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https://www.readbyqxmd.com/read/28644402/choosing-surgery-for-neurogenic-tos-the-roles-of-physical-exam-physical-therapy-and-imaging
#1
REVIEW
David P Kuwayama, Jason R Lund, Charles O Brantigan, Natalia O Glebova
Neurogenic thoracic outlet syndrome (nTOS) is characterized by arm and hand pain, paresthesias, and sometimes weakness resulting from compression of the brachial plexus within the thoracic outlet. While it is the most common subtype of TOS, nTOS can be difficult to diagnose. Furthermore, patient selection for surgical treatment can be challenging as symptoms may be vague and ambiguous, and diagnostic studies may be equivocal. Herein, we describe some approaches to aid in identifying patients who would be expected to benefit from surgical intervention for nTOS...
June 23, 2017: Diagnostics
https://www.readbyqxmd.com/read/28633173/exploring-residents-skills-in-diagnosing-dementia-the-unexpected-dissonance-between-ability-and-confidence
#2
Brian S Lerner, Virginia Kalish, Christy J W Ledford
BACKGROUND AND OBJECTIVES: The diagnosis of dementia is a challenge for physicians due to numerous interrelated barriers. Research shows that this difficulty may be rooted in an incomplete knowledge about dementia. To address this gap, we developed an assessment scale of resident confidence in the diagnosis of dementia and used it to compare resident confidence to their practical ability to diagnose dementia. METHODS: The study used a piloted confidence assessment tool for diagnosing dementia correlated with family medicine residents (n=45) performance during an objective structured clinical examination (OSCE)...
June 2017: Family Medicine
https://www.readbyqxmd.com/read/28631761/-management-of-outpatients-with-cardiac-disease-follow-up-timing-and-modalities
#3
Roberta Rossini, Daniela Lina, Marco Ferlini, Giuseppina Belotti, Salvatore Ivan Caico, Fabrizio Caravati, Pompilio Faggiano, Annamaria Iorio, Davide Lauri, Corrado Lettieri, Emanuela Teresa Locati, Antonio Maggi, Ferdinando Massari, Andrea Mortara, Luigi Moschini, Giuseppe Musumeci, Daniele Nassiacos, Fabrizio Negri, Domenico Pecora, Simona Pierini, Roberto Pedretti, Pierfranco Ravizza, Michele Romano, Fabrizio Oliva
The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more"...
June 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28631523/the-association-among-prematurity-cochlear-hyperintensity-and-hearing-loss
#4
Michael A Wien, Matthew T Whitehead
Background Prematurity is a major risk factor for neonatal hearing loss. Recent advancements in magnetic resonance imaging (MRI) have made it possible to evaluate structural details of the membranous labyrinths in premature infants that have heretofore been inaccessible. Objective We compared the prevalence of abnormal cochlear signal intensity in premature and term neonates and evaluated for a potential link with hearing loss. Materials and methods We retrospectively reviewed 148 consecutive MR exams performed in premature (< 37 weeks' gestation) and term neonates performed over a 30-month period...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28627842/ultrasonography-an-useful-diagnostic-tool-for-the-general-practitioner
#5
Eva Rikley, Noémie Boillat-Blanco, Jean-Yves Meuwly, Éric Breuss, Nicolas Senn
The ultrasound has become an increasingly popular tool in the clinical assessment of patients, not least in the field of general medicine. The technical evolution as well as the recent changes of the application of ultrasounds allows for rapid and targeted exams that has the potential to improve the care of patients. With the help of recent articles regarding ultrasound (US) in general medical practice, this article presents several useful indications for the primary care physician as well as shows today's training in Switzerland and demonstrates the need of an adapted training to better respond to today's need...
May 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28627415/examination-to-assess-the-clinical-exam-and-documentation-of-spine-pathology-among-orthopaedic-residents
#6
Jack M Haglin, John L Zeller, Kenneth A Egol, Donna P Phillips
BACKGROUND: The Accreditation Council of Graduate Medical Education (ACGME) guidelines require residency programs to teach and evaluate residents in six overarching "core competencies" and document progress through educational milestones. In order to assess the progress of orthopaedic interns' skills in performing a history, physical exam, and documentation of the encounter for a standardized patient with spinal stenosis, a Structured Objective Clinical Examination (OSCE) was conducted for 13 orthopaedic intern residents, following a one month boot camp that included communications skills and curriculum in history and physical examination...
June 13, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28623482/cost-effectiveness-analysis-of-a-non-contrast-screening-mri-protocol-for-vestibular-schwannoma-in-patients-with-asymmetric-sensorineural-hearing-loss
#7
Matthew G Crowson, Daniel J Rocke, Jenny K Hoang, Jane L Weissman, David M Kaylie
PURPOSE: We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. METHODS: A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review...
June 16, 2017: Neuroradiology
https://www.readbyqxmd.com/read/28623421/comparison-of-dual-energy-ct-ultrasound-and-surface-measurement-for-assessing-tophus-dissolution-during-rapid-urate-debulking
#8
Dodji V Modjinou, Svetlana Krasnokutsky, Soterios Gyftopoulos, Virginia C Pike, Elaine Karis, Robert T Keenan, Kristen Lee, Daria B Crittenden, Jonathan Samuels, Michael H Pillinger
Tophaceous gout is painful and impairs quality of life. The optimal modality for assessing tophus resolution in response to urate-lowering treatment remains poorly defined. Using pegloticase as a model system for resolving tophi, we compared multiple imaging and physical diagnostic strategies for assessing tophus resolution. A 32-year-old subject with chronic refractory tophaceous gout was enrolled and received 6 months of pegloticase treatment. Measurements of tophi using vernier calipers (monthly), photographs and musculoskeletal ultrasound (MSK-US; every 3 months), and dual-energy CT (DECT) were compared...
June 16, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28620719/large-coverage-mr-neurography-in-cidp-diagnostic-accuracy-and-electrophysiological-correlation
#9
Moritz Kronlage, Philipp Bäumer, Kalliopi Pitarokoili, Daniel Schwarz, Véronique Schwehr, Tim Godel, Sabine Heiland, Ralf Gold, Martin Bendszus, Min-Suk Yoon
The objective of this study was to evaluate large coverage magnetic resonance neurography (MRN) in chronic inflammatory demyelinating polyneuropathy (CIDP). In this prospective study, 18 patients with CIDP and 18 healthy controls were examined by a standardized MRN protocol at 3 T. Lumbosacral plexus was imaged by a T2-weighted 3D sequence and peripheral nerves of the upper and lower extremity by axial T2-weighted turbo spin-echo sequences. Lesions were characterized by nerve cross-sectional area (CSA) and T2-weighted signal (nT2)...
June 15, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28615081/clinical-variables-related-to-the-diagnostic-stability-of-demential-syndromes
#10
Fabiano Moulin de Moraes, Paulo Henrique Ferreira Bertolucci
BACKGROUND: Assigning a diagnosis to a patient with dementia is important for the present treatment of the patient and caregivers, and scientific research. Nowadays, the dementia diagnostic criteria are based on clinical information regarding medical, history, physical examination, neuropsychological tests, and supplementary exams and, therefore, subject to variability through time. METHODS: A retrospective observational study to evaluate variables related to clinical diagnostic stability in dementia syndromes in at least one year follow up...
June 15, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28607789/unilateral-enlarged-vestibular-aqueduct-syndrome-and-bilateral-endolymphatic-hydrops
#11
Massimo Ralli, Giuseppe Nola, Luca Sparvoli, Giovanni Ralli
Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images...
2017: Case Reports in Otolaryngology
https://www.readbyqxmd.com/read/28606818/investigating-unlicensed-retail-drug-vendors-preparedness-and-knowledge-about-malaria-an-exploratory-study-in-rural-uganda
#12
Eric Liow, Rosemin Kassam, Richard Sekiwunga
BACKGROUND: Despite major efforts to increase the uptake of preventive measures and timely use of the first line antimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors' (1) training related to malaria case management for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options...
June 9, 2017: Acta Tropica
https://www.readbyqxmd.com/read/28597948/identification-of-a-carbonized-body-using-implanted-surgical-plates-the-importance-of-computed-tomography
#13
Vanessa Moreira Andrade, Christian Abreu Stibich, Paulo Maurício de Santa Martha, Casimiro Abreu Possante de Almeida, Andrea de Castro Domingos Vieira
In addition to clinical examination, forensic odontologists can use diagnostic imaging as an auxiliary method for identification. This paper reports a case where forensic odontologists from the Afrânio Peixoto Legal Medicine Institute in Rio de Janeiro (Brazil) positively identified a carbonized and partially calcined body using oral and maxillofacial imaging. The cadaver showed several metallic plates fixed with metallic screws on bones of the neurocranium and viscerocranium. Family members provided spiral computed tomography scans of the skull and a panoramic radiograph that were acquired after an accident that required surgical procedures...
June 9, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28594214/the-influence-of-veteran-race-and-psychometric-testing-on-veterans-affairs-posttraumatic-stress-disorder-ptsd-disability-exam-outcomes
#14
Brian P Marx, Eden Engel-Rebitzer, Michelle J Bovin, Kelly S Parker-Guilbert, Samantha Moshier, Kenneth Barretto, Derek Szafranski, Matthew W Gallagher, Darren W Holowka, Raymond C Rosen, Terence M Keane
This study examined the influence of veterans' race and examiners' use of psychometric testing during a Department of Veterans Affairs posttraumatic stress disorder (PTSD) disability examination on diagnostic and service connection status outcomes. Participants were 764 veterans enrolled in a national longitudinal registry. Current and lifetime PTSD diagnostic status was determined with the Structured Clinical Interview for DSM-IV (SCID) and was compared with PTSD diagnosis conferred upon veterans by their compensation and pension (C&P) examiners as well as with ultimate Veterans Affairs (VA) PTSD service connected status...
June 2017: Psychological Assessment
https://www.readbyqxmd.com/read/28590347/focused-assessment-with-sonography-for-trauma-fast-in-children-following-blunt-abdominal-trauma-a-multi-institutional-analysis
#15
Bennett W Calder, Adam M Vogel, Jingwen Zhang, Patrick D Mauldin, Eunice Y Huang, Kate B Savoie, Matthew T Santore, KuoJen Tsao, Tiffany G Ostovar-Kermani, Richard A Falcone, M Sidney Dassinger, John Recicar, Jeffrey H Haynes, Martin L Blakely, Robert T Russell, Bindi J Naik-Mathuria, Shawn D St Peter, David P Mooney, Chinwendu Onwubiko, Jeffrey S Upperman, Jessica A Zagory, Christian J Streck
INTRODUCTION: The utility of FAST in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intraabdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children following blunt abdominal trauma (BAT). METHODS: We prospectively enrolled children <16 years following BAT at 14 Level-One Pediatric Trauma Centers over a 1-year period. Patients who underwent FAST were compared to those that did not using descriptive statistics and univariate analysis; p<0...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28589061/importance-of-thorough-physical-examination-a-lost-art
#16
Talal Asif, Amena Mohiuddin, Badar Hasan, Rebecca R Pauly
Several recent studies have described a deterioration in physical examination skills among modern physicians. Reasons hypothesized for this change are improvements in technology and time constraints. Poor physical exam skills are a noteworthy threat to patient safety as they can lead to incorrect as well as missed diagnoses, causing delays in timely implementation of life-saving treatments. Here, we present a case of extensive acute embolic strokes secondary to infective endocarditis. The patient was initially misdiagnosed as having Bell's palsy due to incorrect physical examination...
May 2, 2017: Curēus
https://www.readbyqxmd.com/read/28587726/occult-cancer-detection-in-patients-with-hemostatic-disorder-and-venous-thromboembolism
#17
Holleh Husseinzadeh, Marc Carrier
There are physiologic ties between Von Willebrand Factor (VWF) and circulating tumor cells. VWF appears to play a role in tumor biology, but it is unclear whether cancer behavior differs in Von Willebrand Disease. In patients presenting with venous thromboembolism (VTE), occult cancer is frequently considered as an underlying cause. The prevalence of occult cancer after provoked VTE is low (3%); therefore, cancer screening in these patients is not routinely recommended. In those with unprovoked VTE, occult cancer is more prevalent, estimated between 4 and 10%...
June 1, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28579858/cardiovascular-magnetic-resonance-imaging-incremental-value-in-a-series-of-361-patients-demonstrating-cost-savings-and-clinical-benefits-an-outcome-based-study
#18
Vinayak A Hegde, Robert Ww Biederman, J Ronald Mikolich
BACKGROUND: This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. METHODS AND RESULTS: Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria...
2017: Clinical Medicine Insights. Cardiology
https://www.readbyqxmd.com/read/28577329/automated-image-quality-evaluation-of-t2-weighted-liver-mri-utilizing-deep-learning-architecture
#19
Steven J Esses, Xiaoguang Lu, Tiejun Zhao, Krishna Shanbhogue, Bari Dane, Mary Bruno, Hersh Chandarana
PURPOSE: To develop and test a deep learning approach named Convolutional Neural Network (CNN) for automated screening of T2 -weighted (T2 WI) liver acquisitions for nondiagnostic images, and compare this automated approach to evaluation by two radiologists. MATERIALS AND METHODS: We evaluated 522 liver magnetic resonance imaging (MRI) exams performed at 1.5T and 3T at our institution between November 2014 and May 2016 for CNN training and validation. The CNN consisted of an input layer, convolutional layer, fully connected layer, and output layer...
June 3, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/28575697/pet-ct-with-18-f-choline-physiological-whole-bio-distribution-in-male-and-female-subjects-and-diagnostic-pitfalls-on-1000-prostate-cancer-patients-18-f-choline-pet-ct-bio-distribution-and-pitfalls-a-southern-italian-experience
#20
Ferdinando Calabria, Agostino Chiaravalloti, Carmelo Cicciò, Vincenzo Gangemi, Domenico Gullà, Federico Rocca, Gianpasquale Gallo, Giuseppe Lucio Cascini, Orazio Schillaci
INTRODUCTION: 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...
April 17, 2017: Nuclear Medicine and Biology
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