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Inappropriately repeated laboratory testing is a commonly occurring problem. However, this has not been studied extensively in the outpatient clinic after referral by general practitioners.

The aim of this study was to investigate how often laboratory tests ordered by the general practitioner were repeated on referral to the outpatient clinic, and how many of the normal test results remained normal on repetition.

This is a post hoc analysis of a study on laboratory testing strategies in patients newly referred to the outpatient clinic.

All patients who had a referral letter including laboratory test results ordered by the general practitioner were included. These results were compared to the laboratory test results ordered in the outpatient clinic.

Data were available for 295 patients, 191 of which had post-visit testing done. In this group, 56% of tests ordered by the general practitioner were repeated. Tests with abnormal results were repeated more frequently than tests with normal results (65% vs 53%;

<0.001). A longer test interval was associated with slightly smaller odds of tests being repeated (OR 0.97 [0.95-0.99];

=0.003). Of the tests with normal test results that were repeated, 90% remained normal. This was independent of testing interval or testing strategy.

Laboratory tests ordered by the general practitioner are commonly repeated on referral to the outpatient clinic. The number of test results remaining normal on repetition suggests a high level of redundancy in laboratory test repetition.

Laboratory tests ordered by the general practitioner are commonly repeated on referral to the outpatient clinic. The number of test results remaining normal on repetition suggests a high level of redundancy in laboratory test repetition.

Care-home residents often have multiple cognitive and physical impairments and are at high risk of adverse drug events (ADEs).

Describe excessive polypharmacy and potentially inappropriate prescribing predisposing care-home residents to ADEs.

Cross-sectional analysis of all dispensed prescriptions for residents of 147 care-homes.

Prevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care-home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted.

32.3% of residents had excessive polypharmacy, which was more common in residents aged 70-74 years (aOR =1.86 [1.04-3.34]) and 80-84 years (aOR =1.75 [1.01-3.02]), living in a residential care-home (aOR =1.50 [95%CI 1.19-1.88]), and located in Fife (aOR =1.37 [1.09-1.71]). Excessive polypharmacy was less common in residents with dementia (aOR =0.73 [0.64-0.84]). 8.9% (5.9%-11.6%) of the variation was attributable to care-home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%).

Excessive polypharmacy is common in care-home residents and is associated with both individual and care-home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADEs categories is common. Research is needed to support and evaluate safe care-home prescribing practices.

Excessive polypharmacy is common in care-home residents and is associated with both individual and care-home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADEs categories is common. Research is needed to support and evaluate safe care-home prescribing practices.

The hemodynamics associated with cerebral AVMs have a significant impact on their clinical presentation. This study aimed to evaluate the hemodynamic features of AVMs using 3D phase-contrast MR imaging with dual velocity-encodings.

Thirty-two patients with supratentorial AVMs who had not received any previous treatment and had undergone 3D phase-contrast MR imaging were included in this study. The nidus diameter and volume were measured for classification of AVMs (small, medium, or large). Flow parameters measured included apparent AVM inflow, AVM inflow index, apparent AVM outflow, AVM outflow index, and the apparent AVM inflow-to-outflow ratio. Correlation coefficients between the nidus volume and each flow were calculated. The flow parameters between small and other AVMs as well as between nonhemorrhagic and hemorrhagic AVMs were compared.

Patients were divided into hemorrhagic (

 = 8) and nonhemorrhagic (

 = 24) groups. The correlation coefficient between the nidus volume and the apparent AVM inflow and outflow was .83. The apparent AVM inflow and outflow in small AVMs were significantly smaller than in medium AVMs (

< .001 for both groups). https://www.selleckchem.com/products/2-2-2-tribromoethanol.html The apparent AVM inflow-to-outflow ratio was significantly larger in the hemorrhagic AVMs than in the nonhemorrhagic AVMs (

= .02).

The apparent AVM inflow-to-outflow ratio was the only significant parameter that differed between nonhemorrhagic and hemorrhagic AVMs, suggesting that a poor drainage system may increase AVM pressure, potentially causing cerebral hemorrhage.

The apparent AVM inflow-to-outflow ratio was the only significant parameter that differed between nonhemorrhagic and hemorrhagic AVMs, suggesting that a poor drainage system may increase AVM pressure, potentially causing cerebral hemorrhage.Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. Despite being almost ubiquitous in brain imaging, the clinicoradiologic association of small vessel disease is weak, and the underlying pathogenesis is poorly understood. The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. These include white matter hyperintensities of presumed vascular origin, recent small subcortical infarcts, lacunes of presumed vascular origin, prominent perivascular spaces, cerebral microbleeds, superficial siderosis, cortical microinfarcts, and brain atrophy. Recently, the rigid categories among cognitive impairment, vascular dementia, stroke, and small vessel disease have become outdated, with a greater emphasis on brain health. Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain heath. In this review, we discuss the pathophysiology of small vessel disease neuroimaging nomenclature by means of the STRIVE criteria, clinical implications, the role of advanced imaging, and future directions.In this second of 3 review articles on the endovascular management of intracranial dural AVFs, we discuss transarterial treatment approaches. The treatment goal is to occlude the fistulous point, including the most distal portion of the arterial supply together with the most proximal portion of the draining vein (ie, the "foot" of the vein), which can be accomplished with liquid embolic agents via transarterial access. Anatomic factors to consider when assessing the safety and efficacy of a transarterial approach using liquid embolic agents include location, angioarchitecture, and proximity of arterial feeders to both the vasa nervosum of adjacent cranial nerves and the external carotid-internal carotid/vertebral artery anastomoses. Anatomic locations typically favorable for transarterial approaches include but are not limited to the transverse/sigmoid sinus, cerebral convexity, and superior sagittal sinus. In this review article, we discuss the technical approaches, outcomes, potential complications, and complication avoidance strategies for transarterial embolization.

Recent studies have suggested that maternal obesity during pregnancy is associated with differences in neurodevelopmental outcomes in children. In this study, we aimed to investigate the relationships between maternal obesity during pregnancy and neonatal brain cortical development.

Forty-four healthy women (28 normal-weight, 16 obese) were prospectively recruited at <10 weeks' gestation, and their healthy full-term neonates (23 boys, 21 girls) underwent brain MR imaging. All pregnant women had their body composition (fat mass percentage) measured at ∼12 weeks of pregnancy. All neonates were scanned at ∼2 weeks of age during natural sleep without sedation, and their 3D T1-weighted images were postprocessed by the new iBEAT2.0 software. Brain MR imaging segmentation and cortical surface reconstruction and parcellation were completed using age-appropriate templates. Mean cortical thickness for 34 regions in each brain hemisphere defined by the UNC Neonatal Cortical Surface Atlas was measured, compared between groups, and correlated with maternal body fat mass percentage, controlled for neonate sex and race, postmenstrual age at MR imaging, maternal age at pregnancy, and the maternal intelligence quotient and education.

Neonates born to obese mothers showed significantly lower (

≤ .05, false discovery rate-corrected) cortical thickness in the left pars opercularis gyrus, left pars triangularis gyrus, and left rostral middle frontal gyrus. Mean cortical thickness in these frontal lobe regions negatively correlated (

= -0.34,

= .04;

= -0.50,

= .001; and

= -0.42,

= .01; respectively) with the maternal body fat mass percentage measured at early pregnancy.

Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

The correlation between imaging findings and clinical status in patients with idiopathic intracranial hypertension is unclear. We aimed to examine the evolution of idiopathic intracranial hypertension-related MR imaging findings in patients treated with venous sinus stent placement.

Thirteen patients with idiopathic intracranial hypertension (median age, 26.9 years) were assessed for changes in the CSF opening pressure, transstenotic pressure gradient, and symptoms after venous sinus stent placement. Optic nerve sheath diameter, posterior globe flattening and/or optic nerve protrusion, empty sella, the Meckel cave, tonsillar ectopia, the ventricles, the occipital emissary vein, and subcutaneous fat were evaluated on MR imaging before and 6 months after venous sinus stent placement. Data are expressed as percentages, medians, or correlation coefficients (

) with

values.

Although all patients showed significant reductions of the CSF opening pressure (31 versus 21 cm H

O;

= .005) and transstenotic pnormalization of intracranial pressure and clinical improvement. However, MR imaging findings related to the optic nerve may reflect treatment success.

Most imaging findings persist long after normalization of intracranial pressure and clinical improvement. However, MR imaging findings related to the optic nerve may reflect treatment success.