Tillmansilver3990

hange in attenuation threshold signifying the need for additional imaging from >20 HU to >30 HU proposed by the Bosniak Classification v.2019 is supported.BACKGROUND. Costochondral junction (CCJ) rib fractures pose a challenge in the radiographic detection and dating of infant abuse. OBJECTIVE. To assess the temporal pattern of radiographic findings of CCJ fractures on serial skeletal surveys (SSs). METHODS. Reports of SSs performed for suspected infant abuse were reviewed to identify those reporting a CCJ fracture. Study inclusion required undergoing initial and approximately 2-week follow-up SSs that included AP and bilateral oblique radiographs of the reported CCJ rib fracture. Two pediatric radiologists retrospectively classified fractures in terms of the primary injury pattern (bucket-handle visible crescentic fracture line; corner visible triangular fracture line; other) and secondary healing pattern (growth disturbance; sclerosis; subperiosteal new bone formation [SPNBF]). Discrepant readings were resolved by consensus. RESULTS. The final cohort included 26 infants with 81 CCJ fractures. On initial SS, 59% (48/81) of fractures showed a primary pattern, mCCJ fractures are in a healing phase at initial diagnosis. The signs of repair commonly remain visible on 2-week follow-up. The increased diagnostic yield of oblique views provides support to the inclusion of these projections in routine SS protocols. CLINICAL IMPACT. The findings will help radiologists improve the diagnosis and dating of CCJ rib fractures.Background Sinistral portal hypertension (SPH) is caused by an obstruction of the splenic vein and is a potential cause of upper gastrointestinal bleeding. Although splenic artery embolization (SAE) and splenic vein stenting (SVS) are accepted treatment options for SPH, their outcomes have not been compared directly. Objective This retrospective study aimed to compare the outcomes of SVS and SAE for SPH-related gastrointestinal bleeding. Methods The data of patients with SPH treated by interventional radiology between Jan 1, 2013 and Jun 1, 2019 and with at least 6-months of clinical follow-up were retrospectively identified from the hospital electronic database. Patients were divided into the SAE group (SAE alone), SVS-SAE group (SAE immediately after SVS failure according to the same procedure as in the SAE group), and SVS group (successful treatment with SVS). The patients' baseline characteristics and follow-up data were retrieved, and their clinical outcomes were compared. Results Thirty-seven patients with SPH were included. A total of 11, 12, and 14 patients were classified into the SAE, SVS-SAE, and SVS groups, respectively. Rebleeding (e.g., hematemesis and/or melena) was significantly less common (P = 0.013) in the SVS group (7.1%, 1/14) than in the SAE and SVS-SAE groups combined (47.8%, 11/23). Splenectomy because of rebleeding was not significantly different (P = 0.630) between the SVS group (7.1%, 1/14) and the SAE and SVS-SAE groups combined (17.4%, 4/23). No interventional procedure-related mortality was observed during follow-up in any group. Conclusion When feasible, SVS is a safe and effective treatment for SPH-related gastrointestinal bleeding that appears to better prevent rebleeding than SAE. Clinical Impact When feasible, SVS should be recommended over SAE for the treatment of SPH-related upper gastrointestinal bleeding.Background The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was published in 2015, recommending more restricted indications for peripherally inserted central catheter (PICC) placement, particularly for those placed by physicians. Changes in PICC placement volume since the publication of MAGIC is largely unknown. Objective To study the trends in volume and reimbursement for PICC placement by physicians and advanced practice providers (APPs) for Medicare enrollees from 2010-2018 with specific attention to the changes in volume following the publication of MAGIC in 2015. Methods Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File (PSPSMF) for the years 2010 to 2018 were extracted using the CPT code for PICC placement. Total volume and payment amounts (professional component) were analyzed. Trendline slopes for volume per 100,000 Medicare beneficiaries before and after the 2015 publication of MAGIC were compared. learn more Results Volume for PICC placement by physicians and role of APPs in PICC placement has increased over this time period. Clinical Impact The findings of this study suggest that evidence-based guidelines impact clinical practice on a national level.We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020 MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included 'child sex (male)', 'child age (younger)', 'type of pain (traumatic)' and 'analgesic administration'. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child's experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration PROSPERO CRD42017058960.