Clinical negligence

BACKGROUND: Despite the importance of CAD for women, there is persistent perception that CAD is a man's disease. Contributing to this notion is the observation of differences in incidence rates according to age; the incidence of CAD in women is lower than men, but rises steadily after fifth decade. The distribution of CAD risk factors varies between men and women across age ranges and failure to consider these differences may have contributed to the belief that women are at lower risk of CAD compared with men...

BACKGROUND: Reference tissue-based quantification of brain PET data does not typically include correction for signal originating from blood vessels, which is known to result in biased outcome measures. The bias extent depends on the amount of radioactivity in the blood vessels. In this study, we seek to revisit the well-established Logan plot and derive alternative formulations that provide estimation of distribution volume ratios (DVRs) that are corrected for the signal originating from the vasculature...

PURPOSE: The purpose of this study was to examine age-related, infratentorial changes in T2 relaxation times during infancy and childhood using routine MRI data at 3 Tesla. METHODS: One hundred patients (0-199 months) without signal abnormalities on conventional MRI were retrospectively selected from our pool of pediatric MRI examinations. T2 maps based on our routinely acquired triple-echo turbo spin-echo (TSE) sequence were created. Based on their clinical symptoms, the children were divided into 43 controls and 57 diseased children with different clinical diseases...

The development of new treatments and their deployment in the clinic may be assisted by imaging methods that allow an early assessment of treatment response in individual patients. The C2A domain of Synaptotagmin-I (C2Am), which binds to the phosphatidylserine (PS) exposed by apoptotic and necrotic cells, has been developed as an imaging probe for detecting cell death. Multispectral optoacoustic tomography (MSOT) is a real-time and clinically applicable imaging modality that was used here with a near infrared (NIR) fluorophore-labeled C2Am to image tumor cell death in mice treated with a TNF-related apoptosis-inducing ligand receptor 2 (TRAILR2) agonist and with 5-fluorouracil (5-FU)...

Purpose: This clinical focus article provides readers with a description of the stimulus characteristics of 12 popular tests of speech sound production. Method: Using significance testing and descriptive analyses, stimulus items were compared in terms of the number of opportunities for production of all consonant singletons, clusters, and rhotic and nonrhotic vowels of Standard American English; phonetic/phonological and structural complexity; and the presence of bound morphemes...

In total knee replacement surgery, implant alignment is one of the most important criteria for successful long-term clinical outcome. During total knee replacement implantation, femoral and tibial alignment are determined through appropriate bone resections, which could vary based on patient anatomy, implant design and surgical technique and further influence loading conditions and clinical outcomes. The current research focused on three critical alignment parameters for total knee replacement insertion: femoral component internal/external (I/E) rotation, varus-valgus tibiofemoral angulation and posterior tibial slope...

The main purpose of our investigation was to quantify the dosimetric influence of intravenous contrast agent for pancreatic cancer radiotherapy treatment. This study focused on complex modulated irradiation techniques of tomotherapy (TOMO) and volumetric-modulated arc therapy (VMAT) to investigate if novel conformal treatment methods could reduce the influence of contrast agent. In our study, patients with pancreatic cancer were enrolled to have 2 computed tomography (CT) scans in the same position without and with intravenous contrast agent for treatment planning...

OBJECTIVE: This study aimed to compare the qualities of whole-body positron emission tomography (PET) images acquired by the step-and-shoot (SS) and continuous bed motion (CBM) techniques with approximately the same acquisition duration, through phantom and clinical studies. METHODS: A body phantom with 10-37 mm spheres was filled with (18)F-fluorodeoxyglucose (FDG) solution at a sphere-to-background radioactivity ratio of 4:1 and acquired by both techniques. Reconstructed images were evaluated by visual assessment, percentages of contrast (%Q H) and background variability (%N) in accordance with the Japanese guideline for oncology FDG-PET/computed tomography (CT)...

BACKGROUND: Improvement in morbidity of pancreatoduodenectomy (PD) largely depends on the reduction in the incidence of clinically relevant (CR) postoperative pancreatic fistula (POPF). METHODS: After internal validation of the clinical risk score (CRS) of POPF, and identification of other predictive factors for POPF, robotic (RPD), and open (OPD) PDs were stratified into risk categories and matched by propensity scores. The primary endpoint of this study was incidence of CR-POPF...

BACKGROUND: Posttranslational oxidation of parathyroid hormone (PTH) modifies its biological activity. Measurement of non-oxidized PTH (n-oxPTH) could be an improvement in assessing PTH status, as intact PTH may rather reflect oxidative stress. However, it is debated whether oxidation of PTH occurs in vivo, or whether it is mainly an in vitro artifact. The aim of this study was to investigate the influence of different preanalytical conditions on the oxidation of PTH within a wide range of plasma PTH concentrations and oxidation propensity...

INTRODUCTION: Barrett's oesophagus (BE) is a premalignant condition associated with oesophageal adenocarcinoma (EAC). Evidence highlights that EAC is associated with an estimated 5-year survival of approximately 10-15%. Therefore, there is a need to determine which biomarkers are of value in the diagnosis of BE and beyond. The aim of our study was to evaluate the clinical significance of markers known to be expressed across BE and associated neoplasia. METHODS: Retrospective tissues were obtained from columnar lined oesophagus (CLE) without goblet cells (n=22), BE (n=29), dysplasia (n=14), and EAC (n=10)...

At present, presurgical functional mapping is the most prevalent clinical application of functional magnetic resonance imaging (fMRI). Signal dropouts and distortions caused by susceptibility effects in the current standard echo planar imaging (EPI)-based fMRI images are well-known problems and pose a major hurdle for the application of fMRI in several brain regions, many of which are related to language mapping in presurgical planning. Such artifacts are particularly problematic in patients with previous surgical resection cavities, craniotomy hardware, hemorrhage, and vascular malformation...

Despite U.S. Food and Drug Administration (FDA) approval of over 40 new treatment options for type 2 diabetes since 2005, the latest data from the National Health and Nutrition Examination Survey show that the proportion of patients achieving glycated hemoglobin (HbA1c) <7.0% (<53 mmol/mol) remains around 50%, with a negligible decline between the periods 2003-2006 and 2011-2014. The Healthcare Effectiveness Data and Information Set reports even more alarming rates, with only about 40% and 30% of patients achieving HbA1c <7...

OBJECTIVE: To assess whether even in the group of localized renal cell carcinoma (RCC), some patients might harbor a disease with a predilection for lymph node invasion (LNI) and/or lymph node (LN) progression and might deserve lymph node dissection (LND) at the time of surgery. MATERIALS AND METHODS: Between 1990 and 2014, 2,010 patients with clinically defined T1-T2N0M0 RCC were treated with nephrectomy and standardized LND at a single tertiary care referral center...

Development of unconventional technologies for wireless collection, storage and analysis of quantitative, clinically relevant information on physiological status is of growing interest. Soft, biocompatible systems are widely regarded as important because they facilitate mounting on external (e.g. skin) and internal (e.g. heart, brain) surfaces of the body. Ultra-miniaturized, lightweight and battery-free devices have the potential to establish complementary options in bio-integration, where chronic interfaces (i...

CONTEXT: Monitoring of health-related quality of life (HRQOL) and symptoms of patients with brain tumors is needed yet not always feasible. This is partially due to lack of brief-yet-precise assessments with minimal administration burden that are easily incorporated into clinics. Dynamic computerized adaptive testing (CAT) or static fixed-length short-forms, derived from psychometrically-sound item banks, are designed to fill this void. OBJECTIVE: This study evaluated the comparability of scores obtained from CATs and short-forms...

John Tingle, Reader in Health Law at Nottingham Trent University, discusses a recent report by the Medical Protection Society on the need to control the costs of clinical negligence litigation.

Objective The study aims to estimate the specific contribution of various forms of child maltreatment on the mental health among a Quebeckers' women representative sample. Method A telephone survey was conducted with a representative sample of 1001 women from the province of Quebec (Canada). Different demographic variables, all four child maltreatment forms (sexual, physical, psychological and neglect) and intimate partner violence experienced in the last 12 months were evaluated to explore their links with depression and post-traumatic stress symptoms of the participants at the time of the investigation...

Dental radiology uses X-ray technology to diagnose and design treatment of various clinical problems related to the oral cavity and surrounding tissues. As technology quickly evolves, there are numerous X-ray modalities using different tools in the attempt to best image and treat efficiently these diseases, disorders or other related clinical conditions. The reported numbers of dental X-rays, the fact that these may be under-reported in many countries and because dental X-rays are performed more on younger individuals, whose teeth and dentition are still developing, calls for increased need on radiation protection...

Cardiovascular diseases are among the leading causes of death and frequently result in local myocardial dysfunction. Among the numerous imaging modalities available to detect these dysfunctional regions, cardiac deformation imaging through tagged magnetic resonance imaging (t-MRI) has been an attractive approach. Nevertheless, fully automatic analysis of these data sets is still challenging. In this work, we present a fully automatic framework to estimate left ventricular myocardial deformation from t-MRI. This strategy performs automatic myocardial segmentation based on B-spline explicit active surfaces, which are initialized using an annular model...