Clinical decisions-making within diagnostic radiography - A scoping review.

OBJECTIVES: To describe and synthesise literature on clinical decision-making within diagnostic radiography, to uncover the important elements, and to identify knowledge gaps for further investigation. The scoping review question was: How do diagnostic radiographers make clinical decisions? KEY FINDINGS: Radiographers make clinical decisions before, during and after examinations. The primary source of information radiographers use is the clinical request, however, if they doubt something, they rely on their colleague's points of view rather than evidence-based practice. Many elements must be considered in the clinical decision-making process; however, lack of autonomy, sparse information on the clinical requests, and lack of time affect the process, which can lead to a barrier to effective decision-making. CONCLUSION: Clinical decisions are made based on many different elements before, during, and after examinations in combination with different types of knowledge, as well as technical and organisational aspects within radiography clinical practice. IMPLICATION FOR PRACTICE: There is a need to focus on giving more attention to developing the decision-making elements. In addition, there must be more focus on improving intra-professional work between radiographers and radiologists to facilitate radiographers' opportunities to act on their clinical decisions.

Degenerative cervical myelopathy: Neuroradiological, neurophysiological and clinical correlations in 27 consecutive cases.

•New insight into prognostic factors for recovery of clinical function following posterior decompression for degenerative cervical myelopathy.•An increase of IOM amplitude of at least 50% coupled with preoperative T2-only and diffuse T2 signal changes on MRI is a positive prognostic factors for clinical improvement 6 months after surgery.•Clinical improvement at 6 months follow-up can be expected in patients with T1 hypo intensity if a diffuse border of the lesion on T2 images is present.

Erythropoietin monotherapy in perinatal asphyxia with moderate to severe encephalopathy: a randomized placebo-controlled trial.

OBJECTIVE: Erythropoietin (EPO) is neuroprotective after asphyxia in animal studies. The efficacy and safety of EPO monotherapy in term neonates with hypoxic ischemic encephalopathy (HIE) is uncertain. STUDY DESIGN: Hundred term neonates with moderate or severe HIE were randomized by random permuted block algorithm to receive either EPO 500 U kg-1 per dose in 2 ml saline intravenously (50 neonates) on alternate days for a total of five doses with the first dose given by 6 h of age (treatment group) or 2 ml of normal saline (50 neonates) similarly for a total of five doses (placebo group) in a double-blind study. No hypothermia was given. The primary outcome was combined end point of death or moderate or severe disability at mean age of 19 months (s.d., 0.61). RESULTS: Death or moderate or severe disability occurred in 40% of neonates in the treatment group vs 70% in the placebo group (risk ratio, 0.57; 95% confidence interval (CI) 0.38 to 0.85; P=0.003). Death occurred in 16% of patients in both the groups (risk ratio, 1.0; 95% CI 0.33 to 2.9; P=0.61). The risk of cerebral palsy was lower among survivors in the treatment group (risk ratio, 0.52; 95% CI 0.25 to 1.03; P=0.04) and lesser number of babies were on anticonvulsants at assessment (risk ratio, 0.47; 95% CI 0.20 to 1.01; P=0.03). Neonatal brain magnetic resonance imaging showed more abnormalities in the placebo group (relative risk, 0.66; 95% CI 0.42 to 1.03; P=0.04)). Improvement in other neurological outcomes was not significant. CONCLUSION: EPO monotherapy reduces the risk of death or disability in term neonates with moderate or severe encephalopathy.

Effects of acute versus post-acute systemic delivery of neural progenitor cells on neurological recovery and brain remodeling after focal cerebral ischemia in mice.

Intravenous transplantation of neural progenitor cells (NPCs) induces functional recovery after stroke, albeit grafted cells are not integrated into residing neural networks. However, a systematic analysis of intravenous NPC delivery at acute and post-acute time points and their long-term consequences does not exist. Male C57BL6 mice were exposed to cerebral ischemia, and NPCs were intravenously grafted on day 0, on day 1 or on day 28. Animals were allowed to survive for up to 84 days. Mice and tissues were used for immunohistochemical analysis, flow cytometry, ELISA and behavioral tests. Density of grafted NPCs within the ischemic hemisphere was increased when cells were transplanted on day 28 as compared with transplantation on days 0 or 1. Likewise, transplantation on day 28 yielded enhanced neuronal differentiation rates of grafted cells. Post-ischemic brain injury, however, was only reduced when NPCs were grafted at acute time points. On the contrary, reduced post-ischemic functional deficits due to NPC delivery were independent of transplantation paradigms. NPC-induced neuroprotection after acute cell delivery was due to stabilization of the blood-brain barrier (BBB), reduction in microglial activation and modulation of both peripheral and central immune responses. On the other hand, post-acute NPC transplantation stimulated post-ischemic regeneration via enhanced angioneurogenesis and increased axonal plasticity. Acute NPC delivery yields long-term neuroprotection via enhanced BBB integrity and modulation of post-ischemic immune responses, whereas post-acute NPC delivery increases post-ischemic angioneurogenesis and axonal plasticity. Post-ischemic functional recovery, however, is independent of NPC delivery timing, which offers a broad therapeutic time window for stroke treatment.

Internal carotid artery occlusion: its natural history including recanalization and subsequent neurological events.

OBJECTIVE: To determine the incidence of recanalization of the occluded internal carotid artery (ICA) and establish its natural history. METHODS: Patients with duplex-confirmed ICA occlusions were identified, and a subgroup offered repeat scanning. The antemortem condition and cause of death of patients who died were recorded. RESULTS: Of 153 patients identified, 77 underwent follow-up at a median of 35 months (interquartile range [IQR]: 14-61).In all, 8 (10.3%) demonstrated recanalization at a median of 53 months (IQR: 35-114). Of 8, 7 underwent carotid endarterectomy with histopathological confirmation of recanalization. Of the 153 patients, 45 (29%) had further neurological events, and 38 (25%) were within the territory of the occluded ICA. In all, 76 patients died, and of the 53 with a confirmed cause of death, 12 (23%) were attributed to a cerebrovascular accident corresponding to the territory of the occluded artery. CONCLUSION: Recanalization of ICA occlusion is common and leads to significant neurological events. Duplex ultrasound follow-up appears mandatory.

Modified bamboo rayon-copper nanoparticle composites as antibacterial textiles.

In the current study the bamboo rayon fabric grafted with acrylamide was utilized as a backbone to immobilize copper nanoprticles. The grafted bamboo rayon was first treated with CuSO4 followed by chemical reduction. The modified product was characterized using FTIR, TGA and SEM. The characteristic color developed after reduction was measured spectrophotometrically. The grafted bamboo rayon with Cu nanoparticles was then evaluated for antibacterial activity against both gram positive and gram negative bacteria and the durability of their antibacterial activity after washing. The product showed antibacterial activity against both types of bacterias which was found to be durable till 50 washes. The material can be claimed as suitable candidate for medical textile applications to prevent cross-infections.

Acetylation of banana fibre to improve oil absorbency.

Oil spill leaves detrimental effects on the environment, living organisms and economy. In the present work, an attempt is made to provide an efficient, easily deployable method of cleaning up oil spills and recovering of the oil. The work reports the use of banana fibres which were acetylated for oil spill recovery. The product so formed was characterized by FT-IR, TG, SEM and its degree of acetylation was also evaluated. The extent of acetylation was measured by weight percent gain. The oil sorption capacity of the acetylated fibre was higher than that of the commercial synthetic oil sorbents such as polypropylene fibres as well as un-modified fibre. Therefore, these oil sorption-active materials which are also biodegradable can be used to substitute non-biodegradable synthetic materials in oil spill cleanup.

Multifunctional finishing of cotton using chitosan extracted from bio-waste.

In the current work, chitosan extracted from waste shrimp shells was used in finishing formulation for cotton fabric, along with DMDHEU and other chemicals, imparting multiple performance characteristics such as wrinkle free, antibacterial and flame retardant properties. The finished fabrics were evaluated for textile properties like tensile strength, bending length, yellowness index and functional properties like crease recovery angle, antibacterial activity and flame retardancy and also for the ecological properties like formaldehyde release. The finished fabric showed excellent crease recovery, antibacterial property and flame retardancy which were retained to a moderate extent even after 20 washes. Besides formaldehyde scavenging action, chitosan clearly showed its positive role in imparting multifunctional properties to cotton.

Extraction of chitosan from shrimp shells waste and application in antibacterial finishing of bamboo rayon.

Chitosan can be best utilized as safe antibacterial agent for textiles but there is always a limitation of its durability. The chitin containing shellfish waste is available in huge quantities, but very low quantities are utilized for extraction of high value products like chitosan. In the current work chitosan was extracted from shrimp shells and then used as antibacterial exhaust finishing agent for grafted bamboo rayon. Chitosan bound bamboo rayon was then evaluated for antibacterial activity against both gram positive and gram negative bacteria. The product showed antibacterial activity against both types of bacterias which was durable till 30 washes.

Prospective study of a new dynamic stabilisation system in the treatment of degenerative discopathy and instability of the lumbar spine.

INTRODUCTION: Posterior dynamic stabilisation (PDS) aims at relieving lumbar discogenic pain and preserving adjacent levels from accelerated degeneration. PURPOSE: To evaluate the results of a novel PDS system in 32 adult patients affected by chronic low back pain (CLBP) due to degenerative lumbar spine instability (DLSI). METHOD: A progressive follow-up for 12 months of 32 patients, with collection of complete clinical (ODI and VAS back + leg) and radiological data (resting + functional radiographs and MRI). RESULTS: Mean ODI scores improved from 49 to 6%, VAS back from 5 to 1 and VAS leg from 7 to 2. Twenty-two patients underwent fusion of a lower lumbar segment and stabilisation of an upper segment (hybrid fusion) whereas ten underwent dynamic stabilisation. In 16/32 patients, decompression was added to treat radicular pain. Motion in non-fused instrumented levels was unrestricted on functional X-rays and MRIs did not show significant morphologic changes. Four patients (12.5%) had unchanged functional and pain scores while two (6.3%) suffered worsening low back pain necessitating implant removal and spinal fusion. No infection, no new neurologic deficit or implant failure was recorded. CONCLUSIONS: The 1 year follow-up shows that the tested PDS system is able to provide a significant improvement in pain and disability scores when applied to patients affected by DLSI. The system does not provide better clinical results when compared to similar trials on posterior fusion. Further follow-up is ongoing to investigate the potential preservation of adjacent levels from accelerated degeneration.

Reliability and validity of the cross-culturally adapted Italian version of the Core Outcome Measures Index.

Patient-orientated outcome questionnaires are essential for the assessment of treatment success in spine care. Standardisation of the instruments used is necessary for comparison across studies and in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders and is the recommended outcome instrument in the Spine Society of Europe Spine Tango Registry; currently, no validated Italian version exists. A cross-cultural adaptation of the COMI into Italian was carried out using established guidelines. 96 outpatients with chronic back problems (>3 months) were recruited from five practices in Switzerland and Italy. They completed the newly translated COMI, the Roland Morris disability (RM), adjectival pain rating, WHO Quality of Life (WHOQoL), EuroQoL-5D, and EuroQoL-VAS scales. Reproducibility was assessed in a subgroup of 63 patients who returned a second questionnaire within 1 month and indicated no change in back status on a 5-point Likert-scale transition question. The COMI scores displayed no floor or ceiling effects. On re-test, the responses for each individual domain of the COMI were within one category in 100% patients for "function", 92% for "symptom-specific well-being", 100% for "general quality of life", 90% for "social disability", and 98% for "work disability". The intraclass correlation coefficients (ICC(2,1)) for the COMI back and leg pain items were 0.78 and 0.82, respectively, and for the COMI summary index, 0.92 (95% CI 0.86-0.95); this compared well with 0.84 for RM, 0.87 for WHOQoL, 0.79 for EQ-5D, and 0.77 for EQ-VAS. The standard error of measurement (SEM) for COMI was 0.54 points, giving a ''minimum detectable change'' for the COMI of 1.5 points. The scores for most of the individual COMI domains and the COMI summary index correlated to the expected extent (0.4-0.8) with the corresponding full-length reference questionnaires (r = 0.45-0.72). The reproducibility of the Italian version of the COMI was comparable to that published for the German and Spanish versions. The COMI scores correlated in the expected manner with existing but considerably longer questionnaires suggesting adequate convergent validity for the COMI. The Italian COMI represents a practical, reliable, and valid tool for use with Italian-speaking patients and will be of value for international studies and surgical registries.

A survey of risk factors in carcinoma esophagus in the valley of Kashmir, Northern India.

BACKGROUND/OBJECTIVE: Esophageal cancer has a peculiar geographical distribution and shows marked differences in incidence within a particular geographical region. Presently, as there seems little prospect of early detection of this cancer, an understanding of the etiological factors may suggest opportunities for its primary prevention. In this paper, we have tried to determine the role of diet and other life-style related factors in the etiology of cancer of esophagus. MATERIAL AND METHODS: A total of 100 confirmed squamous cell carcinoma of esophagus patients were enrolled for the study (Group A). 100 healthy subjects were included as controls (Group B). A predesigned questionnaire dealing with the basic patient data, dietary and smoking habits etc. was distributed among the cases in both groups. The data was thoroughly analyzed to define an association with the development of cancer of esophagus. RESULTS: Group A patients included 71 males and 29 females in the age range of 40-70 years. Majority 37% were farmers, 29% house wives. Of the 72% smokers, 66% smoked hookah. 29% had positive family history. More than 90% took salt-tea at breakfast. Meat consumption was low, 44% took it weekly and 42% on monthly basis. 69% took fish yearly. Group B included 75 males and 25 females of which 35.7% were hookah smokers. CONCLUSION: Poor socio-economic status resulting in fewer intakes of fresh fruits, vegetables and fish in addition to heavy hookah smoking are suspected to be the major risk factors for the development of esophageal cancer.

Profile of lung cancer in Kashmir, India: a five-year study.

AIM: To study the clinico-pathological aspects of lung cancer, and the outcome of various treatment modalities. METHODS: A retrospective review of histopathologically confirmed lung cancer patients who were registered and treated at our institution over a period of five years was carried out. RESULTS: A total of 321 patients were studied. There was a preponderance of males (91.9%) as compared to females (8.1%). Smoking history was present in 88% of the male patients. Cough was the main presenting feature in 71.6% of patients. Diagnosis was established by bronchoscopy in 94% of cases. Squamous cell carcinoma was observed in 77.3%, while 17.1% had small cell carcinoma. Radiotherapy formed the main treatment modality alone (22.4%) and in combination (27%). Out of the 321 patients, 206 were evaluable on follow-up. Local failure and distant metastasis were seen in 9.2% and 19.9% of cases, respectively. The overall survival rate of 2, 3 and 5 years was 19.9%, 13.59% and 6.79%, respectively. CONCLUSIONS: . The outcome of lung cancer is poor. Increased survival is possible if the disease is detected early, treated adequately with multi modality approach.

Influence of the diameters of tendon graft and bone tunnel in hamstring ACL reconstruction. A bovine model.

In an animal model of Anterior Cruciate Ligament reconstruction by hamstring tendons and 8mm diameter biodegradable interference screws, we aimed to investigate whether pull out forces and failure modes were influenced by changing tendon and bone tunnel diameters. Three groups of 10 calf tibiae each were prepared with 8, 9 and 10mm diameter proximal tunnels fitted respectively with 8, 9 and 10mm diameter tendon grafts. Mean +/- SD pull out force was 607.9 +/- 191.5N in the 8mm group, 494.2 +/- 206.2N in the 9mm group and 530.4 +/- 212.5N in the 10mm group. These differences were not significant at t-test. 8mm specimens failed by tendon rupture, 10mm specimens failed by screw pull out and 9mm specimens failed in both ways. In this ACL reconstruction model, safe pull out forces were achieved by fixing tendon grafts to bone by 8 mm absorbable interference screws regardless of tendon and bone tunnel diameter.

Prevalence and treatment of carpal tunnel syndrome in renal haemodialysis.

The purpose of this study was to investigate the prevalence and aetiology of carpal tunnel syndrome (CTS) and the effect of open carpal tunnel decompression (CTD) in a group of patients on renal haemodialysis. In 91 patients attending a Renal Unit who were assessed only by clinical means, the prevalence of CTS was 7.1%. CTS development was not significantly correlated with known risk factors, in particular duration of dialysis and presence of an artero-venous fistula on the symptomatic limb. CTD led to a mean symptom-free period of 12 years. In summary, CTS is a frequent and serious disease affecting renal dialysis patients, but its aetiology remains uncertain. Nevertheless, CTD is an effective and lasting treatment for this condition.

The Mitchell bunionectomy: a prospective study of 60 consecutive cases utilizing single K-wire fixation.

The authors prospectively evaluated 45 patients (60 feet) affected by hallux valgus and treated with a distal metatarsal osteotomy. The surgical procedure consisted of a modified Mitchell osteotomy, in which fixation was achieved with a Kirschner wire that was driven into the proximal osteotomy fragment and buttressed the distal one. Early weightbearing was allowed without a cast. Follow-up averaged 25 months. The mean American Orthopedic Foot and Ankle Society clinical hallux score increased from 44.6/100 preoperatively to 83.2/100. Radiographic evaluation showed that mean metatarsophalangeal and intermetatarsal angles decreased respectively from 31.7 degrees to 16.9 degrees, and from 15.4 degrees to 8.6 degrees. Short-term loss of correction occurred in three cases (4%). Six feet (10%) had unrelieved metatarsalgia that was related to excessive shortening of the first metatarsal and/or inappropriate orientation of the metatarsal head. Stabilization of the Mitchell osteotomy with a Kirschner wire proved safe and effective for the surgical correction of mild to moderate hallux valgus.

Treatment of closed humeral shaft fractures with intramedullary elastic nails.

PURPOSE: Our purpose is a retrospective study of the results of diaphyseal humeral fracture treatment by elastic intramedullary nailing in comparison with plate osteosynthesis. METHODS: Thirty cases were reviewed, with an average follow-up of 2 years. In 14 cases, flexible nails were used, and in the remaining 16 cases, A-O plates were used. We considered patients' sex and age, fracture type according to the A-O classification, type of treatment, consolidation defects, additional therapeutic procedures, healing time, and functional recovery. The surgical technique of elastic nailing appeared very simple, safe, and rather atraumatic because the nail is introduced in a retrograde manner and does not need proximal interlocking. RESULTS: The results of elastic nailing, in terms of fracture healing time and functional recovery, appeared comparable with the results of plating, and complications appeared milder. CONCLUSION: We conclude that intramedullary elastic nailing is valid for routine use in appropriately selected humeral shaft fractures.

The natural history of nonalcoholic fatty liver: a follow-up study.

Nonalcohol-induced fatty liver is widely believed to be a benign condition with little or no risk of disease progression. There have been occasional reports of progression to cirrhosis but none in the absence of preexisting fibrosis on the index biopsy specimen even when co-existing hepatitis was present (steatohepatitis). From our histological database (1978 to 1985), we identified 161 patients with fatty liver seen at our institution and traced the case notes of 156. One hundred five patients were initially excluded as having an alcohol-induced cause, and the remaining 51 either were seen in the clinic (37) or had died, in which cases copies of their death certificates were obtained (14). A further 7 patients were excluded after clinic attendance gave evidence of alcohol excess and another 4 after review of their initial biopsy showed the presence of fibrosis or steatohepatitis. The apparent cause of the steatosis in the 40 included patients with strictly nonalcohol-induced pure fatty liver was obesity in 12, diabetes in 4 (1 obese patient), and cachexia associated with extrahepatic malignancy in 6. Four of the remaining 19 had serological evidence of an autoimmune disorder, but none of these had any clinical or histological features of autoimmune liver disease. Nine patients had evidence of hyperlipidemia, 3 of whom were also obese. At a median follow-up of 11 years (7 to 16), 12 of 26 living patients had abnormal results of liver blood tests and had repeat liver biopsies performed. None had progressed to steatohepatitis or cirrhosis; 1 obese patient had developed mild fibrosis 9.8 years after her index biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of progression to cirrhosis or fibrosis in pure alcoholic fatty liver.

"Pure" alcoholic fatty liver has been widely assumed to be "benign" with very low risk of progression to cirrhosis. Studies thus far have included either patients with coexisting recognised precursor lesions of cirrhosis or have been restricted to short-term histological follow-up. We have followed 88 patients, first seen between 1978 and 1985, with a histological diagnosis of pure alcoholic fatty liver and no evidence of fibrosis or alcoholic hepatitis, for a median of 10.5 years, to determine any factors predictive of disease progression. Of the 88, at follow-up nine had developed cirrhosis and a further seven fibrosis. Eight of nine patients with cirrhosis had continuing alcohol consumption of more than 40 units per week at follow-up; in the other patients, consumption was unknown. Independent histological predictors of progression on index biopsy were: presence of mixed macro/microvesicular fat, and presence of giant mitochondria. We can no longer regard alcoholic fatty liver as benign. In the presence of continuing high alcohol consumption the above histological features identified those at high risk (47-61%) of disease progression. Therefore, patients with these features should be counselled intensively regarding their alcohol consumption.

The effects of roxatidine on neuromuscular transmission.

We have investigated the effects of the H2 receptor antagonist roxatidine on the neuromuscular transmission by using the sciatic nerve-gastrocnemius muscle preparation of the rat in vivo. Roxatidine, administered by i.v. injection, potentiates the neuromuscular blockade induced by d-tubocurarine, pancuronium and aminoglycoside antibiotic, kanamycin. Moreover, the drug alone is capable of producing a blockade on the preparation stimulated at high frequency. The neuromuscular blockade induced by roxatidine is partially reversed by 4-aminopyridine but not by dimaprit.