Gadolinium-based contrast agents (GBCAs) have enjoyed wide use since their introduction some 30 years ago. Used in as many as 30% of MRIs performed in the United States, GBCAs have generally been ...associated with low rates of adverse events. However, the safety profile and attendant medicolegal liability associated with GBCAs changed in 2016 with the description of gadolinium deposition disease (GDD). Despite being unproven scientifically, a groundswell of GDD-related litigation and personal injury advertising targeting potential GDD patients has occurred. In this article, we describe what GDD is, why GDD has created medicolegal risk, and how this risk might be mitigated. This article advocates using a risk mitigation strategy focused on reducing brain gadolinium retention during the period of purported GDD development. As such, based on the currently available data, the authors recommend the preferential use of gadoteridol as the default GBCA for MRI imaging.
Artificial intelligence (AI) applications have been gaining traction across the radiology space, promising to redefine its workflow and delivery. However, they enter into an uncertain legal ...environment. This piece examines the nature, exposure, and theories of liability relevant to musculoskeletal radiologist practice. More specifically, it explores the negligence, vicarious liability, and product liability frameworks by way of illustrative vignettes.
Mobile health (mHealth) technologies stand poised to find broad application in the radiology space. They hold considerable promise for millions of patients in the United States, enabling at-home ...imaging and augmenting clinical decision-making. However, they often lie outside the ambit of FDA regulation and process vast quantities of data largely unprotected by HIPAA. This article explores features of federal mHealth policy relevant to imaging practice and advocates for greater regulatory clarity to assist radiologists, developers, and ultimately, patients.
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•The current status of thermal characterization in the MOF field could be described, charitably, as haphazard. This review lays out some recommendations on performing isothermal ...experiments to accurately identify a decomposition temperature.•The review encourages the use of variable temperature X-ray and differential scanning calorimetry, which would identify changes in phase/state that proceed without mass loss.•Where applicable, the review has highlighted the known pathways of decomposition of several prototypical MOFs.
In order to systematically engineer the properties of crystalline and amorphous metal-organic frameworks (MOFs) towards practical application, a thorough understanding of their high-temperature behaviour is required. However, key properties such as the thermal decomposition temperature of a given MOF are often overlooked in the literature, leading to a huge gap in our understanding of the thermal stability of this vast class of materials. Herein, we undertake a critical review of thermogravimetric analysis (TGA) data from the MOF literature, and question the consistency, accuracy and meaning of the data provided.
We use existing data to collate thermal decomposition temperature (Td) values for a series of archetypal coordination materials and their analogues. Several factors were identified which influence the thermal stability of MOFs. In particular: (i) the nature and position of functional groups, (ii) metal hardness, and, (iii) the presence of coordinated solvent molecules were all found to have a significant impact on decomposition temperature. Isoreticular expansion and interpenetration on the other hand were found to have a relatively modest impact.
Moreover, we propose that decomposition mechanisms in MOFs may be broadly separated into two categories, depending on whether the decomposition is ligand-centred, or inorganic node-centred. Whilst ligand stability appears to be the dominant factor in determining overall thermal decomposition temperature, the stability of the inorganic node is key in realising solid-liquid transitions and high-temperature recrystallisation within the family. Thus, both ligand and node stability must be considered when attempting to engineer the high-temperature properties of MOFs.
The quality of medical literature is increasingly threatened by irresponsible publishing, leading to rising retraction rates, irreproducible results, and a flood of inconsequential publications that ...distract readers from more meaningful scholarship. “Predatory publishers” offer rapid publication with loose peer review, exploiting a system in which faculty seek longer bibliographies to achieve academic promotion. In this Commentary, the authors highlight some of the evidence that this problem exists and suggest actions to address it. Recommendations for protecting the medical literature include preventing predatory journals from being indexed by the National Library of Medicine; encouraging academic promotions committees to ensure that they prioritize value over volume of publications and that faculty understand that priority; excluding publications from predatory journals on curricula vitae and requiring that retractions are included; developing sanctions for repeated retractions or duplicate publications; and convening an expert panel to better elucidate this problem and determine strategies to combat it.
Abstract Objective Current guidelines do not address the disposition of patients with mild traumatic brain injury (TBI) and resultant intracranial hemorrhage (ICH). Emergency medicine clinicians ...working in hospitals without neurosurgery coverage typically transfer patients with both to a trauma center with neurosurgery capability. Evidence is accruing which demonstrates that the risk of neurologic decompensation depends on the type of ICH and as a result, not every patient may need to be transferred. The purpose of this study was to identify risk factors for admission among patients with mild TBI and ICH who were transferred from a community hospital to the emergency department (ED) of a Level 1 trauma center. Methods Study subjects were patients ≥ 18 years of age who were transferred from a community hospital to the ED of an urban, academic Level 1 trauma center between April 1, 2015 and March 31, 2016, and with an isolated traumatic ICH. Patients who had an epidural hematoma, were deemed to require a trauma center's level of service, were found to have non-traumatic ICHs, or had a Glasgow Coma Scale of < 13 were excluded. Using a multivariable logistic regression model, we sought to determine patient factors and Computed Tomography (CT) findings which were associated with admission (to the floor, intensive care unit, or operating room with neurosurgery) of the Level 1 trauma center. Results 644 transferred patients were identified; 205 remained eligible after exclusion criteria. Presence of warfarin (odds ratio OR 4.09, 95% Confidence Interval CI 1.64, 10.25, p = 0.0026) and a subdural hematoma (SDH) ≥ 1 cm (OR 6.28, 95% CI 1.24, 31.71, p = 0.0263) were independently statistically significant factors predicting admission. Age, sex, GCS, presence of neurologic deficit, aspirin use, clopidogrel use, SDH < 1 cm, IPH, and SAH were each independently not significant predictive factors of an admission. Conclusions After controlling for factors, transferred patients with mild TBI with a SDH ≥ 1 cm or on warfarin have a higher odds ratio of requiring inpatient admission to a Level 1 trauma center. While these patients may require admission, there may be opportunities to develop and study a low risk traumatic intracranial hemorrhage protocol, which keeps a subgroup of patients with a mild TBI and resultant ICH at community hospitals with access to a nearby Level 1 trauma center.
A 58-year-old woman from New England presented to the outpatient neurology clinic in early autumn with hypoesthesia of the trunk and abdomen, paresthesia of the hands, and weakness of the left foot ...and abdominal wall. A diagnostic test was performed.
To test whether data elements available in the electronic medical record (EMR) can be effectively leveraged to predict failure to attend a scheduled radiology examination.
Using data from a large ...academic medical center, we identified all patients with a diagnostic imaging examination scheduled from January 1, 2016, to April 1, 2016, and determined whether the patient successfully attended the examination. Demographic, clinical, and health services utilization variables available in the EMR potentially relevant to examination attendance were recorded for each patient. We used descriptive statistics and logistic regression models to test whether these data elements could predict failure to attend a scheduled radiology examination. The predictive accuracy of the regression models were determined by calculating the area under the receiver operator curve.
Among the 54,652 patient appointments with radiology examinations scheduled during the study period, 6.5% were no-shows. No-show rates were highest for the modalities of mammography and CT and lowest for PET and MRI. Logistic regression indicated that 16 of the 27 demographic, clinical, and health services utilization factors were significantly associated with failure to attend a scheduled radiology examination (P ≤ .05). Stepwise logistic regression analysis demonstrated that previous no-shows, days between scheduling and appointments, modality type, and insurance type were most strongly predictive of no-show. A model considering all 16 data elements had good ability to predict radiology no-shows (area under the receiver operator curve = 0.753). The predictive ability was similar or improved when these models were analyzed by modality.
Patient and examination information readily available in the EMR can be successfully used to predict radiology no-shows. Moving forward, this information can be proactively leveraged to identify patients who might benefit from additional patient engagement through appointment reminders or other targeted interventions to avoid no-shows.
ACR Appropriateness Criteria Low Back Pain Patel, Nandini D., MD; Broderick, Daniel F., MD; Burns, Judah, MD ...
Journal of the American College of Radiology,
09/2016, Letnik:
13, Številka:
9
Journal Article
Recenzirano
Abstract Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of ...medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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