Hit by the wave: The experiences of adult males living with lymphoedema.

Lymphoedema arises when the lymphatic system has been damaged and may occur secondary to cancer treatment. While much of the extant literature focuses on quality of life in females with breast cancer- related lymphoedema, this study explores the impact of living with lymphoedema secondary to cancer treatment in males. Semi-structured interviews were conducted with 13 male participants, aged between 50 to 85 years. Data collected were analysed using interpretative phenomenological analysis. The super-ordinate theme 'Hit by a wave' encompasses the profound impact of lymphoedema on the participants' quality of life. The males expressed body image concerns and struggled with feelings of frustration, anger, anxiety and depression. Physical changes such as weight increase, disrupted sleep, pain, swollen genitals and urinary difficulties were experienced. Changes in lifestyle were also expressed, such as an increased dependence on carers; work-related and role changes. Nevertheless, many participants endorsed the need to focus on the present moment and expressed a heightened appreciation of authenticity in life. By understanding the unique narratives of males with lymphoedema, health care practitioners together with patients can formulate care plans that truly resonate with the needs, concerns, and experiences of males living with lymphoedema.

A prospective natural history study of coronary atherosclerosis following liver transplantation.

BACKGROUND & AIMS: Cardiovascular disease remains a leading cause of mortality following liver transplantation (LT). Whether it may be partially attributable to accelerated development of subclinical coronary artery disease is unclear. We sought to assess the longitudinal effect of LT on coronary plaque burden. METHODS: A prospective observational study was conducted in 30 asymptomatic patients who underwent computed tomographic coronary angiography (CTCA) pre- and a median 4-years following LT. Serial changes were quantified using coronary artery calcium score (CACS) and semi-quantitative CTCA scores, in a blinded fashion. High-risk plaque (HRP) characteristics were also assessed. Plaque progression was defined using prognostically significant cut-offs. RESULTS: In the study population (age 59.8 ± 8 years, 80% male), 93 of 459 coronary segments had plaque at baseline. On follow-up CTCA, 68 (+73.1%) new lesions appeared in segments without plaque initially. Nineteen (63.3%) patients demonstrated a clinically significant rise in plaque burden on CACS and semi-quantitative indices on CTCA (all p<0.001). CAD-RADS score rose to ≥4 (≥70% stenosis) in 9 (30%) patients, necessitating ischemia-guided revascularization in 3 (10%) patients. While the absence of coronary calcification or plaque pre-LT was protective, presence of HRP and development of post-transplant metabolic syndrome were both strong independent predictors of atherosclerosis progression. CONCLUSIONS: Our findings suggest that LT is associated with early progression of coronary atherosclerosis. Accelerated progression was noted particularly in those with HRP and post-transplant metabolic syndrome. Understanding the mechanisms of this novel observation and the potential role of preventive cardiovascular therapies in this population merit further study.

Impact of Image Reconstruction Parameters on Abdominal Aortic Calcification Measurement Using Abdominal Computed Tomography.

BACKGROUND AND AIMS: Abdominal aortic calcification (AAC) is correlated with cardiovascular outcomes independent of traditional risk factors. Quantification of AAC on computed tomography (CT) has not been standardized. Reconstruction parameters have been shown to impact coronary calcium scores. The aim of our study was to assess the impact of abdominal CT reconstruction parameters, slice thickness (ST), and display field of view (DFOV) on AAC quantitative scoring on abdominal CT examinations. METHODS: We retrospectively measured AAC on noncontrast CT of 46 patients (mean age, 64.1 years; 35 males) using 5 different reconstruction protocols with a range of ST and DFOV: protocol A, 2.5 mm ST, 35 cm DFOV; protocol B, 2.5 mm ST, 50 cm DFOV; protocol C, 2.5 mm ST, 25 cm DFOV; protocol D, 5 mm ST, 35 cm DFOV; and protocol E: 0.625 mm ST, 35 cm DFOV. The AAC scores from each protocol were compared using concordance correlation coefficient and Bland-Altman agreement analyses. RESULTS: The AAC mean (SD) scores for each protocol were as follows: A, 2022 (2418); B, 2022 (2412); C, 1939 (2310); D, 2220 (2695); and E, 1862 (2234). The AAC mean score differences between protocols and reference protocol A were -0.47, 82.01, -198.94, and 160 for protocols B, C, D, and E, respectively, with differences between protocols C to E statistically significantly different (P < 0.05). The different protocols showed overall excellent correlation (concordance correlation coefficient, >0.9) between AAC scores. CONCLUSIONS: Slice thickness and DFOV can impact AAC score measurement. A description of reconstruction parameters is important to allow comparisons across different cohorts.

Reaching out for Help: Calls to a Mental Health Helpline Prior to and during the COVID-19 Pandemic.

The COVID-19 pandemic is a major health crisis associated with adverse mental health consequences. This study examined 2908 calls made to a national mental health helpline over a 10 month period, 2 months prior to (Pre-COVID) and 8 months during the pandemic phase, that incorporated the imposition of a partial lockdown, followed by the removal and reintroduction of restrictive measures locally. Data collected included reason/s for call assistance, gender, age and number of daily diagnosed cases and deaths due to COVID-19. In the Pre-COVID phase, calls for assistance were related to information needs and depression. With the imposition of a partial lockdown, coupled with the first local deaths and spikes in number of diagnosed cases, a significant increase in number of calls targeting mental health, medication management and physical and financial issues were identified. Following the removal of local restrictions, the number of calls decreased significantly; however, with the subsequent reintroduction of restrictions, coupled with the rise in cases and deaths, assistance requested significantly targeted informational needs. Hence, whilst calls in the initial phase of the pandemic mainly targeted mental health issues, over time this shifted towards information seeking requests, even within a context where the number of deaths and cases had significantly risen.

Service Users' Perception of the Therapeutic Milieu in a Mental Health Rehabilitation Unit.

Although the concept of the therapeutic milieu has been given prominence, the perceptions of care receivers in this regard are sparse. This study aimed to explore service users' perceptions of the therapeutic milieu in a mental health rehabilitation unit. The method used was document analysis of annual reports generated by the unit through data collection from the care receivers. Four themes were identified, namely, the 'physical environment', the 'structure of the therapeutic programme', 'relationships with the professionals' and the 'experience of living as a community'. The study contributed to previous research through meaningful ramifications for research, practice and education.

The effects of sublingual nitroglycerin administration in coronary computed tomography angiography.

PURPOSE: The purpose of our study was to compare coronary luminal diameters in patients undergoing coronary computed tomography angiography (CCTA) performed with different sublingual nitroglycerin (NTG) spray regimens. MATERIALS AND METHODS: We retrospectively reviewed CCTA studies performed in two historical groups (Group 1, single dose nitroglycerin 2 min prior to CCTA, and Group 2, single dose 10 min prior), and a current protocol group (Group 3, single dose at 2 and 10 min prior). Thirty patients were evaluated per group. Two blinded readers measured coronary luminal diameters with comparison of diameter measurements. A third blinded reader assessed image quality of coronary artery segments. RESULTS: Significant group-level differences in median luminal diameters were identified. Higher median diameters (95% CI) across all segments of 0.40 mm (0.20, 0.60) for Group 2 versus 1 and 0.50 mm (0.30, 0.70) for Group 3 versus 1 were recorded (both P < 0.001). No significant differences in median luminal diameters were found between Groups 2 and 3. No significant differences in image quality were found among the groups apart from higher image quality for the distal LAD for both Groups 2 and 3 compared to Group 1. CONCLUSION: Sublingual nitroglycerin spray administered as a single dose at 10 minute dilates coronary arteries more than when only administered at 2 min prior to CCTA. Combined two doses at 10 and 2 min prior to CCTA do not yield further dilatation of coronary arteries.

Risk of Arterial Injury During Hip Internal Fixation.

BACKGROUND: Injury to femoral arterial vessels is a risk with internal fixation of the hip. Understanding the anatomy of proximate vessels, particularly medial vessels not directly visualized, may reduce intraoperative and postoperative complications. METHODS: We analyzed 47 patients (29 men and 18 women) using a computed tomographic (CT) angiogram of the lower limbs. The mean age of our patients was 69 years (range, 46 to 88 years). The distance from the tip of the greater trochanter to the profunda femoris and its perforators within 5 mm of the medial femoral shaft was measured along the length of the expected placement of typical dynamic hip screw constructs and other proximal femoral fracture fixation methods. RESULTS: All patients were found to have 2 perforator vessels within 5 mm of the medial femoral shaft along the line of dynamic hip screw insertion (up to 200 mm from the tip of the greater trochanter). The first perforator was found at a mean distance of 112.6 mm (median, 110 mm) in women and at 123.4 mm (median, 122 mm) in men (p = 0.0066) from the tip of the greater trochanter. The second perforator appeared at a mean distance of 159.7 mm (median, 159 mm) in women and 178.9 mm (median, 180 mm) in men (p = 0.0028) from the tip of the greater trochanter. CONCLUSIONS: Surgeons should be aware of the presence of 2 arteries within 5 mm of the medial femoral shaft during femoral internal fixation procedures. We suggest avoiding the overdrilling of the medial cortex and the insertion of overlong screws along the femoral shaft from 110 to 120 mm in women and 120 to 130 mm in men (as measured from the tip of the greater trochanter) to prevent vascular injury during proximal femoral fracture fixation. CLINICAL RELEVANCE: This article can assist orthopaedic surgeons in planning for procedures involving internal fixation of the hip and may reduce vascular complications from such procedures.

Radiation Dose Associated With Over Scanning in Neck CT.

The increasing utilization of computed tomography scans exposes patients to significant amounts of radiation. One of the factors that can result in unnecessary radiation dose is scanning beyond the clinically indicated anatomical region. This study aims to assess the optimization in overscan frequency, scan length, and radiation dose following targeted educational talks aimed to address a routinely over scanned protocol; the computed tomography Neck. A targeted radiation awareness talk regarding scan adherence as a method of radiation dose optimization was delivered to all medical imaging technologists employed at a large teaching hospital. An audit of the radiation dose associated with computed tomography Neck protocols was conducted in the month before, a month after and 1 year after the awareness talk. Results show that following the radiation awareness talks there was a 15% reduction in overscan frequency, an average over scan length reduction of 33% and a 20% reduction in overall radiation dose. The targeted nature of the talk, explicitly addressing scan range in the neck region, significantly reduced radiation dose to the patients. The results of this study are effective in illustrating the potential clinical radiation dose saving from strict adherence to scan range.

Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease: Assessment of Image Quality and Accuracy in a Tertiary Care Setting.

OBJECTIVE: The aim of this study was to evaluate image quality and accuracy of 64+ detector multidetector computed tomography angiography (MDCTA) for hemodynamically significant (≥50%) stenosis in patients with symptomatic peripheral arterial disease (PAD) using digital subtraction angiography as the reference standard. METHODS: This is a retrospective study of 29 patients with PAD (19 men, 10 women) who underwent lower limb MDCTA (64- or 80-detector) and digital subtraction angiography. Image quality and accuracy of MDCTA for hemodynamically significant stenosis were assessed in the infrarenal aorta and 15 lower extremity segments. RESULTS: Four hundred fifty-three segments were adequately visualized at both modalities. Multidetector CTA had 84.8% sensitivity, 87.7% specificity, and 86.3% accuracy for significant stenosis. Accuracy was decreased in the calf when compromising arterial wall calcifications were present versus absent (55.9% vs 82.4%, P < 0.0001). CONCLUSIONS: 64+ MDCTA is accurate in patients with symptomatic PAD. However, diagnostic accuracy in below-knee vessels remains relatively poorer. Alternative imaging modalities should be considered where below-knee disease is suspected.

Computed tomography overexposure as a consequence of extended scan length.

INTRODUCTION: This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol METHODS: The Monte Carlo-based software CT-Expo (G. Stamm (Medizinische Hochschule Hannover, Hannover, Germany) and H.D. Nagel (SASCRAD, Buchholz, Germany)) was used to simulate the effective dose increase as the scanned region of the standard protocol increased. RESULTS: The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol ; however, radiation exposure should be kept as low as reasonably achievable. CONCLUSION: There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.