, with an increase in articles during the 1990s and 2000. Information about measures or variables was clearly given in all articles. However, the review raises several major concerns regarding method for collection and documentation of data and method for measurement. The most distressing findings were the use of a cross-sectional design in studies of few patients with large age ranges and different types of clefts, the use of highly variable speech samples, and the lack of information about listeners and on reliability. It is hoped that ongoing national and international collaborative efforts to standardize procedures for collection and analysis of perceptual data will help to eliminate such concerns and thus make comparison of published results possible in the future.

  13. Common pitfalls in statistical analysis: Odds versus risk

    Science.gov (United States)

    Ranganathan, Priya; Aggarwal, Rakesh; Pramesh, C. S.

    2015-01-01

    In biomedical research, we are often interested in quantifying the relationship between an exposure and an outcome. “Odds” and “Risk” are the most common terms which are used as measures of association between variables. In this article, which is the fourth in the series of common pitfalls in statistical analysis, we explain the meaning of risk and odds and the difference between the two. PMID:26623395

  14. Importance and pitfalls of molecular analysis to parasite epidemiology.

    Science.gov (United States)

    Constantine, Clare C

    2003-08-01

    Molecular tools are increasingly being used to address questions about parasite epidemiology. Parasites represent a diverse group and they might not fit traditional population genetic models. Testing hypotheses depends equally on correct sampling, appropriate tool and/or marker choice, appropriate analysis and careful interpretation. All methods of analysis make assumptions which, if violated, make the results invalid. Some guidelines to avoid common pitfalls are offered here.

  15. Using demographic data to better interpret pitfall trap catches

    Directory of Open Access Journals (Sweden)

    Andrey Matalin

    2011-05-01

    Full Text Available The results of pitfall trapping are often interpreted as abundance in a particular habitat. At the same time, there are numerous cases of almost unrealistically high catches of ground beetles in seemingly unsuitable sites. The correlation of catches by pitfall trapping with the true distribution and abundance of Carabidae needs corroboration. During a full year survey in 2006/07 in the Lake Elton region (Volgograd Area, Russia, 175 species of ground beetles were trapped. Considering the differences in demographic structure of the local populations, and not their abundances, three groups of species were recognized: residents, migrants and sporadic. In residents, the demographic structure of local populations is complete, and their habitats can be considered “residential”. In migrants and sporadic species, the demographic structure of the local populations is incomplete, and their habitats can be considered “transit”. Residents interact both with their prey and with each other in a particular habitat. Sporadic species are hardly important to a carabid community because of their low abundances. The contribution of migrants to the structure of carabid communities is not apparent and requires additional research. Migrants and sporadic species represent a “labile” component in ground beetles communities, as opposed to a “stable” component, represented by residents. The variability of the labile component substantially limits our interpretation of species diversity in carabid communities. Thus, the criteria for determining the most abundant, or dominant species inevitably vary because the abundance of migrants in some cases can be one order of magnitude higher than that of residents. The results of pitfall trapping adequately reflect the state of carabid communities only in zonal habitats, while azonal and disturbed habitats are merely transit ones for many species of ground beetles. A study of the demographic structure of local

  16. Using demographic data to better interpret pitfall trap catches.

    Science.gov (United States)

    Matalin, Andrey V; Makarov, Kirill V

    2011-01-01

    The results of pitfall trapping are often interpreted as abundance in a particular habitat. At the same time, there are numerous cases of almost unrealistically high catches of ground beetles in seemingly unsuitable sites. The correlation of catches by pitfall trapping with the true distribution and abundance of Carabidae needs corroboration. During a full year survey in 2006/07 in the Lake Elton region (Volgograd Area, Russia), 175 species of ground beetles were trapped. Considering the differences in demographic structure of the local populations, and not their abundances, three groups of species were recognized: residents, migrants and sporadic. In residents, the demographic structure of local populations is complete, and their habitats can be considered "residential". In migrants and sporadic species, the demographic structure of the local populations is incomplete, and their habitats can be considered "transit". Residents interact both with their prey and with each other in a particular habitat. Sporadic species are hardly important to a carabid community because of their low abundances. The contribution of migrants to the structure of carabid communities is not apparent and requires additional research. Migrants and sporadic species represent a "labile" component in ground beetles communities, as opposed to a "stable" component, represented by residents. The variability of the labile component substantially limits our interpretation of species diversity in carabid communities. Thus, the criteria for determining the most abundant, or dominant species inevitably vary because the abundance of migrants in some cases can be one order of magnitude higher than that of residents. The results of pitfall trapping adequately reflect the state of carabid communities only in zonal habitats, while azonal and disturbed habitats are merely transit ones for many species of ground beetles. A study of the demographic structure of local populations and assessment of the

  17. Bone morphogenetic protein-2 and bone therapy: successes and pitfalls.

    Science.gov (United States)

    Poon, Bonnie; Kha, Tram; Tran, Sally; Dass, Crispin R

    2016-02-01

    Bone morphogenetic proteins (BMPs), more specifically BMP-2, are being increasingly used in orthopaedic surgery due to advanced research into osteoinductive factors that may enhance and improve bone therapy. There are many areas in therapy that BMP-2 is being applied to, including dental treatment, open tibial fractures, cancer and spinal surgery. Within these areas of treatment, there are many reports of successes and pitfalls. This review explores the use of BMP-2 and its successes, pitfalls and future prospects in bone therapy. The PubMed database was consulted to compile this review. With successes in therapy, there were descriptions of a more rapid healing time with no signs of rejection or infection attributed to BMP-2 treatment. Pitfalls included BMP-2 'off-label' use, which lead to various adverse effects. Our search highlighted that optimising treatment with BMP-2 is a direction that many researchers are exploring, with areas of current research interest including concentration and dose of BMP-2, carrier type and delivery. © 2015 Royal Pharmaceutical Society.

  18. Avoiding Psychological Pitfalls in Aesthetic Medical Procedures.

    Science.gov (United States)

    Wang, Qiuyu; Cao, Chuan; Guo, Rui; Li, Xiaoge; Lu, Lele; Wang, Wenping; Li, Shirong

    2016-12-01

    To assess the prevalence of body dysmorphic disorder (BDD) in an aesthetic surgery setting in the region of Southwest China, and to ascertain the differences in terms of body images between patients in the aesthetic setting and general Chinese population. This study tracked patient satisfaction with their body image changes while undergoing aesthetic medical procedures to identify whether the condition of patients who were presenting with BDD symptoms or their psychological symptoms could be improved by enhancing their appearance. Additionally, this study explored whether there was improvement in quality of life (QoL) and self-esteem after aesthetic medical procedures. A total of 106 female patients who were undergoing aesthetic medical procedures for the first time (plastic surgery, n = 26; minimally invasive aesthetic treatment, n = 42; and aesthetic dermatological treatment, n = 38) were classified as having body dysmorphic disorder symptoms or not having body dysmorphic disorder symptoms, based on the body dysmorphic disorder examination (BDDE), which was administered preoperatively. These patients were followed up for 1 month after the aesthetic procedures. The multidimensional body self-relations questionnaire-appearance scales (MBSRQ-AS) and rosenberg self-esteem scale (RSE-S) were used to assess patients' preoccupation with appearance and self-esteem pre-procedure and 1 month post-procedure. Additionally, 100 female healthy control participants were recruited as a comparative group into this study and they were also assessed using BDDE, MBSRQ-AS, and RSE-S. A total of 14.2 % of 106 aesthetic patients and 1 % of 100 healthy controls were diagnosed with BDD to varying extents. BDDE scores were 72.83 (SD ± 30.7) and 68.18 (SD ± 31.82), respectively, before and after the procedure for the aesthetic patient group and 43.44 (SD ± 15.65) for the healthy control group (F = 34.28; p aesthetic patients (pre-procedure) and female adult norms from

  19. Retrosternal pain as a diagnostic pitfall

    Energy Technology Data Exchange (ETDEWEB)

    Beck, A; Grosser, G; Hauenstein, K H; Strobel, E S

    1989-03-01

    A 42 year old woman with signs of myocardial infarction is reported. Past history of alcoholic cardiomyopathy with multiple signs of cardiac alterations like arrhythmia, tachycardia and precordial pain are known in patients anamnesis. The intelligence-quotient of the patient is poor. The routine X-ray examination of the chest showed normal lungs and a normal shape of the heart. The metal in projection of the heart was first malinterpreted as an implanted mitral-valve, but the lateral view showed the metal structure behind the heart. The metal resulted after gastroscopy and transesophageal extraction a silvered brooch. (orig.).

  20. Retrosternal pain as a diagnostic pitfall

    International Nuclear Information System (INIS)

    Beck, A.; Grosser, G.; Hauenstein, K.H.

    1989-01-01

    A 42 year old woman with signs of myocardial infarction is reported. Past history of alcoholic cardiomyopathy with multiple signs of cardiac alterations like arrhythmia, tachycardia and precordial pain are known in patients anamnesis. The intelligence-quotient of the patient is poor. The routine X-ray examination of the chest showed normal lungs and a normal shape of the heart. The metal in projection of the heart was first malinterpreted as an implanted mitral-valve, but the lateral view showed the metal structure behind the heart. The metal resulted after gastroscopy and transesophageal extraction a silvered brooch. (orig.) [de

  1. Time-to-event methodology improved statistical evaluation in register-based health services research.

    Science.gov (United States)

    Bluhmki, Tobias; Bramlage, Peter; Volk, Michael; Kaltheuner, Matthias; Danne, Thomas; Rathmann, Wolfgang; Beyersmann, Jan

    2017-02-01

    Complex longitudinal sampling and the observational structure of patient registers in health services research are associated with methodological challenges regarding data management and statistical evaluation. We exemplify common pitfalls and want to stimulate discussions on the design, development, and deployment of future longitudinal patient registers and register-based studies. For illustrative purposes, we use data from the prospective, observational, German DIabetes Versorgungs-Evaluation register. One aim was to explore predictors for the initiation of a basal insulin supported therapy in patients with type 2 diabetes initially prescribed to glucose-lowering drugs alone. Major challenges are missing mortality information, time-dependent outcomes, delayed study entries, different follow-up times, and competing events. We show that time-to-event methodology is a valuable tool for improved statistical evaluation of register data and should be preferred to simple case-control approaches. Patient registers provide rich data sources for health services research. Analyses are accompanied with the trade-off between data availability, clinical plausibility, and statistical feasibility. Cox' proportional hazards model allows for the evaluation of the outcome-specific hazards, but prediction of outcome probabilities is compromised by missing mortality information. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Reducing hospital-acquired pressure ulcers using bundle methodology in pediatric and neonatal patients receiving extracorporeal membrane oxygenation therapy: An integrative review and call to action.

    Science.gov (United States)

    Courtwright, Suzanne E; Mastro, Kari A; Preuster, Christa; Dardashti, Navid; McGill, Sandra; Madelon, Myrlene; Johnson, Donna

    2017-10-01

    This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population. An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of the scientific literature was performed. Studies included were published between January 2011 and February 2016. A total of seven articles met inclusion criteria. Data were extracted from each published article and analyzed to identify common themes, specifically bundle methodology and barriers to implementing HAPU bundles, in this population. There is limited research on effectiveness of care bundle methodology in reducing HAPUs in children, and no research specific to its effectiveness in pediatric or neonatal ECMO patients. No research was identified studying barriers to implementation of HAPU care bundles in this population. Nurses are well poised to test innovative strategies to prevent HAPUs. Nurses should consider implementing and testing bundle methodology to reduce HAPU in this at-risk population, and conduct research to identify any barriers to implementing this strategy. There is literature to support the use of nurses as unit-based skin care champions to facilitate teamwork and reliable use of the bundle, both critical components to the success of bundle methodology. © 2017 Wiley Periodicals, Inc.

  3. Pitfalls in the diagnosis of carcinoid syndrome

    Directory of Open Access Journals (Sweden)

    Dorota Kaczmarska-Turek

    2016-06-01

    Full Text Available Background . Carcinoid syndrome (CS is a rare syndrome, most commonly associated with neuroendocrine neoplasms (NEN s of the small intestine. Carcinoid syndrome consists of diarrhea, vomiting, abdominal pain, cutaneous flushing, teleangiectasias, bronchoconstriction and increased perspiration. Diagnosis of carcinoid syndrome remains a challenge and it is often delayed. Objectives . The aim of this study was to characterize patients with CS and define the most sensitive, primary diagnostic tools for CS . Material and methods. 26 consecutive patients admitted to the Department because of carcinoid-like symptoms. Diagnosis of CS was based on clinical findings and laboratory data (levels of 5-hydroxyindoloacetic acid. Diagnosis of NEN was based on laboratory findings, imaging studies (US , CT , Gallium-68-DOTA TATE PET -CT and histopathological analysis. CS due to NEN was diagnosed in 16 subjects (NEN –CS . Results . The most common symptoms in non-NEN were increased perspiration, flushes and diarrhea. CgA was elevated (40%; n = 4 in this group. However, elevated levels of 5-HIAA and liver lesions were not presented. In the NEN –CS symptoms were reported more often: flush (93.7%; n = 15, diarrhea (87.5%; n = 14, abdominal pain and teleangiectasis (81.2%; n = 13. Elevated CgA and 5-HIAA were noted in 87.5% (n = 14 and 81.2% (n = 13 respectively. US and CT revealed liver metastases in all patients. The mean duration of symptoms before diagnosis was 28.6 months. Conclusions . The combination of several symptoms of carcinoid syndrome and liver lesion in easily available abdominal imaging (US and/or CT should prompt physicians to quick referral to centres specialized in the diagnosis and treatment of NEN.

  4. Frailty Testing Pilot Study: Pros and Pitfalls.

    Science.gov (United States)

    Adlam, Taylor; Ulrich, Elizabeth; Kent, Missy; Malinzak, Lauren

    2018-02-01

    Frailty can be defined as an inflammatory state with a loss of physiologic reserve in multiple systems that manifests as a decreased ability to respond to stressors that ultimately leads to an increased risk of adverse outcomes. The aim of this study was to determine the ease of frailty testing in a pre-kidney transplant clinic and the resources required to do so. A secondary goal was to better understand the utility of frailty testing when evaluating potential kidney transplant recipients. Frailty testing was conducted at a pre-kidney transplant clinic in three phases using Fried's frailty phenotype (shrinking, exhaustion, low physical activity, slowness, and grip strength). A total of 132 frailty tests were completed on 128 patients. Frail patients had significantly higher rates of shrinking (26% vs. 8.5%, P testing was most complete when an examiner dedicated to frailty testing performed the testing. Frailty testing is feasible to complete in a pre-transplant clinic with an appropriate investment in personnel and resources.

  5. Overview, practical tips and potential pitfalls of using automatic exposure control in CT: Siemens care dose 4D

    International Nuclear Information System (INIS)

    Soederberg, Marcus

    2016-01-01

    Today, computed tomography (CT) systems routinely use automatic exposure control (AEC), which modulates the tube current. However, for optimal use, there are several aspects of an AEC system that need to be considered. The purpose of this study was to provide an overview of the Siemens CARE Dose 4D AEC system, discuss practical tips and demonstrate potential pitfalls. Two adult anthropomorphic phantoms were examined using two different Siemens CT systems. When optimising the CT radiation dose and image quality, the projection angle of the localiser, patient centring, protocol selection, scanning direction and the use of protective devices requires special attention. (authors)

  6. Methodological and Reporting Quality of Comparative Studies Evaluating Health-Related Quality of Life of Colorectal Cancer Patients and Controls: A Systematic Review.

    Science.gov (United States)

    Wong, Carlos K H; Guo, Vivian Y W; Chen, Jing; Lam, Cindy L K

    2016-11-01

    Health-related quality of life is an important outcome measure in patients with colorectal cancer. Comparison with normative data has been increasingly undertaken to assess the additional impact of colorectal cancer on health-related quality of life. This review aimed to critically appraise the methodological details and reporting characteristics of comparative studies evaluating differences in health-related quality of life between patients and controls. A systematic search of English-language literature published between January 1985 and May 2014 was conducted through a database search of PubMed, Web of Science, Embase, and Medline. Comparative studies reporting health-related quality-of-life outcomes among patients who have colorectal cancer and controls were selected. Methodological and reporting quality per comparison study was evaluated based on a 11-item methodological checklist proposed by Efficace in 2003 and a set of criteria predetermined by reviewers. Thirty-one comparative studies involving >10,000 patients and >10,000 controls were included. Twenty-three studies (74.2%) originated from European countries, with the largest number from the Netherlands (n = 6). Twenty-eight studies (90.3%) compared the health-related quality of life of patients with normative data published elsewhere, whereas the remaining studies recruited a group of patients who had colorectal cancer and a group of control patients within the same studies. The European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 was the most extensively used instrument (n = 16; 51.6%). Eight studies (25.8%) were classified as "probably robust" for clinical decision making according to the Efficace standard methodological checklist. Our further quality assessment revealed the lack of score differences reported (61.3%), contemporary comparisons (36.7%), statistical significance tested (38.7%), and matching of control group (58.1%), possibly leading to

  7. Predictive genetic tests: problems and pitfalls.

    Science.gov (United States)

    Davis, J G

    1997-12-29

    The role that genetic factors play in medicine has expanded, owing to such recent advances as those made by the Human Genome Project and the work that has spun off from it. The project is focusing particularly on localization and characterization of recognized human genetic disorders, which in turn increases awareness of the potential for improved treatment of these disorders. Technical advances in genetic testing in the absence of effective treatment has presented the health profession with major ethical challenges. The example of the identification of the BRCA1 and BRCA2 genes in families at high risk for breast and ovarian cancer is presented to illustrate the issues of the sensitivity of the method, the degree of susceptibility a positive result implies, the need for and availability of counseling and patient education, and confidentiality of the test results. A compelling need exists for adequate education about medical genetics to raise the "literacy" rate among health professionals.

  8. Pathways, Pitfalls and Opportunities in Partnerships for Development

    DEFF Research Database (Denmark)

    Christensen, David; Vanhill, Josefine; Wolf, Andreas

    The municipal solid waste management systems of many developing countries are commonly constrained by factors such as limited financial resources and poor governance, making it a difficult proposition to break with complex, entrenched and unsustainable technologies and systems. This paper...... some lessons in such partnership building: In Uganda and Denmark respectively, the World Wildlife Fund and the network-administrating organization access2innovation have attempted to mobilize stakeholders around improving the municipal solid waste system in the rural district capital of Kasese. Through...... a municipal solid waste system characterization and mapping exercise, some emergent lessons and guiding principles in partnership building point to both pitfalls and opportunities for designing sustainable pathways....

  9. Pitfalls in VAR based return decompositions: A clarification

    DEFF Research Database (Denmark)

    Engsted, Tom; Pedersen, Thomas Quistgaard; Tanggaard, Carsten

    in their analysis is not "cashflow news" but "inter- est rate news" which should not be zero. Consequently, in contrast to what Chen and Zhao claim, their decomposition does not serve as a valid caution against VAR based decompositions. Second, we point out that in order for VAR based decompositions to be valid......Based on Chen and Zhao's (2009) criticism of VAR based return de- compositions, we explain in detail the various limitations and pitfalls involved in such decompositions. First, we show that Chen and Zhao's interpretation of their excess bond return decomposition is wrong: the residual component...

  10. Cultural Diversity in Nursing Education: Perils, Pitfalls, and Pearls

    Science.gov (United States)

    Bednarz, Hedi; Schim, Stephanie; Doorenbos, Ardith

    2010-01-01

    Increasing diversity in the classroom challenges nursing educators to identify issues that complicate teaching (perils), analyze barriers for themselves and their students (pitfalls), and select new strategies for working with nontraditional students (pearls). This article identifies concerns arising from attitudes and values within nursing and common approaches to diversity education, and then discusses key issues in nursing education that relate to human nature, culture, faculty workload, and student demographics. Finally, some strategies are proposed for increasing the effectiveness of professional preparation with diverse students through a focus on culturally congruent education and development of faculty cultural competence. PMID:20143759

  11. Architectural anthropology – potentials and pitfalls of mixing disciplines

    DEFF Research Database (Denmark)

    Stender, Marie

    approaches to e.g. understand and involve users, clients and citizens. Several other disciplines currently also approach and embrace anthropological methods, and new sub-disciplines such as design anthropology, architectural anthropology, business anthropology and techno-anthropology have emerged...... these cross-disciplinary and applied settings, and how it may contribute to anthropology in general. Based on research and teaching in the field of architectural anthropology, the paper discuss the potentials and pitfalls of mixing approaches from the two disciplines using examples of architects’ approaches...

  12. The pitfalls of dosimetric commissioning for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Tohyama, Naoki; Kodama, Takashi; Hatano, K.

    2013-01-01

    Intensity modulated radiation therapy (IMRT) allows higher radiation dose to be focused to the target volumes while minimizing the dose to OAR. To start of clinical treatment in IMRTvwe must perform commissioning strictly than 3D-conformal radiotherapy (CRT). In this report, pitfalls of dosimetric commissioning for intensity modulated radiation therapy were reviewed. Multileaf collimator (MLC) offsets and MLC transmissions are important parameters in commissioning of RTPS for IMRT. Correction of depth scaling and fluence scaling is necessary for dose measurement using solid phantom. (author)

  13. Pitfalls and artifacts in magnetic resonance imaging

    International Nuclear Information System (INIS)

    Kulkarni, M.V.; Patton, J.A.

    1986-01-01

    As a new imaging technique, MRI is subject to new and unfamiliar artifacts. Because of the wide range of pulse sequences used in MRI, the technique is prone to some artifacts, such as even echo rephasing, which are not found in other imaging systems. With newer and stronger magnetic fields, artifacts such as those caused by chemical shift will be more pronounced. For the maintenance of high quality images, new techniques controlling quality are essential. These techniques include the development of new phantoms and new procedures. The American Association of Physicists in Medicine is currently developing guidelines for quality assurance programs. As with other imaging modalities, these quality assurance guidelines could be unique to MRI. The daily or weekly evaluation of signal-to-noise ratio, image uniformity, signal linearity, spatial linearity, spatial resolution, frequencies, etc. is essential. Some guidelines are described in the current literature. With further modifications and improvements in MRI techniques, new artifacts may be discovered. Identification of these artifacts will improve the interpretation of the image and patient management

  14. Methodological study of radionuclide tomographic phase analysis in localization of accessory conduction pathway in patients with wolff-parkinson-white syndrome

    International Nuclear Information System (INIS)

    Wo Jinshan; Zhu Junren; Li Zhishan

    1994-01-01

    In this study, the methodology of tomographic phase analysis to detect the site of accessory conduction pathway (ACP) in patients with Wolff-Parkinson-White syndrome was presented. We analyzed the major factors that affect image reconstruction, selection of tomographic planes and phase analysis, also discussed the key step for reconstruction short-axial section that parallel and closest to the level of atrio-ventricular rings. Of five patients undergoing this procedure prior to surgery, tomographic phase analysis correctly identified the site of ACP confirmed by epicardial mapping in all of the five patients. Our results suggest this approach to be an objective, clear and correct one for localizing ACP

  15. Social media and professional identity: Pitfalls and potential.

    Science.gov (United States)

    O'Regan, Andrew; Smithson, William Henry; Spain, Eimear

    2018-02-01

    Social media developments have completely changed how information is accessed and communicated. While great potential exists with these platforms, recent reports of online unprofessional behavior by doctors has threatened the medical professional identity; a matter of critical importance for clinicians and medical educators. This paper outlines a role for social media in facilitating support for clinicians and medical teachers; it will raise awareness of pitfalls and explain ethical and legal guidelines. An analysis of inappropriate behaviors and conflicting attitudes regarding what is acceptable in online posts, including the inter-generational contrast in online presence and perceptions of where the boundaries lie. Guidance documents are analyzed and potentially confusing and conflicting statements are identified and clarified. The authors believe that clinicians and medical students must follow ethical imperatives in both personal and professional spheres. It is essential that medical educational and professional bodies encourage clinicians to support one another and share information online while providing clear legal and ethical advice on maintaining standards and avoiding common pitfalls. Education on the responsible use of social media and associated risk awareness should be a priority for medical school curricula.

  16. Neuroimaging of nonaccidental head trauma: pitfalls and controversies

    Energy Technology Data Exchange (ETDEWEB)

    Fernando, Sujan [University of Missouri-Kansas School of Medicine, Department of Medicine, Kansas City, MO (United States); Obaldo, Ruby E. [The University of Kansas Medical Center, Department of Radiology, Kansas City, MO (United States); Walsh, Irene R. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Emergency Medicine, Kansas City, MO (United States); Lowe, Lisa H. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

    2008-08-15

    Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

  17. Pitfalls of CITES Implementation in Nepal: A Policy Gap Analysis

    Science.gov (United States)

    Dongol, Yogesh; Heinen, Joel T.

    2012-08-01

    Implementation of policy involves multiple agencies operating at multiple levels in facilitating processes and actions to accomplish desired results. The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) was developed and implemented to regulate and control international wildlife trade, but violations of the agreement are widespread and growing worldwide, including in Nepal. This study attempts to understand how domestic CITES policies are translated into action and what effect actions and processes have on compliance. In doing so, this study provides insights into the implementation and enforcement pitfalls of national legislation that explain CITES violations in Nepal. Primarily, we used 26 key informants interviews to learn opinions of experts, and the grounded theory approach for further qualitative data analysis. In addition, we used Najman's (1995) policy implementation analysis framework to explain gaps. Many interrelated variables in the content of the policy, commitment and capacity of the agencies, the roles of clients and coalitions and contextual issues were observed. Variables that emerged suggest pitfalls in the regulatory policy represented by low probability of detection, arrest and punishment. Moreover, redistributive policies in buffer zones of protected areas are needed into perpetuity to benefit locals. Also, conservation organizations' support for building public and political salience is imperative.

  18. Neuroimaging of nonaccidental head trauma: pitfalls and controversies

    International Nuclear Information System (INIS)

    Fernando, Sujan; Obaldo, Ruby E.; Walsh, Irene R.; Lowe, Lisa H.

    2008-01-01

    Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

  19. Pitfalls in lung cancer molecular pathology: how to limit them in routine practice?

    Science.gov (United States)

    Ilie, M; Hofman, P

    2012-01-01

    New treatment options in advanced non-small cell lung carcinoma (NSCLC) targeting activating epidermal growth factor receptor (EGFR) gene mutations and other genetic alterations demonstrated the clinical significance of the molecular features of specific subsets of tumors. Therefore, the development of personalized medicine has stimulated the routine integration into pathology departments of somatic mutation testing. However, clinical mutation testing must be optimized and standardized with regard to histological profile, type of samples, pre-analytical steps, methodology and result reporting. Routine molecular testing in NSCLC is currently moving beyond EGFR mutational analysis. Recent progress of targeted therapies will require molecular testing for a wide panel of mutations for a personalized molecular diagnosis. As a consequence, efficient testing of multiple molecular abnormalities is an urgent requirement in thoracic oncology. Moreover, increasingly limited tumor sample becomes a major challenge for molecular pathology. Continuous efforts should be made for safe, effective and specific molecular analyses. This must be based on close collaboration between the departments involved in the management of lung cancer. In this review we explored the practical issues and pitfalls surrounding the routine implementation of molecular testing in NSCLC in a pathology laboratory.

  20. Assessing Brain–Muscle Connectivity in Human Locomotion through Mobile Brain/Body Imaging: Opportunities, Pitfalls, and Future Directions

    Directory of Open Access Journals (Sweden)

    Federico Gennaro

    2018-02-01

    Full Text Available Assessment of the cortical role during bipedalism has been a methodological challenge. While surface electroencephalography (EEG is capable of non-invasively measuring cortical activity during human locomotion, it is associated with movement artifacts obscuring cerebral sources of activity. Recently, statistical methods based on blind source separation revealed potential for resolving this issue, by segregating non-cerebral/artifactual from cerebral sources of activity. This step marked a new opportunity for the investigation of the brains’ role while moving and was tagged mobile brain/body imaging (MoBI. This methodology involves simultaneous mobile recording of brain activity with several other body behavioral variables (e.g., muscle activity and kinematics, through wireless recording wearable devices/sensors. Notably, several MoBI studies using EEG–EMG approaches recently showed that the brain is functionally connected to the muscles and active throughout the whole gait cycle and, thus, rejecting the long-lasting idea of a solely spinal-driven bipedalism. However, MoBI and brain/muscle connectivity assessments during human locomotion are still in their fledgling state of investigation. Mobile brain/body imaging approaches hint toward promising opportunities; however, there are some remaining pitfalls that need to be resolved before considering their routine clinical use. This article discusses several of these pitfalls and proposes research to address them. Examples relate to the validity, reliability, and reproducibility of this method in ecologically valid scenarios and in different populations. Furthermore, whether brain/muscle connectivity within the MoBI framework represents a potential biomarker in neuromuscular syndromes where gait disturbances are evident (e.g., age-related sarcopenia remains to be determined.

  1. Diabetic Nephropathy and CKD?Analysis of Individual Patient Serum Creatinine Trajectories: A Forgotten Diagnostic Methodology for Diabetic CKD Prognostication and Prediction

    OpenAIRE

    Onuigbo, Macaulay Amechi Chukwukadibia; Agbasi, Nneoma

    2015-01-01

    Creatinine is produced in muscle metabolism as the end-product of creatine phosphate and is subsequently excreted principally by way of the kidneys, predominantly by glomerular filtration. Blood creatinine assays constitute the most common clinically relevant measure of renal function. The use of individual patient-level real-time serum creatinine trajectories provides a very attractive and tantalizing methodology in nephrology practice. Topics covered in this review include acute kidney inju...

  2. Aesthetic rhinoplasty plus brow, eyelid and conchal surgery: pitfalls - complications - prevention.

    Science.gov (United States)

    Gubisch, Wolfgang; Dacho, Andreas

    2013-12-13

    Within the last years aesthetic surgery enjoys greater popularity and acceptance. One of the most frequently asked operations has been the aesthetic rhinoplasty. Hardly any other field of surgery is exposed to such a critical analysis than aesthetic rhinoplasty because the results are so obvious. According to the "International Society of Aesthetic Surgery" (ISAPS) over 980,000 cosmetic rhinoplasties have been performed in 2010. This corresponds to 10.4% of all registered aesthetic procedures worldwide. Complications can not be eliminated in such a large number of nasal operations. Five to 15% of all patients re-consult a doctor for a revision because they are much dissatisfied with their final rhinoplasty result. Findings of the tip followed by functional problems and irregularities of the nasal dorsum are named most frequently. The responsible rhinosurgeon has to take into account all anatomical and physiological details and to consider ethical and psychological aspects in the pre-selection and postoperative care of the patient. Aesthetic surgeons should be acquainted with terms and definitions like body image, dysmorphophobia or Thersites complex. Acronyms, like "SIMON" or "SYLVIA", support the physician additionally to analyze and assess the patient. The following article describes the most frequent faults, complications and pitfalls after aesthetic rhinoplasty listed by the anatomical structure. Results will be analyzed and strategies and techniques will be suggested to correct the faults and to prevent them in the future. Furthermore psychologic, social and psychiatric aspects will be discussed and handling with aesthetic patients explained.

  3. Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sheikhbahaei, Sara; Solnes, Lilja B.; Javadi, Mehrbod S.; Pomper, Martin G.; Rowe, Steven P. [Johns Hopkins University School of Medicine, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Afshar-Oromieh, Ali; Haberkorn, Uwe [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); Eiber, Matthias [David Geffen School of Medicine at UCLA, Department of Molecular and Medical Pharmacology, Los Angeles, CA (United States); Technical University of Munich, Department of Nuclear Medicine, Klinikum rechts der Isar, Munich (Germany); Ross, Ashley E.; Pienta, Kenneth J.; Allaf, Mohamad E.; Gorin, Michael A. [Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute and Department of Urology, Baltimore, MD (United States)

    2017-11-15

    The rapidly expanding clinical adaptation of prostate-specific membrane antigen (PSMA)-targeted PET imaging in the evaluation of patients with prostate cancer has placed an increasing onus on understanding both the potential pearls of interpretation as well as limitations of this new technique. As with any new molecular imaging modality, accurate characterization of abnormalities on PSMA-targeted PET imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants of radiotracer uptake, and potential sources of false-positive and false-negative imaging findings. In recent years, a growing number of reports have come to light describing incidental non-prostatic benign or malignant pathologies with high uptake on PSMA-targeted PET imaging. In this review, we have summarized the published literature regarding the potential pearls and technical and interpretive pitfalls of this imaging modality. Knowledge of these limitations can increase the confidence of interpreting physicians and thus improve patient care. As PSMA-targeted PET is expected to be evaluated in larger prospective trials, the dissemination of potential diagnostic pitfalls and the biologic underpinning of those findings will be of increased importance. (orig.)

  4. Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging

    International Nuclear Information System (INIS)

    Sheikhbahaei, Sara; Solnes, Lilja B.; Javadi, Mehrbod S.; Pomper, Martin G.; Rowe, Steven P.; Afshar-Oromieh, Ali; Haberkorn, Uwe; Eiber, Matthias; Ross, Ashley E.; Pienta, Kenneth J.; Allaf, Mohamad E.; Gorin, Michael A.

    2017-01-01

    The rapidly expanding clinical adaptation of prostate-specific membrane antigen (PSMA)-targeted PET imaging in the evaluation of patients with prostate cancer has placed an increasing onus on understanding both the potential pearls of interpretation as well as limitations of this new technique. As with any new molecular imaging modality, accurate characterization of abnormalities on PSMA-targeted PET imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants of radiotracer uptake, and potential sources of false-positive and false-negative imaging findings. In recent years, a growing number of reports have come to light describing incidental non-prostatic benign or malignant pathologies with high uptake on PSMA-targeted PET imaging. In this review, we have summarized the published literature regarding the potential pearls and technical and interpretive pitfalls of this imaging modality. Knowledge of these limitations can increase the confidence of interpreting physicians and thus improve patient care. As PSMA-targeted PET is expected to be evaluated in larger prospective trials, the dissemination of potential diagnostic pitfalls and the biologic underpinning of those findings will be of increased importance. (orig.)

  5. Methodology based on genetic heuristics for in-vivo characterizing the patient-specific biomechanical behavior of the breast tissues.

    Science.gov (United States)

    Lago, M A; Rúperez, M J; Martínez-Martínez, F; Martínez-Sanchis, S; Bakic, P R; Monserrat, C

    2015-11-30

    This paper presents a novel methodology to in-vivo estimate the elastic constants of a constitutive model proposed to characterize the mechanical behavior of the breast tissues. An iterative search algorithm based on genetic heuristics was constructed to in-vivo estimate these parameters using only medical images, thus avoiding invasive measurements of the mechanical response of the breast tissues. For the first time, a combination of overlap and distance coefficients were used for the evaluation of the similarity between a deformed MRI of the breast and a simulation of that deformation. The methodology was validated using breast software phantoms for virtual clinical trials, compressed to mimic MRI-guided biopsies. The biomechanical model chosen to characterize the breast tissues was an anisotropic neo-Hookean hyperelastic model. Results from this analysis showed that the algorithm is able to find the elastic constants of the constitutive equations of the proposed model with a mean relative error of about 10%. Furthermore, the overlap between the reference deformation and the simulated deformation was of around 95% showing the good performance of the proposed methodology. This methodology can be easily extended to characterize the real biomechanical behavior of the breast tissues, which means a great novelty in the field of the simulation of the breast behavior for applications such as surgical planing, surgical guidance or cancer diagnosis. This reveals the impact and relevance of the presented work.

  6. Radiotherapy with linear accelerator in a patient with permanent pacemaker, methodology and results of dose determination in a case in vivo

    International Nuclear Information System (INIS)

    Diaz A, P.; Dominguez O, X.; Toledo B, V.; Nungaray, H.; Zazueta L, F.

    2010-09-01

    This work presents the methodology used by the radiotherapy department of the Hospital San Javier in the patients handling with pacemaker. By means of dosimetry to the implant area of the pacemaker together with electrocardiography measurements during the radiotherapy sessions, the pacemaker performance is evaluated with the objective of detecting any anomaly to the same caused by electromagnetic interference and/or accumulated dose. It is necessary to follow specific protocols in these patients type that guarantee their security during the exposition to ionizing radiation since a definitive consent that allows to calculate the failure probability of pacemaker in this therapeutic condition does not exist. (Author)

  7. Diuresis renography in children: methodological aspects; Nephrogramme isotopique avec epreuve d`hyperdiurese chez l`enfant: aspects methodologiques

    Energy Technology Data Exchange (ETDEWEB)

    Bonnin, F.; Le Stanc, E. [Hopital Beaujon, 92 - Clichy (France); Busquet, G.; Saidi, L. [Hopital Mignot, 78 - Versailles (France); Lyonnet, F. [Hopital Lapeyronie, 34 -Montpellier (France)

    1995-12-31

    In paediatrics, diuresis renography is used as a method to guide clinical management of hydronephrosis or hydro-uretero-nephrosis. Various pitfalls in the technique and other errors exist and may lead to a misinterpretation of the test. The methodology for performing and interpreting the diuresis renography is discussed. (authors). 12 refs., 4 figs.

  8. Probabilistic language models in cognitive neuroscience: Promises and pitfalls.

    Science.gov (United States)

    Armeni, Kristijan; Willems, Roel M; Frank, Stefan L

    2017-12-01

    Cognitive neuroscientists of language comprehension study how neural computations relate to cognitive computations during comprehension. On the cognitive part of the equation, it is important that the computations and processing complexity are explicitly defined. Probabilistic language models can be used to give a computationally explicit account of language complexity during comprehension. Whereas such models have so far predominantly been evaluated against behavioral data, only recently have the models been used to explain neurobiological signals. Measures obtained from these models emphasize the probabilistic, information-processing view of language understanding and provide a set of tools that can be used for testing neural hypotheses about language comprehension. Here, we provide a cursory review of the theoretical foundations and example neuroimaging studies employing probabilistic language models. We highlight the advantages and potential pitfalls of this approach and indicate avenues for future research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Avoiding common pitfalls in qualitative data collection and transcription.

    Science.gov (United States)

    Easton, K L; McComish, J F; Greenberg, R

    2000-09-01

    The subjective nature of qualitative research necessitates scrupulous scientific methods to ensure valid results. Although qualitative methods such as grounded theory, phenomenology, and ethnography yield rich data, consumers of research need to be able to trust the findings reported in such studies. Researchers are responsible for establishing the trustworthiness of qualitative research through a variety of ways. Specific challenges faced in the field can seriously threaten the dependability of the data. However, by minimizing potential errors that can occur when doing fieldwork, researchers can increase the trustworthiness of the study. The purpose of this article is to present three of the pitfalls that can occur in qualitative research during data collection and transcription: equipment failure, environmental hazards, and transcription errors. Specific strategies to minimize the risk for avoidable errors will be discussed.

  10. Ecoinformatics (Big Data) for Agricultural Entomology: Pitfalls, Progress, and Promise.

    Science.gov (United States)

    Rosenheim, Jay A; Gratton, Claudio

    2017-01-31

    Ecoinformatics, as defined in this review, is the use of preexisting data sets to address questions in ecology. We provide the first review of ecoinformatics methods in agricultural entomology. Ecoinformatics methods have been used to address the full range of questions studied by agricultural entomologists, enabled by the special opportunities associated with data sets, nearly all of which have been observational, that are larger and more diverse and that embrace larger spatial and temporal scales than most experimental studies do. We argue that ecoinformatics research methods and traditional, experimental research methods have strengths and weaknesses that are largely complementary. We address the important interpretational challenges associated with observational data sets, highlight common pitfalls, and propose some best practices for researchers using these methods. Ecoinformatics methods hold great promise as a vehicle for capitalizing on the explosion of data emanating from farmers, researchers, and the public, as novel sampling and sensing techniques are developed and digital data sharing becomes more widespread.

  11. Multi-criteria decision analysis: Limitations, pitfalls, and practical difficulties

    Energy Technology Data Exchange (ETDEWEB)

    Kujawski, Edouard

    2003-02-01

    The 2002 Winter Olympics women's figure skating competition is used as a case study to illustrate some of the limitations, pitfalls, and practical difficulties of Multi-Criteria Decision Analysis (MCDA). The paper compares several widely used models for synthesizing the multiple attributes into a single aggregate value. The various MCDA models can provide conflicting rankings of the alternatives for a common set of information even under states of certainty. Analysts involved in MCDA need to deal with the following challenging tasks: (1) selecting an appropriate analysis method, and (2) properly interpreting the results. An additional trap is the availability of software tools that implement specific MCDA models that can beguile the user with quantitative scores. These conclusions are independent of the decision domain and they should help foster better MCDA practices in many fields including systems engineering trade studies.

  12. [Pitfalls in international comparisons of health data and indices].

    Science.gov (United States)

    Rotstein, Z; Shani, M

    1991-05-01

    Comparison of published data and health indices from different countries with different health systems is subject to many pitfalls. Comparison of national expenditure for health care based on purchasing power of the currency may be misleading if the purchasing power of the health services is ignored. Comparisons may also be misleading if they ignore national geographic and demographic structures. Government and health authorities often quote different sets of data and use different terminology and definitions. This article stresses the disparity in the definition of medical manpower and points out differences relating to ratios of manpower to population and to per capita spending. Also addressed is the importance of the qualitative and value aspects of health systems not usually involved in comparison of international health indices. In conclusion, safety measures and precautions such as choosing the right index for the right purpose, adjustment of indices to the purchasing power parity of health, demographics, etc., should be used when conducting health care analyses.

  13. Clinical and Biochemical Pitfalls in the Diagnosis of Peroxisomal Disorders.

    Science.gov (United States)

    Klouwer, Femke C C; Huffnagel, Irene C; Ferdinandusse, Sacha; Waterham, Hans R; Wanders, Ronald J A; Engelen, Marc; Poll-The, Bwee Tien

    2016-08-01

    Peroxisomal disorders are a heterogeneous group of genetic metabolic disorders, caused by a defect in peroxisome biogenesis or a deficiency of a single peroxisomal enzyme. The peroxisomal disorders include the Zellweger spectrum disorders, the rhizomelic chondrodysplasia punctata spectrum disorders, X-linked adrenoleukodystrophy, and multiple single enzyme deficiencies. There are several core phenotypes caused by peroxisomal dysfunction that clinicians can recognize. The diagnosis is suggested by biochemical testing in blood and urine and confirmed by functional assays in cultured skin fibroblasts, followed by mutation analysis. This review describes the phenotype of the main peroxisomal disorders and possible pitfalls in (laboratory) diagnosis to aid clinicians in the recognition of this group of diseases. Georg Thieme Verlag KG Stuttgart · New York.

  14. Neonatal hemochromatosis and patent ductus venosus: clinical course and diagnostic pitfalls

    International Nuclear Information System (INIS)

    Tsai, Andy; Paltiel, Harriet J.; Sena, Laureen M.; Kim, Heung Bae; Fishman, Steven J.; Alomari, Ahmad I.

    2009-01-01

    Neonatal hemochromatosis is a rare metabolic disorder characterized by excessive iron deposition within the liver leading to hepatic failure and portal hypertension. We describe the clinical course and imaging findings in three infants with neonatal hemochromatosis associated with patent ductus venosus. We paid special attention to the diagnostic challenges encountered in these patients in order to emphasize some of the potential diagnostic pitfalls. We conducted a comprehensive search of our radiology database of the last 10 years (1999-2008) for the keywords ''neonatal hemochromatosis.'' Medical records and imaging studies of various modalities were reviewed. Three neonates were found to have neonatal hemochromatosis; all of them were associated with patent ductus venosus. Two of these patients were referred to our tertiary center for embolization of an inaccurately diagnosed hepatic vascular malformation. Two patients underwent successful liver transplantation and one died shortly after referral. The awareness and inclusion of neonatal hemochromatosis in the differential diagnosis of newborns with liver failure and patent ductus venosus has critical treatment implications. (orig.)

  15. Neonatal hemochromatosis and patent ductus venosus: clinical course and diagnostic pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, Andy; Paltiel, Harriet J.; Sena, Laureen M. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Kim, Heung Bae; Fishman, Steven J. [Children' s Hospital Boston and Harvard Medical School, Department of Surgery, Boston, MA (United States); Alomari, Ahmad I. [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Children' s Hospital Boston, Division of Vascular and Interventional Radiology, Boston, MA (United States)

    2009-08-15

    Neonatal hemochromatosis is a rare metabolic disorder characterized by excessive iron deposition within the liver leading to hepatic failure and portal hypertension. We describe the clinical course and imaging findings in three infants with neonatal hemochromatosis associated with patent ductus venosus. We paid special attention to the diagnostic challenges encountered in these patients in order to emphasize some of the potential diagnostic pitfalls. We conducted a comprehensive search of our radiology database of the last 10 years (1999-2008) for the keywords ''neonatal hemochromatosis.'' Medical records and imaging studies of various modalities were reviewed. Three neonates were found to have neonatal hemochromatosis; all of them were associated with patent ductus venosus. Two of these patients were referred to our tertiary center for embolization of an inaccurately diagnosed hepatic vascular malformation. Two patients underwent successful liver transplantation and one died shortly after referral. The awareness and inclusion of neonatal hemochromatosis in the differential diagnosis of newborns with liver failure and patent ductus venosus has critical treatment implications. (orig.)

  16. Big data in sleep medicine: prospects and pitfalls in phenotyping

    Science.gov (United States)

    Bianchi, Matt T; Russo, Kathryn; Gabbidon, Harriett; Smith, Tiaundra; Goparaju, Balaji; Westover, M Brandon

    2017-01-01

    Clinical polysomnography (PSG) databases are a rich resource in the era of “big data” analytics. We explore the uses and potential pitfalls of clinical data mining of PSG using statistical principles and analysis of clinical data from our sleep center. We performed retrospective analysis of self-reported and objective PSG data from adults who underwent overnight PSG (diagnostic tests, n=1835). Self-reported symptoms overlapped markedly between the two most common categories, insomnia and sleep apnea, with the majority reporting symptoms of both disorders. Standard clinical metrics routinely reported on objective data were analyzed for basic properties (missing values, distributions), pairwise correlations, and descriptive phenotyping. Of 41 continuous variables, including clinical and PSG derived, none passed testing for normality. Objective findings of sleep apnea and periodic limb movements were common, with 51% having an apnea–hypopnea index (AHI) >5 per hour and 25% having a leg movement index >15 per hour. Different visualization methods are shown for common variables to explore population distributions. Phenotyping methods based on clinical databases are discussed for sleep architecture, sleep apnea, and insomnia. Inferential pitfalls are discussed using the current dataset and case examples from the literature. The increasing availability of clinical databases for large-scale analytics holds important promise in sleep medicine, especially as it becomes increasingly important to demonstrate the utility of clinical testing methods in management of sleep disorders. Awareness of the strengths, as well as caution regarding the limitations, will maximize the productive use of big data analytics in sleep medicine. PMID:28243157

  17. Designing sensory-substitution devices: Principles, pitfalls and potential1.

    Science.gov (United States)

    Kristjánsson, Árni; Moldoveanu, Alin; Jóhannesson, Ómar I; Balan, Oana; Spagnol, Simone; Valgeirsdóttir, Vigdís Vala; Unnthorsson, Rúnar

    2016-09-21

    An exciting possibility for compensating for loss of sensory function is to augment deficient senses by conveying missing information through an intact sense. Here we present an overview of techniques that have been developed for sensory substitution (SS) for the blind, through both touch and audition, with special emphasis on the importance of training for the use of such devices, while highlighting potential pitfalls in their design. One example of a pitfall is how conveying extra information about the environment risks sensory overload. Related to this, the limits of attentional capacity make it important to focus on key information and avoid redundancies. Also, differences in processing characteristics and bandwidth between sensory systems severely constrain the information that can be conveyed. Furthermore, perception is a continuous process and does not involve a snapshot of the environment. Design of sensory substitution devices therefore requires assessment of the nature of spatiotemporal continuity for the different senses. Basic psychophysical and neuroscientific research into representations of the environment and the most effective ways of conveying information should lead to better design of sensory substitution systems. Sensory substitution devices should emphasize usability, and should not interfere with other inter- or intramodal perceptual function. Devices should be task-focused since in many cases it may be impractical to convey too many aspects of the environment. Evidence for multisensory integration in the representation of the environment suggests that researchers should not limit themselves to a single modality in their design. Finally, we recommend active training on devices, especially since it allows for externalization, where proximal sensory stimulation is attributed to a distinct exterior object.

  18. Decreasing Turnaround Time and Increasing Patient Satisfaction in a Safety Net Hospital-Based Pediatrics Clinic Using Lean Six Sigma Methodologies.

    Science.gov (United States)

    Jayasinha, Yasangi

    2016-01-01

    Increasingly, health care quality indicators are focusing on patient-centeredness as an indicator of performance. The National Quality Forum lists assessment of patient experience, often conducted using patient surveys, as a top priority. We developed a patient-reported time stamp data collection tool that was used to collect cycle times in a safety net hospital-based outpatient pediatrics clinic. Data were collected using patient-reported survey to obtain cycle times in Pediatric clinic, as well as qualitative and quantitative patient satisfaction data. Several rapid-cycle improvements were performed using Lean Six Sigma methodologies to reduce cycle time by eliminating waste and revise unnecessary processes to improve operational effectiveness and patient and staff satisfaction. A total of 94 surveys were collected and revealed average cycle time of 113 minutes. Our measured patient satisfaction rating was 87%. Discharge and check-in processes were identified as the least efficient and were targeted for intervention. Following implementation, the overall cycle time was decreased from 113 to 90 minutes. Patient satisfaction ratings increased from 87% to 95%. We demonstrate that using Lean Six Sigma tools can be invaluable to clinical restructuring and redesign and results in measurable, improved outcomes in care delivery.

  19. Translating patient reported outcome measures: methodological issues explored using cognitive interviewing with three rheumatoid arthritis measures in six European languages

    NARCIS (Netherlands)

    Hewlett, Sarah E.; Nicklin, Joanna; Bode, Christina; Carmona, Loretto; Dures, Emma; Engelbrecht, Matthias; Hagel, Sofia; Kirwan, John R.; Molto, Anna; Redondo, Marta; Gossec, Laure

    2016-01-01

    Objective. Cross-cultural translation of patient-reported outcome measures (PROMs) is a lengthy process, often performed professionally. Cognitive interviewing assesses patient comprehension of PROMs. The objective was to evaluate the usefulness of cognitive interviewing to assess translations and

  20. Pitfalls in Persuasion: How Do Users Experience Persuasive Techniques in a Web Service?

    Science.gov (United States)

    Segerståhl, Katarina; Kotro, Tanja; Väänänen-Vainio-Mattila, Kaisa

    Persuasive technologies are designed by utilizing a variety of interactive techniques that are believed to promote target behaviors. This paper describes a field study in which the aim was to discover possible pitfalls of persuasion, i.e., situations in which persuasive techniques do not function as expected. The study investigated persuasive functionality of a web service targeting weight loss. A qualitative online questionnaire was distributed through the web service and a total of 291 responses were extracted for interpretative analysis. The Persuasive Systems Design model (PSD) was used for supporting systematic analysis of persuasive functionality. Pitfalls were identified through situations that evoked negative user experiences. The primary pitfalls discovered were associated with manual logging of eating and exercise behaviors, appropriateness of suggestions and source credibility issues related to social facilitation. These pitfalls, when recognized, can be addressed in design by applying functional and facilitative persuasive techniques in meaningful combinations.

  1. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Power, Sarah, E-mail: drsarahpower@gmail.com [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); McEvoy, Sinead H., E-mail: sineadmcevoy@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Cunningham, Jane, E-mail: janecunningham0708@gmail.com [Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Ti, Joanna P., E-mail: joannapearlyti@gmail.com [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Looby, Seamus, E-mail: seamuslooby@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); O' Hare, Alan, E-mail: alanohare@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Williams, David, E-mail: davidwilliams@rcsi.ie [Department of Geriatrics and Stroke Medicine, Royal College of Surgeons in Ireland (RCSI) and Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Brennan, Paul, E-mail: paulbrennan@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Thornton, John, E-mail: johnthornton@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland)

    2015-07-15

    Highlights: • Site of occlusion determines potential collateralization routes and impacts outcome. • Multifocality of arterial occlusion is common, seen in approximately 20% of cases. • ICA false occlusion sign can be seen in setting of ICA stenosis or carotid T occlusion. • False patency sign: hyperdense thrombus/calcified occlusive plaque misinterpreted as patent vessel. • Additional abnormalities on CTA may infer stroke mechanism or alter decision making. - Abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome.

  2. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls

    International Nuclear Information System (INIS)

    Power, Sarah; McEvoy, Sinead H.; Cunningham, Jane; Ti, Joanna P.; Looby, Seamus; O'Hare, Alan; Williams, David; Brennan, Paul; Thornton, John

    2015-01-01

    Highlights: • Site of occlusion determines potential collateralization routes and impacts outcome. • Multifocality of arterial occlusion is common, seen in approximately 20% of cases. • ICA false occlusion sign can be seen in setting of ICA stenosis or carotid T occlusion. • False patency sign: hyperdense thrombus/calcified occlusive plaque misinterpreted as patent vessel. • Additional abnormalities on CTA may infer stroke mechanism or alter decision making. - Abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome

  3. On methodology

    DEFF Research Database (Denmark)

    Cheesman, Robin; Faraone, Roque

    2002-01-01

    This is an English version of the methodology chapter in the authors' book "El caso Berríos: Estudio sobre información errónea, desinformación y manipulación de la opinión pública".......This is an English version of the methodology chapter in the authors' book "El caso Berríos: Estudio sobre información errónea, desinformación y manipulación de la opinión pública"....

  4. Pitfalls in the MR diagnosis of primary malignant bone tumors; Pitfalls in der MR-Diagnostik primaer maligner Knochentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Bader, T.R. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteologie; Imhof, H.; Breitenseher, M.J. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Osteologie]|[Wien Univ. (Austria). Einrichtung UOG Magnetic Resonanz; Dominkus, M. [Universitaetsklinik fuer Orthopaedie, Wien (Austria)

    1998-06-01

    MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiography and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts. (orig.) [Deutsch] Bei der Diagnostik von malignen Knochentumoren hat die MRT einen fixen Platz nicht nur in der Verifikation der Nativdiagnostik und der Differentialdiagnostik, sondern zunehmende Bedeutung bei der primaeren Beurteilung von Dignitaet und Wachstumsgeschwindigkeit, Definition einer geeigneten Biopsiestelle, beim lokoregionaeren, praeoperativen Staging und der Evaluation des Ansprechens auf Chemotherapie. Zahlreiche Pitfalls finden sich jedoch bei der Wahl der technischen Parameter (Spulen, Sequenzen, Schichtebenen), der Tumordifferenzierung und beim Staging von malignen Tumoren. Beim Staging sind die kritischen Punkte die Beurteilung von Tumorausdehnung, Integritaet der Kortikalis, Vorhandensein einer Weichteilkomponente, Infiltration eines Gelenks oder des

  5. Autoantibodies in a Three-Year-Old Girl with Visceral Leishmaniasis: A Potential Diagnostic Pitfall

    Directory of Open Access Journals (Sweden)

    Gholamreza Pouladfar

    2016-01-01

    Full Text Available Visceral leishmaniasis (VL, a life-threatening parasitic infection, is endemic in the Mediterranean region. Diagnosis of VL is based on epidemiologic, clinical, and laboratory findings. However, sometimes, clinical features and laboratory findings overlap with those of autoimmune diseases. In some cases, autoantibodies are detected in patients with VL and this could be a potential diagnostic pitfall. In this study, we have reported on a three-year-old girl from a VL-endemic area in Iran, who presented with prolonged fever and splenomegaly. Bone marrow examination, serologic tests, and the molecular PCR assay were performed; however, results were inconclusive. The levels of anti-double stranded DNA, cytoplasmic antineutrophil cytoplasmic autoantibody, and perinuclear antineutrophil cytoplasmic autoantibody were elevated and, at the end, splenic biopsy was performed. The splenic tissue PCR test detected the DNA of Leishmania infantum. The patient’s condition improved with anti-Leishmania therapy, and the autoantibodies disappeared within the following four months. Clinical presentations and laboratory findings of VL and autoimmune diseases may overlap in some patients.

  6. Diagnosis of hepatic iron overload: a family study illustrating pitfalls in diagnosing hemochromatosis.

    Science.gov (United States)

    Schranz, Melanie; Talasz, Heribert; Graziadei, Ivo; Winder, Thomas; Sergi, Consolato; Bogner, Klaus; Vogel, Wolfgang; Zoller, Heinz

    2009-03-01

    Recent identification of genetic variants in iron storage disease has changed the classification system and diagnostic algorithms for hemochromatosis. Clinical diagnosis of the disease requires phenotypic evidence of iron overload because the commonly disease-associated HFE genotypes have an incomplete penetrance. Furthermore, approximately 20% of patients with a clinical diagnosis of hemochromatosis have no disease-associated genotype, which underlines the importance of clear phenotypic criteria of hemochromatosis. A diagnosis of hemochromatosis cannot be made even in patients with liver cirrhosis simply on the basis of genetic testing that indicates that iron overload is the cause of the disease and not its consequence. Proper diagnosis requires integration of clinical presentation, family history, and the results of biochemical and histopathologic tests. Here we propose a rational diagnostic algorithm for hepatic iron overload syndromes and illustrate potential pitfalls by presenting a family study in a pedigree with rare HFE variants (H63D and E168Q), in cis on the same chromosome. Although the clinical suspicion of hemochromatosis was confirmed by histology, chemical analysis of liver tissue revealed a normal hepatic iron concentration, which is compatible with the genetic finding of 1 normal and 1 doubly mutated allele. In conclusion, clinical suspicion of hemochromatosis and elevated serum iron parameters should prompt HFE genotyping for C282Y and H63D. Should they be uninformative, further genetic tests should be recommended only if iron overload in liver tissue has been confirmed chemically.

  7. Use of automated medication adherence monitoring in bipolar disorder research: pitfalls, pragmatics, and possibilities.

    Science.gov (United States)

    Levin, Jennifer B; Sams, Johnny; Tatsuoka, Curtis; Cassidy, Kristin A; Sajatovic, Martha

    2015-04-01

    Medication nonadherence occurs in 20-60% of persons with bipolar disorder (BD) and is associated with serious negative outcomes, including relapse, hospitalization, incarceration, suicide and high healthcare costs. Various strategies have been developed to measure adherence in BD. This descriptive paper summarizes challenges and workable strategies using electronic medication monitoring in a randomized clinical trial (RCT) in patients with BD. Descriptive data from 57 nonadherent individuals with BD enrolled in a prospective RCT evaluating a novel customized adherence intervention versus control were analyzed. Analyses focused on whole group data and did not assess intervention effects. Adherence was assessed with the self-reported Tablets Routine Questionnaire and the Medication Event Monitoring System (MEMS). The majority of participants were women (74%), African American (69%), with type I BD (77%). Practical limitations of MEMS included misuse in conjunction with pill minders, polypharmacy, cost, failure to bring to research visits, losing the device, and the device impacting baseline measurement. The advantages were more precise measurement, less biased recall, and collecting data from past time periods for missed interim visits. Automated devices such as MEMS can assist investigators in evaluating adherence in patients with BD. Knowing the anticipated pitfalls allows study teams to implement preemptive procedures for successful implementation in BD adherence studies and can help pave the way for future refinements as automated adherence assessment technologies become more sophisticated and readily available.

  8. Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology.

    Science.gov (United States)

    Laws, M Barton; Lee, Yoojin; Taubin, Tatiana; Rogers, William H; Wilson, Ira B

    2018-01-01

    While some studies have assessed patient recall of important information from ambulatory care visits, none has done so recently. Furthermore, little is known about features of clinical interactions which are associated with patient understanding and recall, without which shared decision making, a widely shared ideal for patient care, cannot occur. Our objective was to evaluate characteristics of patients and outpatient encounters associated with patient recall of information after one week, along with observation of elements of shared decision making. This was an observational study based on coded transcripts of 189 outpatient encounters, and post-visit interviews with patients 1 week later. Coding used three previously validated systems, adopted for this study. Forty-nine percent of decisions and recommendations were recalled accurately without prompting; 36% recalled with a prompt; 15% recalled erroneously or not at all. Provider behaviors hypothesized to be associated with patient recall, such as open-questioning and "teach back," were rare. Patients with less than high school education recalled 38% of items freely and accurately, while patients with a college degree recalled 65% (p total number of items to be recalled per visit, and percentage of utterances in decision-making processes by the provider ("verbal dominance"), were significant predictors of poorer recall. The item count was associated with poorer recall for lower, but not higher, educated patients.

  9. Neuroimaging in psychiatric pharmacogenetics research: the promise and pitfalls.

    Science.gov (United States)

    Falcone, Mary; Smith, Ryan M; Chenoweth, Meghan J; Bhattacharjee, Abesh Kumar; Kelsoe, John R; Tyndale, Rachel F; Lerman, Caryn

    2013-11-01

    The integration of research on neuroimaging and pharmacogenetics holds promise for improving treatment for neuropsychiatric conditions. Neuroimaging may provide a more sensitive early measure of treatment response in genetically defined patient groups, and could facilitate development of novel therapies based on an improved understanding of pathogenic mechanisms underlying pharmacogenetic associations. This review summarizes progress in efforts to incorporate neuroimaging into genetics and treatment research on major psychiatric disorders, such as schizophrenia, major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, and addiction. Methodological challenges include: performing genetic analyses in small study populations used in imaging studies; inclusion of patients with psychiatric comorbidities; and the extensive variability across studies in neuroimaging protocols, neurobehavioral task probes, and analytic strategies. Moreover, few studies use pharmacogenetic designs that permit testing of genotype × drug effects. As a result of these limitations, few findings have been fully replicated. Future studies that pre-screen participants for genetic variants selected a priori based on drug metabolism and targets have the greatest potential to advance the science and practice of psychiatric treatment.

  10. Decreasing laboratory turnaround time and patient wait time by implementing process improvement methodologies in an outpatient oncology infusion unit.

    Science.gov (United States)

    Gjolaj, Lauren N; Gari, Gloria A; Olier-Pino, Angela I; Garcia, Juan D; Fernandez, Gustavo L

    2014-11-01

    Prolonged patient wait times in the outpatient oncology infusion unit indicated a need to streamline phlebotomy processes by using existing resources to decrease laboratory turnaround time and improve patient wait time. Using the DMAIC (define, measure, analyze, improve, control) method, a project to streamline phlebotomy processes within the outpatient oncology infusion unit in an academic Comprehensive Cancer Center known as the Comprehensive Treatment Unit (CTU) was completed. Laboratory turnaround time for patients who needed same-day lab and CTU services and wait time for all CTU patients was tracked for 9 weeks. During the pilot, the wait time from arrival to CTU to sitting in treatment area decreased by 17% for all patients treated in the CTU during the pilot. A total of 528 patients were seen at the CTU phlebotomy location, representing 16% of the total patients who received treatment in the CTU, with a mean turnaround time of 24 minutes compared with a baseline turnaround time of 51 minutes. Streamlining workflows and placing a phlebotomy station inside of the CTU decreased laboratory turnaround times by 53% for patients requiring same day lab and CTU services. The success of the pilot project prompted the team to make the station a permanent fixture. Copyright © 2014 by American Society of Clinical Oncology.

  11. Workflow with pitfalls to derive a regional airborne magnetic compilation

    Science.gov (United States)

    Brönner, Marco; Baykiev, Eldar; Ebbing, Jörg

    2017-04-01

    Today, large scale magnetic maps are usually a patchwork of different airborne surveys from different size, different resolution and different years. Airborne magnetic acquisition is a fast and economic method to map and gain geological and tectonic information for large areas, onshore and offshore. Depending on the aim of a survey, acquisition parameters like altitude and profile distance are usually adjusted to match the purpose of investigation. The subsequent data processing commonly follows a standardized workflow comprising core-field subtraction and line leveling to yield a coherent crustal field magnetic grid for a survey area. The resulting data makes it possible to correlate with geological and tectonic features in the subsurface, which is of importance for e.g. oil and mineral exploration. Crustal scale magnetic interpretation and modeling demand regional compilation of magnetic data and the merger of adjacent magnetic surveys. These studies not only focus on shallower sources, reflected by short to intermediate magnetic wavelength anomalies, but also have a particular interest in the long wavelength deriving from deep seated sources. However, whilst the workflow to produce such a merger is supported by quite a few powerful routines, the resulting compilation contains several pitfalls and limitations, which were discussed before, but still are very little recognized. The maximum wavelength that can be resolved of each individual survey is directly related to the survey size and consequently a merger will contribute erroneous long-wavelength components in the magnetic data compilation. To minimize this problem and to homogenous the longer wavelengths, a first order approach is the combination of airborne and satellite magnetic data commonly combined with the compilation from airborne data, which is sufficient only under particular preconditions. A more advanced approach considers the gap in frequencies between airborne and satellite data, which motivated

  12. Methodological guidelines

    International Nuclear Information System (INIS)

    Halsnaes, K.; Callaway, J.M.; Meyer, H.J.

    1999-01-01

    The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs

  13. Methodological guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Halsnaes, K.; Callaway, J.M.; Meyer, H.J.

    1999-04-01

    The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs.

  14. Pharmaceutical care for patients with hypertension: a new methodology and the importance of this practice in home care

    OpenAIRE

    Valdomiro Vagner de Souza; Ana Lúcia Francisco Bertoncin

    2008-01-01

    Objective: To evaluate and increase the knowledge of patients about hypertension trying to guide and motivate them for the correct use of medication and for the adherence to adequate health styles, pointing out the importance of pharmaceutical home care in the treatment of the illness. Methods: A prospective, experimental and longitudinal study held with 10 randomly selected patients from a municipal pharmacy. Data on life style, information concerning the used drugs and results after the acc...

  15. A review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia.

    Science.gov (United States)

    Hocking, Graham; Hebard, Simon; Mitchell, Christopher H

    2011-01-01

    With the growth of ultrasound-guided regional anesthesia, so has the requirement for training tools to practice needle guidance skills and evaluate echogenic needles. Ethically, skills in ultrasound-guided needle placement should be gained in a phantom before performance of nerve blocks on patients in clinical practice. However, phantom technology is varied, and critical evaluation of the images is needed to understand their application to clinical use. Needle visibility depends on the echogenicity of the needle relative to the echogenicity of the tissue adjacent the needle. We demonstrate this point using images of echogenic and nonechogenic needles in 5 different phantoms at both shallow angles (20 degrees) and steep angles (45 degrees). The echogenicity of phantoms varies enormously, and this impacts on how needles are visualized. Water is anechoic, making all needles highly visible, but does not fix the needle to allow practice placement. Gelatin phantoms and Blue Phantoms provide tactile feedback but have very low background echogenicity, which greatly exaggerates needle visibility. This makes skill acquisition easier but can lead to false confidence in regard to clinical ability. Fresh-frozen cadavers retain much of the textural feel of live human tissue and are nearly as echogenic. Similar to clinical practice, this makes needles inserted at steep angles practically invisible, unless they are highly echogenic. This review describes the uses and pitfalls of phantoms that have been described or commercially produced. Copyright © 2011 by American Society of Regional Anesthesia and Pain Medicine

  16. Deregulation of allopathic prescription and medical practice in India: Benefits and pitfalls

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2016-01-01

    Full Text Available In the background of debates on Universal Health Coverage, skill transfer from the medical practice license holders to other health-care providers such as nurse practitioner has become a global norm. In India, where the world's largest numbers of medical graduates are produced, this discussion is expanding to extremes and serious suggestions are coming forward for the development of legal framework for allowing dentists, homeopaths, pharmacists, and half duration trained doctors; permission to issue allopathic prescription. Allopathic medical prescription. It is noteworthy that this discussion only pertains to the pharmaceutical products retailed through “allopathic medical prescriptions.” A prescription is not only advice for patient's recovery but it also is a legitimate order for the sale of controlled drugs and pharmaceutical product; thereby functions as a regulatory tool for consumption of pharmaceutical products at retail level. Who is ultimately going to benefit from this prescription deregulation? This editorial explores benefits and pitfalls of prescription and medical practice deregulation.

  17. Orthopedic surgery-related benign uptake on FDG-PET. Case examples and pitfalls

    International Nuclear Information System (INIS)

    Liu, Y.

    2009-01-01

    Orthopedic surgical procedures often create some special postoperative complications, which may demonstrate abnormally increased or focal uptake for an extended period of time on fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT images. The distinction of normal from pathologic, benign from malignant uptake is very important to minimize the number of false positive results. To date, very little data have been published regarding surgical-related benign musculoskeletal uptake on PET-CT imaging. In this paper, we present to the readers some case examples of FDG PET-CT imaging for postoperative fracture, infection or osteomyelitis, metallic implants, aggressive bone edge, heterotopic ossification, granuloma and neuroma. We also discuss potential pitfalls to recognize these orthopedic surgery-related complications and identify benign nature of increased FDG uptake. In all cases, the patient's medical and surgical history would be of paramount importance to the radiologists/nuclear medicine physicians who interprets the scan. It is also crucial to carefully correlate FDG uptake with the anatomy on the co-registered CT images in all transaxial, coronal and sagittal views in order to identify the location and pattern of uptake. (author)

  18. ABDUCENS NERVE PALSY AND THROMBOSIS OF THE CEREBRAL VEINS AND SINUSES - A DIAGNOSTIC PITFALL

    Directory of Open Access Journals (Sweden)

    Alexandra J. Tzoukeva

    2012-12-01

    Full Text Available Thrombosis of the cerebral veins and sinuses is an infrequent cerebrovascular disorder. Because the highly variable symptoms, recent neuroimaging plays a key role in the diagnosis. Abducens nerve palsy as a focal neurological deficit is a rare clinical manifestation in these patients. We present two cases with sudden onset of diplopia and headache. Case 1: A 3-year old girl with B cell lymphoblastic leukemia developed bilateral abducens deficit and bilateral optic disc edema after treatment including L-asparaginase. Thrombosis of the right jugular vein, sagittal and right sigmoid sinuses was visualized on magnetic resonance imaging (MRI and magnetic resonance venography (MRV. Symptoms gradually resolved after treatment with enoxiparine and MRV demonstrated recanalization.Case 2: A 75-year old female with medical history of arterial hypertension presented with headache and sudden left abduction deficit. Computerized tomography (CT scan was normal. MRI and MRV revealed aging brain and disruption of venous flow at the left internal jugular vein, suspecting thrombosis. Extracranial colour duplex sonography and CT angiography proved haemodinamic equivalent of left internal jugular vein thrombosis due to sclerotic pathology of aortic arch.Our first case illustrates the role of improved neuroimaging techniques as the best method for diagnosis of cerebral veins and sinuses thrombosis, presenting with abducens nerve palsy. With second case the potential neuroimaging pitfalls concerning the accurate diagnosis of these cerebrovascular disorders with neuro-ophthalmologic manifestation are discussed.

  19. Magnetic resonance imaging in local staging of endometrial carcinoma: diagnostic performance, pitfalls, and literature review.

    Science.gov (United States)

    Zandrino, Franco; La Paglia, Ernesto; Musante, Francesco

    2010-01-01

    To assess the diagnostic accuracy of magnetic resonance imaging in local staging of endometrial carcinoma, and to review the results and pitfalls described in the literature. Thirty women with a histological diagnosis of endometrial carcinoma underwent magnetic resonance imaging. Unenhanced T2-weighted and dynamic contrast-enhanced Ti-weighted sequences were obtained. Hysterectomy and salpingo-oophorectomy was performed in all patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the detection of deep myometrial and cervical infiltration. For deep myometrial infiltration T2-weighted sequences reached a sensitivity of 85%, specificity of 76%, PPV of 73%, NVP of 87%, and accuracy of 80%, while contrast-enhanced scans reached a sensitivity of 90%, specificity of 80%, PPV of 82%, NPV of 89%, and accuracy of 85%. For cervical infiltration T2-weighted sequences reached a sensitivity of 75%, specificity of 88%, PPV of 50%, NPV of 96%, and accuracy of 87%, while contrast-enhanced scans reached a sensitivity of 100%, specificity of 94%, PPV of 75%, NPV of 100%, and accuracy of 95%. Unenhanced and dynamic gadolinium-enhanced magnetic resonance allows accurate assessment of myometrial and cervical infiltration. Information provided by magnetic resonance imaging can define prognosis and management.

  20. Soft Tissue Tumor Immunohistochemistry Update: Illustrative Examples of Diagnostic Pearls to Avoid Pitfalls.

    Science.gov (United States)

    Wei, Shi; Henderson-Jackson, Evita; Qian, Xiaohua; Bui, Marilyn M

    2017-08-01

    - Current 2013 World Health Organization classification of tumors of soft tissue arranges these tumors into 12 groups according to their histogenesis. Tumor behavior is classified as benign, intermediate (locally aggressive), intermediate (rarely metastasizing), and malignant. In our practice, a general approach to reaching a definitive diagnosis of soft tissue tumors is to first evaluate clinicoradiologic, histomorphologic, and cytomorphologic features of the tumor to generate some pertinent differential diagnoses. These include the potential line of histogenesis and whether the tumor is benign or malignant, and low or high grade. Although molecular/genetic testing is increasingly finding its applications in characterizing soft tissue tumors, currently immunohistochemistry still not only plays an indispensable role in defining tumor histogenesis, but also serves as a surrogate for underlining molecular/genetic alterations. Objective- To provide an overview focusing on the current concepts in the classification and diagnosis of soft tissue tumors, incorporating immunohistochemistry. This article uses examples to discuss how to use the traditional and new immunohistochemical markers for the diagnosis of soft tissue tumors. Practical diagnostic pearls, summary tables, and figures are used to show how to avoid diagnostic pitfalls. - Data were obtained from pertinent peer-reviewed English-language literature and the authors' first-hand experience as bone and soft tissue pathologists. - -The ultimate goal for a pathologist is to render a specific diagnosis that provides diagnostic, prognostic, and therapeutic information to guide patient care. Immunohistochemistry is integral to the diagnosis and management of soft tissue tumors.

  1. Abdomen after a Puestow procedure: postoperative CT appearance, complications, and potential pitfalls.

    Science.gov (United States)

    Freed, K S; Paulson, E K; Frederick, M G; Keogan, M T; Pappas, T N

    1997-06-01

    To evaluate the postoperative computed tomographic (CT) appearance, complications, and potential pitfalls after a Puestow procedure (lateral side-to-side pancreaticojejunostomy). Forty CT examinations were performed after the Puestow procedure in 20 patients. Images were retrospectively reviewed by three radiologists. The pancreaticojejunal anastomosis was identified at 30 examinations and was immediately anterior to the pancreatic body or tail. The anastomosis contained fluid or gas on 11 scans and oral contrast material on four scans. On 15 scans, the anastomosis appeared as collapsed bowel without gas, fluid, or oral contrast material. The Roux-en-Y loop was identified on 28 (70%) scans and contained fluid or gas on 16 scans and oral contrast material on six scans. The Roux-en-Y loop appeared as collapsed bowel on six scans. When the anastomosis or Roux-en-Y loop contained fluid and gas, the appearance mimicked that of a pancreatic or parapancreatic abscess. Peripancreatic stranding was present on 28 scans and was due to either ongoing pancreatitis or postoperative change. Complications included 15 transient fluid collections, three abscesses, four pseudocysts, one hematoma, and one small-bowel and Roux-en-Y obstruction. Knowledge of the anatomy after a Puestow procedure is essential for accurate interpretation of CT scans.

  2. Pitfalls in the biological diagnosis of common hemoglobin disorders.

    Science.gov (United States)

    Wajcman, Henri; Moradkhani, Kamran

    2015-01-01

    In West-European countries, hemoglobin disorders are no more rare diseases. Programs for diagnosis of heterozygous carriers have been established to prevent cases with major sickle cell disease or thalassemias. These studies have been done essentially by high performance liquid chromatography on cation-exchange columns and electrophoresis (mostly capillary electrophoresis). They have been done through systematic population studies or premarital diagnosis. We describe in this work the frequent or rare pitfalls encountered, which led to false negative or positive diagnosis both in the field of sickle cell disease and thalassemias. In the absence of a well identified hemoglobin disorder in the proband's family, it is a rule that the use of a single test is insufficient to identify formally HbS. The presence of HbS could also be masked by another hemoglobin abnormality. The sole measurement of HbA2 level is insufficient to characterize a thalassemic trait: this level needs always to be interpreted considering RBC parameters and iron metabolic status. In difficult cases, the definitive answer may require a family study and/or a molecular genetic characterization.

  3. Pitfalls in the MR diagnosis of primary malignant bone tumors

    International Nuclear Information System (INIS)

    Bader, T.R.

    1998-01-01

    MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiography and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts. (orig.) [de

  4. Osteoporotic Animal Models of Bone Healing: Advantages and Pitfalls.

    Science.gov (United States)

    Calciolari, Elena; Donos, Nikolaos; Mardas, Nikos

    2017-10-01

    The aim of this review was to summarize the advantages and pitfalls of the available osteoporotic animal models of bone healing. A thorough literature search was performed in MEDLINE via OVID and EMBASE to identify animal studies investigating the effect of experimental osteoporosis on bone healing and bone regeneration. The osteotomy model in the proximal tibia is the most popular osseous defect model to study the bone healing process in osteoporotic-like conditions, although other well-characterized models, such as the post-extraction model, might be taken into consideration by future studies. The regenerative potential of osteoporotic bone and its response to biomaterials/regenerative techniques has not been clarified yet, and the critical size defect model might be an appropriate tool to serve this purpose. Since an ideal animal model for simulating osteoporosis does not exist, the type of bone remodeling, the animal lifespan, the age of peak bone mass, and the economic and ethical implications should be considered in our selection process. Furthermore, the influence of animal species, sex, age, and strain on the outcome measurement should be taken into account. In order to make future studies meaningful, standardized international guidelines for osteoporotic animal models of bone healing need to be set up.

  5. Optimizing methods and dodging pitfalls in microbiome research.

    Science.gov (United States)

    Kim, Dorothy; Hofstaedter, Casey E; Zhao, Chunyu; Mattei, Lisa; Tanes, Ceylan; Clarke, Erik; Lauder, Abigail; Sherrill-Mix, Scott; Chehoud, Christel; Kelsen, Judith; Conrad, Máire; Collman, Ronald G; Baldassano, Robert; Bushman, Frederic D; Bittinger, Kyle

    2017-05-05

    Research on the human microbiome has yielded numerous insights into health and disease, but also has resulted in a wealth of experimental artifacts. Here, we present suggestions for optimizing experimental design and avoiding known pitfalls, organized in the typical order in which studies are carried out. We first review best practices in experimental design and introduce common confounders such as age, diet, antibiotic use, pet ownership, longitudinal instability, and microbial sharing during cohousing in animal studies. Typically, samples will need to be stored, so we provide data on best practices for several sample types. We then discuss design and analysis of positive and negative controls, which should always be run with experimental samples. We introduce a convenient set of non-biological DNA sequences that can be useful as positive controls for high-volume analysis. Careful analysis of negative and positive controls is particularly important in studies of samples with low microbial biomass, where contamination can comprise most or all of a sample. Lastly, we summarize approaches to enhancing experimental robustness by careful control of multiple comparisons and to comparing discovery and validation cohorts. We hope the experimental tactics summarized here will help researchers in this exciting field advance their studies efficiently while avoiding errors.

  6. Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: multilevel analyses applied to experience sampling methodology.

    Science.gov (United States)

    Nisenbaum, Rosane; Links, Paul S; Eynan, Rahel; Heisel, Marnin J

    2010-05-01

    Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients' initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring.

  7. PSA methodology

    Energy Technology Data Exchange (ETDEWEB)

    Magne, L

    1997-12-31

    The purpose of this text is first to ask a certain number of questions on the methods related to PSAs. Notably we will explore the positioning of the French methodological approach - as applied in the EPS 1300{sup 1} and EPS 900{sup 2} PSAs - compared to other approaches (Part One). This reflection leads to more general reflection: what contents, for what PSA? This is why, in Part Two, we will try to offer a framework for definition of the criteria a PSA should satisfy to meet the clearly identified needs. Finally, Part Three will quickly summarize the questions approached in the first two parts, as an introduction to the debate. 15 refs.

  8. PSA methodology

    International Nuclear Information System (INIS)

    Magne, L.

    1996-01-01

    The purpose of this text is first to ask a certain number of questions on the methods related to PSAs. Notably we will explore the positioning of the French methodological approach - as applied in the EPS 1300 1 and EPS 900 2 PSAs - compared to other approaches (Part One). This reflection leads to more general reflection: what contents, for what PSA? This is why, in Part Two, we will try to offer a framework for definition of the criteria a PSA should satisfy to meet the clearly identified needs. Finally, Part Three will quickly summarize the questions approached in the first two parts, as an introduction to the debate. 15 refs

  9. Impact of Molecular Diagnostics for Tuberculosis on Patient-Important Outcomes: A Systematic Review of Study Methodologies.

    Directory of Open Access Journals (Sweden)

    Samuel G Schumacher

    Full Text Available Several reviews on the accuracy of Tuberculosis (TB Nucleic Acid Amplification Tests (NAATs have been performed but the evidence on their impact on patient-important outcomes has not been systematically reviewed. Given the recent increase in research evaluating such outcomes and the growing list of TB NAATs that will reach the market over the coming years, there is a need to bring together the existing evidence on impact, rather than accuracy. We aimed to assess the approaches that have been employed to measure the impact of TB NAATs on patient-important outcomes in adults with possible pulmonary TB and/or drug-resistant TB.We first develop a conceptual framework to clarify through which mechanisms the improved technical performance of a novel TB test may lead to improved patient outcomes and outline which designs may be used to measure them. We then systematically review the literature on studies attempting to assess the impact of molecular TB diagnostics on such outcomes and provide a narrative synthesis of designs used, outcomes assessed and risk of bias across different study designs.We found 25 eligible studies that assessed a wide range of outcomes and utilized a variety of experimental and observational study designs. Many potentially strong design options have never been used. We found that much of the available evidence on patient-important outcomes comes from a small number of settings with particular epidemiological and operational context and that confounding, time trends and incomplete outcome data receive insufficient attention.A broader range of designs should be considered when designing studies to assess the impact of TB diagnostics on patient outcomes and more attention needs to be paid to the analysis as concerns about confounding and selection bias become relevant in addition to those on measurement that are of greatest concern in accuracy studies.

  10. Analysis of post-operative changes in serum protein expression profiles from colorectal cancer patients by MALDI-TOF mass spectrometry: a pilot methodological study

    Directory of Open Access Journals (Sweden)

    Marsh Simon

    2010-04-01

    Full Text Available Abstract Background Mass spectrometry-based protein expression profiling of blood sera can be used to discriminate colorectal cancer (CRC patients from unaffected individuals. In a pilot methodological study, we have evaluated the changes in protein expression profiles of sera from CRC patients that occur following surgery to establish the potential of this approach for monitoring post-surgical response and possible early prediction of disease recurrence. Methods In this initial pilot study, serum specimens from 11 cancer patients taken immediately prior to surgery and at approximately 6 weeks following surgery were analysed alongside 10 normal control sera by matrix-assisted laser desorption ionisation time of-flight-mass spectrometry (MALDI-TOF MS. Using a two-sided t-test the top 20 ranked protein peaks that discriminate normal from pre-operative sera were identified. These were used to classify post-operative sera by hierarchical clustering analysis (Spearman's Rank correlation and, as an independent 'test' dataset, by k-nearest neighbour and weighted voting supervised learning algorithms. Results Hierarchical cluster analysis classified post-operative sera from all six early Dukes' stage (A and B patients as normal. The remaining five post-operative sera from more advanced Dukes' stages (C1 and C2 were classified as cancer. Analysis by supervised learning algorithms similarly grouped all advanced Dukes' stages as cancer, with four of the six post-operative sera from early Dukes' stages being classified as normal (P = 0.045; Fisher's exact test. Conclusions The results of this pilot methodological study illustrate the proof-of-concept of using protein expression profiling of post-surgical blood sera from individual patients to monitor disease course. Further validation on a larger patient cohort and using an independent post-operative sera dataset would be required to evaluate the potential clinical relevance of this approach. Prospective

  11. Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

    Science.gov (United States)

    Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

    2017-06-22

    The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta

  12. How to treat a patient with chronic low back pain - methodology and results of the first international case conference of integrative medicine.

    Science.gov (United States)

    Brinkhaus, Benno; Lewith, George; Rehberg, Benno; Heusser, Peter; Cummings, Mike; Michalsen, Andreas; Teut, Michael; Willich, Stefan N; Irnich, Dominik

    2011-02-01

    Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool "case conference on IM" is also described. The interactive case conference took place on November 20th, 2009 as part of the "2nd European Congress of IM" in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM. In this case conference, the expert panel agreed on a diagnosis of "chronic non-specific LBP with somatic and psychological factors" and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of "effective and adequate treatment" being met by their own individual treatment method. The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment

  13. Methodological challenges in following up patients of a hospital child protection team: is there a recruitment bias?

    Directory of Open Access Journals (Sweden)

    Lips Ulrich

    2010-11-01

    Full Text Available Abstract Background The aims of this study are to describe the methodological challenges in recruiting a follow-up sample of children referred to an interdisciplinary hospital child protection team (CPT and to compare participating versus non-participating groups on several demographic variables and maltreatment characteristics. Methods Of the 319 in- and outpatients referred to the CPT at University Children's Hospital Zurich from 2005–2006 a sample of 180 children was drawn to contact for a follow-up. The children and their parents were asked to participate in a face-to-face interview at the hospital; in 42 cases the children and parents consented to do so. Alternatively, the parents could take part in a telephone interview (n = 39. Non-participation resulted because no contact or adequate communication in German, French, or English could be established (n = 49 or because the parents or children refused to participate (n = 50. Results Participants and non-participants did not differ significantly in mean child age at follow-up, gender, family status, place of residence, certainty and type of maltreatment, and type of perpetrator. However, the child's nationality had a significant impact: Percentages of foreign nationals were higher in the fully participating group (45%; n = 19 and the non-contactable group (53%; n = 26 and significantly lower in the refusal (26%; n = 10 and the telephone interview group (18%; n = 9. Although a high percentage of families had moved in the few years since the CPT intervention (32%; n = 57, the percentage of moves was not significantly higher in non-participants compared to participants. Conclusions Further research is needed to support these results in different national backgrounds and to test for biases in variables not included – especially socioeconomic status. This includes gathering more detailed information on non-participants, while respecting ethical boundaries. Overall, the fact that only child

  14. A methodology to extract outcomes from routine healthcare data for patients with locally advanced non-small cell lung cancer.

    Science.gov (United States)

    Wong, Swee-Ling; Ricketts, Kate; Royle, Gary; Williams, Matt; Mendes, Ruheena

    2018-04-11

    Outcomes for patients in UK with locally advanced non-small cell lung cancer (LA NSCLC) are amongst the worst in Europe. Assessing outcomes is important for analysing the effectiveness of current practice. However, data quality is inconsistent and regular large scale analysis is challenging. This project investigates the use of routine healthcare datasets to determine progression free survival (PFS) and overall survival (OS) of patients treated with primary radical radiotherapy for LA NSCLC. All LA NSCLC patients treated with primary radical radiotherapy in a 2 year period were identified and paired manual and routine data generated for an initial pilot study. Manual data was extracted information from hospital records and considered the gold standard. Key time points were date of diagnosis, recurrence, death or last clinical encounter. Routine data was collected from various data sources including, Hospital Episode Statistics, Personal Demographic Service, chemotherapy data, and radiotherapy datasets. Relevant event dates were defined by proxy time points and refined using backdating and time interval optimization. Dataset correlations were then tested on key clinical outcome indicators to establish if routine data could be used as a reliable proxy measure for manual data. Forty-three patients were identified for the pilot study. The manual data showed a median age of 67 years (range 46- 89 years) and all patients had stage IIIA/B disease. Using the manual data, the median PFS was 10.78 months (range 1.58-37.49 months) and median OS was 16.36 months (range 2.69-37.49 months). Based on routine data, using proxy measures, the estimated median PFS was 10.68 months (range 1.61-31.93 months) and estimated median OS was 15.38 months (range 2.14-33.71 months). Overall, the routine data underestimated the PFS and OS of the manual data but there was good correlation with a Pearson correlation coefficient of 0.94 for PFS and 0.97 for OS. This is a novel approach

  15. Conditionally reprogrammed cells (CRC) methodology does not allow the in vitro expansion of patient-derived primary and metastatic lung cancer cells.

    Science.gov (United States)

    Sette, Giovanni; Salvati, Valentina; Giordani, Ilenia; Pilozzi, Emanuela; Quacquarini, Denise; Duranti, Enrico; De Nicola, Francesca; Pallocca, Matteo; Fanciulli, Maurizio; Falchi, Mario; Pallini, Roberto; De Maria, Ruggero; Eramo, Adriana

    2018-07-01

    Availability of tumor and non-tumor patient-derived models would promote the development of more effective therapeutics for non-small cell lung cancer (NSCLC). Recently, conditionally reprogrammed cells (CRC) methodology demonstrated exceptional potential for the expansion of epithelial cells from patient tissues. However, the possibility to expand patient-derived lung cancer cells using CRC protocols is controversial. Here, we used CRC approach to expand cells from non-tumoral and tumor biopsies of patients with primary or metastatic NSCLC as well as pulmonary metastases of colorectal or breast cancers. CRC cultures were obtained from both tumor and non-malignant tissues with extraordinary high efficiency. Tumor cells were tracked in vitro through tumorigenicity assay, monitoring of tumor-specific genetic alterations and marker expression. Cultures were composed of EpCAM+ lung epithelial cells lacking tumorigenic potential. NSCLC biopsies-derived cultures rapidly lost patient-specific genetic mutations or tumor antigens. Similarly, pulmonary metastases of colon or breast cancer generated CRC cultures of lung epithelial cells. All CRC cultures examined displayed epithelial lung stem cell phenotype and function. In contrast, brain metastatic lung cancer biopsies failed to generate CRC cultures. In conclusion, patient-derived primary and metastatic lung cancer cells were negatively selected under CRC conditions, limiting the expansion to non-malignant lung epithelial stem cells from either tumor or non-tumor tissue sources. Thus, CRC approach cannot be applied for direct therapeutic testing of patient lung tumor cells, as the tumor-derived CRC cultures are composed of (non-tumoral) airway basal cells. © 2018 UICC.

  16. The Power and Pitfalls of Big Data Research in Obstetrics and Gynecology: A Consumer's Guide.

    Science.gov (United States)

    Goodin, Amie; Delcher, Chris; Valenzuela, Chelsea; Wang, Xi; Zhu, Yanmin; Roussos-Ross, Dikea; Brown, Joshua D

    2017-11-01

    Research in obstetrics and gynecology (OB/GYN) increasingly relies on "big data" and observational study designs. There is a gap in practitioner-relevant guides to interpret and critique such research. This guide is an introduction to interpreting research using observational data and provides explanations and context for related terminology. In addition, it serves as a guide for critiquing OB/GYN studies that use observational data by outlining how to assess common pitfalls of experimental and observational study designs. Lastly, the piece provides a compendium of observational data resources commonly used within OB/GYN research. Review of literature was conducted for the collection of definitions and examples of terminology related to observational data research. Data resources were collected via Web search and researcher recommendations. Next, each data resource was reviewed and analyzed for content and accessibility. Contents of data resources were organized into summary tables and matched to relevant literature examples. We identified 26 observational data resources frequently used in secondary analysis for OB/GYN research. Cost, accessibility considerations for software/hardware capabilities, and contents of each data resource varied substantially. Observational data sources can provide researchers with a variety of options in tackling their research questions related to OB/GYN practice, patient health outcomes, trends in utilization of medications/procedures, or prevalence estimates of disease states. Insurance claims data resources are useful for population-level prevalence estimates and utilization trends, whereas electronic health record-derived data and patient survey data may be more useful for exploring patient behaviors and trends in practice.

  17. A systematic review of empirical studies on methodology and burden of informal patient payments in health systems.

    Science.gov (United States)

    Khodamoradi, Abdolvahed; Ghaffari, Mohammad Payam; Daryabeygi-Khotbehsara, Reza; Sajadi, Haniye Sadat; Majdzadeh, Reza

    2018-01-01

    Informal patients' payments (IPPs) is a sensitive subject. The aim of current study was to assess the trends in informal payment studies and explore methods of IPPs measurement, prevalence, and features (payment type, volume, and receiver) in various contexts. A search strategy was developed to identify peer-reviewed articles addressing informal payments on PubMed, Science Direct, Web of Science, Scopus, and CINAHL. A total of 1252 studies were identified initially. After screening process, 38 studies were included in the systematic review. The selected studies were appraised, and findings were synthesized. Among selected studies, quantitative approaches were mostly used for measuring IPPs from general public and patients' perspective, and qualitative methods mainly targeted health care providers. Reported IPP prevalence in selected articles ranges between 2% and 80%, more prevalent in the inpatient sector than in outpatient. There are a number of strategies for the measurement of IPPs with different strengths and weaknesses. Most applied strategies for general public were quantitative surveys recruiting more than 1000 participants using a face-to-face structured interview, and then qualitative studies on less than 150 health care providers, with focus group discussion. This review provides a comprehensive picture of current informal patients' payments measurement tools, which helps researchers in future investigations. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Emotional communication in medical consultations with native and non-native patients applying two different methodological approaches.

    Science.gov (United States)

    Kale, Emine; Skjeldestad, Kristin; Finset, Arnstein

    2013-09-01

    To explore the potential agreement between two different methods to investigate emotional communication of native and non-native patients in medical consultations. The data consisted of 12 videotaped hospital consultations with six native and six non-native patients. The consultations were coded according to coding rules of the Verona Coding definitions of Emotional Sequences (VR-CoDES) and afterwards analyzed by discourse analysis (DA) by two co-workers who were blind to the results from VR-CoDES. The agreement between VR-CoDES and DA was high in consultations with many cues and concerns, both with native and non-native patients. In consultations with no (or one cue) according to VR-CoDES criteria the DA still indicated the presence of emotionally salient expressions and themes. In some consultations cues to underlying emotions are communicated so vaguely or veiled by language barriers that standard VR-CoDES coding may miss subtle cues. Many of these sub-threshold cues could potentially be coded as cues according to VR-CoDES main coding categories, if criteria for coding vague or ambiguous cues had been better specified. Combining different analytical frameworks on the same dataset provide us new insights on emotional communication. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes.

    Science.gov (United States)

    Quattrin, R; Zanini, A; Buchini, S; Turello, D; Annunziata, M A; Vidotti, C; Colombatti, A; Brusaferro, S

    2006-03-01

    To examine the effectiveness of reflexology foot massage in hospitalized cancer patients undergoing second or third chemotherapy cycles. Since the late-1970s, studies have been conducted to assess the efficacy of behavioural and relaxation approaches in controlling nausea/vomiting, anxiety and other side-effects associated with chemotherapy. The study consisted of 30 patients being admitted to the oncology unit at a Scientific Research Hospital in Italy. Only 15 of the 30 participants received therapeutic massage. The subjects' self-reports of anxiety (measured by the Spielberger State-Trait Anxiety Inventory) were recorded before, after and 24 hours after the intervention. There was an average decrease of 7.9 points on the state-anxiety scale in the treatment group and of 0.8 points in the control group (P Reflexology foot massage can be considered a support treatment used in combination with traditional medical treatments and executed by an expert, qualified person to help cancer patients receiving chemotherapy feel better and also cope better with their disease.

  20. Probabilistic risk assessment methodology for risk management and regulatory applications

    International Nuclear Information System (INIS)

    See Meng Wong; Kelly, D.L.; Riley, J.E.

    1997-01-01

    This paper discusses the development and potential applications of PRA methodology for risk management and regulatory applications in the U.S. nuclear industry. The new PRA methodology centers on the development of This paper discusses the time-dependent configuration risk profile for evaluating the effectiveness of operational risk management programs at U.S. nuclear power plants. Configuration-risk profiles have been used as risk-information tools for (1) a better understanding of the impact of daily operational activities on plant safety, and (2) proactive planning of operational activities to manage risk. Trial applications of the methodology were undertaken to demonstrate that configuration-risk profiles can be developed routinely, and can be useful for various industry and regulatory applications. Lessons learned include a better understanding of the issues and characteristics of PRA models available to industry, and identifying the attributes and pitfalls in the developement of risk profiles

  1. SU-D-204-01: A Methodology Based On Machine Learning and Quantum Clustering to Predict Lung SBRT Dosimetric Endpoints From Patient Specific Anatomic Features

    Energy Technology Data Exchange (ETDEWEB)

    Lafata, K; Ren, L; Wu, Q; Kelsey, C; Hong, J; Cai, J; Yin, F [Duke University Medical Center, Durham, NC (United States)

    2016-06-15

    Purpose: To develop a data-mining methodology based on quantum clustering and machine learning to predict expected dosimetric endpoints for lung SBRT applications based on patient-specific anatomic features. Methods: Ninety-three patients who received lung SBRT at our clinic from 2011–2013 were retrospectively identified. Planning information was acquired for each patient, from which various features were extracted using in-house semi-automatic software. Anatomic features included tumor-to-OAR distances, tumor location, total-lung-volume, GTV and ITV. Dosimetric endpoints were adopted from RTOG-0195 recommendations, and consisted of various OAR-specific partial-volume doses and maximum point-doses. First, PCA analysis and unsupervised quantum-clustering was used to explore the feature-space to identify potentially strong classifiers. Secondly, a multi-class logistic regression algorithm was developed and trained to predict dose-volume endpoints based on patient-specific anatomic features. Classes were defined by discretizing the dose-volume data, and the feature-space was zero-mean normalized. Fitting parameters were determined by minimizing a regularized cost function, and optimization was performed via gradient descent. As a pilot study, the model was tested on two esophageal dosimetric planning endpoints (maximum point-dose, dose-to-5cc), and its generalizability was evaluated with leave-one-out cross-validation. Results: Quantum-Clustering demonstrated a strong separation of feature-space at 15Gy across the first-and-second Principle Components of the data when the dosimetric endpoints were retrospectively identified. Maximum point dose prediction to the esophagus demonstrated a cross-validation accuracy of 87%, and the maximum dose to 5cc demonstrated a respective value of 79%. The largest optimized weighting factor was placed on GTV-to-esophagus distance (a factor of 10 greater than the second largest weighting factor), indicating an intuitively strong

  2. Methodological constraints in interpreting serum paraoxonase-1 activity measurements: an example from a study in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Joven Jorge

    2010-03-01

    Full Text Available Abstract Background Paraoxonase-1 (PON1 is an antioxidant enzyme that attenuates the production of the monocyte chemoattractant protein-1 (MCP-1 in vitro. Although oxidation and inflammation are closely related processes, the association between PON1 and MCP-1 has not been completely characterised due, probably, to that the current use of synthetic substrates for PON1 measurement limits the interpretation of the data. In the present study, we explored the relationships between the circulating levels of PON1 and MCP-1 in human immunodeficiency virus-infected patients in relation to the multifunctional capabilities of PON1. Methods We measured selected variables in 227 patients and in a control group of 409 participants. Serum PON1 esterase and lactonase activities were measured as the rates of hydrolysis of paraoxon and of 5-(thiobutyl-butyrolactone, respectively. Oxidised LDL and MCP-1 concentrations were determined by enzyme-linked immunosorbent assay. High-density lipoproteins cholesterol, apolipoprotein A-I, and C-reactive protein concentrations were measured by standard automated methods. Results There were significant relationships between PON1 activity and several indices of oxidation and inflammation in control subjects and in infected patients. However, these relationships varied not only with disease status but also on the type of substrate used for PON1 measurement. Conclusion The present study is a cautionary tale highlighting that results of clinical studies on PON1 may vary depending on the methods used as well as the disease studied. Until more specific methods using physiologically-akin substrates are developed for PON1 measurement, we suggest the simultaneous employment of at least two different substrates in order to improve the reliability of the results obtained.

  3. Primary cultured fibroblasts derived from patients with chronic wounds: a methodology to produce human cell lines and test putative growth factor therapy such as GMCSF

    Directory of Open Access Journals (Sweden)

    Coppock Donald L

    2008-12-01

    Full Text Available Abstract Background Multiple physiologic impairments are responsible for chronic wounds. A cell line grown which retains its phenotype from patient wounds would provide means of testing new therapies. Clinical information on patients from whom cells were grown can provide insights into mechanisms of specific disease such as diabetes or biological processes such as aging. The objective of this study was 1 To culture human cells derived from patients with chronic wounds and to test the effects of putative therapies, Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF on these cells. 2 To describe a methodology to create fibroblast cell lines from patients with chronic wounds. Methods Patient biopsies were obtained from 3 distinct locations on venous ulcers. Fibroblasts derived from different wound locations were tested for their migration capacities without stimulators and in response to GM-CSF. Another portion of the patient biopsy was used to develop primary fibroblast cultures after rigorous passage and antimicrobial testing. Results Fibroblasts from the non-healing edge had almost no migration capacity, wound base fibroblasts were intermediate, and fibroblasts derived from the healing edge had a capacity to migrate similar to healthy, normal, primary dermal fibroblasts. Non-healing edge fibroblasts did not respond to GM-CSF. Six fibroblast cell lines are currently available at the National Institute on Aging (NIA Cell Repository. Conclusion We conclude that primary cells from chronic ulcers can be established in culture and that they maintain their in vivo phenotype. These cells can be utilized for evaluating the effects of wound healing stimulators in vitro.

  4. The rainfall plot: its motivation, characteristics and pitfalls.

    Science.gov (United States)

    Domanska, Diana; Vodák, Daniel; Lund-Andersen, Christin; Salvatore, Stefania; Hovig, Eivind; Sandve, Geir Kjetil

    2017-05-18

    A visualization referred to as rainfall plot has recently gained popularity in genome data analysis. The plot is mostly used for illustrating the distribution of somatic cancer mutations along a reference genome, typically aiming to identify mutation hotspots. In general terms, the rainfall plot can be seen as a scatter plot showing the location of events on the x-axis versus the distance between consecutive events on the y-axis. Despite its frequent use, the motivation for applying this particular visualization and the appropriateness of its usage have never been critically addressed in detail. We show that the rainfall plot allows visual detection even for events occurring at high frequency over very short distances. In addition, event clustering at multiple scales may be detected as distinct horizontal bands in rainfall plots. At the same time, due to the limited size of standard figures, rainfall plots might suffer from inability to distinguish overlapping events, especially when multiple datasets are plotted in the same figure. We demonstrate the consequences of plot congestion, which results in obscured visual data interpretations. This work provides the first comprehensive survey of the characteristics and proper usage of rainfall plots. We find that the rainfall plot is able to convey a large amount of information without any need for parameterization or tuning. However, we also demonstrate how plot congestion and the use of a logarithmic y-axis may result in obscured visual data interpretations. To aid the productive utilization of rainfall plots, we demonstrate their characteristics and potential pitfalls using both simulated and real data, and provide a set of practical guidelines for their proper interpretation and usage.

  5. Drug targeting to tumors: principles, pitfalls and (pre-) clinical progress.

    Science.gov (United States)

    Lammers, Twan; Kiessling, Fabian; Hennink, Wim E; Storm, Gert

    2012-07-20

    Many different systems and strategies have been evaluated for drug targeting to tumors over the years. Routinely used systems include liposomes, polymers, micelles, nanoparticles and antibodies, and examples of strategies are passive drug targeting, active drug targeting to cancer cells, active drug targeting to endothelial cells and triggered drug delivery. Significant progress has been made in this area of research both at the preclinical and at the clinical level, and a number of (primarily passively tumor-targeted) nanomedicine formulations have been approved for clinical use. Significant progress has also been made with regard to better understanding the (patho-) physiological principles of drug targeting to tumors. This has led to the identification of several important pitfalls in tumor-targeted drug delivery, including I) overinterpretation of the EPR effect; II) poor tumor and tissue penetration of nanomedicines; III) misunderstanding of the potential usefulness of active drug targeting; IV) irrational formulation design, based on materials which are too complex and not broadly applicable; V) insufficient incorporation of nanomedicine formulations in clinically relevant combination regimens; VI) negligence of the notion that the highest medical need relates to metastasis, and not to solid tumor treatment; VII) insufficient integration of non-invasive imaging techniques and theranostics, which could be used to personalize nanomedicine-based therapeutic interventions; and VIII) lack of (efficacy analyses in) proper animal models, which are physiologically more relevant and more predictive for the clinical situation. These insights strongly suggest that besides making ever more nanomedicine formulations, future efforts should also address some of the conceptual drawbacks of drug targeting to tumors, and that strategies should be developed to overcome these shortcomings. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. Nano(Q)SAR: Challenges, pitfalls and perspectives.

    Science.gov (United States)

    Tantra, Ratna; Oksel, Ceyda; Puzyn, Tomasz; Wang, Jian; Robinson, Kenneth N; Wang, Xue Z; Ma, Cai Y; Wilkins, Terry

    2015-01-01

    Regulation for nanomaterials is urgently needed, and the drive to adopt an intelligent testing strategy is evident. Such a strategy will not only provide economic benefits but will also reduce moral and ethical concerns arising from animal testing. For regulatory purposes, such an approach is promoted by REACH, particularly the use of quantitative structure-activity relationships [(Q)SAR] as a tool for the categorisation of compounds according to their physicochemical and toxicological properties. In addition to compounds, (Q)SAR has also been applied to nanomaterials in the form of nano(Q)SAR. Although (Q)SAR in chemicals is well established, nano(Q)SAR is still in early stages of development and its successful uptake is far from reality. This article aims to identify some of the pitfalls and challenges associated with nano-(Q)SARs in relation to the categorisation of nanomaterials. Our findings show clear gaps in the research framework that must be addressed if we are to have reliable predictions from such models. Three major barriers were identified: the need to improve quality of experimental data in which the models are developed from, the need to have practical guidelines for the development of the nano(Q)SAR models and the need to standardise and harmonise activities for the purpose of regulation. Of these three, the first, i.e. the need to improve data quality requires immediate attention, as it underpins activities associated with the latter two. It should be noted that the usefulness of data in the context of nano-(Q)SAR modelling is not only about the quantity of data but also about the quality, consistency and accessibility of those data.

  7. Top ten pitfalls to avoid when performing musculoskeletal sonography: What you should know before entering the examination room

    International Nuclear Information System (INIS)

    Arend, Carlos Frederico

    2013-01-01

    Sonography has been used successfully to evaluate a number of musculoskeletal disorders. The method is operator dependent and familiarity with sonographic pitfalls greatly improves diagnostic accuracy and helps to optimize management. In this article, we discuss ten common pitfalls which can become a source of confusion and misdiagnosis in musculoskeletal sonography

  8. More Pitfalls with Sperm Viability Staining and a Viability-Based Stress Test to Characterize Sperm Quality

    Directory of Open Access Journals (Sweden)

    Barbara A. Eckel

    2017-12-01

    Full Text Available Sperm viability (SV, the proportion of live sperm in a sample, is a widely applied measure of sperm quality but few studies test its robustness. At least three reasons make SV problematic as a surrogate for sperm quality. First, reviewing the ecological literature revealed that previously identified methodological pitfalls have not been overcome, including low cross-study standardization of protocols, inadequate statistical treatment, and unaccounted for within-sample heterogeneity. Second, SV is affected by biological variation such as between species, reproductive organs, or sperm age cohorts. Third, the proportion of live sperm extracted from males appears more related to male than to sperm quality in the sense of the future performance of sperm. We propose an alternative method to assess sperm quality by characterizing the temporal decrease of SV in a stressor medium and illustrate in two species, the common bedbug (Cimex lectularius and the fruit fly (Drosophila melanogaster how some common methodological pitfalls may be circumvented. Our data empirically support the well-known but little-considered facts that (i non-blind measurements may alter SV and (ii that SV frequently have non-significant repeatability within one sample. (iii Cross-sectional sampling of ejaculates showed that this heterogeneity even masked a biological pattern—the sperm stratification within males. We show (iv that this shortcoming can be overcome by following the temporal decline of SV of a sperm subsample in a stress test. Finally, (v comparing the staining pattern of sperm between Cimex and Drosophila, we found that in the latter, the visibility of sperm is substantially delayed (30 min when sperm density is high. We show that this delay in stained sperm visibility was, however, not biased toward dead or live sperm. To measure sperm quality, we advocate analyzing the temporal decline in SV in a stressor medium over current protocols that use SV per se and

  9. Cognitive interviewing methodology in the development of a pediatric item bank: a patient reported outcomes measurement information system (PROMIS study

    Directory of Open Access Journals (Sweden)

    DeWalt Darren A

    2009-01-01

    Full Text Available Abstract Background The evaluation of patient-reported outcomes (PROs in health care has seen greater use in recent years, and methods to improve the reliability and validity of PRO instruments are advancing. This paper discusses the cognitive interviewing procedures employed by the Patient Reported Outcomes Measurement Information System (PROMIS pediatrics group for the purpose of developing a dynamic, electronic item bank for field testing with children and adolescents using novel computer technology. The primary objective of this study was to conduct cognitive interviews with children and adolescents to gain feedback on items measuring physical functioning, emotional health, social health, fatigue, pain, and asthma-specific symptoms. Methods A total of 88 cognitive interviews were conducted with 77 children and adolescents across two sites on 318 items. From this initial item bank, 25 items were deleted and 35 were revised and underwent a second round of cognitive interviews. A total of 293 items were retained for field testing. Results Children as young as 8 years of age were able to comprehend the majority of items, response options, directions, recall period, and identify problems with language that was difficult for them to understand. Cognitive interviews indicated issues with item comprehension on several items which led to alternative wording for these items. Conclusion Children ages 8–17 years were able to comprehend most item stems and response options in the present study. Field testing with the resulting items and response options is presently being conducted as part of the PROMIS Pediatric Item Bank development process.

  10. Translation and linguistic validation of the Pediatric Patient-Reported Outcomes Measurement Information System measures into simplified Chinese using cognitive interviewing methodology.

    Science.gov (United States)

    Liu, Yanyan; Hinds, Pamela S; Wang, Jichuan; Correia, Helena; Du, Shizheng; Ding, Jian; Gao, Wen Jun; Yuan, Changrong

    2013-01-01

    The Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) measures were developed using modern measurement theory and tested in a variety of settings to assess the quality of life, function, and symptoms of children and adolescents experiencing a chronic illness and its treatment. Developed in English, this set of measures had not been translated into Chinese. The objective of this study was to develop the Chinese version of the Pediatric PROMIS measures (C-Ped-PROMIS), specifically 8 short forms, and to pretest the translated measures in children and adolescents through cognitive interviewing methodology. The C-Ped-PROMIS was developed following the standard Functional Assessment of Chronic Illness Therapy Translation Methodology. Bilingual teams from the United States and China reviewed the translation to develop a provisional version, which was then pretested with cognitive interview by probing 10 native Chinese-speaking children aged 8 to 17 years in China. The translation was finalized by the bilingual teams. Most items, response options, and instructions were well understood by the children, and some revisions were made to address patient's comments during the cognitive interview. The results indicated that the C-Ped-PROMIS items were semantically and conceptually equivalent to the original. Children aged 8 to 17 years in China were able to comprehend these measures and express their experience and feelings about illness or their life. The C-Ped-PROMIS is available for psychometric validation. Future work will be directed at translating the rest of the item banks, calibrating them and creating a Chinese final version of the short forms.

  11. Application of an engineering problem-solving methodology to address persistent problems in patient safety: a case study on retained surgical sponges after surgery.

    Science.gov (United States)

    Anderson, Devon E; Watts, Bradley V

    2013-09-01

    Despite innumerable attempts to eliminate the postoperative retention of surgical sponges, the medical error persists in operating rooms worldwide and places significant burden on patient safety, quality of care, financial resources, and hospital/physician reputation. The failure of countless solutions, from new sponge counting methods to radio labeled sponges, to truly eliminate the event in the operating room requires that the emerging field of health-care delivery science find innovative ways to approach the problem. Accordingly, the VA National Center for Patient Safety formed a unique collaboration with a team at the Thayer School of Engineering at Dartmouth College to evaluate the retention of surgical sponges after surgery and find a solution. The team used an engineering problem solving methodology to develop the best solution. To make the operating room a safe environment for patients, the team identified a need to make the sponge itself safe for use as opposed to resolving the relatively innocuous counting methods. In evaluation of this case study, the need for systematic engineering evaluation to resolve problems in health-care delivery becomes clear.

  12. New Acquisition Protocol of 18F-Choline PET/CT in Prostate Cancer Patients: Review of the Literature about Methodology and Proposal of Standardization

    Directory of Open Access Journals (Sweden)

    Sotirios Chondrogiannis

    2014-01-01

    Full Text Available Purpose. (1 To evaluate a new acquisition protocol of 18F-choline (FCH PET/CT for prostate cancer patients (PC, (2 to review acquisition 18F-choline PET/CT methodology, and (3 to propose a standardized acquisition protocol on FCH PET/CT in PC patients. Materials. 100 consecutive PC patients (mean age 70.5 years, mean PSA 21.35 ng/mL were prospectively evaluated. New protocol consisted of an early scan of the pelvis immediately after the injection of the tracer (1 bed position of 4 min followed by a whole body scan at one 1 hour. Early and 1 hour images were compared for interfering activity and pathologic findings. Results. The overall detection rate of FCH PET/CT was 64%. The early static images of the pelvis showed absence of radioactive urine in ureters, bladder, or urethra which allowed a clean evaluation of the prostatic fossae. Uptake in the prostatic region was better visualized in the early phase in 26% (7/30 of cases. Other pelvic pathologic findings (bone and lymph nodes were visualized in both early and late images. Conclusion. Early 18F-choline images improve visualization of abnormal uptake in prostate fossae. All pathologic pelvic deposits (prostate, lymph nodes, and bone were visualized in both early and late images.

  13. Action research methodology in clinical pharmacy: how to involve and change.

    Science.gov (United States)

    Nørgaard, Lotte Stig; Sørensen, Ellen Westh

    2016-06-01

    Introduction The focus in clinical pharmacy practice is and has for the last 30-35 years been on changing the role of pharmacy staff into service orientation and patient counselling. One way of doing this is by involving staff in change process and as a researcher to take part in the change process by establishing partnerships with staff. On the background of the authors' widespread action research (AR)-based experiences, recommendations and comments for how to conduct an AR-study is described, and one of their AR-based studies illustrate the methodology and the research methods used. Methodology AR is defined as an approach to research which is based on a problem-solving relationship between researchers and clients, which aims at both solving a problem and at collaboratively generating new knowledge. Research questions relevant in AR-studies are: what was the working process in this change oriented study? What learning and/or changes took place? What challenges/pitfalls had to be overcome? What were the influence/consequences for the involved parts? When to use If you want to implement new services and want to involve staff and others in the process, an AR methodology is very suitable. The basic advantages of doing AR-based studies are grounded in their participatory and democratic basis and their starting point in problems experienced in practice. Limitations Some of the limitations in AR-studies are that neither of the participants in a project steering group are the only ones to decide. Furthermore, the collective process makes the decision-making procedures relatively complex.

  14. Least-cost Paths - Some Methodological Issues

    Directory of Open Access Journals (Sweden)

    Irmela Herzog

    2014-06-01

    Full Text Available This article deals with methodological issues connected with least-cost path (LCP calculations in archaeology. The number of LCP studies in archaeology has increased rapidly during the last couple of years, but not all of the approaches applied are based on an appropriate model and implementation. Many archaeologists rely on standard GIS software with default settings for calculating LCPs and are not aware of possible alternatives and the pitfalls that are described in this article. After briefly introducing the aims and applications of LCP methods in archaeology, LCP algorithms are discussed. The outcome of the LCP calculations depends not only on the algorithm but also on the cost model, which often includes several cost components. The discussion of the cost components has a focus on slope, because nearly all archaeological LCP studies take this cost component into account and because several methodological issues are connected with slope-based cost models. Other possible cost components are: the load of the walker, vegetation cover, wetlands or other soil properties, travelling and transport on water, water as barrier and as attractor, aspect, altitude, and social or cultural cost components. Eventually, advantages and disadvantages of different ways of combining cost components are presented. Based on the methodological issues I conclude that both validation checks and variations of the model are necessary to analyse the reliability of archaeological LCP results.

  15. Elderly Patients with Dementia-Related Symptoms of Severe Agitation and Aggression: Consensus Statement on Treatment Options, Clinical Trials Methodology, and Policy

    Science.gov (United States)

    Salzman, C; Jeste, D; Meyer, RE; Cohen-Mansfield, J; Cummings, J; Grossberg, G; Jarvik, L; Kraemer, H; Lebowitz, B; Maslow, K; Pollock, B; Raskind, M; Schultz, S; Wang, P; Zito, JM; Zubenko, GS

    2009-01-01

    Atypical antipsychotic drugs have been used off-label in clinical practice for treatment of serious dementia-associated agitation and aggression. Following reports of cerebrovascular adverse events associated with the use of atypical antipsychotic in elderly patients with dementia, the FDA issued black box warnings for several atypical antipsychotics, titled “Cerebrovascular Adverse Events, including Stroke, in Elderly Patients with Dementia.” Subsequently, the FDA initiated a meta-analysis of safety data from 17 registration trials across six antipsychotic drugs (five atypical antipsychotics and haloperidol). In 2005, the Agency issued a black box warning regarding increased risk of mortality associated with the use of atypical antipsychotic drugs in this patient population. Geriatric mental health experts participating in a 2006 consensus conference reviewed evidence on the safety and efficacy of antipsychotics, as well as nonpharmacologic approaches, in treating dementia-related symptoms of agitation and aggression. They concluded that, while problems in clinical trials design may have been one of the contributors to the failure to find a signal of drug efficacy, the findings related to drug safety should be taken seriously by clinicians in assessing the potential risks and benefits of treatment in a frail population, and in advising families about treatment. Information provided to patients and family members should be documented in the patient’s chart. Drugs should be used only when non-pharmacologic approaches have failed to adequately control behavioral disruption. Participants also agreed that that there is a need for an FDA-approved medication for the treatment of severe, persistent or recurrent dementia-related symptoms of agitation and aggression (even in the absence of psychosis), that are unresponsive to nonpharmacologic intervention. The authors have outlined methodological enhancements to better evaluate treatment approaches in future

  16. Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Albert, T.J.; Veth, R.P.H.; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Methodologic systematic review. OBJECTIVE: To determine the validity of reported risk factors for mortality in elderly patients with cervical spine injury. SUMMARY OF BACKGROUND DATA: In elderly patients with cervical spine injury, mortality has frequently been associated with the type

  17. Using Delphi methodology in the development of a new patient-reported outcome measure for stroke survivors with visual impairment.

    Science.gov (United States)

    Hepworth, Lauren R; Rowe, Fiona J

    2018-02-01

    The aim of this study was to ascertain what items stroke survivors and stroke care professionals think are important when assessing quality of life for stroke survivors with visual impairment for inclusion in the new patient-reported outcome measure. A reactive Delphi process was used in a three-round electronic-based survey. The items presented consisted of 62 items originally sourced from a systematic review of existing vision-related quality of life instruments and stroke survivor interviews, reduced and refined following a ranking exercise and pilot with stroke survivors with visual impairment. Stakeholders (stroke survivors/clinicians) were invited to take part in the process. A consensus definition of ≥70% was decided a priori. Participants were asked to rank importance on a 9-point scale and categorize the items by relevance to types of visual impairment following stroke or not relevant. Analysis of consensus, stability, and agreement was conducted. In total, 113 participants registered for the Delphi survey of which 47 (41.6%) completed all three rounds. Response rates to the three rounds were 78/113 (69.0%), 61/76 (81.3%), and 49/64 (76.6%), respectively. The participants included orthoptists (45.4%), occupational therapists (44.3%), and stroke survivors (10.3%). Consensus was reached on 56.5% of items in the three-round process, all for inclusion. A consensus was reached for 83.8% in the categorization of items. The majority (82.6%) of consensus were for relevant to 'all visual impairment following stroke'; two items were deemed 'not relevant'. The lack of item reduction achieved by this Delphi process highlights the need for additional methods of item reduction in the development of a new PROM for visual impairment following stroke. These results will be considered alongside Rasch analysis to achieve further item reduction. However, the Delphi survey remains important as it provides clinical and patient insight into each item rather than purely relying

  18. Testing methodologies

    Energy Technology Data Exchange (ETDEWEB)

    Bender, M.A.

    1990-01-01

    Several methodologies are available for screening human populations for exposure to ionizing radiation. Of these, aberration frequency determined in peripheral blood lymphocytes is the best developed. Individual exposures to large doses can easily be quantitated, and population exposures to occupational levels can be detected. However, determination of exposures to the very low doses anticipated from a low-level radioactive waste disposal site is more problematical. Aberrations occur spontaneously, without known cause. Exposure to radiation induces no new or novel types, but only increases their frequency. The limitations of chromosomal aberration dosimetry for detecting low level radiation exposures lie mainly in the statistical signal to noise'' problem, the distribution of aberrations among cells and among individuals, and the possible induction of aberrations by other environmental occupational or medical exposures. However, certain features of the human peripheral lymphocyte-chromosomal aberration system make it useful in screening for certain types of exposures. Future technical developments may make chromosomal aberration dosimetry more useful for low-level radiation exposures. Other methods, measuring gene mutations or even minute changes on the DNA level, while presently less will developed techniques, may eventually become even more practical and sensitive assays for human radiation exposure. 15 refs.

  19. Testing methodologies

    International Nuclear Information System (INIS)

    Bender, M.A.

    1990-01-01

    Several methodologies are available for screening human populations for exposure to ionizing radiation. Of these, aberration frequency determined in peripheral blood lymphocytes is the best developed. Individual exposures to large doses can easily be quantitated, and population exposures to occupational levels can be detected. However, determination of exposures to the very low doses anticipated from a low-level radioactive waste disposal site is more problematical. Aberrations occur spontaneously, without known cause. Exposure to radiation induces no new or novel types, but only increases their frequency. The limitations of chromosomal aberration dosimetry for detecting low level radiation exposures lie mainly in the statistical ''signal to noise'' problem, the distribution of aberrations among cells and among individuals, and the possible induction of aberrations by other environmental occupational or medical exposures. However, certain features of the human peripheral lymphocyte-chromosomal aberration system make it useful in screening for certain types of exposures. Future technical developments may make chromosomal aberration dosimetry more useful for low-level radiation exposures. Other methods, measuring gene mutations or even minute changes on the DNA level, while presently less will developed techniques, may eventually become even more practical and sensitive assays for human radiation exposure. 15 refs

  20. Wedding Rigorous Scientific Methodology and Ancient Herbal Wisdom to Benefit Cancer Patients: The Development of PHY906.

    Science.gov (United States)

    Chu, Edward

    2018-02-15

    Our research group has extensively characterized the preclinical and clinical activities of PHY906, a traditional Chinese herbal medicine, as a modulator of irinotecan-based chemotherapy for the treatment of colorectal cancer. This article reviews the critical issues of quality control and standardization of PHY906 and highlights the importance of high-quality material for the conduct of preclinical and clinical studies. Studies to investigate the potential biological mechanisms of action using a systems biology approach play a pivotal role in providing the preclinical rationale to move forward with clinical studies. For early-phase clinical studies, translational biomarkers should be incorporated to characterize the biological effects of the herbal medicine. These biomarkers include tumor mutational load, cytokine/chemokine expression, metabolomic profiling, and the presence of key herbal metabolites. Sophisticated bioinformatic approaches are critical for mining the data and identifying those biomarkers that can define the subset of patients who will benefit from PHY906 or any other herbal medicine, in terms of reduced treatment toxicity, improved quality of life, and/or enhanced clinical activity of treatment.

  1. Do COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term? A mixed methodological study.

    Science.gov (United States)

    Roberts, S E; Schreuder, F M; Watson, T; Stern, M

    2017-12-01

    To investigate whether COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term and, if so, their experience of this. A mixed methodological approach using semi-structured telephone interviews, a focus group and observation of current PLB technique was used. Qualitative analysis was based on grounded theory. Participants were recruited from the two inner city London (UK) boroughs. A purposive sample of 13 patients with COPD taught PLB 6 to 24 months previously. 11 participants took part in the telephone interviews; focus group participation and observed PLB was 5/11 and 6/11 respectively. A thematic analysis of interviews and focus group; observation of PLB technique. Nine reported on-going use of PLB with 8 reporting definite benefit. Observed technique showed ongoing ability for PLB to reduce RR and increase SpO 2 . Four distinct themes emerged from the data: use of PLB when short of breath due to physical activity (8/9), increased confidence and reduced panic (4/9), use as an exercise (3/9), use at night (3/9). Those that had discontinued PLB had done so because it didn't help (2) and they had forgotten/were too busy to continue. This study found 9 of 13 of patients taught PLB continued with long-term use and 8 of 13 reporting definite benefit from PLB. The role of PLB in increasing patients' confidence in their ability to manage their breathlessness and, use at night, were novel findings. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  2. Impact of SPECT corrections on 3D-dosimetry for liver transarterial radioembolization using the patient relative calibration methodology

    Energy Technology Data Exchange (ETDEWEB)

    Pacilio, Massimiliano, E-mail: mpacilio@scamilloforlanini.rm.it; Basile, Chiara [Department of Medical Physics, Azienda Ospedaliera San Camillo Forlanini, Rome 00152 (Italy); Ferrari, Mahila; Botta, Francesca; Cremonesi, Marta [Department of Medical Physics, Istituto Europeo di Oncologia, Milan 20141 (Italy); Chiesa, Carlo [Department of Nuclear Medicine, Istituto Nazionale Tumori IRCCS Foundation, Milan 20133 (Italy); Lorenzon, Leda; Becci, Domenico [Postgraduate School of Medical Physics, “Sapienza” University of Rome, Rome 00185 (Italy); Mira, Marta [Post graduate Health Physics School, University of Milan, Milan 20122 (Italy); Torres, Leonel Alberto; Vergara Gil, Alex [Department of Nuclear Medicine, Clinical Research Division of the Center of Isotopes (DIC-CENTIS), Havana 11100 (Cuba); Coca Perez, Marco [Department of PET-CT and Nuclear Medicine, Imaging Center Medscan-Concepciòn, Concepciòn 4070061 (Chile); Ljungberg, Michael [Department of Medical Radiation Physics, University of Lund, Lund 22100 (Sweden); Pani, Roberto [Department of Medico-surgical Sciences and Biotecnologies, “Sapienza” University of Rome, Rome 00185 (Italy)

    2016-07-15

    Purpose: Many centers aim to plan liver transarterial radioembolization (TARE) with dosimetry, even without CT-based attenuation correction (AC), or with unoptimized scatter correction (SC) methods. This work investigates the impact of presence vs absence of such corrections, and limited spatial resolution, on 3D dosimetry for TARE. Methods: Three voxelized phantoms were derived from CT images of real patients with different body sizes. Simulations of {sup 99m}Tc-SPECT projections were performed with the SIMIND code, assuming three activity distributions in the liver: uniform, inside a “liver’s segment,” or distributing multiple uptaking nodules (“nonuniform liver”), with a tumoral liver/healthy parenchyma ratio of 5:1. Projection data were reconstructed by a commercial workstation, with OSEM protocol not specifically optimized for dosimetry (spatial resolution of 12.6 mm), with/without SC (optimized, or with parameters predefined by the manufacturer; dual energy window), and with/without AC. Activity in voxels was calculated by a relative calibration, assuming identical microspheres and {sup 99m}Tc-SPECT counts spatial distribution. 3D dose distributions were calculated by convolution with {sup 90}Y voxel S-values, assuming permanent trapping of microspheres. Cumulative dose-volume histograms in lesions and healthy parenchyma from different reconstructions were compared with those obtained from the reference biodistribution (the “gold standard,” GS), assessing differences for D95%, D70%, and D50% (i.e., minimum value of the absorbed dose to a percentage of the irradiated volume). γ tool analysis with tolerance of 3%/13 mm was used to evaluate the agreement between GS and simulated cases. The influence of deep-breathing was studied, blurring the reference biodistributions with a 3D anisotropic gaussian kernel, and performing the simulations once again. Results: Differences of the dosimetric indicators were noticeable in some cases, always negative

  3. Pitfalls and important issues in testing reliability using intraclass correlation coefficients in orthopaedic research.

    Science.gov (United States)

    Lee, Kyoung Min; Lee, Jaebong; Chung, Chin Youb; Ahn, Soyeon; Sung, Ki Hyuk; Kim, Tae Won; Lee, Hui Jong; Park, Moon Seok

    2012-06-01

    Intra-class correlation coefficients (ICCs) provide a statistical means of testing the reliability. However, their interpretation is not well documented in the orthopedic field. The purpose of this study was to investigate the use of ICCs in the orthopedic literature and to demonstrate pitfalls regarding their use. First, orthopedic articles that used ICCs were retrieved from the Pubmed database, and journal demography, ICC models and concurrent statistics used were evaluated. Second, reliability test was performed on three common physical examinations in cerebral palsy, namely, the Thomas test, the Staheli test, and popliteal angle measurement. Thirty patients were assessed by three orthopedic surgeons to explore the statistical methods testing reliability. Third, the factors affecting the ICC values were examined by simulating the data sets based on the physical examination data where the ranges, slopes, and interobserver variability were modified. Of the 92 orthopedic articles identified, 58 articles (63%) did not clarify the ICC model used, and only 5 articles (5%) described all models, types, and measures. In reliability testing, although the popliteal angle showed a larger mean absolute difference than the Thomas test and the Staheli test, the ICC of popliteal angle was higher, which was believed to be contrary to the context of measurement. In addition, the ICC values were affected by the model, type, and measures used. In simulated data sets, the ICC showed higher values when the range of data sets were larger, the slopes of the data sets were parallel, and the interobserver variability was smaller. Care should be taken when interpreting the absolute ICC values, i.e., a higher ICC does not necessarily mean less variability because the ICC values can also be affected by various factors. The authors recommend that researchers clarify ICC models used and ICC values are interpreted in the context of measurement.

  4. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Ignacio [Musculoskeletal Research Fellow at NYU Langone Medical Center, New York, NY (United States); Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires (Argentina); Rosenberg, Zehava [NYU Langone Medical Center, New York, NY (United States); Zember, Jonathan [Albert Einstein College of Medicine Jacobi Medical Center, Bronx, NY (United States)

    2016-04-15

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  5. Benefits, pitfalls and risks of phytotherapy in clinical practice in otorhinolaryngology.

    Science.gov (United States)

    Laccourreye, O; Werner, A; Laccourreye, L; Bonfils, P

    2017-04-01

    To elucidate the benefits, pitfalls and risks of phytotherapy in the clinical practice of otorhinolaryngology. The PubMed and Cochrane databases were searched using the following keywords: phytotherapy, phytomedicine, herbs, otology, rhinology, laryngology, otitis, rhinitis, laryngitis and otorhinolaryngology. Seventy-two articles (18 prospective randomized studies, 4 Cochrane analyses, 4 meta-analysis and 15 reviews of the literature) devoted to clinical studies were analyzed. Articles devoted to in vitro or animal studies, biochemical analyses or case reports (including fewer than 10 patients) and articles dealing with honey, aromatherapy or minerals were excluded. Per os ginkgo biloba has no indications in tinnitus, presbycusis or anosmia following viral rhinitis. Traditional Asian medicine has no proven benefit in sudden deafness or laryngeal papillomatosis. Per os mistletoe extracts associated to conventional treatment for head and neck squamous cell carcinoma does not increase 5-year survival. Extracts of various herbs, notably echinacea, eucalyptus, petasites hybridus, pelargonium sidoides, rosemary, spirulina and thyme, show superiority over placebo for rhinosinusitis and allergic rhinitis, as does gingko biloba for selected vertigo. There have been encouraging preliminary results for intratumoral injection of mistletoe in head and neck carcinoma and acupoint herbal patching for allergic rhinitis. Herb intake should be screened for in case of certain unexplained symptoms such as epistaxis, headache or dizziness, or signs suggesting allergy. Phytotherapy should be interrupted ahead of surgery and/or chemotherapy. Scientific proof of the benefit of phytotherapy in otorhinolaryngology remains to be established but, given its widespread use and the reported data, knowledge of this form of treatment needs to be developed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    International Nuclear Information System (INIS)

    Rossi, Ignacio; Rosenberg, Zehava; Zember, Jonathan

    2016-01-01

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  7. Electrogastrography in Adults and Children: The Strength, Pitfalls, and Clinical Significance of the Cutaneous Recording of the Gastric Electrical Activity

    Directory of Open Access Journals (Sweden)

    Giuseppe Riezzo

    2013-01-01

    Full Text Available Cutaneous electrogastrography (EGG is a non-invasive technique to record gastric myoelectrical activity from the abdominal surface. Although the recent rapid increase in the development of electrocardiography, EGG still suffers from several limitations. Currently, computer analysis of EGG provides few reliable parameters, such as frequency and the percentage of normal and altered slow wave activity (bradygastria and tachygastria. New EGG hardware and software, along with an appropriate arrangement of abdominal electrodes, could detect the coupling of the gastric slow wave from the EGG. At present, EGG does not diagnose a specific disease, but it puts in evidence stomach motor dysfunctions in different pathological conditions as gastroparesis and functional dyspepsia. Despite the current pitfalls of EGG, a multitasking diagnostic protocol could involve the EGG and the 13C-breath testing for the evaluation of the gastric emptying time—along with validated gastrointestinal questionnaires and biochemical evaluations of the main gastrointestinal peptides—to identify dyspeptic subgroups. The present review tries to report the state of the art about the pathophysiological background of the gastric electrical activity, the recording and processing methodology of the EGG with particular attention to multichannel recording, and the possible clinical application of the EGG in adult and children.

  8. Promises, pitfalls, and basic guidelines for applying machine learning classifiers to psychiatric imaging data, with autism as an example

    Directory of Open Access Journals (Sweden)

    Pegah Kassraian Fard

    2016-12-01

    Full Text Available Most psychiatric disorders are associated with subtle alterations in brain function and are subject to large inter-individual differences. Typically the diagnosis of these disorders requires time-consuming behavioral assessments administered by a multi-disciplinary team with extensive experience. Whilst the application of machine learning classification methods (ML classifiers to neuroimaging data has the potential to speed and simplify diagnosis of psychiatric disorders, the methods, assumptions, and analytical steps are not currently opaque and accessible to researchers and clinicians outside the field. In this paper, we describe potential classification pipelines for Autism Spectrum Disorder, as an example of a psychiatric disorder. The analyses are based on resting-state fMRI data derived from a multi-site data repository (ABIDE. We compare several popular ML classifiers such as support vector machines, neural networks and regression approaches, among others. In a tutorial style, written to be equally accessible for researchers and clinicians, we explain the rationale of each classification approach, clarify the underlying assumptions, and discuss possible pitfalls and challenges. We also provide the data as well as the MATLAB code we used to achieve our results. We show that out-of-the-box ML classifiers can yield classification accuracies of about 60-70%. Finally, we discuss how classification accuracy can be further improved, and we mention methodological developments that are needed to pave the way for the use of ML classifiers in clinical practice.

  9. Pitfalls and Precautions When Using Predicted Failure Data for Quantitative Analysis of Safety Risk for Human Rated Launch Vehicles

    Science.gov (United States)

    Hatfield, Glen S.; Hark, Frank; Stott, James

    2016-01-01

    Launch vehicle reliability analysis is largely dependent upon using predicted failure rates from data sources such as MIL-HDBK-217F. Reliability prediction methodologies based on component data do not take into account system integration risks such as those attributable to manufacturing and assembly. These sources often dominate component level risk. While consequence of failure is often understood, using predicted values in a risk model to estimate the probability of occurrence may underestimate the actual risk. Managers and decision makers use the probability of occurrence to influence the determination whether to accept the risk or require a design modification. The actual risk threshold for acceptance may not be fully understood due to the absence of system level test data or operational data. This paper will establish a method and approach to identify the pitfalls and precautions of accepting risk based solely upon predicted failure data. This approach will provide a set of guidelines that may be useful to arrive at a more realistic quantification of risk prior to acceptance by a program.

  10. Pitfalls of Systematic Reviews and Meta-Analyses in Imaging Research

    NARCIS (Netherlands)

    McInnes, Matthew D. F.; Bossuyt, Patrick M. M.

    2015-01-01

    Systematic reviews of imaging research represent a tool to better understand test accuracy or the efficacy of interventions. Like any type of research, appropriate methods must be applied to optimize quality. The purpose of this review is to outline common pitfalls in performing systematic reviews

  11. Common pitfalls in statistical analysis: "P" values, statistical significance and confidence intervals

    Directory of Open Access Journals (Sweden)

    Priya Ranganathan

    2015-01-01

    Full Text Available In the second part of a series on pitfalls in statistical analysis, we look at various ways in which a statistically significant study result can be expressed. We debunk some of the myths regarding the ′P′ value, explain the importance of ′confidence intervals′ and clarify the importance of including both values in a paper

  12. Common pitfalls in statistical analysis: Understanding the properties of diagnostic tests - Part 1.

    Science.gov (United States)

    Ranganathan, Priya; Aggarwal, Rakesh

    2018-01-01

    In this article in our series on common pitfalls in statistical analysis, we look at some of the attributes of diagnostic tests (i.e., tests which are used to determine whether an individual does or does not have disease). The next article in this series will focus on further issues related to diagnostic tests.

  13. Common pitfalls in statistical analysis: “P” values, statistical significance and confidence intervals

    Science.gov (United States)

    Ranganathan, Priya; Pramesh, C. S.; Buyse, Marc

    2015-01-01

    In the second part of a series on pitfalls in statistical analysis, we look at various ways in which a statistically significant study result can be expressed. We debunk some of the myths regarding the ‘P’ value, explain the importance of ‘confidence intervals’ and clarify the importance of including both values in a paper PMID:25878958

  14. Common pitfalls in statistical analysis: Absolute risk reduction, relative risk reduction, and number needed to treat

    Science.gov (United States)

    Ranganathan, Priya; Pramesh, C. S.; Aggarwal, Rakesh

    2016-01-01

    In the previous article in this series on common pitfalls in statistical analysis, we looked at the difference between risk and odds. Risk, which refers to the probability of occurrence of an event or outcome, can be defined in absolute or relative terms. Understanding what these measures represent is essential for the accurate interpretation of study results. PMID:26952180

  15. Diagnostic pitfalls associated with a large true posterior communicating artery aneurysm: a case report.

    Science.gov (United States)

    Nagatani, Kimihiro; Otani, Naoki; Seno, Soichiro; Takeuchi, Satoru; Wada, Kojiro; Mori, Kentaro

    2013-10-01

    True posterior communicating artery (PCoA) aneurysm is an aneurysm that originates from the PCoA, and large or giant true PCoA aneurysms are rare. We report a case of a large true PCoA aneurysm successfully clipped after anterior clinoidectomy and discuss the diagnostic pitfalls associated with this rare clinical entity.

  16. Empathy and Social-Emotional Learning: Pitfalls and Touchstones for School-Based Programs

    Science.gov (United States)

    Maxwell, Bruce; DesRoches, Sarah

    2010-01-01

    This chapter identifies three common pitfalls in the use of the concept of empathy in formal social-emotional learning interventions: (1) not distinguishing between affective and cognitive empathy ("equivocation"); (2) overestimating the role of the imagination in empathizing ("Piaget's fallacy"); and (3) not accommodating the developmental and…

  17. Two new planthopper species (Hemiptera, Fulgoroidea, Caliscelidae) collected in pitfall traps in Zambia.

    Science.gov (United States)

    Chmurova, Lucia; Webb, Michael D

    2016-08-22

    Two new species of planthoppers in the family Caliscelidae (Hemiptera: Fulgoroidea) are described from Zambia, i.e., Afronaso spinosa sp. n. and Calampocus zambiaensis sp. n. All specimens are flightless males and nearly all were collected from baited pitfall traps (except for one specimen collected from a yellow pan trap), suggesting that they live near to or on the ground.

  18. Benefits and Pitfalls: Simple Guidelines for the Use of Social Networking Tools in K-12 Education

    Science.gov (United States)

    Huffman, Stephanie

    2013-01-01

    The article will outline a framework for the use of social networking tools in K-12 education framed around four thought provoking questions: 1) what are the benefits and pitfalls of using social networking tools in P-12 education, 2) how do we plan effectively for the use of social networking tool, 3) what role does professional development play…

  19. Diffuse fatty infiltration of the liver: Pitfalls in computed tomography diagnosis

    International Nuclear Information System (INIS)

    Loh, Y.H.; Dunn, G.D.

    1997-01-01

    The presence of a fatty liver often complicates the interpretation of abdominal computed tomography (CT). Abnormalities in or adjacent to the liver, including dilated bile ducts, liver masses and subphrenic collections, may be masked by the fatty liver. Furthermore, normal structures may simulate pathological conditions. Five cases are presented to illustrate some of these diagnostic pitfalls. (authors)

  20. Integration of Gamification into Course Design: A Noble Endeavor with Potential Pitfalls

    Science.gov (United States)

    Moore-Russo, Deborah; Wiss, Andrew; Grabowski, Jeremiah

    2018-01-01

    In this article, we provide a commentary on the current state of gamification in higher education by reviewing the research literature, noting a lack of research focused on the design of gamified postsecondary courses. To address this issue, we discuss four potential pitfalls instructors may encounter when designing gamified learning activities.…

  1. Pitfalls and Promises: The Use of Secondary Data Analysis in Educational Research

    Science.gov (United States)

    Smith, Emma

    2008-01-01

    This paper considers the use of secondary data analysis in educational research. It addresses some of the promises and potential pitfalls that influence its use and explores a possible role for the secondary analysis of numeric data in the "new" political arithmetic tradition of social research. Secondary data analysis is a relatively under-used…

  2. The uterine doughnut: Potential pitfall for technetium-99m gastrointestinal bleeding study

    International Nuclear Information System (INIS)

    Swayne, L.C.

    1989-01-01

    A case of intense uterine hyperemia secondary to recent pregnancy, the so-called uterine doughnut sign, is presented as a potential pitfall in the evaluation of gastrointestinal bleeding. Delayed imaging helped in evaluating the lack of serial change in appearance and the failure of progression of the scintigraphic abnormality

  3. Imaging patterns of hepatic steatosis on multidetector CT: Pearls and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Kani, K.K., E-mail: khalatbarik@yahoo.com [Department of Radiology, Body Imaging, University of Washington Medical Center, Seattle, WA (United States); Moshiri, M.; Cuevas, C.; Lee, J.H.; Mitsumori, L.M.; Kolokythas, O. [Department of Radiology, Body Imaging, University of Washington Medical Center, Seattle, WA (United States)

    2012-04-15

    Fatty liver disease is an important cause of chronic liver disease in Western countries. The purpose of this article is to describe and illustrate the diagnostic criteria and various morphological patterns of fatty liver disease on multidetector computed tomography (MDCT) with an emphasis on potential limitations and diagnostic pitfalls.

  4. The Pitfalls of Mobile Devices in Learning: A Different View and Implications for Pedagogical Design

    Science.gov (United States)

    Ting, Yu-Liang

    2012-01-01

    Studies have been devoted to the design, implementation, and evaluation of mobile learning in practice. A common issue among students' responses toward this type of learning concerns the pitfalls of mobile devices, including small screen, limited input options, and low computational power. As a result, mobile devices are not always perceived by…

  5. Gabor Deconvolution as Preliminary Method to Reduce Pitfall in Deeper Target Seismic Data

    Science.gov (United States)

    Oktariena, M.; Triyoso, W.

    2018-03-01

    Anelastic attenuation process during seismic wave propagation is the trigger of seismic non-stationary characteristic. An absorption and a scattering of energy are causing the seismic energy loss as the depth increasing. A series of thin reservoir layers found in the study area is located within Talang Akar Fm. Level, showing an indication of interpretation pitfall due to attenuation effect commonly occurred in deeper level seismic data. Attenuation effect greatly influences the seismic images of deeper target level, creating pitfalls in several aspect. Seismic amplitude in deeper target level often could not represent its real subsurface character due to a low amplitude value or a chaotic event nearing the Basement. Frequency wise, the decaying could be seen as the frequency content diminishing in deeper target. Meanwhile, seismic amplitude is the simple tool to point out Direct Hydrocarbon Indicator (DHI) in preliminary Geophysical study before a further advanced interpretation method applied. A quick-look of Post-Stack Seismic Data shows the reservoir associated with a bright spot DHI while another bigger bright spot body detected in the North East area near the field edge. A horizon slice confirms a possibility that the other bright spot zone has smaller delineation; an interpretation pitfall commonly occurs in deeper level of seismic. We evaluates this pitfall by applying Gabor Deconvolution to address the attenuation problem. Gabor Deconvolution forms a Partition of Unity to factorize the trace into smaller convolution window that could be processed as stationary packets. Gabor Deconvolution estimates both the magnitudes of source signature alongside its attenuation function. The enhanced seismic shows a better imaging in the pitfall area that previously detected as a vast bright spot zone. When the enhanced seismic is used for further advanced reprocessing process, the Seismic Impedance and Vp/Vs Ratio slices show a better reservoir delineation, in which the

  6. Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.

    Science.gov (United States)

    Palmer, Gary; Abernathy, James H; Swinton, Greg; Allison, David; Greenstein, Joel; Shappell, Scott; Juang, Kevin; Reeves, Scott T

    2013-11-01

    Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR). Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized. The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%). By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.

  7. Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies.

    Science.gov (United States)

    Rowe, Steven P; Deville, Curtiland; Paller, Channing; Cho, Steve Y; Fishman, Elliot K; Pomper, Martin G; Ross, Ashley E; Gorin, Michael A

    2015-12-01

    Prostate-specific membrane antigen (PSMA)-targeted PET imaging is an emerging technique for evaluating patients with prostate cancer (PCa) in a variety of clinical contexts. As with any new imaging modality, there are interpretive pitfalls that are beginning to be recognized. In this image report, we describe the findings in a 63-year-old male with biochemically recurrent PCa after radical prostatectomy who was imaged with 18 F-DCFPyL, a small molecule inhibitor of PSMA. Diffuse radiotracer uptake was noted throughout the sacrum, corresponding to imaging findings on contrast-enhanced CT, bone scan, and pelvic MRI consistent with Paget's disease of bone. The uptake of 18 F-DCFPyL in Paget's disease is most likely due to hyperemia and increased radiotracer delivery. In light of the overlap in patients affected by PCa and Paget's, it is important for nuclear medicine physicians and radiologists interpreting PSMA PET/CT scans to be aware of the potential for this diagnostic pitfall. Correlation to findings on conventional imaging such as diagnostic CT and bone scan can help confirm the diagnosis.

  8. The Promise, Pitfalls, and Persistent Challenge of Action Research

    Science.gov (United States)

    Higgins, Chris

    2016-01-01

    Action research began as an ambitious epistemological and social intervention. As the concept has become reified, packaged for methodology textbooks and professional development workshops, it has degenerated into a cure that may be worse than the disease. The point is not the trivial one that action research, like any practice, sometimes shows up…

  9. Radiotracer methodology

    International Nuclear Information System (INIS)

    Eng, R.R.

    1988-01-01

    In 1923, George Hevesy demonstrated the distribution of radioactive lead in the horsebean plant. This early demonstration of the potential use of radiotracers in biology was reinforced when J.G. Hamilton and colleagues used iodine-131 for diagnostic purposes in patients. Then in 1950 Cassen et al. designed the first scintillation counter for measuring radioiodine in the body, using calcium tungstate crystals coupled to a photomultiplier tube. This was followed by the development of the Anger camera, which permitted visualization of radiotracer distribution in biological systems. From these significant early discoveries to the present, many advances have been made. They include the discovery and production of many useful radioisotopes; the formulation of these radioisotopes into useful radiotracers; the advent of first- , and second-, and third-generation instrumentation for monitoring in vitro and in vivo distributions of new radiotracers; and the application of this knowledge to allow us to better understand physiological processes and treat disease states. Radiotracer techniques are integral to numerous techniques described in this volume. Autoradiography, nuclear scintigraphy, positron emission tomography, and single-photon emission computed tomography (SPECT) are all dependent on an understanding of radiotracer techniques to properly utilize these probe devices

  10. Diagnostic Accuracy and Pitfalls of Preoperative Fine Needle Aspiration Cytology in Salivary Gland Lesions

    International Nuclear Information System (INIS)

    TAHOUN, N.; EZZAT, N.

    2008-01-01

    Purpose: Evaluation of diagnostic accuracy of preoperative fine needle aspiration cytology (FNAC) in salivary gland lesions. Patients and Methods: This is a retrospective study of 82 patients presented at NCI, Cairo University with salivary gland lesion who underwent preoperative FNAC diagnosis with subsequent excision and histopathologic assessment. Cytology results were classified as negative, positive, suspicious for cancer and inadequate. The definitive histopathologic report according to WHO Histological typing was the gold standard diagnosis against which FNAC was compared. Results: Our study included 82 patients who underwent preoperative FNAC of major salivary glands with subsequent surgical excision. Male to female ratio was 1.4: 1. The median age was 42 years. Parotid gland was involved in (68.3%), submandibular in (28%) and sub mental gland in (3.7%). Forty cases (48.8%) were cytologically diagnosed as benign lesions, 26 (31.7%) were malignant and 10 (12.2%) were suspicious. Cytological findings were non diagnostic in 6 (7.3%). The most common benign cytologic diagnosis was pleomorphic adenoma; 16 out of 40 cases (40%), while the most common malignant tumor was carcinoma; 22 out of 26 cases (84.6%). Cytologic diagnoses were compared with histopathologic ones and were true-negative in 37 (92.5%), true-positive in 33 (91.6%), false-negative in 3 (8.3%) and false-positive in 3 (7.5%) cases regarding detection of malignant tumors. The cytologic diagnosis achieved a sensitivity of 91.7%; a specificity of 92.5%, PPV 91.6%, NPV 92.5% and diagnostic accuracy 92%. The rates of agreement of histopathologic type for benign and malignant tumors were 89.2% and 91%, respectively. Conclusion: The sensitivity, specificity and diagnostic accuracy of FNAC were 91.7%, 92.5% and 92%, respectively. Attention to subtle morphologic changes, pitfalls and limitations are important to increase diagnostic accuracy. Multidirectional aspiration is preferred to avoid selective

  11. Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 2: methodological quality and effects.

    Science.gov (United States)

    Johansen, Monika Alise; Berntsen, Gro K Rosvold; Schuster, Tibor; Henriksen, Eva; Horsch, Alexander

    2012-10-03

    We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy. To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies. We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12

  12. Methodology for calibration of detector of NaI (TI)) 3 ' X 3 ' for in vivo measurements of patients with hyperthyroidism undergoing to radioiodotherapy

    International Nuclear Information System (INIS)

    Carvalho, Carlaine B.; Lacerda, Isabelle V.B.; Oliveira, Mercia L.; Hazin, Clovis A.; Lima, Fabiana F.

    2013-01-01

    The aim of this study is to establish the methodology for calibration of the detection system to be used in determining the therapeutic activity of 131 I required to release desired absorbed dose in the thyroid gland . This step is critical to the development of a protocol for individualized doses. The system consists of a detector of NaI (Tl ) 3'x3' coupled to software Genie 2000. We used the calibration sources of 60 Co , 137 Cs and 133 Ba. We obtained the straight calibration system, with sources 60 Co and 137 Cs. Subsequently , the detector was calibrated using a thyroid phantom-neck designed and produced by the IRD / CNEN with known activity of 133 Ba standard solution containing 18.7 kBq (on 09/24/12) evenly distributed. He was also calibrated with other thyroid- neck phantom model 3108 manufactured by Searle Radigraphics Ind., containing a liquid source of 131 I ( 7.7 MBq ). Five measurements were performed during 5 minutes for three different distances detector-simulator and calculated the corresponding calibration factors . The values of the calibration factors found for the simulator made by IRD and Searle Radigraphics Ind. for the distances 20, 25 and 30 cm were 0.35 , 0.24, 0.18, 0.15 , 0.11, 0, 09 , respectively. With the detection system properly calibrated and the calibration factors established, the technique is suitable for the evaluation of diagnostic activities of 131 I incorporated by hyperthyroid patients. (author)

  13. Standards and Methodological Rigor in Pulmonary Arterial Hypertension Preclinical and Translational Research.

    Science.gov (United States)

    Provencher, Steeve; Archer, Stephen L; Ramirez, F Daniel; Hibbert, Benjamin; Paulin, Roxane; Boucherat, Olivier; Lacasse, Yves; Bonnet, Sébastien

    2018-03-30

    Despite advances in our understanding of the pathophysiology and the management of pulmonary arterial hypertension (PAH), significant therapeutic gaps remain for this devastating disease. Yet, few innovative therapies beyond the traditional pathways of endothelial dysfunction have reached clinical trial phases in PAH. Although there are inherent limitations of the currently available models of PAH, the leaky pipeline of innovative therapies relates, in part, to flawed preclinical research methodology, including lack of rigour in trial design, incomplete invasive hemodynamic assessment, and lack of careful translational studies that replicate randomized controlled trials in humans with attention to adverse effects and benefits. Rigorous methodology should include the use of prespecified eligibility criteria, sample sizes that permit valid statistical analysis, randomization, blinded assessment of standardized outcomes, and transparent reporting of results. Better design and implementation of preclinical studies can minimize inherent flaws in the models of PAH, reduce the risk of bias, and enhance external validity and our ability to distinguish truly promising therapies form many false-positive or overstated leads. Ideally, preclinical studies should use advanced imaging, study several preclinical pulmonary hypertension models, or correlate rodent and human findings and consider the fate of the right ventricle, which is the major determinant of prognosis in human PAH. Although these principles are widely endorsed, empirical evidence suggests that such rigor is often lacking in pulmonary hypertension preclinical research. The present article discusses the pitfalls in the design of preclinical pulmonary hypertension trials and discusses opportunities to create preclinical trials with improved predictive value in guiding early-phase drug development in patients with PAH, which will need support not only from researchers, peer reviewers, and editors but also from

  14. What are the benefits and the pitfalls of preoperative fasting?

    Science.gov (United States)

    Webb, Katherine

    Preoperative fasting has been a traditional practice for many years to reduce the risk of aspiration while the patient is under general anaesthetic and to eliminate the risk of postoperative nausea and vomiting. Although it is generally accepted that fasting is beneficial, the fasting regimens that patients undergo are not dependent on the individual patient or the timing of their operation.

  15. MIRD methodology; Metodologia MIRD

    Energy Technology Data Exchange (ETDEWEB)

    Rojo, Ana M [Autoridad Regulatoria Nuclear, Buenos Aires (Argentina); Gomez Parada, Ines [Sociedad Argentina de Radioproteccion, Buenos Aires (Argentina)

    2004-07-01

    The MIRD (Medical Internal Radiation Dose) system was established by the Society of Nuclear Medicine of USA in 1960 to assist the medical community in the estimation of the dose in organs and tissues due to the incorporation of radioactive materials. Since then, 'MIRD Dose Estimate Report' (from the 1 to 12) and 'Pamphlets', of great utility for the dose calculations, were published. The MIRD system was planned essentially for the calculation of doses received by the patients during nuclear medicine diagnostic procedures. The MIRD methodology for the absorbed doses calculations in different tissues is explained.

  16. Temperature effects on pitfall catches of epigeal arthropods: a model and method for bias correction.

    Science.gov (United States)

    Saska, Pavel; van der Werf, Wopke; Hemerik, Lia; Luff, Martin L; Hatten, Timothy D; Honek, Alois; Pocock, Michael

    2013-02-01

    Carabids and other epigeal arthropods make important contributions to biodiversity, food webs and biocontrol of invertebrate pests and weeds. Pitfall trapping is widely used for sampling carabid populations, but this technique yields biased estimates of abundance ('activity-density') because individual activity - which is affected by climatic factors - affects the rate of catch. To date, the impact of temperature on pitfall catches, while suspected to be large, has not been quantified, and no method is available to account for it. This lack of knowledge and the unavailability of a method for bias correction affect the confidence that can be placed on results of ecological field studies based on pitfall data.Here, we develop a simple model for the effect of temperature, assuming a constant proportional change in the rate of catch per °C change in temperature, r , consistent with an exponential Q 10 response to temperature. We fit this model to 38 time series of pitfall catches and accompanying temperature records from the literature, using first differences and other detrending methods to account for seasonality. We use meta-analysis to assess consistency of the estimated parameter r among studies.The mean rate of increase in total catch across data sets was 0·0863 ± 0·0058 per °C of maximum temperature and 0·0497 ± 0·0107 per °C of minimum temperature. Multiple regression analyses of 19 data sets showed that temperature is the key climatic variable affecting total catch. Relationships between temperature and catch were also identified at species level. Correction for temperature bias had substantial effects on seasonal trends of carabid catches. Synthesis and Applications . The effect of temperature on pitfall catches is shown here to be substantial and worthy of consideration when interpreting results of pitfall trapping. The exponential model can be used both for effect estimation and for bias correction of observed data. Correcting for temperature

  17. Carcinoma involving the gallbladder: a retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma

    Directory of Open Access Journals (Sweden)

    Giang Tran H

    2012-01-01

    Full Text Available Abstract Background Carcinoma of the gallbladder (GBC clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC. Methods We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5 with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC. Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract. Results These cases illustrate seven potential pitfalls which can be encountered. These include: 1 mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis, 2 misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis, 3 differentiating between primary NEC of gallbladder and metastasis, 4 confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5 confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6 undersampling early, grossly occult disease, and 7 misinterpreting extracellular mucin pools. Conclusions Clinical history and a high index of suspicion are

  18. Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Tony Zitek, MD

    2016-03-01

    Full Text Available Introduction: Two-point compression ultrasound is purportedly a simple and accurate means to diagnose proximal lower extremity deep vein thrombosis (DVT, but the pitfalls of this technique have not been fully elucidated. The objective of this study is to determine the accuracy of emergency medicine resident-performed two-point compression ultrasound, and to determine what technical errors are commonly made by novice ultrasonographers using this technique. Methods: This was a prospective diagnostic test assessment of a convenience sample of adult emergency department (ED patients suspected of having a lower extremity DVT. After brief training on the technique, residents performed two-point compression ultrasounds on enrolled patients. Subsequently a radiology department ultrasound was performed and used as the gold standard. Residents were instructed to save videos of their ultrasounds for technical analysis. Results: Overall, 288 two-point compression ultrasound studies were performed. There were 28 cases that were deemed to be positive for DVT by radiology ultrasound. Among these 28, 16 were identified by the residents with two-point compression. Among the 260 cases deemed to be negative for DVT by radiology ultrasound, 10 were thought to be positive by the residents using two-point compression. This led to a sensitivity of 57.1% (95% CI [38.8-75.5] and a specificity of 96.1% (95% CI [93.8-98.5] for resident-performed two-point compression ultrasound. This corresponds to a positive predictive value of 61.5% (95% CI [42.8-80.2] and a negative predictive value of 95.4% (95% CI [92.9-98.0]. The positive likelihood ratio is 14.9 (95% CI [7.5-29.5] and the negative likelihood ratio is 0.45 (95% CI [0.29-0.68]. Video analysis revealed that in four cases the resident did not identify a DVT because the thrombus was isolated to the superior femoral vein (SFV, which is not evaluated by two-point compression. Moreover, the video analysis revealed that the

  19. Methodology to reduce 6D patient positional shifts into a 3D linear shift and its verification in frameless stereotactic radiotherapy

    Science.gov (United States)

    Sarkar, Biplab; Ray, Jyotirmoy; Ganesh, Tharmarnadar; Manikandan, Arjunan; Munshi, Anusheel; Rathinamuthu, Sasikumar; Kaur, Harpreet; Anbazhagan, Satheeshkumar; Giri, Upendra K.; Roy, Soumya; Jassal, Kanan; Kalyan Mohanti, Bidhu

    2018-04-01

    The aim of this article is to derive and verify a mathematical formulation for the reduction of the six-dimensional (6D) positional inaccuracies of patients (lateral, longitudinal, vertical, pitch, roll and yaw) to three-dimensional (3D) linear shifts. The formulation was mathematically and experimentally tested and verified for 169 stereotactic radiotherapy patients. The mathematical verification involves the comparison of any (one) of the calculated rotational coordinates with the corresponding value from the 6D shifts obtained by cone beam computed tomography (CBCT). The experimental verification involves three sets of measurements using an ArcCHECK phantom, when (i) the phantom was not moved (neutral position: 0MES), (ii) the position of the phantom shifted by 6D shifts obtained from CBCT (6DMES) from neutral position and (iii) the phantom shifted from its neutral position by 3D shifts reduced from 6D shifts (3DMES). Dose volume histogram and statistical comparisons were made between ≤ft and ≤ft . The mathematical verification was performed by a comparison of the calculated and measured yaw (γ°) rotation values, which gave a straight line, Y  =  1X with a goodness of fit as R 2  =  0.9982. The verification, based on measurements, gave a planning target volume receiving 100% of the dose (V100%) as 99.1  ±  1.9%, 96.3  ±  1.8%, 74.3  ±  1.9% and 72.6  ±  2.8% for the calculated treatment planning system values TPSCAL, 0MES, 3DMES and 6DMES, respectively. The statistical significance (p-values: paired sample t-test) of V100% were found to be 0.03 for the paired sample ≤ft and 0.01 for ≤ft . In this paper, a mathematical method to reduce 6D shifts to 3D shifts is presented. The mathematical method is verified by using well-matched values between the measured and calculated γ°. Measurements done on the ArcCHECK phantom also proved that the proposed methodology is correct. The post-correction of the

  20. Quantitative measurements of trefoil factor family peptides: possibilities and pitfalls

    DEFF Research Database (Denmark)

    Samson, Mie Hessellund

    2013-01-01

    The trefoil factor family (TFF) peptides TFF1, TFF2, and TFF3 are produced and secreted by mucous membranes throughout the body. Their importance for the protection and repair of epithelial surfaces is well established, and the three peptides are present in various amounts in mucosal secretions...... as well as in the circulation. They have been linked to both inflammatory diseases and to various types of cancer, and serum concentrations of TFF3 show a more than 47-fold increase during pregnancy. Several both commercial and in-house immunoassays exist, but a number of methodological issues remain...

  1. The use of questionnaires in colour research in real-life settings : In search of validity and methodological pitfalls

    NARCIS (Netherlands)

    Bakker, I.C.; van der Voordt, Theo; Vink, P.; de Boon, J

    2014-01-01

    This research discusses the validity of applying questionnaires in colour research in real life settings.
    In the literature the conclusions concerning the influences of colours on human performance and well-being are often conflicting. This can be caused by the artificial setting of the test

  2. Clinical trial methodology

    National Research Council Canada - National Science Library

    Peace, Karl E; Chen, Ding-Geng

    2011-01-01

    ... in the pharmaceutical industry, Clinical trial methodology emphasizes the importance of statistical thinking in clinical research and presents the methodology as a key component of clinical research...

  3. Immunohistochemical Pitfalls: Common Mistakes in the Evaluation of Lynch Syndrome.

    Science.gov (United States)

    Markow, Michael; Chen, Wei; Frankel, Wendy L

    2017-12-01

    At least 15% of colorectal cancers diagnosed in the United States are deficient in mismatch repair mechanisms. Most of these are sporadic, but approximately 3% of colorectal cancers result from germline alterations in mismatch repair genes and represent Lynch syndrome. It is critical to identify patients with Lynch syndrome to institute appropriate screening and surveillance for patients and their families. Exclusion of Lynch syndrome in sporadic cases is equally important because it reduces anxiety for patients and prevents excessive spending on unnecessary surveillance. Immunohistochemistry is one of the most widely used screening tools for identifying patients with Lynch syndrome. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Diffusion-weighted MRI of the liver—Interpretative pearls and pitfalls

    International Nuclear Information System (INIS)

    Culverwell, A.D.; Sheridan, M.B.; Guthrie, J.A.; Scarsbrook, A.F.

    2013-01-01

    Diffusion-weighted magnetic resonance imaging (DW MRI) is an established technique in neuroradiology and more recently has emerged as a useful adjunct to various oncological applications of MRI. It has an expanding role in the evaluation of liver lesions, offers higher detection rates for small lesions, and can increase confidence in differentiating between benign and malignant lesions. Other applications include assessment of tumour response to therapy, differentiating tumour from bland thrombus, and assessment of liver fibrosis. DW sequences can be performed on most modern MRI machines with relative ease, in a short time period and without the need for contrast medium. DW MRI can be of value in the detection and characterization of hepatic lesions but there are pitfalls, which can potentially cause interpretative difficulty. This article will review the rationale for DW MRI in liver imaging, demonstrate the clinical utility of the technique in a spectrum of hepatic diseases, and illustrate key interpretative pearls and pitfalls

  5. Complexities and potential pitfalls of clinical study design and data analysis in assisted reproduction.

    Science.gov (United States)

    Patounakis, George; Hill, Micah J

    2018-06-01

    The purpose of the current review is to describe the common pitfalls in design and statistical analysis of reproductive medicine studies. It serves to guide both authors and reviewers toward reducing the incidence of spurious statistical results and erroneous conclusions. The large amount of data gathered in IVF cycles leads to problems with multiplicity, multicollinearity, and over fitting of regression models. Furthermore, the use of the word 'trend' to describe nonsignificant results has increased in recent years. Finally, methods to accurately account for female age in infertility research models are becoming more common and necessary. The pitfalls of study design and analysis reviewed provide a framework for authors and reviewers to approach clinical research in the field of reproductive medicine. By providing a more rigorous approach to study design and analysis, the literature in reproductive medicine will have more reliable conclusions that can stand the test of time.

  6. Potentials and pitfalls of the encounter between leisure-time centers and primary schools

    DEFF Research Database (Denmark)

    Ringskou, Lea Thomsen; Gravesen, David Thore

    Our research offers a qualitative, in depth-perspective on the encounter between leisure-time centers and primary schools in Denmark. In our presentration we will, in a cross-cultural perspective, reappraise the roles of leisure-time pedagogues and discuss the potentials and pitfalls of the encou......Our research offers a qualitative, in depth-perspective on the encounter between leisure-time centers and primary schools in Denmark. In our presentration we will, in a cross-cultural perspective, reappraise the roles of leisure-time pedagogues and discuss the potentials and pitfalls...... of the encounter between leisure-time centers and primary schools. In 2014, the Danish Primary School was reformed. To a considerable extent, the reform can be understood in response to receding results in international tests (Knudsen 2010). The official aim of the reform is to challenge all pupils, regardless...... the encounter between leisure-time centers and primary schools?...

  7. Miscellaneous conditions of the shoulder: Anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis

    International Nuclear Information System (INIS)

    Farid, Nikdokht; Bruce, Dean; Chung, Christine B.

    2008-01-01

    The purpose of this article is to review the key imaging findings in major categories of pathology affecting the shoulder joint including hydroxyapatite deposition disease, rotator cuff interval pathology, acromioclavicular joint pathology, glenohumeral osteoarthrosis, and synovial inflammatory processes, with specific emphasis on findings that have associated pitfalls in imaging diagnosis. The pathophysiology and clinical manifestations of the above mentioned categories of pathology will be reviewed, followed in each section by a detailed pictorial review of the key imaging findings in each category including plain film, computed tomography, and magnetic resonance imaging findings as applicable. Imaging challenges that relate to both diagnosis and characterization will be addressed with each type of pathology. The goal is that after reading this article, the reader will be able to recognize the key imaging findings in major categories of pathology affecting the shoulder joint and will become familiar with the potential pitfalls in their imaging diagnosis

  8. Miscellaneous conditions of the shoulder: Anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Farid, Nikdokht [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); Bruce, Dean [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); University of Alberta, Edmonton, Alberta (Canada); Chung, Christine B. [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States)], E-mail: cbchung@ucsd.edu

    2008-10-15

    The purpose of this article is to review the key imaging findings in major categories of pathology affecting the shoulder joint including hydroxyapatite deposition disease, rotator cuff interval pathology, acromioclavicular joint pathology, glenohumeral osteoarthrosis, and synovial inflammatory processes, with specific emphasis on findings that have associated pitfalls in imaging diagnosis. The pathophysiology and clinical manifestations of the above mentioned categories of pathology will be reviewed, followed in each section by a detailed pictorial review of the key imaging findings in each category including plain film, computed tomography, and magnetic resonance imaging findings as applicable. Imaging challenges that relate to both diagnosis and characterization will be addressed with each type of pathology. The goal is that after reading this article, the reader will be able to recognize the key imaging findings in major categories of pathology affecting the shoulder joint and will become familiar with the potential pitfalls in their imaging diagnosis.

  9. Twinkling artifact on color Doppler ultrasound: an advantage or a pitfall?

    Science.gov (United States)

    Ozan, Ebru; Atac, Gokce Kaan; Gundogdu, Sadi

    2016-07-01

    The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered.

  10. How can activity-based costing methodology be performed as a powerful tool to calculate costs and secure appropriate patient care?

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Chao, Te-Hsin; Yao, Yuh; Tu, Shu-Min; Wu, Chun-Ching; Chern, Jin-Yuan; Chao, Shiu-Hsiung; Shaw, Keh-Yuong

    2007-04-01

    Previous studies have shown the advantages of using activity-based costing (ABC) methodology in the health care industry. The potential values of ABC methodology in health care are derived from the more accurate cost calculation compared to the traditional step-down costing, and the potentials to evaluate quality or effectiveness of health care based on health care activities. This project used ABC methodology to profile the cost structure of inpatients with surgical procedures at the Department of Colorectal Surgery in a public teaching hospital, and to identify the missing or inappropriate clinical procedures. We found that ABC methodology was able to accurately calculate costs and to identify several missing pre- and post-surgical nursing education activities in the course of treatment.

  11. Common pitfalls in statistical analysis: "No evidence of effect" versus "evidence of no effect"

    Directory of Open Access Journals (Sweden)

    Priya Ranganathan

    2015-01-01

    Full Text Available This article is the first in a series exploring common pitfalls in statistical analysis in biomedical research. The power of a clinical trial is the ability to find a difference between treatments, where such a difference exists. At the end of the study, the lack of difference between treatments does not mean that the treatments can be considered equivalent. The distinction between "no evidence of effect" and "evidence of no effect" needs to be understood.

  12. Venous intravasation: a potential pitfall of confirmatory hysterosalpingogram following essure hysteroscopic sterilization.

    Science.gov (United States)

    Chang, Michael C; Shim, John J

    2012-09-01

    Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs.

  13. Estimation of the Joint Patient Condition Occurrence Frequencies from Operation Iraqi Freedom and Operation Enduring Freedom. Volume I: Development of Methodology

    Science.gov (United States)

    2011-03-28

    Chest PCOF Vol. 1: Development of Methodology 18 Supplemented BM To more accurately describe combat trauma , a slight modification was made to the BM... Pneumothorax without Open Wound into Thorax INTERNAL ORGAN CHEST 860.1 Traumatic Pneumothorax with open Wound into Thorax INTERNAL ORGAN CHEST ...with Open Wound into Thorax INTERNAL ORGAN CHEST PCOF Vol. 1: Development of Methodology 31 DMMPO ICD-9 codes Trauma category Anatomical location

  14. CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Taslakian, Bedros, E-mail: bedros.taslakian@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Latson, Larry A., E-mail: larry.latson@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Truong, Mylene T., E-mail: mtruong@mdanderson.org [Department of Radiology, University of Texas, MD Anderson Cancer Center, TX (United States); Aaltonen, Eric, E-mail: Eric.Aaltonen@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Shiau, Maria C., E-mail: Maria.Shiau@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Girvin, Francis, E-mail: Francis.Girvin@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Alpert, Jeffrey B., E-mail: Jeffrey.Alpert@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Wickstrom, Maj, E-mail: Maj.Wickstrom@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States); Ko, Jane P., E-mail: Jane.Ko@nyumc.org [Department of Radiology, NYU Langone Medical Center, NY (United States)

    2016-11-15

    Highlights: • CTPA plays a key role in the evaluation of pulmonary vascular diseases. • Improvements in CT technology have improved visualization of pulmonary arteries. • Knowledge of the technical pitfalls is essential for accurate diagnosis. • Dual energy CT imaging enables parenchymal iodine evaluation. • An awareness of the entities affecting the pulmonary arteries is important. - Abstract: Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.

  15. CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls

    International Nuclear Information System (INIS)

    Taslakian, Bedros; Latson, Larry A.; Truong, Mylene T.; Aaltonen, Eric; Shiau, Maria C.; Girvin, Francis; Alpert, Jeffrey B.; Wickstrom, Maj; Ko, Jane P.

    2016-01-01

    Highlights: • CTPA plays a key role in the evaluation of pulmonary vascular diseases. • Improvements in CT technology have improved visualization of pulmonary arteries. • Knowledge of the technical pitfalls is essential for accurate diagnosis. • Dual energy CT imaging enables parenchymal iodine evaluation. • An awareness of the entities affecting the pulmonary arteries is important. - Abstract: Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.

  16. Short overview of PSA quantification methods, pitfalls on the road from approximate to exact results

    International Nuclear Information System (INIS)

    Banov, Reni; Simic, Zdenko; Sterc, Davor

    2014-01-01

    Over time the Probabilistic Safety Assessment (PSA) models have become an invaluable companion in the identification and understanding of key nuclear power plant (NPP) vulnerabilities. PSA is an effective tool for this purpose as it assists plant management to target resources where the largest benefit for plant safety can be obtained. PSA has quickly become an established technique to numerically quantify risk measures in nuclear power plants. As complexity of PSA models increases, the computational approaches become more or less feasible. The various computational approaches can be basically classified in two major groups: approximate and exact (BDD based) methods. In recent time modern commercially available PSA tools started to provide both methods for PSA model quantification. Besides availability of both methods in proven PSA tools the usage must still be taken carefully since there are many pitfalls which can drive to wrong conclusions and prevent efficient usage of PSA tool. For example, typical pitfalls involve the usage of higher precision approximation methods and getting a less precise result, or mixing minimal cuts and prime implicants in the exact computation method. The exact methods are sensitive to selected computational paths in which case a simple human assisted rearrangement may help and even switch from computationally non-feasible to feasible methods. Further improvements to exact method are possible and desirable which opens space for a new research. In this paper we will show how these pitfalls may be detected and how carefully actions must be done especially when working with large PSA models. (authors)

  17. Active Search on Carcasses versus Pitfall Traps: a Comparison of Sampling Methods.

    Science.gov (United States)

    Zanetti, N I; Camina, R; Visciarelli, E C; Centeno, N D

    2016-04-01

    The study of insect succession in cadavers and the classification of arthropods have mostly been done by placing a carcass in a cage, protected from vertebrate scavengers, which is then visited periodically. An alternative is to use specific traps. Few studies on carrion ecology and forensic entomology involving the carcasses of large vertebrates have employed pitfall traps. The aims of this study were to compare both sampling methods (active search on a carcass and pitfall trapping) for each coleopteran family, and to establish whether there is a discrepancy (underestimation and/or overestimation) in the presence of each family by either method. A great discrepancy was found for almost all families with some of them being more abundant in samples obtained through active search on carcasses and others in samples from traps, whereas two families did not show any bias towards a given sampling method. The fact that families may be underestimated or overestimated by the type of sampling technique highlights the importance of combining both methods, active search on carcasses and pitfall traps, in order to obtain more complete information on decomposition, carrion habitat and cadaveric families or species. Furthermore, a hypothesis advanced on the reasons for the underestimation by either sampling method showing biases towards certain families. Information about the sampling techniques indicating which would be more appropriate to detect or find a particular family is provided.

  18. The Three Pitfalls of Sustainable City: A Conceptual Framework for Evaluating the Theory-Practice Gap

    Directory of Open Access Journals (Sweden)

    Valeria Saiu

    2017-12-01

    Full Text Available Over the last three decades the environmental, economic and social crisis and the challenges and possibilities offered by new technologies have become the drivers of plans and projects for sustainable cities. In the face of a wide experimentation, the aim of this paper is to answer the question: what progress is implemented by the goal of sustainable city? To this end, I hold it is important point at the watershed between the declared intended goals of the projects realized to date and the results on the ground. To analyze this discrepancy, I have identified a common theory-practice gap in the form of the three pitfalls of sustainable city, which bring about economic and ethical conflicts and risks creating socio-spatial utopias. The three pitfalls are: (1 the idea of the city as a business; (2 the oversimplification of urban complexity; (3 the quest for the ideal community. This conceptual framework has two purposes. First, it helps to systematize the existing literature on the sustainable city project, focusing on few selected issues. Second, it offers a project evaluation framework, useful both for the management of resources and for the planning of urban space. To pinpoint these pitfalls in projects for sustainable cities could allow us to adopt a holistic approach to the city project and practice.

  19. Diagnostic and therapeutic pitfalls in benign vocal fold diseases

    Science.gov (United States)

    Bohlender, Jörg

    2013-01-01

    More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

  20. Alveolar cell carcinoma: diagnostic pitfalls in evaluating the chest roentgenogram

    International Nuclear Information System (INIS)

    Shin, M.S.; Bailey, W.C.

    1985-01-01

    A report is given of two patients with initial symptoms of congestive heart failure who had an extensive work-up that failed to reveal any signs of pulmonary malignancy. Subsequent biopsy by fiberoptic bronchoscopy confirmed alveolar cell carcinoma in both cases, suggesting that bronchoscopy with biopsy should be considered in patients with congestive heart failure if pulmonary edema does not resolve with appropriate therapy. 11 references, 2 figures

  1. Pitfalls and Limitations of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Urinary Bladder Cancer

    Directory of Open Access Journals (Sweden)

    Wei-Ching Lin

    2015-06-01

    Full Text Available Adequately selecting a therapeutic approach for bladder cancer depends on accurate grading and staging. Substantial inaccuracy of clinical staging with bimanual examination, cystoscopy, and transurethral resection of bladder tumor has facilitated the increasing utility of magnetic resonance imaging to evaluate bladder cancer. Diffusion-weighted imaging (DWI is a noninvasive functional magnetic resonance imaging technique. The high tissue contrast between cancers and surrounding tissues on DWI is derived from the difference of water molecules motion. DWI is potentially a useful tool for the detection, characterization, and staging of bladder cancers; it can also monitor posttreatment response and provide information on predicting tumor biophysical behaviors. Despite advancements in DWI techniques and the use of quantitative analysis to evaluate the apparent diffusion coefficient values, there are some inherent limitations in DWI interpretation related to relatively poor spatial resolution, lack of cancer specificity, and lack of standardized image acquisition protocols and data analysis procedures that restrict the application of DWI and reproducibility of apparent diffusion coefficient values. In addition, inadequate bladder distension, artifacts, thinness of bladder wall, cancerous mimickers of normal bladder wall and benign lesions, and variations in the manifestation of bladder cancer may interfere with diagnosis and monitoring of treatment. Recognition of these pitfalls and limitations can minimize their impact on image interpretation, and carefully applying the analyzed results and combining with pathologic grading and staging to clinical practice can contribute to the selection of an adequate treatment method to improve patient care.

  2. Critical Pitfalls in the use of BRAF Mutation as a Diagnostic Tool in Thyroid Nodules: a Case Report.

    Science.gov (United States)

    Kuhn, Elisabetta; Ragazzi, Moira; Zini, Michele; Giordano, Davide; Nicoli, Davide; Piana, Simonetta

    2016-09-01

    Thyroid fine-needle aspiration (FNA) cytology is the primary tool for the diagnostic evaluation of thyroid nodules. BRAF mutation analysis is employed as an ancillary tool in indeterminate cases, as recommended by the American Thyroid Association management guidelines. Hereby, we report the case of a 73-year-old woman who presented an 8-mm-size, ill-defined, left thyroid nodule. FNA resulted "suspicious for papillary thyroid carcinoma". BRAF mutation status was analyzed, and somatic BRAF (V600E) mutation identified. The patient underwent a total thyroidectomy. At histological examination, the nodule was composed of Langerhans cells, admixed with many eosinophils. A final diagnosis of Langerhans cell histiocytosis of the thyroid was made. Our case emphasizes the critical diagnostic pitfalls due to the use of BRAF (V600E) mutation analysis in thyroid FNA. Notably, BRAF (V600E) mutation is common in melanoma, colorectal carcinoma, lung carcinoma, ovarian carcinoma, brain tumors, hairy cell leukemia, multiple myeloma, and histiocytoses. Therefore, in cases of indeterminate FNA with unclassifiable atypical cells BRAF (V600E) mutated, the possibility of a localization of hystiocytosis or a secondary thyroid malignancy should be taken into account.

  3. Pitfalls and Limitations of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Urinary Bladder Cancer

    Science.gov (United States)

    Lin, Wei-Ching; Chen, Jeon-Hor

    2015-01-01

    Adequately selecting a therapeutic approach for bladder cancer depends on accurate grading and staging. Substantial inaccuracy of clinical staging with bimanual examination, cystoscopy, and transurethral resection of bladder tumor has facilitated the increasing utility of magnetic resonance imaging to evaluate bladder cancer. Diffusion-weighted imaging (DWI) is a noninvasive functional magnetic resonance imaging technique. The high tissue contrast between cancers and surrounding tissues on DWI is derived from the difference of water molecules motion. DWI is potentially a useful tool for the detection, characterization, and staging of bladder cancers; it can also monitor posttreatment response and provide information on predicting tumor biophysical behaviors. Despite advancements in DWI techniques and the use of quantitative analysis to evaluate the apparent diffusion coefficient values, there are some inherent limitations in DWI interpretation related to relatively poor spatial resolution, lack of cancer specificity, and lack of standardized image acquisition protocols and data analysis procedures that restrict the application of DWI and reproducibility of apparent diffusion coefficient values. In addition, inadequate bladder distension, artifacts, thinness of bladder wall, cancerous mimickers of normal bladder wall and benign lesions, and variations in the manifestation of bladder cancer may interfere with diagnosis and monitoring of treatment. Recognition of these pitfalls and limitations can minimize their impact on image interpretation, and carefully applying the analyzed results and combining with pathologic grading and staging to clinical practice can contribute to the selection of an adequate treatment method to improve patient care. PMID:26055180

  4. A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries.

    Science.gov (United States)

    Yilmaz, Tugba H; Ndofor, Brown C; Smith, Martin D; Degiannis, Elias

    2010-07-14

    There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and pitfalls that will be encountered in penetrating trauma to the abdomen, will help the occasional trauma surgeons to avoid intraoperative errors and improve patient care. This manuscript provides a heuristic approach from surgeons working in a high volume penetrating trauma centers in South African. Some of the statements could be considered heretic by the "accepted" trauma literature. We believe that this heuristic ("rule of thumb" approach, that originating from "try and error" experience) can help surgical trainees or less experienced in penetrating trauma surgeons to improve their surgical decision making and technique, resulting in better patient outcome.

  5. A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries

    Directory of Open Access Journals (Sweden)

    Smith Martin D

    2010-07-01

    Full Text Available Abstract There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and pitfalls that will be encountered in penetrating trauma to the abdomen, will help the occasional trauma surgeons to avoid intraoperative errors and improve patient care. This manuscript provides a heuristic approach from surgeons working in a high volume penetrating trauma centers in South African. Some of the statements could be considered heretic by the "accepted" trauma literature. We believe that this heuristic ("rule of thumb" approach, that originating from "try and error" experience can help surgical trainees or less experienced in penetrating trauma surgeons to improve their surgical decision making and technique, resulting in better patient outcome.

  6. Granulomatous prostatitis: a pitfall in MR imaging of prostatic carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gevenois, P.A. [Dept. of Radiology, Cliniques Univ. de Bruxelles, Hopital Erasme (Belgium); Stallenberg, B. [Dept. of Radiology, Cliniques Univ. de Bruxelles, Hopital Erasme (Belgium); Sintzoff, S.A. [Dept. of Radiology, Cliniques Univ. de Bruxelles, Hopital Erasme (Belgium); Salmon, I. [Dept. of Pathology, Cliniques Univ. de Bruxelles, Hopital Erasme (Belgium); Regemorter, G. van [Dept. of Urology, Cliniques Univ. de Bruxelles, Hopital Erasme (Belgium); Struyven, J. [Dept. of Radiology, Cliniques Univ. de Bruxelles, Hopital Erasme (Belgium)

    1992-08-01

    Granulomatous prostatitis is an uncommon disease that can mimic prostatic carcinoma on both digital rectal examination and transrectal ultrasound. Four patients who underwent magnetic resonance imaging of the prostate had a histological diagnosis of granulomatous prostatitis; three of them had recent urinary tract infections. The other patient had an associated midline prostatic cyst and a focus of malignancy. T1- and T2-weighted spin-echo images were obtained in all cases. Peripheral zone lesions of decreased signal intensity, suggestive of carcinoma, were found in all four patients on T2-weighted images. Granulomatous prostatitis should be considered in the differential diagnosis of low signal intensity areas with prostatic magnetic resonance imaging. (orig.)

  7. Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls

    Directory of Open Access Journals (Sweden)

    Charalampos G. Markakis

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs.

  8. Common pitfalls in radiographic interpretation of the Thorax

    International Nuclear Information System (INIS)

    Godshalk, C.P.

    1994-01-01

    Errors in radiographic interpretation of the thorax are common. Many mistakes result from interpreting normal anatomic variants as abnormalstructures, such as misdiagnosing dorsal and rightward deviation of the cranial thoracic trachea on lateral radiographs of normal dogs. Some of the more common errors specifically relate to misinterpretation of radiographs made on obese patients. The age of the patient also plays a role in misdiagnosis. Aging cats seem to have a horizontally positioned heart on lateral radiographs, and older dogs, primarily collies,often have pulmonary osteomas that are misdiagnosed as metastatic neoplastic disease or healed pulmonary fungal infections

  9. Planning strategies for the avoidance of pitfalls in intervention research.

    Science.gov (United States)

    Pruitt, R H; Privette, A B

    2001-08-01

    With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.

  10. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    OpenAIRE

    Robinson, Yohan; Sand?n, Bengt

    2009-01-01

    Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging reco...

  11. Ethical principles and pitfalls of genetic testing for dementia.

    Science.gov (United States)

    Hedera, P

    2001-01-01

    Progress in the genetics of dementing disorders and the availability of clinical tests for practicing physicians increase the need for a better understanding of multifaceted issues associated with genetic testing. The genetics of dementia is complex, and genetic testing is fraught with many ethical concerns. Genetic testing can be considered for patients with a family history suggestive of a single gene disorder as a cause of dementia. Testing of affected patients should be accompanied by competent genetic counseling that focuses on probabilistic implications for at-risk first-degree relatives. Predictive testing of at-risk asymptomatic patients should be modeled after presymptomatic testing for Huntington's disease. Testing using susceptibility genes has only a limited diagnostic value at present because potential improvement in diagnostic accuracy does not justify potentially negative consequences for first-degree relatives. Predictive testing of unaffected subjects using susceptibility genes is currently not recommended because individual risk cannot be quantified and there are no therapeutic interventions for dementia in presymptomatic patients.

  12. Users and user study methodology: the JUBILEE project

    Directory of Open Access Journals (Sweden)

    Linda Banwell

    2004-01-01

    Full Text Available This paper presents both theoretical aspects and practical examples from the on-going and large-scale JUBILEE (JISC User Behaviour in Information seeking: Longitudinal Evaluation of Electronic information services project, now in its fifth year. Particular emphasis will be placed on the importance of using robust theory and methods as the basis for reputable user studies, especially those undertaken by practitioners. Theory underlying the development of the JUBILEE project and Toolkit is outlined, followed by demonstration of its practical use and impact during the project's on-going program of monitoring and evaluation activities. Themes underlying the paper concern the importance to practitioners of the need to understand and adopt a well founded methodology and sound methods with which to conduct projects, the additional benefits they can derive by so doing, and the pitfalls and dangers of not so doing. JUBILEE is used throughout as the example project to demonstrate the points made.

  13. Splenic infarct as a diagnostic pitfall in radiology

    Directory of Open Access Journals (Sweden)

    Joshi Sanjeev

    2008-01-01

    Full Text Available Follow-up of colorectal carcinoma after therapy is based on symptoms, tumor markers, and imaging studies. Clinicians sometimes face diagnostic dilemmas because of unusual presentations on the imaging modalities coupled with rising serum markers. We report a case of colorectal carcinoma that presented with gastrointestinal symptoms 14 months after completion of treatment. Investigations showed rise in carcinoembryonic antigen (CEA. Suspecting disease recurrence, complete radioimaging workup was performed; the only abnormality detected was a smooth, hypodense area in the posterior third of the spleen on contrast-enhanced computed tomography abdomen. In view of the previous diagnosis of carcinoma colon, the symptoms reported by the patient, the elevated CEA, and the atypical CECT appearance, a diagnosis of splenic metastasis was made. The patient was subjected to splenectomy as a curative treatment. However, the histopathological report revealed it to be a splenic infarct. The present case reemphasizes the limitations of radiological studies in the follow-up of carcinoma colon.

  14. Promise and pitfalls of molecular markers of thyroid nodules

    Science.gov (United States)

    Jadhav, S.; Lila, Anurag; Bandgar, Tushar; Shah, Nalini

    2012-01-01

    Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG) and fine needle aspiration biopsy (FNAB). The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly being studied for their diagnostic utility in assessing thyroid nodules. The various molecular markers consist of gene mutations, gene re arrangements, RNA based assays and immunohistochemical markers. The molecular markers definitely would help to optimise the management of such patients. PMID:23565369

  15. Promise and pitfalls of molecular markers of thyroid nodules

    Directory of Open Access Journals (Sweden)

    S Jadhav

    2012-01-01

    Full Text Available Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG and fine needle aspiration biopsy (FNAB. The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly being studied for their diagnostic utility in assessing thyroid nodules. The various molecular markers consist of gene mutations, gene re arrangements, RNA based assays and immunohistochemical markers. The molecular markers definitely would help to optimise the management of such patients.

  16. Pitfalls in diagnosing colon cancer on abdominal CT.

    Science.gov (United States)

    Klang, E; Eifer, M; Kopylov, U; Belsky, V; Raskin, S; Konen, E; Amitai, M M

    2017-10-01

    To assess the frequency of undetected colon cancer on conventional abdominal CT and to evaluate the imaging features that are characteristic of those cancers. The present study included consecutive patients diagnosed with colorectal cancer at colonoscopy (2006-2015) who also underwent abdominal computed tomography (CT) performed for various reasons within a year prior to the colonoscopy. The frequency of undetected lesions was evaluated for the original CT interpretations ("original readers"). Two radiologists ("study readers"), blinded to the tumour location, independently performed interpretations oriented for colon cancer detection. The study readers analysed the imaging features of detected tumours (tumour shape, length, maximal wall thickness, free fluid, fat stranding, vascular engorgement, stenosis, and lymphadenopathy). Imaging features of the cancers undetected by the original readers were evaluated. The study included 127 patients. The original readers' frequency of undetected cancer was 25/127 (19.7%). Each study reader could not identify the cancer in 8/127 (6.3%) patients. Imaging features associated with undetected cancers by the original readers included the absence of fat stranding (p=0.007, p=0.003), absence of vascular engorgement (pColon cancer is undetected in 20% of abdominal CT examinations in patients subsequently proven to have colon cancer at colonoscopy. The absence of fat stranding, vascular engorgement, or lymphadenopathy, and an average tumour length of 3.3 cm are contributing factors for failure of detection. Radiologists' training should emphasis these findings as it may improve cancer detection, and clinicians should be aware of the limitations of abdominal CT. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  17. Promise and pitfalls of molecular markers of thyroid nodules

    OpenAIRE

    Jadhav, S.; Lila, Anurag; Bandgar, Tushar; Shah, Nalini

    2012-01-01

    Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG) and fine needle aspiration biopsy (FNAB). The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly ...

  18. [Pitfalls in hypertension management--misjudgements in diagnosis and therapy].

    Science.gov (United States)

    Scholze, J; Rautenberg, B; Hansen, A

    2002-11-08

    A 71-year-old woman with arterial hypertension, diabetes type 2, peripheral vascular disease and Sjögren's syndrome presented with progressive weakness, dizziness, insomnia, palpitations and headache. These symptoms did not improve by changing her antihypertensive treatment. The patient's general condition was quite normal and there were no signs of acute or chronic cardiopulmonary decompensation. Besides arterial hypertension, she also had an elevated body mass index, dyslipoproteinemia, microalbuminuria, diabetic metabolism, left ventricular hypertrophy with signs of an abnormal diastolic cardiac function as well as atherosclerotic lesions (in both carotid arteries) which were identified as the patient's cardiovascular risk factors. Ambulant blood pressure monitoring revealed decreasing BP values for a period of 5 hrs after drug intake but, subsequently, severe hypertensive values (up to 220 mmHg systolic) without adequate decrease at night. Moreover, a hyperkinetic regulation of her circulation was demonstrated by hemodynamic monitoring and assessment of the autonomic nervous system. By changing drug treatment, i. e. administration of an anti-adrenergic calcium antagonist of the non-dihydropyridine type combined with an ACE inhibitor and a diuretic, respectively, (both given in fixed combinations) led to the normalization of the blood pressure and pulse rate as well as an improvement of the patient's condition. This case emphasizes the importance of ambulant blood pressure monitoring and an assessment of the heart rate in individually adapted antihypertensive drug therapy. The application of metabolically neutral fixed drug combinations with special regard to associated diseases, organ protection and the patient's compliance resulted in normotensive blood pressure values and an improvement of the quality of life.

  19. Pitfalls in diagnosing limbic encephalitis - a case report.

    Science.gov (United States)

    Kerling, F; Blümcke, I; Stefan, H

    2008-11-01

    The syndrome of limbic encephalitis (LE) is characterized by subacute onset of temporal lobe epilepsy, loss of short-term memory, cognitive confusion and psychiatric symptoms. We report a patient with pharmacoresistant epilepsy who underwent presurgical video-electroencephalogram (EEG)-monitoring with normal psychiatric and neuropsychological findings. Magnetic resonance imaging (MRI) revealed a hyperintense lesion within the right amygdala but no contrast enhancement. Analysis of cerebrospinal fluid (CSF) showed pleocytosis and positive oligoclonal bands, but all tests for neurotropic viruses or borrelia antibodies were negative. Presurgical evaluation identified a right mesiotemporal focus. As a tumour was the most likely differential diagnosis, we performed selective amygdalohippocampectomy of the right hemisphere. Subsequent histopathological examination revealed the surprising diagnosis of LE. As a consequence, tumour screening was initiated and a testicular carcinoma with high anti-Ma2-antibody titres was detected. Following surgical and chemotherapeutical treatment, the patient was seizure-free and Ma2-antibodies decreased below detection limits. Conclusion - This case report highlights that LE has to be considered even in patients with atypical clinical presentation, i.e. without neuropsychological deficits, if CSF analysis reveals an inflammatory response. When LE is diagnosed, extensive tumour search is mandatory to detect and treat the paraneoplastic origin of LE. Therapeutic strategies of LE include surgical treatment as well as early immunosuppression.

  20. Methodology for construction compliance monitoring in the crediting of investment projects for road construction

    Science.gov (United States)

    Vaynshtok, Natalia

    2017-10-01

    The article provides the results of development of the methodology for construction compliance monitoring in the crediting of investment projects for road construction. Work scope analysis of construction audit was conducted and an algorithm of financial audit in the crediting investment projects was developed. Furthermore, the possible pitfalls and abuses of counterparties were investigated and recommendations were given allowing the bank to receive objective and independent information on the progress of the project in real time. This mechanism is useful for the bank in insurance of possible risks, targeted and rational use of credit funds.

  1. Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization

    International Nuclear Information System (INIS)

    Lenoir, Laurence; Garin, Etienne; Edeline, Julien; Rolland, Yann; Pracht, Marc; Raoul, Jean-Luc; Ardisson, Valerie; Bourguet, Patrick; Clement, Bruno; Boucher, Eveline

    2012-01-01

    Identifying gastroduodenal uptake of 99m Tc-macroaggregated albumin (MAA), which is associated with an increased risk of ulcer disease, is a crucial part of the therapeutic management of patients undergoing radioembolization for liver tumours. Given this context, the use of MAA single photon emission computed tomography (SPECT)/CT may be essential, but the procedure has still not been thoroughly evaluated. The aim of this retrospective study was to determine the effectiveness of MAA SPECT/CT in identifying digestive extrahepatic uptake, while determining potential diagnostic pitfalls. Overall, 139 MAA SPECT/CT scans were performed on 103 patients with different hepatic tumour types. Patients were followed up for at least 6 months according to standard requirements. Digestive, or digestive-like, uptake other than free pertechnetate was identified in 5.7% of cases using planar imaging and in 36.6% of cases using SPECT/CT. Uptake sites identified by SPECT/CT included the gastroduodenal region (3.6%), gall bladder (12.2%), portal vein thrombosis (6.5%), hepatic artery (6.5%), coil embolization site (2.1%) as well as falciform artery (5.0%). For 2.1% of explorations, a coregistration error between SPECT and CT imaging could have led to a false diagnosis by erroneously attributing an uptake site to the stomach or gall bladder, when the uptake actually occurred in the liver. SPECT/CT is more efficacious than planar imaging in identifying digestive extrahepatic uptake sites, with extrahepatic uptake observed in one third of scans using the former procedure. However, more than half of the uptake sites in our study were vascular in nature, without therapeutic implications. The risk of coregistration errors must also be kept in mind. (orig.)

  2. Pitfalls in molecular analysis for mismatch repair deficiency in a family with biallelic pms2 germline mutations.

    Science.gov (United States)

    Leenen, C H M; Geurts-Giele, W R R; Dubbink, H J; Reddingius, R; van den Ouweland, A M; Tops, C M J; van de Klift, H M; Kuipers, E J; van Leerdam, M E; Dinjens, W N M; Wagner, A

    2011-12-01

    Heterozygous germline mutations in the mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2 cause Lynch syndrome. Biallelic mutations in the MMR genes are associated with a childhood cancer syndrome [constitutional mismatch repair deficiency (CMMR-D)]. This is predominantly characterized by hematological malignancies and tumors of the bowel and brain, often associated with signs of neurofibromatosis type 1 (NF1). Diagnostic strategies for selection of patients for MMR gene analysis include analysis of microsatellite instability (MSI) and immunohistochemical (IHC) analysis of MMR proteins in tumor tissue. We report the clinical characterization and molecular analyses of tumor specimens from a family with biallelic PMS2 germline mutations. This illustrates the pitfalls of present molecular screening strategies. Tumor tissues of five family members were analyzed for MSI and IHC. MSI was observed in only one of the analyzed tissues. However, IHC analysis of brain tumor tissue of the index patient and his sister showed absence of PMS2 expression, and germline mutation analyses showed biallelic mutations in PMS2: p.Ser46IIe and p.Pro246fs. The same heterozygous mutations were confirmed in the father and mother, respectively. These data support the conclusion that in case of a clinical phenotype of CMMR-D, it is advisable to routinely combine MSI analysis with IHC analysis for the expression of MMR proteins. With inconclusive or conflicting results, germline mutation analysis of the MMR genes should be considered after thorough counselling of the patients and/or their relatives. © 2011 John Wiley & Sons A/S.

  3. BRCA1 and BRCA2 genetic testing—pitfalls and recommendations for managing variants of uncertain clinical significance

    Science.gov (United States)

    Eccles, D. M.; Mitchell, G.; Monteiro, A. N. A.; Schmutzler, R.; Couch, F. J.; Spurdle, A. B.; Gómez-García, E. B.

    2015-01-01

    Background Increasing use of BRCA1/2 testing for tailoring cancer treatment and extension of testing to tumour tissue for somatic mutation is moving BRCA1/2 mutation screening from a primarily prevention arena delivered by specialist genetic services into mainstream oncology practice. A considerable number of gene tests will identify rare variants where clinical significance cannot be inferred from sequence information alone. The proportion of variants of uncertain clinical significance (VUS) is likely to grow with lower thresholds for testing and laboratory providers with less experience of BRCA. Most VUS will not be associated with a high risk of cancer but a misinterpreted VUS has the potential to lead to mismanagement of both the patient and their relatives. Design Members of the Clinical Working Group of ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles) global consortium (www.enigmaconsortium.org) observed wide variation in practices in reporting, disclosure and clinical management of patients with a VUS. Examples from current clinical practice are presented and discussed to illustrate potential pitfalls, explore factors contributing to misinterpretation, and propose approaches to improving clarity. Results and conclusion Clinicians, patients and their relatives would all benefit from an improved level of genetic literacy. Genetic laboratories working with clinical geneticists need to agree on a clinically clear and uniform format for reporting BRCA test results to non-geneticists. An international consortium of experts, collecting and integrating all available lines of evidence and classifying variants according to an internationally recognized system, will facilitate reclassification of variants for clinical use. PMID:26153499

  4. BRCA1 and BRCA2 genetic testing-pitfalls and recommendations for managing variants of uncertain clinical significance.

    Science.gov (United States)

    Eccles, D M; Mitchell, G; Monteiro, A N A; Schmutzler, R; Couch, F J; Spurdle, A B; Gómez-García, E B

    2015-10-01

    Increasing use of BRCA1/2 testing for tailoring cancer treatment and extension of testing to tumour tissue for somatic mutation is moving BRCA1/2 mutation screening from a primarily prevention arena delivered by specialist genetic services into mainstream oncology practice. A considerable number of gene tests will identify rare variants where clinical significance cannot be inferred from sequence information alone. The proportion of variants of uncertain clinical significance (VUS) is likely to grow with lower thresholds for testing and laboratory providers with less experience of BRCA. Most VUS will not be associated with a high risk of cancer but a misinterpreted VUS has the potential to lead to mismanagement of both the patient and their relatives. Members of the Clinical Working Group of ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles) global consortium (www.enigmaconsortium.org) observed wide variation in practices in reporting, disclosure and clinical management of patients with a VUS. Examples from current clinical practice are presented and discussed to illustrate potential pitfalls, explore factors contributing to misinterpretation, and propose approaches to improving clarity. Clinicians, patients and their relatives would all benefit from an improved level of genetic literacy. Genetic laboratories working with clinical geneticists need to agree on a clinically clear and uniform format for reporting BRCA test results to non-geneticists. An international consortium of experts, collecting and integrating all available lines of evidence and classifying variants according to an internationally recognized system, will facilitate reclassification of variants for clinical use. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  5. Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Lenoir, Laurence; Garin, Etienne [Comprehensive Cancer Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); University of Rennes 1, Rennes (France); Liver Metabolisms and Cancer, INSERM, U-991, Rennes (France); Edeline, Julien [University of Rennes 1, Rennes (France); Comprehensive Cancer Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France); Rolland, Yann [Comprehensive Cancer Institute Eugene Marquis, Department of Medical Imaging, CS 44229, Rennes (France); Pracht, Marc [Comprehensive Cancer Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France); Raoul, Jean-Luc [Comprehensive Cancer Institute Paoli Calmette, Department of Medical Oncology, Marseille (France); Ardisson, Valerie [Comprehensive Cancer Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); Bourguet, Patrick [Comprehensive Cancer Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); University of Rennes 1, Rennes (France); Clement, Bruno [Liver Metabolisms and Cancer, INSERM, U-991, Rennes (France); Boucher, Eveline [Liver Metabolisms and Cancer, INSERM, U-991, Rennes (France); Comprehensive Cancer Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France)

    2012-05-15

    Identifying gastroduodenal uptake of {sup 99m}Tc-macroaggregated albumin (MAA), which is associated with an increased risk of ulcer disease, is a crucial part of the therapeutic management of patients undergoing radioembolization for liver tumours. Given this context, the use of MAA single photon emission computed tomography (SPECT)/CT may be essential, but the procedure has still not been thoroughly evaluated. The aim of this retrospective study was to determine the effectiveness of MAA SPECT/CT in identifying digestive extrahepatic uptake, while determining potential diagnostic pitfalls. Overall, 139 MAA SPECT/CT scans were performed on 103 patients with different hepatic tumour types. Patients were followed up for at least 6 months according to standard requirements. Digestive, or digestive-like, uptake other than free pertechnetate was identified in 5.7% of cases using planar imaging and in 36.6% of cases using SPECT/CT. Uptake sites identified by SPECT/CT included the gastroduodenal region (3.6%), gall bladder (12.2%), portal vein thrombosis (6.5%), hepatic artery (6.5%), coil embolization site (2.1%) as well as falciform artery (5.0%). For 2.1% of explorations, a coregistration error between SPECT and CT imaging could have led to a false diagnosis by erroneously attributing an uptake site to the stomach or gall bladder, when the uptake actually occurred in the liver. SPECT/CT is more efficacious than planar imaging in identifying digestive extrahepatic uptake sites, with extrahepatic uptake observed in one third of scans using the former procedure. However, more than half of the uptake sites in our study were vascular in nature, without therapeutic implications. The risk of coregistration errors must also be kept in mind. (orig.)

  6. Pitfalls in genetic analysis of pheochromocytomas/paragangliomas-case report.

    Science.gov (United States)

    Canu, Letizia; Rapizzi, Elena; Zampetti, Benedetta; Fucci, Rossella; Nesi, Gabriella; Richter, Susan; Qin, Nan; Giachè, Valentino; Bergamini, Carlo; Parenti, Gabriele; Valeri, Andrea; Ercolino, Tonino; Eisenhofer, Graeme; Mannelli, Massimo

    2014-07-01

    About 35% of patients with pheochromocytoma/paraganglioma carry a germline mutation in one of the 10 main susceptibility genes. The recent introduction of next-generation sequencing will allow the analysis of all these genes in one run. When positive, the analysis is generally unequivocal due to the association between a germline mutation and a concordant clinical presentation or positive family history. When genetic analysis reveals a novel mutation with no clinical correlates, particularly in the presence of a missense variant, the question arises whether the mutation is pathogenic or a rare polymorphism. We report the case of a 35-year-old patient operated for a pheochromocytoma who turned out to be a carrier of a novel SDHD (succinate dehydrogenase subunit D) missense mutation. With no positive family history or clinical correlates, we decided to perform additional analyses to test the clinical significance of the mutation. We performed in silico analysis, tissue loss of heterozygosity analysis, immunohistochemistry, Western blot analysis, SDH enzymatic assay, and measurement of the succinate/fumarate concentration ratio in the tumor tissue by tandem mass spectrometry. Although the in silico analysis gave contradictory results according to the different methods, all the other tests demonstrated that the SDH complex was conserved and normally active. We therefore came to the conclusion that the variant was a nonpathogenic polymorphism. Advancements in technology facilitate genetic analysis of patients with pheochromocytoma but also offer new challenges to the clinician who, in some cases, needs clinical correlates and/or functional tests to give significance to the results of the genetic assay.

  7. "Telemarketing" hospital services: benefits, pitfalls and the planning process.

    Science.gov (United States)

    Hafer, J C

    1984-01-01

    "Telemarketing" is an innovative concept used by many firms to increase the efficiency and effectiveness of product delivery efforts. It can be used by hospitals to benefit both patients and physicians. Further, it can be a tool that, if used properly, can improve the image of the hospital and assist in positioning the organization uniquely among its competitors. This paper discusses the exploratory nature, potential problems, and benefits of telemarketing hospital services and offers pre- and post-implementation considerations. This paper also provides an outline of a sample marketing plan that could serve as an initial model for hospitals that might consider this unique marketing approach.

  8. Pitfalls in the diagnosis of biallelic PMS2 mutations.

    Science.gov (United States)

    Antelo, Marina; Milito, Daniela; Rhees, Jennifer; Roca, Enrique; Barugel, Miguel; Cuatrecasas, Miriam; Moreira, Leticia; Leoz, Maria Liz; Carballal, Sabela; Ocaña, Teresa; Pellisé, Maria; Castells, Antoni; Boland, C Richard; Goel, Ajay; Balaguer, Francesc

    2015-09-01

    Constitutional Mismatch Repair Deficiency (CMMR-D) syndrome is an inherited childhood cancer syndrome due to bi-allelic mutations in one of the four DNA mismatch repair genes involved in Lynch syndrome. The tumor spectrum of this syndrome includes hematological, brain and Lynch syndrome associated malignancies, with an increased risk of synchronous and metachronous cancers, and signs of Neurofibromatosis type-1 syndrome such as café-au-lait macules during the first three decades of life. Here, we report the first Argentinian patient with CMMR-D syndrome, focusing on her history of cancer and gastrointestinal manifestations, and the challenging molecular algorithm to finally reach her diagnosis.

  9. Leishmaniasis Panamensis Masquerading as Myiasis and Sporotrichosis: A Clinical Pitfall

    Directory of Open Access Journals (Sweden)

    Peter G. Pavlidakey

    2015-01-01

    Full Text Available We report a case of cutaneous leishmaniasis panamensis in nonendemic Costa Rica. A 19-year-old female presented with nonhealing, unilateral eruption of erythematous papules with superficial central ulceration in a sporotrichoid pattern on right upper arm and back. Given the clinical picture and geographic locale, the patient was initially diagnosed with myiasis or human botfly infestation; however, the sporotrichoid pattern of the bites is an unlikely finding in myiasis. Peripheral blood smear, Giemsa stain, and polymerase chain reaction (PCR were consistent for Leishmania spp. Ulceration resolved with 20-day course of IV sodium stibogluconate.

  10. A diagnostic pitfall: pancreatic tuberculosis, not pancreatic cancer

    International Nuclear Information System (INIS)

    Samuel, D.O.; Mukhtar, A.A.M.; Philip, I.O.

    2013-01-01

    Abdominal tuberculosis (TB) is one of the most common forms of extra-pulmonary tuberculosis and is responsible for considerable morbidity and mortality globally. Tuberculosis can involve any part of the gastrointestinal tract from mouth to anus, the peritoneum, liver, spleen and the pancreatobiliary system. The occurrence of abdominal TB is independent of pulmonary disease in most patients, with a reported incidence of co-existing pulmonary disease varying from 6 to 38% worldwide. We report a case of pancreatic tuberculosis also involving the vertebrae, which was initially treated as a case of pancreatic cancer. (author)

  11. Increasing clinical presence of mobile communication technology: avoiding the pitfalls.

    Science.gov (United States)

    Visvanathan, Akila; Gibb, Alan P; Brady, Richard R W

    2011-10-01

    Mobile communication technologies are employed in many diverse areas of healthcare delivery to provide improved quality and efficiency of communication and facilitate increased rapidity of data or information transfer. Mobile phones enable healthcare professionals to possess a portable platform from which to provide many healthcare-related applications and are a popular means to directly communicate with colleagues and patients. As involvement of mobile communication technology in healthcare delivery continues to rapidly expand, there are also important considerations of relevance to patient safety and security as a result. Here, we review the previous evidence of reported clinical risks associated with mobile communication technology, such as electromagnetic interference, confidentiality and data security, distraction/noise, infection control, and cross contamination. In conclusion, although mobile phones provide much putative potential improvement to healthcare delivery, further evaluation and research are required to both inform and protect health professionals and users of such technology in the healthcare environment and provide the evidence base to support the provision of clear and comprehensive guidelines.

  12. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    Directory of Open Access Journals (Sweden)

    Sandén Bengt

    2009-07-01

    Full Text Available Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI. Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.

  13. Challenges and pitfalls in the introduction of pharmacogenetics for cancer.

    Science.gov (United States)

    Loh, Marie; Soong, Richie

    2011-08-01

    There have been several success stories in the field of pharmacogenetics in recent years, including the analysis of HER2 amplification for trastuzumab selection in breast cancer and VKORC1 genotyping for warfarin dosing in thrombosis. Encouraging results from these studies suggest that genetic factors may indeed be important determinants of drug response and toxicity for at least some drugs. However, to apply pharmacogenetics appropriately, a thorough understanding of the scope and limitations of this field is required. The challenges include an appreciation of biological variability, logistical issues pertaining to the proper management of information, the need for robust methods and adequate sample quality with well-designed workflows. At the same time, the economics of pharmacogenetic testing from the perspective of clinicians, patients, governments, insurance companies and pharmaceutical companies will play an important role in determining its future use. Ethical considerations such as informed consent and patient privacy, as well as the role of regulatory bodies in addressing these issues, must be fully understood. Only once these issues are properly dealt with can the full benefits of pharmacogenetics begin to be realised.

  14. The wandering spleen: CT findings and possible pitfalls in diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ben Ely, A.; Zissin, R.; Copel, L.; Vasserman, M.; Hertz, M.; Gottlieb, P.; Gayer, G

    2006-11-15

    Aim: To report the CT features of wandering spleen, a rare condition which can be incidentally detected as an abdominal or pelvic mass or can present with torsion, causing an acute abdomen. Materials and methods: The CT studies of seven patients, two children and five adults, with wandering spleen were reviewed. CT was performed urgently in three patients for acute abdomen, and electively in four. Results: CT findings of wandering spleen included absence of the spleen in its normal position and a mass located elsewhere in the abdomen or pelvis, i.e. an ectopic spleen, enhancing homogeneously in four cases and failing partially or completely to enhance in the other three, indicating infarction. A 'whirl' appearance representing the twisted splenic pedicle was seen in the three cases with torsion. Urgent splenectomy confirmed infarction secondary to torsion. Conclusion: The possible diagnosis of wandering spleen should be kept in mind when CT shows the spleen to be absent from its usual position and a mass is found elsewhere in the abdomen or pelvis. When, in addition, a 'whirl' or partial or no enhancement of this mass are seen in a case presenting with acute abdomen, torsion of a wandering spleen is a likely diagnosis.

  15. Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery

    Directory of Open Access Journals (Sweden)

    Jan Frederick Cornelius

    2014-01-01

    Full Text Available Surgical C1C2-stabilization may be complicated by arterial-arterial embolism or arterial injury. Another potential complication is hemodynamic stroke. The latter might be induced in patients with poor posterior fossa collateralization (risk factor 1 when the vertebral artery (VA is compressed during reduction (risk factor 2. We report a clinical case where this rare situation occurred: A 72-year old patient was undergoing C1C2-stabilization for subluxation due to rheumatoid arthritis. Preoperative computed tomography angiography (CTA had shown poor collaterals in the posterior fossa. Furthermore, intraoperative Doppler ultrasound (US detected unilateral VA occlusion during reduction. It appeared to be a high-risk situation for hemodynamic stroke. Surgical inspection of the VA found osteofibrous compressing elements. Arterial decompression was performed resulting in the normal flow as detected by US. Subsequently, C1C2-stabilization could be realized. The clinical and radiological outcome was very favorable. In C1C2-stabilization precise analysis of preoperative CTA and intraoperative US are important to detect risk factors of hemodynamic stroke. Using these data may prevent this rare, but potentially life-threatening complication.

  16. Pitfalls of tungsten multileaf collimator in proton beam therapy

    Energy Technology Data Exchange (ETDEWEB)

    Moskvin, Vadim; Cheng, Chee-Wai; Das, Indra J. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States) and Indiana University Health Proton Therapy Center (Formerly Midwest Proton Radiotherapy Institute), Bloomington, Indiana 47408 (United States)

    2011-12-15

    Purpose: Particle beam therapy is associated with significant startup and operational cost. Multileaf collimator (MLC) provides an attractive option to improve the efficiency and reduce the treatment cost. A direct transfer of the MLC technology from external beam radiation therapy is intuitively straightforward to proton therapy. However, activation, neutron production, and the associated secondary cancer risk in proton beam should be an important consideration which is evaluated. Methods: Monte Carlo simulation with FLUKA particle transport code was applied in this study for a number of treatment models. The authors have performed a detailed study of the neutron generation, ambient dose equivalent [H*(10)], and activation of a typical tungsten MLC and compared with those obtained from a brass aperture used in a typical proton therapy system. Brass aperture and tungsten MLC were modeled by absorber blocks in this study, representing worst-case scenario of a fully closed collimator. Results: With a tungsten MLC, the secondary neutron dose to the patient is at least 1.5 times higher than that from a brass aperture. The H*(10) from a tungsten MLC at 10 cm downstream is about 22.3 mSv/Gy delivered to water phantom by noncollimated 200 MeV beam of 20 cm diameter compared to 14 mSv/Gy for the brass aperture. For a 30-fraction treatment course, the activity per unit volume in brass aperture reaches 5.3 x 10{sup 4} Bq cm{sup -3} at the end of the last treatment. The activity in brass decreases by a factor of 380 after 24 h, additional 6.2 times after 40 days of cooling, and is reduced to background level after 1 yr. Initial activity in tungsten after 30 days of treating 30 patients per day is about 3.4 times higher than in brass that decreases only by a factor of 2 after 40 days and accumulates to 1.2 x 10{sup 6} Bq cm{sup -3} after a full year of operation. The daily utilization of the MLC leads to buildup of activity with time. The overall activity continues to increase

  17. Methodology for clinical trials involving patients with cancer who have febrile neutropenia: updated guidelines of the Immunocompromised Host Society/Multinational Association for Supportive Care in Cancer, with emphasis on outpatient studies.

    Science.gov (United States)

    Feld, Ronald; Paesmans, Marianne; Freifeld, Alison G; Klastersky, Jean; Pizzo, Philip A; Rolston, Kenneth V I; Rubenstein, Edward; Talcott, James A; Walsh, Thomas J

    2002-12-15

    Two multinational organizations, the Immunocompromised Host Society and the Multinational Association for Supportive Care in Cancer, have produced for investigators and regulatory bodies a set of guidelines on methodology for clinical trials involving patients with febrile neutropenia. The guidelines suggest that response (i.e., success of initial empirical antibiotic therapy without any modification) be determined at 72 h and again on day 5, and the reasons for modification should be stated. Blinding and stratification are to be encouraged, as should statistical consideration of trials specifically designed for showing equivalence. Patients enrolled in outpatient studies should be selected by use of a validated risk model, and patients should be carefully monitored after discharge from the hospital. Response and safety parameters should be recorded along with readmission rates. If studies use these guidelines, comparisons between studies will be simpler and will lead to further improvements in patient therapy.

  18. The Pitfalls of Febrile Jaundice. A Case Report

    Directory of Open Access Journals (Sweden)

    Obreja Maria

    2016-04-01

    Full Text Available Jaundice in sepsis is usually caused by cholestasis, and its onset can precede other manifestations of the infection. Inflammation-induced cholestasis is a common complication in patients with an extrahepatic infection or those with inflammatory processes. We describe the case of a 47 years old female who presented with low back pain and paravertebral muscular contracture. She subsequently developed a cholestatic syndrome with clinical manifestations such as jaundice, followed by fever and sepsis with multiple organ dysfunction. Initially labeled as biliary sepsis, the diagnosis was crucially reoriented as the blood cultures were positive for Streptococcus pyogenes and the magnetic resonance imaging (MRI findings suggested spondylodiscitis as well as a paravertebral abscess.

  19. Pearls and pitfalls in human pharmacological models of migraine

    DEFF Research Database (Denmark)

    Ashina, Messoud; Hansen, Jakob Møller; Olesen, Jes

    2013-01-01

    In vitro studies have contributed to the characterization of receptors in cranial blood vessels and the identification of new possible anti-migraine agents. In vivo animal models enable the study of vascular responses, neurogenic inflammation, peptide release and genetic predisposition and thus......- or migraine-provoking property of naturally occurring signaling molecules can be tested in a human model. If such an endogenous substance can provoke migraine in human patients, then it is likely, although not certain, that blocking its effect will be effective in the treatment of acute migraine attacks...... an important role in translational migraine research leading to the identification of three new principally different targets in the treatment of acute migraine attacks and has been used to examine other endogenous signaling molecules as well as genetic susceptibility factors. New additions to the model...

  20. Behind a mask: tricks, pitfalls, and prejudices for noninvasive ventilation.

    Science.gov (United States)

    Nava, Stefano

    2013-08-01

    It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

  1. Pharmacogenetics: progress, pitfalls and clinical potential for coronary heart disease.

    Science.gov (United States)

    Humphries, Steve E; Hingorani, Aroon

    2006-02-01

    Much has been written about the potential of pharmacogenetic testing to inform therapy based on an individual's genetic makeup, and to decide the most effective choice of available drugs, or to avoid dangerous side effects. Currently, there is little hard data for either in the field of cardiovascular disease. The usual approach has been opportunistic use of drug trials in unrelated patients, and to look for differences in response or outcome by "candidate gene" genotype, for example genes coding for drug metabolising enzymes (activators and metabolisers), and enzymes and receptors involved in lipid metabolism, adrenergic response, etc. As with all association studies, initially promising results have often failed the test of replication in larger studies, and the relationship between the CETP Taq-I variant and response to statins has now been disproved. The strongest data to date is the report [Chasman, D.I., Posada, D., Subrahmanyan, L., Cook, N.R., Stanton Jr., V.P., Ridker, P.M., 2004. Pharmacogenetic study of statin therapy and cholesterol reduction. J. Am. Med. Assoc. 291, 2821-2827] of a poorer cholesterol-lowering response to Pravastatin in the 7% of patients carrying a certain haplotype of the HMG CoA reductase gene (14% fall versus 19%), but if this is overcome simply by a higher dose, it is of little clinical relevance. Currently, the best example of avoiding side effects is determining genotype at the CYP2C9 locus with respect of warfarin treatment, since carriers for functional variants (>20% of the population) require lower doses for optimal anticoagulation, and homozygotes, although rare, may well experience serious bleeding if given a usual dose. The full potential of this field will only be realised with much further work.

  2. Biodegradable airway stents in infants - Potential life-threatening pitfalls.

    Science.gov (United States)

    Sztanó, B; Kiss, G; Márai, K; Rácz, G; Szegesdi, I; Rácz, K; Katona, G; Rovó, L

    2016-12-01

    The solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. Five SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). The breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing 'foreign body' from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. Polydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4-6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Going single but not solo with podocytes: potentials, limitations, and pitfalls of single-cell analysis.

    Science.gov (United States)

    Schiffer, Mario

    2017-11-01

    Single-cell RNA-sequence (RNA-seq) is a widely used tool to study biological questions in single cells. The discussed study identified 92 genes being predominantly expressed in podocytes based on a 5-fold higher expression compared with endothelial and mesangial cells. In addition to technical pitfalls, the question that is discussed in this commentary is whether results of a single-cell RNAseq study are able to deliver expression data that truly characterize a podocyte. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  4. PET kinetic analysis --pitfalls and a solution for the Logan plot.

    Science.gov (United States)

    Kimura, Yuichi; Naganawa, Mika; Shidahara, Miho; Ikoma, Yoko; Watabe, Hiroshi

    2007-01-01

    The Logan plot is a widely used algorithm for the quantitative analysis of neuroreceptors using PET because it is easy to use and simple to implement. The Logan plot is also suitable for receptor imaging because its algorithm is fast. However, use of the Logan plot, and interpretation of the formed receptor images should be regarded with caution, because noise in PET data causes bias in the Logan plot estimates. In this paper, we describe the basic concept of the Logan plot in detail and introduce three algorithms for the Logan plot. By comparing these algorithms, we demonstrate the pitfalls of the Logan plot and discuss the solution.

  5. Can artificial parthenogenesis sidestep ethical pitfalls in human therapeutic cloning? An historical perspective

    Science.gov (United States)

    Fangerau, H

    2005-01-01

    The aim of regenerative medicine is to reconstruct tissue that has been lost or pathologically altered. Therapeutic cloning seems to offer a method of achieving this aim; however, the ethical debate surrounding human therapeutic cloning is highly controversial. Artificial parthenogenesis—obtaining embryos from unfertilised eggs—seems to offer a way to sidestep these ethical pitfalls. Jacques Loeb (1859–1924), the founding father of artificial parthogenesis, faced negative public opinion when he published his research in 1899. His research, the public's response to his findings, and his ethical foundations serve as an historical argument both for the communication of science and compromise in biological research. PMID:16319240

  6. Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Angoules, Antonios G; Givissis, Panagiotis

    2017-12-18

    Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

  7. MR spectroscopy in children: protocols and pitfalls in non-tumorous brain pathology

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Jacques F. [University Children' s Hospital Basel (UKBB), Basel (Switzerland)

    2016-06-15

    Proton nuclear magnetic resonance spectroscopy (MRS) delivers information about cell content and metabolism in a noninvasive manner. The diagnostic strength of MRS lies in its evaluation of pathologies in combination with conventional magnetic resonance imaging (MRI). MRS in children has been most widely used to evaluate brain conditions like tumors, infections, metabolic diseases or learning disabilities and especially in neonates with hypoxic-ischemic encephalopathy. This article reviews some basic theoretical considerations, routine procedures, protocols and pitfalls and will illustrate the range of spectrum alterations occurring in some non-tumorous pediatric brain pathologies. (orig.)

  8. History of Science as Interdisciplinary Education in American Colleges: Its Origins, Advantages, and Pitfalls

    Directory of Open Access Journals (Sweden)

    Paula Viterbo

    2007-01-01

    Full Text Available Before 1950, history of science did not exist as an independent academic branch, but was instead pursued by practitioners across various humanities and scientific disciplines. After professionalization, traces of its prehistory as a cross-disciplinary area of interest bound to an interdisciplinary, educational philosophy have remained. This essay outlines the development of history of science as an interdisciplinary academic field, and argues that it constitutes an obvious choice for inclusion in an interdisciplinary academic program, provided faculty and administrators learn how best to manage its advantages and pitfalls.

  9. MR spectroscopy in children: protocols and pitfalls in non-tumorous brain pathology

    International Nuclear Information System (INIS)

    Schneider, Jacques F.

    2016-01-01

    Proton nuclear magnetic resonance spectroscopy (MRS) delivers information about cell content and metabolism in a noninvasive manner. The diagnostic strength of MRS lies in its evaluation of pathologies in combination with conventional magnetic resonance imaging (MRI). MRS in children has been most widely used to evaluate brain conditions like tumors, infections, metabolic diseases or learning disabilities and especially in neonates with hypoxic-ischemic encephalopathy. This article reviews some basic theoretical considerations, routine procedures, protocols and pitfalls and will illustrate the range of spectrum alterations occurring in some non-tumorous pediatric brain pathologies. (orig.)

  10. [Spinal instrumentation, source of progress, but also revealing pitfalls].

    Science.gov (United States)

    Dubousset, Jean

    2003-01-01

    The second half of the XXo century and especially the last 30 years have been the source of a great improvement for surgical treatment of spinal pathology essentially in 3 directions:--First, for the patient himself and his comfort by suppression for most of the cases of any post operative external support thanks to the rigidity, security and strength of segmental fixation given by the hooks, screws and rods systems, as well for posterior as anterior instrumentation. In addition, these new techniques allow the patient to return quickly to standing and walking activity and subsequently the surgery for adult people increased dramatically especially for all kind of degenerative diseases and more and more extended spinal deformities.--The second major improvement came from the real and new understanding of the 3 dimensions for all the physiology and pathology of the spine leading to practical applications for the design and surgical strategies for correction. The exploding expansion of the era of computer technology brought a lot of help in such understanding as well as for the development of spinal instrumentation.--Finally the impressive development of medical imaging with CT scan and less and less invasive techniques like MRI allow a much better vision of spinal cord and roots (a major concern for the spinal surgeon). All this occurs also because simultaneous revolution occurred in the field of anesthesia and intensive care especially post operatively, but also because the big progress for monitoring of vital function as well as neurological monitoring during surgery. The consequence of that was an improvement for the results concerning the patient for functional quality of life as well as for cosmesis. The subsequent failures resulting of these improvements came from various fields even if we exclude infection or neurological complications more and more controlled now.--At the level of the indications because of these lack of post operative external immobilization

  11. What is an acceptable outcome of treatment before it begins? Methodological considerations and implications for patients with chronic low back pain

    DEFF Research Database (Denmark)

    Lauridsen, Henrik; Manniche, Claus; Korsholm, Lars

    2009-01-01

    (LBP) patients' view of an acceptable change (MCID(pre)) before treatment begins. One-hundred and forty-seven patients with chronic LBP were recruited from an out-patient hospital back pain unit and followed over an 8-week period. Original and modified versions of the Oswestry disability index (ODI...

  12. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment.

    Science.gov (United States)

    Talbot, Brett S; Gange, Christopher P; Chaturvedi, Apeksha; Klionsky, Nina; Hobbs, Susan K; Chaturvedi, Abhishek

    2017-01-01

    The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. © RSNA, 2017.

  13. Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Stephan Rosenkranz

    2015-12-01

    Full Text Available Right heart catheterisation (RHC plays a central role in identifying pulmonary hypertension (PH disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH. Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice.

  14. Cytokeratin positivity in myxopapillary ependymoma – a potential diagnostic pitfall

    Directory of Open Access Journals (Sweden)

    Sur Monalisa

    2008-10-01

    Full Text Available Abstract Background Myxopapillary ependymomas (MPE occur in the filum terminale of the spinal cord, but also present in extra-spinal locations such as subcutaneous tissue and brain. They are slow growing grade I gliomas. Areas of solid growth pattern with aggregates of cells with "epithelioid morphology" seen in MPE can mimic metastatic carcinoma. The presence of occasional cells with clear cytoplasm and morphology can resemble Chordoma. Diagnosis can be missed due to these morphological similarities, which could affect patient management and hence, long term survival. Case presentation We describe two cases of MPE with cytokeratin (AE1 AE3, CAM 5.2, Cytokeratin 7 and cytokeratin 20 expression. Conclusion MPE can be positive for Cytokeratins (CAM 5.2, AE1 AE3, CK7 and focally for EMA, which could be misdiagnosed as metastatic carcinoma. In cases demonstrating epithelioid and clear cell morphology, the diagnosis of MPE should be made in conjunction with histology, proper immunohistochemical profile which includes co-expression of GFAP, S-100 protein and epithelial markers, radiologic findings and site. It is important to be aware of the cytokeratin profile in MPE to avoid erroneous diagnosis with other tumour entities.

  15. Pitfalls in the detection of cholesterol in Huntington's disease models.

    Science.gov (United States)

    Marullo, Manuela; Valenza, Marta; Leoni, Valerio; Caccia, Claudio; Scarlatti, Chiara; De Mario, Agnese; Zuccato, Chiara; Di Donato, Stefano; Carafoli, Ernesto; Cattaneo, Elena

    2012-10-11

    Background Abnormalities in brain cholesterol homeostasis have been reported in Huntington's disease (HD), an adult-onset neurodegenerative disorder caused by an expansion in the number of CAG repeats in the huntingtin (HTT) gene. However, the results have been contradictory with respect to whether cholesterol levels increase or decrease in HD models. Biochemical and mass spectrometry methods show reduced levels of cholesterol precursors and cholesterol in HD cells and in the brains of several HD animal models. Abnormal brain cholesterol homeostasis was also inferred from studies in HD patients. In contrast, colorimetric and enzymatic methods indicate cholesterol accumulation in HD cells and tissues. Here we used several methods to investigate cholesterol levels in cultured cells in the presence or absence of mutant HTT protein. Results Colorimetric and enzymatic methods with low sensitivity gave variable results, whereas results from a sensitive analytical method, gas chromatography-mass spectrometry, were more reliable. Sample preparation, high cell density and cell clonality also influenced the detection of intracellular cholesterol. Conclusions Detection of cholesterol in HD samples by colorimetric and enzymatic assays should be supplemented by detection using more sensitive analytical methods. Care must be taken to prepare the sample appropriately. By evaluating lathosterol levels using isotopic dilution mass spectrometry, we confirmed reduced cholesterol biosynthesis in knock-in cells expressing the polyQ mutation in a constitutive or inducible manner. *Correspondence should be addressed to Elena Cattaneo: elena.cattaneo@unimi.it.

  16. Pitfalls in soft tissue sarcoma imaging: chronic expanding hematomas.

    Science.gov (United States)

    Jahed, Kiarash; Khazai, Behnaz; Umpierrez, Monica; Subhawong, Ty K; Singer, Adam D

    2018-01-01

    Solid or nodular enhancement is typical of soft tissue sarcomas although high grade soft tissue sarcomas and those with internal hemorrhage often appear heterogeneous with areas of nonenhancement and solid or nodular enhancement. These MRI findings often prompt an orthopedic oncology referral, a biopsy or surgery. However, not all masses with these imaging findings are malignant. We report the multimodality imaging findings of two surgically proven chronic expanding hematomas (CEH) with imaging features that mimicked sarcomas. A third case of nonenhancing CEH of the lower extremity is also presented as a comparison. It is important that in the correct clinical scenario with typical imaging findings, the differential diagnosis of a chronic expanding hematoma be included in the workup of these patients. An image-guided biopsy of nodular tissue within such masses that proves to be negative for malignancy should not necessarily be considered discordant. A correct diagnosis may prevent a morbid unnecessary surgery and may indicate the need for a conservative noninvasive follow-up with imaging.

  17. Exceptional know how? Possible pitfalls of routinising genetic services.

    Science.gov (United States)

    Schmitz, Dagmar

    2010-09-01

    Genetic testing practices are increasingly advancing clinical medicine. This process of 'routinisation of genetics' has been conceived as a medical and ethical problem mainly because of the assumption that non-geneticists might lack the necessary skills to provide these services. In particular, the relevant theoretical knowledge in clinical genetics is viewed as insufficient in general practitioners and physicians from other specialities. Empirical findings seem to indicate significant variations not only in theoretical but also in practical knowledge between geneticists and non-geneticists. Several fields of practical knowledge-regarding for example the focus of clinical action, the relevance of therapeutic action or the normative framework-can be identified that are or could be areas of conflict when the routinisation of genetic services proceeds. From an ethical point of view, these variations in know how and background are especially relevant whenever the respective genetic service is concerned with medical information of exceptional normative quality, such as, for example, in prenatal genetic screening and diagnosis of untreatable conditions. Here, the clinically acquired practical knowledge of the non-geneticist could be particularly misleading insofar as there is no relation to therapy and-in a narrow sense-no clinical utility to be assessed. Non-geneticists need a chance to acquire the relevant theoretical and practical knowledge in order to understand and fulfil their own duties in the respective situations in a way that secures the important rights at stake of their patients and clients.

  18. Opportunities and Pitfalls in the Definition of Data Validity.

    Science.gov (United States)

    Stausberg, Jürgen; Kuklik, Nils; Jöckel, Karl-Heinz

    2018-01-01

    Several dimensions of data quality are described in the literature. One overriding aspect is considered to be the extent to which data represent the truth which is captured by data validity. Unfortunately, a common terminology, well defined concepts, and approved measures are missing in regard to data validity. In particular, there is a need to discuss the gold standard as reference for the data at hand and respective measures. Ultimate gold standard would be the state of the patient which itself is subjected to human and personal interpretations. Usually, an often diverse form of source data is used as gold standard. Based on the concept of the measure, it might be inappropriate differentiating between present and absent while calculating precision and recall. Due to the complexity and uncertainty of many health care related issues, a more sophisticated comparison might be necessary in order to establish relevant and general figures of data quality. Unfortunately, a harmonization in this field is not visible. Further research is needed to establish validated standards to measure data quality.

  19. Diagnostic pitfalls in the assessment of congenital hypopituitarism.

    Science.gov (United States)

    Cavarzere, Paolo; Biban, Paolo; Gaudino, Rossella; Perlini, Silvia; Sartore, Lorenzo; Chini, Lorenza; Silvagni, Davide; Antoniazzi, Franco

    2014-12-01

    The diagnosis of congenital hypopituitarism is difficult and often delayed because its symptoms are nonspecific. To describe the different clinical presentations of children with congenital hypopituitarism to reduce the time for diagnosis and to begin a precocious and appropriate treatment. We analyzed a cohort of five children with congenital hypopituitarism, describing their clinical, biochemical and radiological characteristics from the birth to diagnosis. As first sign of the disease, all of five patients presented a neonatal hypoglycemia, associated in four cases with jaundice. In all these four cases, the clinicians hypothesized a metabolic disease delaying the diagnosis, which was performed in only two cases within the neonatal period. In the other three cases, the diagnosis was formulated at 2, 5 and 8 years of life because there was severe and precocious growth impairment. It is important to suspect congenital hypopituitarism in the presence of persistent neonatal hypoglycemia associated with jaundice and of a precocious and severe reduction of the growth velocity in childhood. In all these cases, it is necessary to undertake a hypothalamic-pituitary magnetic resonance imaging scan as soon as possible, and to start appropriate treatment.

  20. Genome-wide association studies in asthma: progress and pitfalls

    Directory of Open Access Journals (Sweden)

    March ME

    2015-01-01

    Full Text Available Michael E March,1 Patrick MA Sleiman,1,2 Hakon Hakonarson1,2 1Center for Applied Genomics, Children's Hospital of Philadelphia Research Institute, 2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Abstract: Genetic studies of asthma have revealed that there is considerable heritability to the phenotype. An extensive history of candidate-gene studies has identified a long list of genes associated with immune function that are potentially involved in asthma pathogenesis. However, many of the results of candidate-gene studies have failed to be replicated, leaving in question the true impact of the implicated biological pathways on asthma. With the advent of genome-wide association studies, geneticists are able to examine the association of hundreds of thousands of genetic markers with a phenotype, allowing the hypothesis-free identification of variants associated with disease. Many such studies examining asthma or related phenotypes have been published, and several themes have begun to emerge regarding the biological pathways underpinning asthma. The results of many genome-wide association studies have currently not been replicated, and the large sample sizes required for this experimental strategy invoke difficulties with sample stratification and phenotypic heterogeneity. Recently, large collaborative groups of researchers have formed consortia focused on asthma, with the goals of sharing material and data and standardizing diagnosis and experimental methods. Additionally, research has begun to focus on genetic variants that affect the response to asthma medications and on the biology that generates the heterogeneity in the asthma phenotype. As this work progresses, it will move asthma patients closer to more specific, personalized medicine. Keywords: asthma, genetics, GWAS, pharmacogenetics, biomarkers

  1. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls.

    Science.gov (United States)

    Legro, Richard S; Castracane, V Daniel; Kauffman, Robert P

    2004-02-01

    Approximately 50% to 70% of all women with polycystic ovary syndrome (PCOS) have some degree of insulin resistance, and this hormone insensitivity probably contributes to the hyperandrogenism that is responsible for the signs and symptoms of PCOS. Although uncertainty exists, early detection and treatment of insulin resistance in this population could ultimately reduce the incidence or severity of diabetes mellitus, dyslipidemia, hypertension, and cardiovascular disease. Even if that proves to be the case, there are still several problems with our current approach to insulin sensitivity assessment in PCOS, including the apparent lack of consensus on what defines PCOS and "normal" insulin sensitivity, ethnic and genetic variability, the presence of other factors contributing to insulin resistance such as obesity, stress, and aging, and concern about whether simplified models of insulin sensitivity have the precision to predict treatment needs, responses, and future morbidity. Although the hyperinsulinemic-euglycemic clamp technique is the gold standard for measuring insulin sensitivity, it is too expensive, time-consuming, and labor-intensive to be of practical use in an office setting. Homeostatic measurements (fasting glucose/insulin ratio or homeostatic model assessment [HOMA] value) and minimal model tests (particularly the oral glucose tolerance test [OGTT]) represent the easiest office-based assessments of insulin resistance in the PCOS patient. The OGTT is probably the best simple, office-based method to assess women with PCOS because it provides information about both insulin resistance and glucose intolerance. The diagnosis of glucose intolerance holds greater prognostic and treatment implications. All obese women with PCOS should be screened for the presence of insulin resistance by looking for other stigmata of the insulin resistance syndrome such as hypertension, dyslipidemia, central obesity, and glucose intolerance.

  2. Adult classical homocystinuria requiring parenteral nutrition: Pitfalls and management.

    Science.gov (United States)

    Tran, Christel; Bonafé, Luisa; Nuoffer, Jean-Marc; Rieger, Julie; Berger, Mette M

    2017-07-25

    Homocystinuria due to cystathionine beta synthase (CBS) deficiency presents with a wide clinical spectrum. Treatment by the enteral route aims at reducing homocysteine levels by using vitamin B6, possibly methionine-restricted diet, betaine and/or folate and vitamin B 12 supplementation. Currently no nutritional guidelines exist regarding parenteral nutrition (PN) under acute conditions. Exhaustive literature search was performed, in order to identify the relevant studies describing the pathogenesis and nutritional intervention of adult classical homocystinuria requiring PN. Description of an illustrative case of an adult female with CBS deficiency and intestinal perforation, who required total PN due to contraindication to enteral nutrition. Nutritional management of decompensated classical homocystinuria is complex and currently no recommendation exists regarding PN composition. Amino acid profile and monitoring of total homocysteine concentration are the main tools enabling a precise assessment of the severity of metabolic alterations. In case of contraindication to enteral nutrition, compounded PN will be required, as described in this paper, to ensure adequate low amounts of methionine and others essential amino acids and avoid potentially fatal toxic hypermethioninemia. By reviewing the literature and reporting successful nutritional management of a decompensated CBS deficiency using tailored PN with limited methionine intake and n-3 PUFA addition, we would like to underscore the fact that standard PN solutions are not adapted for CBS deficient critical ill patients: new solutions are required. High methionine levels (>800 μmol/L) being potentially neurotoxic, there is an urgent need to improve our knowledge of acute nutritional therapy. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  3. A tutorial review of functional connectivity analysis methods and their interpretational pitfalls

    Directory of Open Access Journals (Sweden)

    Andre M Bastos

    2016-01-01

    Full Text Available Oscillatory neuronal activity may provide a mechanism for dynamic network coordination. Rhythmic neuronal interactions can be quantified using multiple metrics, each with their own advantages and disadvantages. This tutorial will review and summarize current analysis methods used in the field of invasive and non-invasive electrophysiology to study the dynamic connections between neuronal populations. First, we review metrics for functional connectivity, including coherence, phase synchronization, phase-slope index, and Granger causality, with the specific aim to provide an intuition for how these metrics work, as well as their quantitative definition. Next, we highlight a number of interpretational caveats and common pitfalls that can arise when performing functional connectivity analysis, including the common reference problem, the signal to noise ratio problem, the volume conduction problem, the common input problem, and the trial sample size bias problem. These pitfalls will be illustrated by presenting a set of MATLAB-scripts, which can be executed by the reader to simulate each of these potential problems. We discuss of how these issues can be addressed using current methods.

  4. Methodological update in Medicina Intensiva.

    Science.gov (United States)

    García Garmendia, J L

    2018-04-01

    Research in the critically ill is complex by the heterogeneity of patients, the difficulties to achieve representative sample sizes and the number of variables simultaneously involved. However, the quantity and quality of records is high as well as the relevance of the variables used, such as survival. The methodological tools have evolved to offering new perspectives and analysis models that allow extracting relevant information from the data that accompanies the critically ill patient. The need for training in methodology and interpretation of results is an important challenge for the intensivists who wish to be updated on the research developments and clinical advances in Intensive Medicine. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  5. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies.

    Directory of Open Access Journals (Sweden)

    Anick Nater

    Full Text Available While several clinical prediction rules (CPRs of survival exist for patients with symptomatic spinal metastasis (SSM, these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL. We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs.Seven electronic databases were searched (1990-2015, without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor.Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret.The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.

  6. Scenario development methodologies

    International Nuclear Information System (INIS)

    Eng, T.; Hudson, J.; Stephansson, O.

    1994-11-01

    In the period 1981-1994, SKB has studied several methodologies to systematize and visualize all the features, events and processes (FEPs) that can influence a repository for radioactive waste in the future. All the work performed is based on the terminology and basic findings in the joint SKI/SKB work on scenario development presented in the SKB Technical Report 89-35. The methodologies studied are a) Event tree analysis, b) Influence diagrams and c) Rock Engineering Systems (RES) matrices. Each one of the methodologies is explained in this report as well as examples of applications. One chapter is devoted to a comparison between the two most promising methodologies, namely: Influence diagrams and the RES methodology. In conclusion a combination of parts of the Influence diagram and the RES methodology is likely to be a promising approach. 26 refs

  7. Reliability Centered Maintenance - Methodologies

    Science.gov (United States)

    Kammerer, Catherine C.

    2009-01-01

    Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

  8. Conducting research in a resource-constrained environment: avoiding the pitfalls

    Directory of Open Access Journals (Sweden)

    Janine I. Munsamy

    2014-03-01

    Full Text Available Practical challenges affected the conducting of a retrospective drug use evaluation (DUE on the rational use of tenofovir in a resourceconstrained South African Antiretroviral Treatment Programme. The primary outcome measure was the percentage of patient records compliant with DUE criteria using initiation prescriptions from March 2009 to February 2010. Health system challenges encountered included stringent institutional administrative procedures, lack of efficient communication channels, reliance on overburdened personnel and fear of audit. Forty percent (222 of 556 of patient records identified for inclusion in the study had to be excluded, mainly due to poor record keeping. Research budgetary constraints also limited data collection. This experience highlighted real, unforeseen challenges when conducting a retrospective study in a resource-constrained environment. A sound understanding of the environment and adequate preparation is recommended. The lessons learnt may prove valuable to both firsttime and experienced researchers in a resource-limited setting using a similar methodology.

  9. Sonography of the neonatal spine: part 1, Normal anatomy, imaging pitfalls, and variations that may simulate disorders.

    Science.gov (United States)

    Lowe, Lisa H; Johanek, Andrew J; Moore, Charlotte W

    2007-03-01

    Our objective is to discuss neonatal spine sonography with emphasis on imaging pitfalls and normal variants that may simulate disease and to distinguish them from true spinal disorders. Sonography of the neonatal spine is now accepted as a highly sensitive, readily available screening study that can be used to evaluate various anomalies of the lumbar spine in most infants younger than 4 months.

  10. A time-driven, activity-based costing methodology for determining the costs of red blood cell transfusion in patients with beta thalassaemia major.

    Science.gov (United States)

    Burns, K E; Haysom, H E; Higgins, A M; Waters, N; Tahiri, R; Rushford, K; Dunstan, T; Saxby, K; Kaplan, Z; Chunilal, S; McQuilten, Z K; Wood, E M

    2018-04-10

    To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre. Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end-organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies. We describe the bottom-up, time-driven, activity-based costing methodology used to develop process maps to provide a step-by-step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks. Thirty-one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses. Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings. © 2018 British Blood Transfusion Society.

  11. Do Not Hallow until You Are out of the Wood! Ultrasonographic Detection of CPP Crystal Deposits in Menisci: Facts and Pitfalls

    Directory of Open Access Journals (Sweden)

    Georgios Filippou

    2013-01-01

    Full Text Available Purpose. Ultrasonography (US has been demonstrated to be an important tool in the diagnosis of calcium pyrophosphate (CPP crystal deposition disease. The aim of our study was to individuate and describe possible pitfalls in US detection of such deposits in menisci. Patients and Methods. We enrolled all patients waiting to undergo knee replacement surgery due to osteoarthritis, for one-month period. Each patient underwent US examination of the knee, focusing on the menisci. After surgery, the menisci were examined by US, macroscopically and microscopically, using the microscopic analysis as the gold standard for CPP deposition. Results. 11 menisci of 6 patients have been studied. Ex vivo examination of menisci performed better in CPP identification than in vivo examination. The possible reasons of misinterpretation or misdiagnosis of the in vivo exam were identified and are extensively described in the paper. Also a new sign of CPP crystal deposits was found. Conclusions. This study permitted to highlight some difficulties in CPP crystal detection by US in menisci. Further studies are needed to define completely US CPP crystal aspect and to improve the sensibility and specificity of US in CPP deposition diagnosis.

  12. Morphologic mimickers of Cryptococcus occurring within inflammatory infiltrates in the setting of neutrophilic dermatitis: a series of three cases highlighting clinical dilemmas associated with a novel histopathologic pitfall.

    Science.gov (United States)

    Ko, Jennifer S; Fernandez, Anthony P; Anderson, Kyle A; Burdick, Laura M; Billings, Steven D; Procop, Gary W; McMahon, James T; Bergfeld, Wilma F; Piliang, Melissa P

    2013-01-01

    A neutrophil-predominant inflammatory infiltrate in a cutaneous biopsy can be associated with a broad spectrum of diseases. Here we describe three cases showing a neutrophil-predominant dermal infiltrate admixed with abundant acellular bodies surrounded by capsule-like vacuolated spaces, which strikingly mimicked Cryptococcus. Two cases occurred within the settings of underlying hematologic malignancies; the third case was associated with immune dysregulation. Two patients were acutely ill in the medical intensive care unit. Fungal work-up, including cultures and multiple stains were negative. Because of clinical deterioration in these patients, transmission electron microscopy was pursued to definitively rule out fungal infection. In both cases, characteristics most compatible with autolysing human cells, not Cryptococcus, were identified. Chemotherapy and high-dose steroids were given, but both patients eventually succumbed to their diseases. To the best of our knowledge, these represent the first reported cases of autolysing human cells mimicking Cryptococcus organisms within neutrophilic infiltrates. They highlight the therapeutic dilemmas arising with histopathologic mimics, as well as the importance of thorough investigation to distinguish mimickers from true infectious organisms. We believe recognition of this microscopic pitfall will be useful to dermatopathologists faced with similar findings in the future, and may prevent unnecessary delay of appropriate therapy in acutely ill patients. Copyright © 2012 John Wiley & Sons A/S.

  13. The clinical value and pitfalls of 18F-fluoroethylcholine PET/CT imaging in the diagnosis of prostate cancer

    International Nuclear Information System (INIS)

    Zhou Shuo; Lin Meifu; Chen Wenxin; Chen Guobao; Li Junxia

    2012-01-01

    Objective: To evaluate the clinical value of 18 F-fluoroethylcholine (FECH) PET/CT imaging in the diagnosis of prostate cancer and to investigate its physiological or non-cancerous uptake. Methods: The subjects consisted of 30 patients (age ranged from 56 to 83 years, mean age 61 years) with pathologically confirmed prostate cancer, in whom 18 F-FECH and 18 F-FDG PET/CT scans were undertaken from October 2009 to December 2011. The sensitivity and accuracy of the two tracers in detecting prostate cancer were compared.SUV max was obtained for quantitative analysis. χ 2 test and t test were used for statistic analysis. Results: Of the 30 patients, 41 lesions presented high uptake in prostate region. The sensitivity and accuracy for diagnosing prostate cancer with 18 F-FECH PET/CT were 87.9% (29/33) and 82.9%(34/41), respectively, while the sensitivity and accuracy with 18 F-FDG PET/CT were 36.4% (12/33) and 36.6% (15/41), respectively. There were significant differences in sensitivity and accuracy between the two methods (χ 2 =8.1 and 11.1, both P<0.05). Physiological uptake appeared in the liver, pancreas, spleen, salivary gland, and also, owing to renal excretion,in the urinary tract. The SUV max in liver and pancreas were 10.1 ± 1.6 and 6.1 ± 1.1, respectively. The SUV max was 6.0 ± 2.2 in prostate cancer, while it was 2.6 ± 1.3 in benign lesions (t=2.9, P<0.05). Other abnormalities that were not related to prostate cancer were detected in 10 patients. Of these 10 patients, there were 6 with inflammation, 1 with lymphoma, 1 with tuberculosis, 1 with lung cancer and 1 with germinoma in pineal body. Conclusions: 18 F-FECH PET/CT is promising for diagnosis of prostate cancer.Understanding the biodistribution and pitfalls of 18 F-FECH is very important for image interpretation. (authors)

  14. Introduction to LCA Methodology

    DEFF Research Database (Denmark)

    Hauschild, Michael Z.

    2018-01-01

    In order to offer the reader an overview of the LCA methodology in the preparation of the more detailed description of its different phases, a brief introduction is given to the methodological framework according to the ISO 14040 standard and the main elements of each of its phases. Emphasis...

  15. Methodologies, languages and tools

    International Nuclear Information System (INIS)

    Amako, Katsuya

    1994-01-01

    This is a summary of the open-quotes Methodologies, Languages and Toolsclose quotes session in the CHEP'94 conference. All the contributions to methodologies and languages are relevant to the object-oriented approach. Other topics presented are related to various software tools in the down-sized computing environment

  16. Archetype modeling methodology.

    Science.gov (United States)

    Moner, David; Maldonado, José Alberto; Robles, Montserrat

    2018-03-01

    Clinical Information Models (CIMs) expressed as archetypes play an essential role in the design and development of current Electronic Health Record (EHR) information structures. Although there exist many experiences about using archetypes in the literature, a comprehensive and formal methodology for archetype modeling does not exist. Having a modeling methodology is essential to develop quality archetypes, in order to guide the development of EHR systems and to allow the semantic interoperability of health data. In this work, an archetype modeling methodology is proposed. This paper describes its phases, the inputs and outputs of each phase, and the involved participants and tools. It also includes the description of the possible strategies to organize the modeling process. The proposed methodology is inspired by existing best practices of CIMs, software and ontology development. The methodology has been applied and evaluated in regional and national EHR projects. The application of the methodology provided useful feedback and improvements, and confirmed its advantages. The conclusion of this work is that having a formal methodology for archetype development facilitates the definition and adoption of interoperable archetypes, improves their quality, and facilitates their reuse among different information systems and EHR projects. Moreover, the proposed methodology can be also a reference for CIMs development using any other formalism. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Menopause and Methodological Doubt

    Science.gov (United States)

    Spence, Sheila

    2005-01-01

    Menopause and methodological doubt begins by making a tongue-in-cheek comparison between Descartes' methodological doubt and the self-doubt that can arise around menopause. A hermeneutic approach is taken in which Cartesian dualism and its implications for the way women are viewed in society are examined, both through the experiences of women…

  18. VEM: Virtual Enterprise Methodology

    DEFF Research Database (Denmark)

    Tølle, Martin; Vesterager, Johan

    2003-01-01

    This chapter presents a virtual enterprise methodology (VEM) that outlines activities to consider when setting up and managing virtual enterprises (VEs). As a methodology the VEM helps companies to ask the right questions when preparing for and setting up an enterprise network, which works...

  19. Data Centric Development Methodology

    Science.gov (United States)

    Khoury, Fadi E.

    2012-01-01

    Data centric applications, an important effort of software development in large organizations, have been mostly adopting a software methodology, such as a waterfall or Rational Unified Process, as the framework for its development. These methodologies could work on structural, procedural, or object oriented based applications, but fails to capture…

  20. The Methodology of Magpies

    Science.gov (United States)

    Carter, Susan

    2014-01-01

    Arts/Humanities researchers frequently do not explain methodology overtly; instead, they "perform" it through their use of language, textual and historic cross-reference, and theory. Here, methodologies from literary studies are shown to add to Higher Education (HE) an exegetical and critically pluralist approach. This includes…

  1. Computer Simulation: A Methodology to Improve the Efficiency in the Brooke Army Medical Center Family Care Clinic (A Patient Wait Case Study)

    National Research Council Canada - National Science Library

    Merkie, John

    2000-01-01

    .... The purpose of this study was to describe the current system and to evaluate the potential impact of process/resource changes in patient wait times, access and resource utilization at the BAMC Family Care Clinic (FCC...

  2. Assessing HIV and AIDS treatment safety and health-related quality of life among cohort of Malaysian patients: a discussion on methodological approach.

    Science.gov (United States)

    Syed, Imran Ahmed; Syed Sulaiman, Syed Azhar; Hassali, Mohammad Azmi; Lee, Christopher K C

    2015-10-01

    Health-related quality of life (HRQoL) is increasingly recognized as an important outcome and as a complement to traditional biological end points of diseases such as mortality. Unless there is a complete cure available for HIV/AIDS, development and implementation of a reliable and valid cross cultural quality of life measure is necessary to assess not only the physical and medical needs of HIV/AIDS people, but their psychological, social, environmental, and spiritual areas of life. A qualitative exploration of HIV/AIDS patients' understanding, perceptions and expectations will be carried out with the help of semi structured interview guide by in depth interviews, while quantitative assessment of patient reported adverse drug reactions and their impact on health related quality of life will be carried out by using data collection tool comprising patient demographics, SF-12, Naranjo scale, and a clinical data sheet. The findings may serve as baseline QOL data of people living with HIV/AIDS in Malaysia and also a source data to aid construction of management plan to improve HIV/AIDS patients' QOL. It will also provide basic information about HIV/AIDS patients' perceptions, expectations and believes towards HIV/AIDS and its treatment which may help in designing strategies to enhance patients' awareness which in turn can help in addressing issues related to compliance and adherence. © 2013 John Wiley & Sons Ltd.

  3. Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions.

    Science.gov (United States)

    Keefe, Francis J; Main, Chris J; George, Steven Z

    2018-05-01

    There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.

  4. [Biomarkers in emergency medicine and critical care patients: advances and pitfalls for news tools].

    Science.gov (United States)

    Claessens, Yann-Erick; Mallet-Coste, Thomas; Riqué, Thomas; Macchi, Marc-Alexis; Ray, Patrick; Chenevier-Gobeaux, Camille

    2014-01-01

    The use of biomarkers has changed approach of diagnosis and treatment procedures in emergency medicine, especially in the field of cardiovascular disorders. Effectiveness of new strategies that integrate biomarkers has precluded development and research in novel tools that may improve safety and efficiency at bedside. This mini-review presents current knowledge on utility of biomarkers in emergency medicine, including data that should be taken into account to avoid misleading utilization. Copyright © 2013. Published by Elsevier Masson SAS.

  5. Genetic testing for patients with renal disease: procedures, pitfalls, and ethical considerations.

    Science.gov (United States)

    Korf, B R

    1999-07-01

    The Human Genome Project is rapidly producing insights into the molecular basis of human genetic disorders. The most immediate clinical benefit is the advent of new diagnostic methods. Molecular diagnostic tools are available for several genetic renal disorders and are in development for many more. Two general approaches to molecular diagnosis are linkage-based testing and direct mutation detection. The former is used when the gene has not been cloned but has been mapped in relation to polymorphic loci. Linkage-based testing is also helpful when a large diversity of mutations makes direct detection difficult. Limitations include the need to study multiple family members, the need for informative polymorphisms, and genetic heterogeneity. Direct mutation detection is limited by genetic heterogeneity and the need to distinguish nonpathogenic allelic variants from pathogenic mutations. Molecular testing raises a number of complex ethical issues, including those associated with prenatal or presymptomatic diagnosis. In addition, there are concerns about informed consent, privacy, genetic discrimination, and technology transfer for newly developed tests. Health professionals need to be aware of the technical and ethical implications of these new methods of testing, as well as the complexities in test interpretation, as molecular approaches are increasingly integrated into medical practice.

  6. Reporting the methodology of height and weight acquisition in studies of body mass index-based prognosis in critically ill patients.

    Science.gov (United States)

    Oud, Lavi

    2013-10-01

    Conflicting findings were reported on the body mass index (BMI)-based prognosis of critically patients. Errors in source weight and height data can confound BMI group allocation. The aim of the present work was to examine investigators' reporting on the methods of height and weight acquisition (HWA). PubMed and Embase databases were searched for studies describing BMI group-based risk of death in critically ill patients. Eligible studies were examined for reporting on (1) the use of measured and/or estimated HWA, (2) details of measuring devices, (3) device accuracy, and (4) methods of adjustment for acute and chronic fluid-related weight changes. Thirty studies met the eligibility criteria, including 159,565 patients. No data were provided in 13 studies (52% of reported patients) on whether estimates or measurements were used for HWA. Measured HWA was used exclusively in 6 studies (3% of patients), and an unspecified combination of estimated and/or measured HWA was reported for the remainder. Only 1 study reported the specific devices used. None of the studies provided data on the bias and precision of measuring devices. Adjustment for chronic and/or acute fluid-related weight changes was addressed in 2 studies for each. These findings demonstrate the prevalent risk for BMI group misallocation in the reviewed studies, which may confound BMI-based prognosis, raising concerns about the validity of reported BMI-related prognostic impact. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Methodology for calibration of detector of Nal (TI) 3 'X 3' for measurements in vivo of patients with hyperthyroidism undergoing radioiodine therapy

    International Nuclear Information System (INIS)

    Carvalho, Carlaine B.; Lacerda, Isabelle V.B.; Oliveira, Mercia L.; Hazin, Clovis A.; Lima, Fabiana F.

    2013-01-01

    The aim of this study is to establish the methodology for calibration of the detection system to be used in determining the therapeutic activity of 131 I required to release the desired absorbed dose in the thyroid. This step is critical to the development of a protocol for individualized doses. The system consists of a detector of NaI (Tl ) 3 'x3' coupled to Genie 2000 software. The calibration sources of 60 CO, 137 Cs and 133 Ba were used. Obtained straight calibration system, with 60 CO and 137 Cs sources. Subsequently, the detector was calibrated using a simulator -neck thyroid designed and produced by the IRD/CNEN with known standard solution containing 18.7 kBq 133 Ba activity (in 12/09/24) evenly distributed. He was also calibrated with other thyroid - neck phantom Model 3108 manufactured by Searle Radigraphics Ind., containing a net source of 131 I ( 7.7 MBq ). Five measurements of five minutes were realized for three different distances detector simulator, and the respective calculated calibration factors was performed to three. The values of the calibration factors found for the simulator manufactured by IRD and the Searle Radigraphics Ind. for the distances 20 , 25 and 30cm were 0.35, 0.24, 0.18, and 0.15, 0.11, 0.09, respectively. With the detection system properly calibrated and the calibration factors established, the technique is suitable for the evaluation of diagnostic activity of 131 I incorporated by hyperthyroidism

  8. A novel methodology for energy performance benchmarking of buildings by means of Linear Mixed Effect Model: The case of space and DHW heating of out-patient Healthcare Centres

    International Nuclear Information System (INIS)

    Capozzoli, Alfonso; Piscitelli, Marco Savino; Neri, Francesco; Grassi, Daniele; Serale, Gianluca

    2016-01-01

    Highlights: • 100 Healthcare Centres were analyzed to assess energy consumption reference values. • A novel robust methodology for energy benchmarking process was proposed. • A Linear Mixed Effect estimation Model was used to treat heterogeneous datasets. • A nondeterministic approach was adopted to consider the uncertainty in the process. • The methodology was developed to be upgradable and generalizable to other datasets. - Abstract: The current EU energy efficiency directive 2012/27/EU defines the existing building stocks as one of the most promising potential sector for achieving energy saving. Robust methodologies aimed to quantify the potential reduction of energy consumption for large building stocks need to be developed. To this purpose, a benchmarking analysis is necessary in order to support public planners in determining how well a building is performing, in setting credible targets for improving performance or in detecting abnormal energy consumption. In the present work, a novel methodology is proposed to perform a benchmarking analysis particularly suitable for heterogeneous samples of buildings. The methodology is based on the estimation of a statistical model for energy consumption – the Linear Mixed Effects Model –, so as to account for both the fixed effects shared by all individuals within a dataset and the random effects related to particular groups/classes of individuals in the population. The groups of individuals within the population have been classified by resorting to a supervised learning technique. Under this backdrop, a Monte Carlo simulation is worked out to compute the frequency distribution of annual energy consumption and identify a reference value for each group/class of buildings. The benchmarking analysis was tested for a case study of 100 out-patient Healthcare Centres in Northern Italy, finally resulting in 12 different frequency distributions for space and Domestic Hot Water heating energy consumption, one for

  9. Regressive research: The pitfalls of post hoc data selection in the study of unconscious mental processes.

    Science.gov (United States)

    Shanks, David R

    2017-06-01

    Many studies of unconscious processing involve comparing a performance measure (e.g., some assessment of perception or memory) with an awareness measure (such as a verbal report or a forced-choice response) taken either concurrently or separately. Unconscious processing is inferred when above-chance performance is combined with null awareness. Often, however, aggregate awareness is better than chance, and data analysis therefore employs a form of extreme group analysis focusing post hoc on participants, trials, or items where awareness is absent or at chance. The pitfalls of this analytic approach are described with particular reference to recent research on implicit learning and subliminal perception. Because of regression to the mean, the approach can mislead researchers into erroneous conclusions concerning unconscious influences on behavior. Recommendations are made about future use of post hoc selection in research on unconscious cognition.

  10. Is NF-kappaB a good target for cancer therapy? Hopes and pitfalls.

    Science.gov (United States)

    Baud, Véronique; Karin, Michael

    2009-01-01

    Nuclear factor kappaB (NF-kappaB) transcription factors have a key role in many physiological processes such as innate and adaptive immune responses, cell proliferation, cell death, and inflammation. It has become clear that aberrant regulation of NF-kappaB and the signalling pathways that control its activity are involved in cancer development and progression, as well as in resistance to chemotherapy and radiotherapy. This article discusses recent evidence from cancer genetics and cancer genome studies that support the involvement of NF-kappaB in human cancer, particularly in multiple myeloma. The therapeutic potential and benefit of targeting NF-kappaB in cancer, and the possible complications and pitfalls of such an approach, are explored.

  11. Processing of uranyl nitrate hexahydrate (UNH) at DOE's Fernald Site: Success and pitfalls

    International Nuclear Information System (INIS)

    Luken, D.W.; Brettschneider, D.J.; Heck, R.P. III; White, C.A.

    1996-01-01

    After 36 years of operation, uranium production at the Department of Energy Fernald Environmental Management Project (FEMP) was halted in 1989. Uranyl Nitrate Hexahydrate (UNH) had been produced during the uranium refining. In June 1991, DOE determined the UNH to be a mixed hazardous waste under the Resource Conservation and Recovery Act. A UNH Neutralization Project began processing UNH stored in stainless steel tanks located in various areas within the Fernald Plant 2/3 Complex. It was discovered that the valves, flanges, and other fittings of the UNH storage tanks were leaking. This made processing the UNH a high priority and Comprehensive, Environmental, Response, Compensation, and Liability Act Removal Action No. 20, Stabilization of UNH Inventories, was initiated. This report presents the successes and pitfalls of the cleanup of UNH

  12. Possible pitfalls in the search for uranium deposits using lake sediments and lake waters

    International Nuclear Information System (INIS)

    Levinson, A.A.; Bland, C.J.

    1978-01-01

    The organic-rich sediments from the centres of Canadian lakes are a valuable sampling medium in the search for uranium. However, because of the young age of hydromorphically transported uranium in these sediments, which must post-date the last period of glaciation, there has been insufficient time for the isotope 214 Bi to reach equilibrium with its ancestor 238 U. This results in equivalent uranium (eU) values significantly lower than actual uranium values determined by fluorometry or delayed neutron activation analysis. Radiometric ( 226 Ra) analyses of 12 centre-lake sediments from Seahorse Lake, Saskatchewan illustrate the potential pitfalls which may be encountered using gamma-ray spectrometry, as only 3-8% of the actual uranium present in most of the samples would have been detected. (author)

  13. THE PITFALLS OF THE BLUE OCEAN STRATEGY IMPLICATIONS OF “THE SIX PATHS FRAMEWORK”

    DEFF Research Database (Denmark)

    Lindgren, Peter; Saghaug, Kristin Margrethe; Clemmensen, Suberia

    The Blue Ocean Strategy (Kim & Mauborgne 2005) has been one of the most important analytical techniques related to the area of innovation and new business model (BM) innovation since 2005. Today many consultancies and managers responsible for innovation use the Blue Ocean framework as one...... of their top 5 innovation tools. Addressing the Blue Ocean framework’s tools, this paper will accentuate the importance of using the Six Paths framework carefully when generating new business models. It is important to understand The Six Paths frame work’s foundation – value. This paper address the questions......: What does it mean to innovate values related to the Six Paths framework? and What are the implications, challenges and pitfalls of the Blue Ocean Strategy’s Six Paths frame work – related to exploring and developing the values inherent in the company, when pursuing to create a new market?...

  14. Private Protected Areas as policy instruments to tackle environmental challenges: discussing potentialities and pitfalls

    Directory of Open Access Journals (Sweden)

    Giulia Iannuzzi

    2016-12-01

    Full Text Available Protected Areas owned and managed by private actors are expected to have a relevant role in nature conservation policy as an additional tool to public-run protected sites. By reducing natural habitats destruction and degradation, well designed and well governed private protected areas (PPAs can have a key role in tackling two intertwined global threats: biodiversity loss and climate change. In this article we will present PPAs diffusion in Europe basing on data collected from the European Common Database on Nationally Designated Areas. In addition, an assessment framework will be proposed, with the purpose of contributing to a broader understanding of PPAs potentialities and pitfalls. The main challenges for PPAs effectiveness deal with their geographical distribution and their ability to provide strong and stable legal structures for private protection, assuring adequate and inclusive governance.

  15. Promises and Pitfalls of Computer-Supported Mindfulness: Exploring a Situated Mobile Approach

    Directory of Open Access Journals (Sweden)

    Ralph Vacca

    2017-12-01

    Full Text Available Computer-supported mindfulness (CSM is a burgeoning area filled with varied approaches such as mobile apps and EEG headbands. However, many of the approaches focus on providing meditation guidance. The ubiquity of mobile devices may provide new opportunities to support mindfulness practices that are more situated in everyday life. In this paper, a new situated mindfulness approach is explored through a specific mobile app design. Through an experimental design, the approach is compared to traditional audio-based mindfulness meditation, and a mind wandering control, over a one-week period. The study demonstrates the viability for a situated mobile mindfulness approach to induce mindfulness states. However, phenomenological aspects of the situated mobile approach suggest both promises and pitfalls for computer-supported mindfulness using a situated approach.

  16. Genetic Contributions to Clinical Pain and Analgesia: Avoiding Pitfalls in Genetic Research

    Science.gov (United States)

    Kim, Hyungsuk; Clark, David; Dionne, Raymond A.

    2010-01-01

    Understanding the genetic basis of human variations in pain is critical to elucidating the molecular basis of pain sensitivity, variable responses to analgesic drugs, and, ultimately, to individualized treatment of pain and improved public health. With the help of recently accumulated knowledge and advanced technologies, pain researchers hope to gain insight into genetic mechanisms of pain and eventually apply this knowledge to pain treatment. Perspective We critically reviewed the published literature to examine the strength of evidence supporting genetic influences on clinical and human experimental pain. Based on this evidence and the experience of false associations that have occurred in other related disciplines, we provide recommendations for avoiding pitfalls in pain genetic research. PMID:19559388

  17. Acquisition and analysis of cardiovascular signals on smartphones: potential, pitfalls and perspectives: by the Task Force of the e-Cardiology Working Group of European Society of Cardiology.

    Science.gov (United States)

    Bruining, Nico; Caiani, Enrico; Chronaki, Catherine; Guzik, Przemyslaw; van der Velde, Enno

    2014-11-01

    Smartphones, mobile applications ('apps'), social media, analytics, and the cloud are profoundly changing the practice of medicine and the way health decisions are made. With the constant progress of technology, the measurement of vital signals becomes easier, cheaper, and practically a standard approach in clinical practice. The interest in measuring vital signals goes beyond medical professionals to the general public, patients, informal caregivers, and healthy individuals, who frequently lack any formal medical training. On smartphone platforms such as iOS and Android, a proliferation of health or medical 'apps' acquire and analyse a variety of vital signs through embedded sensors, interconnected devices or peripherals utilising on occasion analytics and social media. Smartphone vendors compete with traditional medical device manufacturers in the grey area between health care, wellness, and fitness, as US and EU regulatory bodies are setting and revising rules for these new technologies. On the other hand, in the absence of robust validation results, clinicians are hesitant to trust measurements by apps or recommend specific apps to their patients, partly also due to lack of a cost reimbursement policy. This review focuses on the acquisition and analysis on smartphones of three important vital signs in the cardiovascular and respiratory field as well as in rehabilitation i.e. heart or pulse rate, blood pressure, and blood oxygenation. The potential, pitfalls, and perspectives on mobile devices and smartphone apps for health management by patients and healthy individuals are discussed. © Authors 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. Secreted pitfall-trap fluid of carnivorous Nepenthes plants is unsuitable for microbial growth.

    Science.gov (United States)

    Buch, Franziska; Rott, Matthias; Rottloff, Sandy; Paetz, Christian; Hilke, Ines; Raessler, Michael; Mithöfer, Axel

    2013-03-01

    Carnivorous plants of the genus Nepenthes possess modified leaves that form pitfall traps in order to capture prey, mainly arthropods, to make additional nutrients available for the plant. These pitchers contain a digestive fluid due to the presence of hydrolytic enzymes. In this study, the composition of the digestive fluid was further analysed with regard to mineral nutrients and low molecular-weight compounds. A potential contribution of microbes to the composition of pitcher fluid was investigated. Fluids from closed pitchers were harvested and analysed for mineral nutrients using analytical techniques based on ion-chromatography and inductively coupled plasma-optical emission spectroscopy. Secondary metabolites were identified by a combination of LC-MS and NMR. The presence of bacteria in the pitcher fluid was investigated by PCR of 16S-rRNA genes. Growth analyses of bacteria and yeast were performed in vitro with harvested pitcher fluid and in vivo within pitchers with injected microbes. The pitcher fluid from closed pitchers was found to be primarily an approx. 25-mm KCl solution, which is free of bacteria and unsuitable for microbial growth probably due to the lack of essential mineral nutrients such as phosphate and inorganic nitrogen. The fluid also contained antimicrobial naphthoquinones, plumbagin and 7-methyl-juglone, and defensive proteins such as the thaumatin-like protein. Challenging with bacteria or yeast caused bactericide as well as fungistatic properties in the fluid. Our results reveal that Nepenthes pitcher fluids represent a dynamic system that is able to react to the presence of microbes. The secreted liquid of closed and freshly opened Nepenthes pitchers is exclusively plant-derived. It is unsuitable to serve as an environment for microbial growth. Thus, Nepenthes plants can avoid and control, at least to some extent, the microbial colonization of their pitfall traps and, thereby, reduce the need to vie with microbes for the prey

  19. Overcoming pitfalls: Results from a mandatory peer review process for written examinations.

    Science.gov (United States)

    Wilby, Kyle John; El Hajj, Maguy S; El-Bashir, Marwa; Mraiche, Fatima

    2018-04-01

    Written assessments are essential components of higher education practices. However, faculty members encounter common pitfalls when designing questions intended to evaluate student-learning outcomes. The objective of this project was to determine the impact of a mandatory examination peer review process on question accuracy, alignment with learning objectives, use of best practices in question design, and language/grammar. A mandatory peer review process was implemented for all midterm (before phase) and final (after phase) examinations. Peer review occurred by two reviewers and followed a pre-defined guidance document. Non-punitive feedback given to faculty members served as the intervention. Frequencies of flagged questions according to guidance categories were compared between phases. A total of 21 midterm and 21 final exam reviews were included in the analysis. A total of 637 questions were reviewed across all midterms and 1003 questions were reviewed across all finals. Few questions were flagged for accuracy and alignment with learning outcomes. The median total proportion of questions flagged for best practices was significantly lower for final exams versus midterm exams (15.8 vs. 6.45%, p = 0.014). The intervention did not influence language and grammar errors (9.68 vs. 10.0% of questions flagged before and after, respectively, p = 0.305). A non-punitive peer review process for written examinations can overcome pitfalls in exam creation and improve best practices in question writing. The peer-review process had a substantial effect at flagging language/grammar errors but error rate did not differ between midterm and final exams. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Postural instability in subjects with parkinson’s disease undergoing different sensory pitfalls

    Directory of Open Access Journals (Sweden)

    Silva Thaís Cardoso Da

    2017-12-01

    Full Text Available Purpose. Previous research has reported postural instability in subjects with Parkinson’s disease (PD. However, there are still doubts about the effect of sensory stimuli on one’s balance. In this study, we further investigated the stabilometric measures of individuals with PD, analysing the impact of different sensory stimuli on the outcomes. Methods. The total of 26 participants (13 with PD and 13 matched control peers were submitted to 8 sensorimotor dynamics differing in relation to support base (30 cm vs. 10 cm, feet in parallel vs. feet in semi-tandem position, contact surface (foam vs. no foam, and visual conditions (eyes open vs. eyes closed. The measures used to assess one’s balance were body position in space, area of support base, and velocity of postural control. The variables involved the anterior-posterior and the mediolateral axes. Participants with PD were evaluated during the off medication state. Mann-Whitney U test and Friedman’s test were applied to carry out inter- and intra-group comparisons. Significance was set at 5%. Results. Cross-sectional analyses illustrated that tasks with sensory pitfalls impacted postural stability to a larger extent in PD subjects. The differences were found in anterior-posterior body position, area of support base, anterior-posterior velocity, and mediolateral velocity. Complementary analyses confirmed considerable instability on balance when support bases were small and visual information was absent (p < 0.05. Conclusions. The current results confirm worse postural stability response in subjects with PD and highlight that the interference of the sensory pitfalls is notable when individuals are off medication.

  1. Paleomagnetism Onboard the IODP Research Vessel JOIDES Resolution: Recent Advances, Best Practices, and Pitfalls

    Science.gov (United States)

    Acton, G. D.; Morris, A.; Musgrave, R. J.; Zhao, X., , prof; Clement, B. M.; Evans, H. F.; Hastedt, M.; Houpt, D.; Mills, B.; Novak, B.; Petronotis, K. E.

    2017-12-01

    One of the largest openly available paleomagnetism databases is derived from paleomagnetic data acquired continuously along drill cores collected by the International Ocean Discovery Program (IODP) and its predecessors. The bulk of data are magnetic remanences measured using superconducting rock magnetometers (SRMs) with automated track systems and in-line alternating field (AF) demagnetization units produced by 2G Enterprises. Our goal in this study is to (1) report on the new SRM that was installed onboard the JOIDES Resolution in December 2016 prior to the start of IODP Expedition 366, (2) consider best practices that may aid shipboard scientists in collecting high quality data, and (3) discuss common pitfalls associated with using an SRM in the shipboard environment to measure a diverse range of lithologies collected in metal core barrels that pass through a relatively strongly magnetized drill string. From a series of tests conducted on the new SRM during a June 11-13, 2017 port call, our main conclusion was that the new magnetometer is functioning as designed. While overall its capabilities are comparable to the previous magnetometer, the new SRM does have several significant advances, including better flux counting, which allows more strongly magnetized rocks to be measured accurately. It also performs AF demagnetizations at high fields (up to 80 mT) without imparting spurious anhysteretic magnetizations, which was a common problem in the old SRM. A worrisome observation, and one that has been made in many shore-based labs, is that devices that emit radio-frequency electromagnetic waves, like actively transmitting cell phones, interfere significantly with SRM measurements. This pitfall will likely have to be addressed on all forthcoming cruises unless better electromagnetic shielding for the SQUID sensors can be found.

  2. Improving outcomes for hospital patients with critical bleeding requiring massive transfusion: the Australian and New Zealand Massive Transfusion Registry study methodology.

    Science.gov (United States)

    Oldroyd, J C; Venardos, K M; Aoki, N J; Zatta, A J; McQuilten, Z K; Phillips, L E; Andrianopoulos, N; Cooper, D J; Cameron, P A; Isbister, J P; Wood, E M

    2016-10-06

    The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines. The MTR commenced in 2011. At each participating site, all eligible patients aged ≥18 years with CB from any clinical context receiving MT are included using a waived consent model. Patient information and clinical coding, transfusion history, and laboratory test results are extracted for each patient's hospital admission at the episode level. Thirty-two hospitals have enrolled and 3566 MT patients have been identified across Australia and New Zealand between 2011 and 2015. The majority of CB contexts are surgical, followed by trauma and gastrointestinal haemorrhage. Validation studies have verified that the definition of MT used in the registry correctly identifies 94 % of CB events, and that the median time of transfusion for the majority of fresh products is the 'product event issue time' from the hospital blood bank plus 20 min. Data linkage between the MTR and mortality databases in Australia and New Zealand will allow comparisons of risk-adjusted mortality estimates across different bleeding contexts, and between countries. Data extracts will be examined to determine if there are differences in patient outcomes according to transfusion practice. The ratios of blood components (e.g. FFP:RBC) used in different types of critical bleeding will also

  3. Sjögren SER: National registry of the Spanish Society of Rheumatology of patients with primary Sjögren syndrome: Objectives and methodology.

    Science.gov (United States)

    Fernández Castro, Mónica; Andreu, Jose Luis; Sánchez-Piedra, Carlos; Martínez Taboada, Víctor; Olivé, Alejandro; Rosas, José; Sánchez-Alonso, Fernando

    2016-01-01

    To describe the objectives and methods of the Spanish Society of Rheumatology primary Sjögren syndrome (pSS) registry (SJOGREN-SER) METHODS: This is a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American consensus criteria collected from Rheumatology clinics all over Spain. Patients were included by randomisation from an anonymised list provided by every department. Data were collected by reviewing clinical records and an interviewing the patients. Two hundred and ninety eight variables were investigated: epidemiological, clinical, serological characteristics, treatments and complications. Informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75). A total of 3 rheumatology departments participated in the registry. A total of 437 patients were included. And 95% of them were women, with a median age of 58. Median age at pSS 's diagnosis was 50 years. Dryness symptoms (95%) were the most frequent complaint and anti-Ro/SS-A were present in 94% of the cases. Only 27% of the patients fulfilled the new 2012 SICCA-ACR classification criteria. SJOGREN-SER has been designed in order to characterize a representative pSS Spanish cohort, in clinical daily practice, to analyze the magnitude and distribution of its manifestations, activity, accumulated damage and therapeutic management of the disease. This will allow broadening the knowledge of this disease and plan strategies of action in pSS. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  4. Induced pluripotent stem cells for the treatment of stroke: the potential and the pitfalls.

    Science.gov (United States)

    Yu, Fenggang; Li, Yingying; Morshead, Cindi M

    2013-09-01

    The extraordinary discovery of induced pluripotent stem cells (iPSCs) has led to the very real possibility that patient-specific cell therapy can be realized. The potential to develop cell replacement therapies outside the ethical and legal limitations, has initiated a new era of hope for regenerative strategies to treat human neurological disease including stroke. In this article, we will review and compare the current approaches to derive iPSCs from different somatic cells, and the induction into neuronal phenotypes, considering the advantages and disadvantages to the methodologies of derivation. We will highlight the work relating to the use of iPSC-based therapies in models of stroke and their potential use in clinical trials. Finally, we will consider future directions and areas of exploration which may promote the realization of iPSC-based cell replacement strategies for the treatment of stroke.

  5. Design Methodology - Design Synthesis

    DEFF Research Database (Denmark)

    Andreasen, Mogens Myrup

    2003-01-01

    Design Methodology is part of our practice and our knowledge about designing, and it has been strongly supported by the establishing and work of a design research community. The aim of this article is to broaden the reader¿s view of designing and Design Methodology. This is done by sketching...... the development of Design Methodology through time and sketching some important approaches and methods. The development is mainly forced by changing industrial condition, by the growth of IT support for designing, but also by the growth of insight into designing created by design researchers.......ABSTRACT Design Methodology shall be seen as our understanding of how to design; it is an early (emerging late 60ies) and original articulation of teachable and learnable methodics. The insight is based upon two sources: the nature of the designed artefacts and the nature of human designing. Today...

  6. GPS system simulation methodology

    Science.gov (United States)

    Ewing, Thomas F.

    1993-01-01

    The following topics are presented: background; Global Positioning System (GPS) methodology overview; the graphical user interface (GUI); current models; application to space nuclear power/propulsion; and interfacing requirements. The discussion is presented in vugraph form.

  7. Hazard classification methodology

    International Nuclear Information System (INIS)

    Brereton, S.J.

    1996-01-01

    This document outlines the hazard classification methodology used to determine the hazard classification of the NIF LTAB, OAB, and the support facilities on the basis of radionuclides and chemicals. The hazard classification determines the safety analysis requirements for a facility

  8. Nonlinear Image Denoising Methodologies

    National Research Council Canada - National Science Library

    Yufang, Bao

    2002-01-01

    In this thesis, we propose a theoretical as well as practical framework to combine geometric prior information to a statistical/probabilistic methodology in the investigation of a denoising problem...

  9. Clinical trial methodology

    National Research Council Canada - National Science Library

    Peace, Karl E; Chen, Ding-Geng

    2011-01-01

    "Now viewed as its own scientific discipline, clinical trial methodology encompasses the methods required for the protection of participants in a clinical trial and the methods necessary to provide...

  10. CASES ON GLOBAL E-LEARNING PRACTICES:Successes and Pitfalls

    Directory of Open Access Journals (Sweden)

    Reviewed by Yavuz AKBULUT

    2007-10-01

    students from Namibian teacher education programs and students from New Jersey. The aim is mentioned as giving all students a chance to interact with peers. Besides, students had the chance to explore differences and similarities between their education systems. Pitfalls and successes in meeting the objective of sustaining interaction are provided along with implications for internationalization efforts. Chapter 6: Delivery of a Social Science Online Program in India The chapter provides a narrative of an engagement with the open and distance learning system which leads to launching an online learning package in 2001. The aim is to integrate various components of the multimedia in course development. Using the information technology tools leads students to communicate and interact more effectively. Besides, meeting the various needs of diverse learners became possible through the information technology tools. Well-structured architecture of the program’s website and its discussion board has been accepted by learners. The program generated an interest in the institution to launch further online programs of study. Chapter 7: Introducing Integrated E-Portfolio across Courses in a Postgraduate Program in Distance and Online Education The chapter presents an analysis of important issues related to the development of an integrated e-portfolio application which was implemented at Massey University. The aim is to help students track evidence of skills they developed during their study period. The e-portfolio project helped students to demonstrate their own conceptual understanding and identify the connections across different papers they prepared. Based on the experiences of the study, administrative issues and considerations for future developments are discussed as well. Chapter 8: The Mediated Action of Educational Reform: An Inquiry into Collaborative Online Professional Development The chapter describes and evaluates the online collaboration of four teachers in four

  11. A new methodological approach to assess cardiac work by pressure-volume and stress-length relations in patients with aortic valve stenosis and dilated cardiomyopathy.

    Science.gov (United States)

    Alter, P; Rupp, H; Rominger, M B; Klose, K J; Maisch, B

    2008-01-01

    In experimental animals, cardiac work is derived from pressure-volume area and analyzed further using stress-length relations. Lack of methods for determining accurately myocardial mass has until now prevented the use of stress-length relations in patients. We hypothesized, therefore, that not only pressure-volume loops but also stress-length diagrams can be derived from cardiac volume and cardiac mass as assessed by cardiac magnetic resonance imaging (CMR) and invasively measured pressure. Left ventricular (LV) volume and myocardial mass were assessed in seven patients with aortic valve stenosis (AS), eight with dilated cardiomyopathy (DCM), and eight controls using electrocardiogram (ECG)-gated CMR. LV pressure was measured invasively. Pressure-volume curves were calculated based on ECG triggering. Stroke work was assessed as area within the pressure-volume loop. LV wall stress was calculated using a thick-wall sphere model. Similarly, stress-length loops were calculated to quantify stress-length-based work. Taking the LV geometry into account, the normalization with regard to ventricular circumference resulted in "myocardial work." Patients with AS (valve area 0.73+/-0.18 cm(2)) exhibited an increased LV myocardial mass when compared with controls (Pwork of AS was unchanged when compared with controls (0.539+/-0.272 vs 0.621+/-0.138 Nm, not significant), whereas DCM exhibited a significant depression (0.367+/-0.157 Nm, Pwork was significantly reduced in both AS and DCM when compared with controls (129.8+/-69.6, 200.6+/-80.1, 332.2+/-89.6 Nm/m(2), Pmethodological approach of using CMR and invasive pressure measurement. Myocardial work was reduced in patients with DCM and noteworthy also in AS, while stroke work was reduced in DCM only. Most likely, deterioration of myocardial work is crucial for the prognosis. It is suggested to include these basic physiological procedures in the clinical assessment of the pump function of the heart.

  12. Methodology of sustainability accounting

    Directory of Open Access Journals (Sweden)

    O.H. Sokil

    2017-03-01

    Full Text Available Modern challenges of the theory and methodology of accounting are realized through the formation and implementation of new concepts, the purpose of which is to meet the needs of users in standard and unique information. The development of a methodology for sustainability accounting is a key aspect of the management of an economic entity. The purpose of the article is to form the methodological bases of accounting for sustainable development and determine its goals, objectives, object, subject, methods, functions and key aspects. The author analyzes the theoretical bases of the definition and considers the components of the traditional accounting methodology. Generalized structural diagram of the methodology for accounting for sustainable development is offered in the article. The complex of methods and principles of sustainable development accounting for systematized and non-standard provisions has been systematized. The new system of theoretical and methodological provisions of accounting for sustainable development is justified in the context of determining its purpose, objective, subject, object, methods, functions and key aspects.

  13. Ground-foraging ants (Hymenoptera: Formicidae and rainfall effect on pitfall trapping in a deciduous thorn woodland (Caatinga, Northeastern Brazil

    Directory of Open Access Journals (Sweden)

    Francyregis A Nunes

    2011-12-01

    Full Text Available The semi-arid Caatinga is the fourth largest biome of Brazil, which biota still remains one of the most poorly known, especially with regard to invertebrate groups. In this study, a ground-foraging ant assemblage was surveyed during one year and the effect of rainfall on pitfall trapping was assessed. The study was performed in an area located in the municipality of Pentecoste (3º48’ S - 39º20’ W, in the State of Ceará. A 200m transect with 20 equidistant sampling points was established. Transect sampling was performed once a month during 12 months, over the period August 2008-August 2009. At each sampling point, a pitfall trap partially filled with a mixture of ethanol and monoethylene glycol was placed at the beginning of each month and remained in the field for seven days. 39 species belonging to six subfamilies and 19 genera, plus two unidentified species, were collected, with Pheidole (10 spp. and Camponotus (8 spp. being the taxa with the most species. 23 species were frequent, being found in more than 50% of the 12 transect samplings. Five species had an intermediate frequency (25 to 50%, while 13 were relatively infrequent (less than 25%. Most of the species (22 showed low occurrence, being found in less than 10% of the 240 samples (20 samples each month, during 12 months. Only five species were collected in more than 50% of the samples, those species being also responsible for most of the total abundance (number of captured individuals of all species observed each month. The speciesaccumulation curves (observed and estimated indicated that sampling sufficiency was attained, and that about 92% of the estimated ground-foraging ant fauna had been collected. 40 and 29 species were collected in the dry and rainy season, respectively, with monthly species richness ranging from 13 to 28. The total ant abundance showed a drastic decrease during the rainy season, and a negative linear correlation was found between rainfall and total ant

  14. Engaging First-year University Students in Research: Promise, Potentials, and Pitfalls

    Directory of Open Access Journals (Sweden)

    Sarah L. Sangster

    2016-06-01

    Full Text Available In 2014, the Undergraduate Research Initiative at the University of Saskatchewan implemented a pilot project to organize, support, and promote curriculum-based research experience as an integral aspect of participating first-year courses. The framework for the course-based initiative was the research arc; usually in groups, students in these classes would develop a research question, investigate it using discipline-appropriate methodologies, and disseminate the results. Nine classes (Agriculture, Animal Bioscience, Environmental Science, Women’s and Gender Studies, Psychology, Kinesiology, and Interdisciplinary Studies participated in this program pilot. There were four key agents in the program: faculty instructors, research coaches, students in participating first-year classes, and university administrative staff. This preliminary evaluation of the pilot suggests that first-year undergraduate research experiences have potential to benefit the undergraduate student participants as well as the faculty and research coaches involved. The primary benefits that faculty reported experiencing included an increased interest in ways to engage learners, reexamination of and reflection on their teaching strategies, the pragmatic support of a research coach helping with their work load, and an invigoration of their research. The primary benefits to research coaches included enhancement of their professional skills, experience in lesson planning and facilitation, CV building, and an ideology shift in how to best facilitate learning for undergraduate students. The most prominent benefits for undergraduate students appeared to be that they gained a better idea about how researchers think and work, that they increased their understanding of how research works, and that their own research and professional skills had improved. Early, bottom-up evaluation identified characteristics of implementation that appear to best facilitate achievement of the initiative

  15. Methodology and early findings of the Diabetes Management Project: a cohort study investigating the barriers to optimal diabetes care in diabetic patients with and without diabetic retinopathy.

    Science.gov (United States)

    Lamoureux, Ecosse Luc; Fenwick, Eva; Xie, Jing; Mcauley, Annie; Nicolaou, Theona; Larizza, Melanie; Rees, Gwyn; Qureshi, Salmaan; Wong, Tien Yin; Benarous, Rehab; Dirani, Mohamed

    2012-01-01

    The Diabetes Management Project is investigating the clinical, behavioural and psychosocial barriers to optimal diabetes care in individuals with and without diabetic retinopathy. Prospective cohort. Two hundred and twenty-three and 374 patients without and with diabetic retinopathy, respectively. All individuals underwent a comprehensive dilated eye test, anthropometric measurements, blood and urine samples, and psychosocial questionnaires. Good glycaemic control was defined as glycosylated haemoglobin Management Project, developed to assess factors associated with suboptimal diabetes care. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

  16. Impact of missing attenuation and scatter corrections on 99m Tc-MAA SPECT 3D dosimetry for liver radioembolization using the patient relative calibration methodology: A retrospective investigation on clinical images.

    Science.gov (United States)

    Botta, Francesca; Ferrari, Mahila; Chiesa, Carlo; Vitali, Sara; Guerriero, Francesco; Nile, Maria Chiara De; Mira, Marta; Lorenzon, Leda; Pacilio, Massimiliano; Cremonesi, Marta

    2018-04-01

    To investigate the clinical implication of performing pre-treatment dosimetry for 90 Y-microspheres liver radioembolization on 99m Tc-MAA SPECT images reconstructed without attenuation or scatter correction and quantified with the patient relative calibration methodology. Twenty-five patients treated with SIR-Spheres ® at Istituto Europeo di Oncologia and 31 patients treated with TheraSphere ® at Istituto Nazionale Tumori were considered. For each acquired 99m Tc-MAA SPECT, four reconstructions were performed: with attenuation and scatter correction (AC_SC), only attenuation (AC_NoSC), only scatter (NoAC_SC) and without corrections (NoAC_NoSC). Absorbed dose maps were calculated from the activity maps, quantified applying the patient relative calibration to the SPECT images. Whole Liver (WL) and Tumor (T) regions were drawn on CT images. Injected Liver (IL) region was defined including the voxels receiving absorbed dose >3.8 Gy/GBq. Whole Healthy Liver (WHL) and Healthy Injected Liver (HIL) regions were obtained as WHL = WL - T and HIL = IL - T. Average absorbed dose to WHL and HIL were calculated, and the injection activity was derived following each Institute's procedure. The values obtained from AC_NoSC, NoAC_SC and NoAC_NoSC images were compared to the reference value suggested by AC_SC images using Bland-Altman analysis and Wilcoxon paired test (5% significance threshold). Absorbed-dose maps were compared to the reference map (AC_SC) in global terms using the Voxel Normalized Mean Square Error (%VNMSE), and at voxel level by calculating for each voxel the normalized difference with the reference value. The uncertainty affecting absorbed dose at voxel level was accounted for in the comparison; to this purpose, the voxel counts fluctuation due to Poisson and reconstruction noise was estimated from SPECT images of a water phantom acquired and reconstructed as patient images. NoAC_SC images lead to activity prescriptions not significantly different from the

  17. Regional Shelter Analysis Methodology

    Energy Technology Data Exchange (ETDEWEB)

    Dillon, Michael B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Dennison, Deborah [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Kane, Jave [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Walker, Hoyt [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Miller, Paul [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2015-08-01

    The fallout from a nuclear explosion has the potential to injure or kill 100,000 or more people through exposure to external gamma (fallout) radiation. Existing buildings can reduce radiation exposure by placing material between fallout particles and exposed people. Lawrence Livermore National Laboratory was tasked with developing an operationally feasible methodology that could improve fallout casualty estimates. The methodology, called a Regional Shelter Analysis, combines the fallout protection that existing buildings provide civilian populations with the distribution of people in various locations. The Regional Shelter Analysis method allows the consideration of (a) multiple building types and locations within buildings, (b) country specific estimates, (c) population posture (e.g., unwarned vs. minimally warned), and (d) the time of day (e.g., night vs. day). The protection estimates can be combined with fallout predictions (or measurements) to (a) provide a more accurate assessment of exposure and injury and (b) evaluate the effectiveness of various casualty mitigation strategies. This report describes the Regional Shelter Analysis methodology, highlights key operational aspects (including demonstrating that the methodology is compatible with current tools), illustrates how to implement the methodology, and provides suggestions for future work.

  18. Methodological challenges in assessment of current use of warfarin among patients with atrial fibrillation using dispensation data from administrative health care databases.

    Science.gov (United States)

    Sinyavskaya, Liliya; Matteau, Alexis; Johnson, Sarasa; Durand, Madeleine

    2018-06-05

    Algorithms to define current exposure to warfarin using administrative data may be imprecise. Study objectives were to characterize dispensation patterns, to measure gaps between expected and observed refill dates for warfarin and direct oral anticoagulants (DOACs). Retrospective cohort study using administrative health care databases of the Régie de l'assurance-maladie du Québec. We identified every dispensation of warfarin, dabigatran, rivaroxaban, or apixaban for patients with AF initiating oral anticoagulants between 2010 and 2015. For each dispensation, we extracted date and duration. Refill gaps were calculated as difference between expected and observed dates of successive dispensation. Refill gaps were summarized using descriptive statistics. To account for repeated observations nested within patients and to assess the components of variance of refill gaps, we used unconditional multilevel linear models. We identified 61 516 new users. Majority were prescribed warfarin (60.3%), followed by rivaroxaban (16.4%), dabigatran (14.5%), apixaban (8.8%). Most frequent recorded duration of dispensation was 7 days, suggesting use of pharmacist-prepared weekly pillboxes. The average refill gap from multilevel model was higher for warfarin (9.28 days, 95%CI:8.97-9.59) compared with DOACs (apixaban 3.08 days, 95%CI: 2.96-3.20, dabigatran 3.70, 95%CI: 3.56-3.84, rivaroxaban 3.15, 95%CI: 3.03-3.27). The variance of refill gaps was greater among warfarin users than among DOAC users. Greater refill gaps for warfarin may reflect inadequate capture of the period covered by the number of dispensed pills recorded in administrative data. A time-dependent definition of exposure using dispensation data would lead to greater misclassification of warfarin than DOACs use. Copyright © 2018 John Wiley & Sons, Ltd.

  19. Ultrasonic energy enhanced the efficiency of advance extraction methodology for enrichment of trace level of copper in serum samples of patients having neurological disorders.

    Science.gov (United States)

    Arain, Mariam S; Kazi, Tasneem G; Afridi, Hassan I; Ali, Jamshed; Akhtar, Asma

    2017-07-01

    An innovative dual dispersive ionic liquid based on ultrasound assisted microextraction (UDIL-μE), for the enrichment of trace levels of copper ion (Cu 2+ ), in serum (blood) of patients suffering from different neurological disorders. The enriched metal ions were subjected to flame atomic absorption spectrometry (FAAS). In the UDIL-μE method, the extraction solvent, ionic liquid, 1-butyl-3-methylimidazolium hexafluorophosphate [C 4 mim][PF 6 ], was dispersed into the aqueous samples using an ultrasonic bath. The(PAN) 1-(2-pyridylazo)-2-naphthol was used as ligand for the complexation of Cu ion in IL (as extracting solvent). The various variables such as sonication time, pH, concentration of complexing agent, time and rate of centrifugation, IL volume that affect the extraction process were optimized. The enhancement factor (EF) and detection limit (LOD) was found under favorable condition was 31 and 0.36μgL -1 , respectively. Reliability of the proposed method was checked by relative standard deviation (%RSD), which was found to be <5%. The accuracy of developed procedure was assured by using certified reference material (CRM) of blood serum. The developed procedure was applied successfully to the analysis of concentration of Cu ion in blood serum of different neurological disorders subjects and referents of same age group. It was observed that the levels of Cu ion was two folds higher in serum samples of neurological disorders patients as related to normal referents of same age group. Copyright © 2016. Published by Elsevier B.V.

  20. Common pitfalls in statistical analysis: “No evidence of effect” versus “evidence of no effect”

    Science.gov (United States)

    Ranganathan, Priya; Pramesh, C. S.; Buyse, Marc

    2015-01-01

    This article is the first in a series exploring common pitfalls in statistical analysis in biomedical research. The power of a clinical trial is the ability to find a difference between treatments, where such a difference exists. At the end of the study, the lack of difference between treatments does not mean that the treatments can be considered equivalent. The distinction between “no evidence of effect” and “evidence of no effect” needs to be understood. PMID:25657905

  1. A time-sorting pitfall trap and temperature datalogger for the sampling of surface-active arthropods

    OpenAIRE

    McMunn, Marshall S.

    2017-01-01

    Nearly all arthropods display consistent patterns of activity according to time of day. These patterns of activity often limit the extent of animal co-occurrence in space and time. Quantifying when particular species are active and how activity varies with environmental conditions is difficult without the use of automated devices due to the need for continuous monitoring. Time-sorting pitfall traps passively collect active arthropods into containers with known beginning and end sample times. ...

  2. The policy trail methodology

    DEFF Research Database (Denmark)

    Holford, John; Larson, Anne; Melo, Susana

    of ‘policy trail’, arguing that it can overcome ‘methodological nationalism’ and link structure and agency in research on the ‘European educational space’. The ‘trail’ metaphor, she suggests, captures the intentionality and the erratic character of policy. The trail connects sites and brings about change......, but – although policy may be intended to be linear, with specific outcomes – policy often has to bend, and sometimes meets insurmountable obstacles. This symposium outlines and develops the methodology, but also reports on research undertaken within a major FP7 project (LLLIght’in’Europe, 2012-15) which made use......In recent years, the “policy trail” has been proposed as a methodology appropriate to the shifting and fluid governance of lifelong learning in the late modern world (Holford et al. 2013, Holford et al. 2013, Cort 2014). The contemporary environment is marked by multi-level governance (global...

  3. Principal component and volume of interest analyses in depressed patients imaged by {sup 99m}Tc-HMPAO SPET: a methodological comparison

    Energy Technology Data Exchange (ETDEWEB)

    Pagani, Marco [Institute of Cognitive Sciences and Technologies, CNR, Rome (Italy); Section of Nuclear Medicine, Department of Hospital Physics, Karolinska Hospital, Stockholm (Sweden); Gardner, Ann; Haellstroem, Tore [NEUROTEC, Division of Psychiatry, Karolinska Institutet, Huddinge University Hospital, Stockholm (Sweden); Salmaso, Dario [Institute of Cognitive Sciences and Technologies, CNR, Rome (Italy); Sanchez Crespo, Alejandro; Jonsson, Cathrine; Larsson, Stig A. [Section of Nuclear Medicine, Department of Hospital Physics, Karolinska Hospital, Stockholm (Sweden); Jacobsson, Hans [Department of Radiology, Karolinska Hospital, Stockholm (Sweden); Lindberg, Greger [Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska Institutet, Huddinge University Hospital, Stockholm (Sweden); Waegner, Anna [Department of Clinical Neuroscience, Division of Neurology, Karolinska Hospital, Stockholm (Sweden)

    2004-07-01

    Previous regional cerebral blood flow (rCBF) studies on patients with unipolar major depressive disorder (MDD) have analysed clusters of voxels or single regions and yielded conflicting results, showing either higher or lower rCBF in MDD as compared to normal controls (CTR). The aim of this study was to assess rCBF distribution changes in 68 MDD patients, investigating the data set with both volume of interest (VOI) analysis and principal component analysis (PCA). The rCBF distribution in 68 MDD and 66 CTR, at rest, was compared. Technetium-99m d,l-hexamethylpropylene amine oxime single-photon emission tomography was performed and the uptake in 27 VOIs, bilaterally, was assessed using a standardising brain atlas. Data were then grouped into factors by means of PCA performed on rCBF of all 134 subjects and based on all 54 VOIs. VOI analysis showed a significant group x VOI x hemisphere interaction (P<0.001). rCBF in eight VOIs (in the prefrontal, temporal, occipital and central structures) differed significantly between groups at the P<0.05 level. PCA identified 11 anatomo-functional regions that interacted with groups (P<0.001). As compared to CTR, MDD rCBF was relatively higher in right associative temporo-parietal-occipital cortex (P<0.01) and bilaterally in prefrontal (P<0.005) and frontal cortex (P<0.025), anterior temporal cortex and central structures (P<0.05 and P<0.001 respectively). Higher rCBF in a selected group of MDD as compared to CTR at rest was found using PCA in five clusters of regions sharing close anatomical and functional relationships. At the single VOI level, all eight regions showing group differences were included in such clusters. PCA is a data-driven method for recasting VOIs to be used for group evaluation and comparison. The appearance of significant differences absent at the VOI level emphasises the value of analysing the relationships among brain regions for the investigation of psychiatric disease. (orig.)

  4. TH-E-202-01: Pitfalls and Remedies in PET/CT Imaging for RT Planning

    International Nuclear Information System (INIS)

    Pan, T.

    2016-01-01

    PET/CT is a very important imaging tool in the management of oncology patients. PET/CT has been applied for treatment planning and response evaluation in radiation therapy. This educational session will discuss: Pitfalls and remedies in PET/CT imaging for RT planning The use of hypoxia PET imaging for radiotherapy PET for tumor response evaluation The first presentation will address the issue of mis-registration between the CT and PET images in the thorax and the abdomen. We will discuss the challenges of respiratory gating and introduce an average CT technique to improve the registration for dose calculation and image-guidance in radiation therapy. The second presentation will discuss the use of hypoxia PET Imaging for radiation therapy. We will discuss various hypoxia radiotracers, the choice of clinical acquisition protocol (in particular a single late static acquisition versus a dynamic acquisition), and the compartmental modeling with different transfer rate constants explained. We will demonstrate applications of hypoxia imaging for dose escalation/de-escalation in clinical trials. The last presentation will discuss the use of PET/CT for tumor response evaluation. We will discuss anatomic response assessment vs. metabolic response assessment, visual evaluation and semi-quantitative evaluation, and limitations of current PET/CT assessment. We will summarize clinical trials using PET response in guiding adaptive radiotherapy. Finally, we will summarize recent advancements in PET/CT radiomics and non-FDG PET tracers for response assessment. Learning Objectives: Identify the causes of mis-registration of CT and PET images in PET/CT, and review the strategies to remedy the issue. Understand the basics of PET imaging of tumor hypoxia (radiotracers, how PET measures the hypoxia selective uptake, imaging protocols, applications in chemo-radiation therapy). Understand the basics of dynamic PET imaging, compartmental modeling and parametric images. Understand the

  5. TH-E-202-01: Pitfalls and Remedies in PET/CT Imaging for RT Planning

    Energy Technology Data Exchange (ETDEWEB)

    Pan, T. [UT MD Anderson Cancer Center (United States)

    2016-06-15

    PET/CT is a very important imaging tool in the management of oncology patients. PET/CT has been applied for treatment planning and response evaluation in radiation therapy. This educational session will discuss: Pitfalls and remedies in PET/CT imaging for RT planning The use of hypoxia PET imaging for radiotherapy PET for tumor response evaluation The first presentation will address the issue of mis-registration between the CT and PET images in the thorax and the abdomen. We will discuss the challenges of respiratory gating and introduce an average CT technique to improve the registration for dose calculation and image-guidance in radiation therapy. The second presentation will discuss the use of hypoxia PET Imaging for radiation therapy. We will discuss various hypoxia radiotracers, the choice of clinical acquisition protocol (in particular a single late static acquisition versus a dynamic acquisition), and the compartmental modeling with different transfer rate constants explained. We will demonstrate applications of hypoxia imaging for dose escalation/de-escalation in clinical trials. The last presentation will discuss the use of PET/CT for tumor response evaluation. We will discuss anatomic response assessment vs. metabolic response assessment, visual evaluation and semi-quantitative evaluation, and limitations of current PET/CT assessment. We will summarize clinical trials using PET response in guiding adaptive radiotherapy. Finally, we will summarize recent advancements in PET/CT radiomics and non-FDG PET tracers for response assessment. Learning Objectives: Identify the causes of mis-registration of CT and PET images in PET/CT, and review the strategies to remedy the issue. Understand the basics of PET imaging of tumor hypoxia (radiotracers, how PET measures the hypoxia selective uptake, imaging protocols, applications in chemo-radiation therapy). Understand the basics of dynamic PET imaging, compartmental modeling and parametric images. Understand the

  6. Changing methodologies in TESOL

    CERN Document Server

    Spiro, Jane

    2013-01-01

    Covering core topics from vocabulary and grammar to teaching, writing speaking and listening, this textbook shows you how to link research to practice in TESOL methodology. It emphasises how current understandings have impacted on the language classroom worldwide and investigates the meaning of 'methods' and 'methodology' and the importance of these for the teacher: as well as the underlying assumptions and beliefs teachers bring to bear in their practice. By introducing you to language teaching approaches, you will explore the way these are influenced by developments in our understanding of l

  7. Creativity in phenomenological methodology

    DEFF Research Database (Denmark)

    Dreyer, Pia; Martinsen, Bente; Norlyk, Annelise

    2014-01-01

    on the methodologies of van Manen, Dahlberg, Lindseth & Norberg, the aim of this paper is to argue that the increased focus on creativity and arts in research methodology is valuable to gain a deeper insight into lived experiences. We illustrate this point through examples from empirical nursing studies, and discuss......Nursing research is often concerned with lived experiences in human life using phenomenological and hermeneutic approaches. These empirical studies may use different creative expressions and art-forms to describe and enhance an embodied and personalised understanding of lived experiences. Drawing...... may support a respectful renewal of phenomenological research traditions in nursing research....

  8. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system

    Directory of Open Access Journals (Sweden)

    N Byrne

    2016-04-01

    Full Text Available Background Shortcomings in existing methods of image segmentation preclude the widespread adoption of patient-specific 3D printing as a routine decision-making tool in the care of those with congenital heart disease. We sought to determine the range of cardiovascular segmentation methods and how long each of these methods takes. Methods A systematic review of literature was undertaken. Medical imaging modality, segmentation methods, segmentation time, segmentation descriptive quality (SDQ and segmentation software were recorded. Results Totally 136 studies met the inclusion criteria (1 clinical trial; 80 journal articles; 55 conference, technical and case reports. The most frequently used image segmentation methods were brightness thresholding, region growing and manual editing, as supported by the most popular piece of proprietary software: Mimics (Materialise NV, Leuven, Belgium, 1992–2015. The use of bespoke software developed by individual authors was not uncommon. SDQ indicated that reporting of image segmentation methods was generally poor with only one in three accounts providing sufficient detail for their procedure to be reproduced. Conclusions and implication of key findings Predominantly anecdotal and case reporting precluded rigorous assessment of risk of bias and strength of evidence. This review finds a reliance on manual and semi-automated segmentation methods which demand a high level of expertise and a significant time commitment on the part of the operator. In light of the findings, we have made recommendations regarding reporting of 3D printing studies. We anticipate that these findings will encourage the development of advanced image segmentation methods.

  9. Satellite Remote Sensing of Particulate Matter Air Quality: Progress, Potential and Pitfalls (Invited)

    Science.gov (United States)

    Christopher, S. A.

    2009-12-01

    Satellite Remote Sensing of Particulate Matter Air Quality: Progress, Potential and Pitfalls Abstract. Fine or respirable particles with particle aerodynamic diameters less than 2.5 µm (PM2.5) affect visibility, change cloud properties, reflect and absorb incoming solar radiation, affect human health and are ubiquitous in the atmosphere. These particles are injected into the atmosphere either as primary emissions or form into the atmosphere by gas to particle conversion. There are various sources of PM2.5 including emissions from automobiles, industrial exhaust, and agricultural fires. In 2006, the United States Environmental Protection Agency (EPA) made the standards stringent by changing the 24-hr averaged PM2.5 mass values from 65µgm-3 to 35µgm-3. This was primarily based on epidemiological studies that showed the long term health benefits of making the PM2.5 standards stringent. Typically PM2.5 mass concentration is measured from surface monitors and in the United States there are nearly 1000 such filter based daily and 600 contiguous stations managed by federal, state, local, and tribal agencies. Worldwide, there are few PM2.5 ground monitors since they are expensive to purchase, maintain and operate. Satellite remote sensing therefore provides a viable method for monitoring PM2.5 from space. Although, there are several hundred satellites currently in orbit and not all of them are suited for PM2.5 air quality assessments. Typically multi-spectral reflected solar radiation measurements from space-borne sensors are converted to aerosol optical depth (AOD) which is a measure of the column (surface to top of atmosphere) integrated extinction (absorption plus scattering). This column AOD (usually at 550 nm) is often converted to PM2.5 mass near the ground using various techniques. In this presentation we discuss the progress over the last decade on assessing PM2.5 from satellites; outline the potential and discuss the various pitfalls that one encounters. We

  10. Communication pitfalls of traditional history and physical write-up documentation.

    Science.gov (United States)

    Brown, Jeffrey L

    2017-01-01

    An unofficial standardized "write-up" outline is commonly used for documenting history and physical examinations, giving oral presentations, and teaching clinical skills. Despite general acceptance, there is an apparent discrepancy between the way clinical encounters are conducted and how they are documented. Fifteen medical school websites were randomly selected from search-engine generated lists. One example of a history and physical write-up from each of six sites, one teaching outline from each of nine additional sites, and recommendations for documentation made in two commonly used textbooks were compared for similarities and differences. Except for minor variations in documenting background information, all sampled materials utilized the same standardized format. When the examiners' early perceptions of the patients' degree of illness or level of distress were described, they were categorized as "general appearance" within the physical findings. Contrary to clinical practice, none of the examples or recommendations documented these early perceptions before chief concerns and history were presented. An examiner's initial perceptions of a patient's affect, degree of illness, and level of distress can influence the content of the history, triage decisions, and prioritization of likely diagnoses. When chief concerns and history are shared without benefit of this information, erroneous assumptions and miscommunications can result. This survey confirms common use of a standardized outline for documenting, communicating, and teaching history-taking and physical examination protocol. The present outline shares early observations out of clinical sequence and may provide inadequate context for accurate interpretation of chief concerns and history. Corrective actions include modifying the documentation sequence to conform to clinical practice and teaching contextual methodology for sharing patient information.

  11. Using emergency department-based inception cohorts to determine genetic characteristics associated with long term patient outcomes after motor vehicle collision: Methodology of the CRASH study

    Directory of Open Access Journals (Sweden)

    Peak David A

    2011-09-01

    Full Text Available Abstract Background Persistent musculoskeletal pain and psychological sequelae following minor motor vehicle collision (MVC are common problems with a large economic cost. Prospective studies of pain following MVC have demonstrated that demographic characteristics, including female gender and low education level, and psychological characteristics, including high pre-collision anxiety, are independent predictors of persistent pain. These results have contributed to the psychological and social components of a biopsychosocial model of post-MVC pain pathogenesis, but the biological contributors to the model remain poorly defined. Recent experimental studies indicate that genetic variations in adrenergic system function influence the vulnerability to post-traumatic pain, but no studies have examined the contribution of genetic factors to existing predictive models of vulnerability to persistent pain. Methods/Design The Project CRASH study is a federally supported, multicenter, prospective study designed to determine whether variations in genes affecting synaptic catecholamine levels and alpha and beta adrenergic receptor function augment social and psychological factors in a predictive model of persistent musculoskeletal pain and posttraumatic stress disorder (PTSD following minor MVC. The Project CRASH study will assess pain, pain interference and PTSD symptoms at 6 weeks, 6 months, and 1 year in approximately 1,000 patients enrolled from 8 Emergency Departments in four states with no-fault accident laws. Discussion The results from this study will provide insights into the pathophysiology of persistent pain and PTSD following MVC and may serve to improve the ability of clinicians and researchers to identify individuals at high risk for adverse outcomes following minor MVC.

  12. Protocol and methodology of the Stroke in Young Fabry Patients (sifap1) study: a prospective multicenter European study of 5,024 young stroke patients aged 18-55 years.

    LENUS (Irish Health Repository)

    Rolfs, Arndt

    2011-01-01

    Stroke in the young has not been thoroughly investigated with most previous studies based on a small number of patients from single centers. Furthermore, recent reports indicate that Fabry disease may be a significant cause for young stroke. The primary aim of our study was to determine the prevalence of Fabry disease in young stroke patients, while the secondary aim was to describe patterns of stroke in young patients.

  13. Computer Network Operations Methodology

    Science.gov (United States)

    2004-03-01

    means of their computer information systems. Disrupt - This type of attack focuses on disrupting as “attackers might surreptitiously reprogram enemy...by reprogramming the computers that control distribution within the power grid. A disruption attack introduces disorder and inhibits the effective...between commanders. The use of methodologies is widespread and done subconsciously to assist individuals in decision making. The processes that

  14. SCI Hazard Report Methodology

    Science.gov (United States)

    Mitchell, Michael S.

    2010-01-01

    This slide presentation reviews the methodology in creating a Source Control Item (SCI) Hazard Report (HR). The SCI HR provides a system safety risk assessment for the following Ares I Upper Stage Production Contract (USPC) components (1) Pyro Separation Systems (2) Main Propulsion System (3) Reaction and Roll Control Systems (4) Thrust Vector Control System and (5) Ullage Settling Motor System components.

  15. A Functional HAZOP Methodology

    DEFF Research Database (Denmark)

    Liin, Netta; Lind, Morten; Jensen, Niels

    2010-01-01

    A HAZOP methodology is presented where a functional plant model assists in a goal oriented decomposition of the plant purpose into the means of achieving the purpose. This approach leads to nodes with simple functions from which the selection of process and deviation variables follow directly...

  16. Complicating Methodological Transparency

    Science.gov (United States)

    Bridges-Rhoads, Sarah; Van Cleave, Jessica; Hughes, Hilary E.

    2016-01-01

    A historical indicator of the quality, validity, and rigor of qualitative research has been the documentation and disclosure of the behind-the-scenes work of the researcher. In this paper, we use what we call "methodological data" as a tool to complicate the possibility and desirability of such transparency. Specifically, we draw on our…

  17. Methodological Advances in Dea

    NARCIS (Netherlands)

    L. Cherchye (Laurens); G.T. Post (Thierry)

    2001-01-01

    textabstractWe survey the methodological advances in DEA over the last 25 years and discuss the necessary conditions for a sound empirical application. We hope this survey will contribute to the further dissemination of DEA, the knowledge of its relative strengths and weaknesses, and the tools

  18. NUSAM Methodology for Assessment.

    Energy Technology Data Exchange (ETDEWEB)

    Leach, Janice [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Snell, Mark K. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-07-01

    This document provides a methodology for the performance-based assessment of security systems designed for the protection of nuclear and radiological materials and the processes that produce and/or involve them. It is intended for use with both relatively simple installations and with highly regulated complex sites with demanding security requirements.

  19. MIRD methodology. Part 1

    International Nuclear Information System (INIS)

    Rojo, Ana M.

    2004-01-01

    This lecture develops the MIRD (Medical Internal Radiation Dose) methodology for the evaluation of the internal dose due to the administration of radiopharmaceuticals. In this first part, the basic concepts and the main equations are presented. The ICRP Dosimetric System is also explained. (author)

  20. Response Surface Methodology

    NARCIS (Netherlands)

    Kleijnen, Jack P.C.

    2014-01-01

    Abstract: This chapter first summarizes Response Surface Methodology (RSM), which started with Box and Wilson’s article in 1951 on RSM for real, non-simulated systems. RSM is a stepwise heuristic that uses first-order polynomials to approximate the response surface locally. An estimated polynomial