Deciding whether to consult the GP or an emergency department: A qualitative study of patient reasoning in Switzerland.

Background: Non-urgent care is an important factor responsible for rising healthcare costs and general practitioners (GPs) are known to be more cost-effective than emergency departments (EDs). Objectives: To understand the reasons why patients confronted with a medical problem perceived as urgent choose to consult either a GP or an ED. Methods: We conducted a qualitative study in Switzerland, using data collected between 2014 and 2015 through semi-structured interviews of adults with non-vital medical problems. Half were recruited after an ambulatory consultation in an ED, and half were patients who consulted their GP. The audio-recorded interviews were transcribed, coded, and analysed according to the constant comparative method. Results: The main reason given by patients who consulted their GP first was the quality of the relationship. The more meaningful the relationship, the more likely patients were to seek advice from their GP. One marker of a privileged relationship was GPs supplying their mobile phone number to the patient. The perceived nature of the complaint, for example, symptoms considered as life-threatening or severe pain, together with the expected waiting time in an ED were additional factors influencing the patients' choice. Conclusion: Our study showed that when patients are confronted with what they perceive as a medical emergency, the quality of the relationship with the GP, in particular the continuity of care provided, seem to be the major reasons why they consult their GP rather than an ED

Diagnostic Value of Software-Based Image Fusion of Computed Tomography and F18-FDG PET Scans in Patients with Malignant Lymphoma

Aim. The purpose of this study was to evaluate the accuracy of 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG) positron emission tomography (PET), computed tomography (CT), and software-based image fusion of both modalities in the imaging of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Methods. 77 patients with NHL (n = 58) or HD (n = 19) underwent a FDG PET scan, a contrast-enhanced CT, and a subsequent digital image fusion during initial staging or followup. 109 examinations of each modality were evaluated and compared to each other. Conventional staging procedures, other imaging techniques, laboratory screening, and follow-up data constituted the reference standard for comparison with image fusion. Sensitivity and specificity were calculated for CT and PET separately. Results. Sensitivity and specificity for detecting malignant lymphoma were 90% and 76% for CT and 94% and 91% for PET, respectively. A lymph node region-based analysis (comprising 14 defined anatomical regions) revealed a sensitivity of 81% and a specificity of 97% for CT and 96% and 99% for FDG PET, respectively. Only three of 109 image fusion findings needed further evaluation (false positive). Conclusion. Digital fusion of PET and CT improves the accuracy of staging, restaging, and therapy monitoring in patients with malignant lymphoma and may reduce the need for invasive diagnostic procedures

Developmental differences in affective representation between prefrontal and subcortical structures

Developmental studies have identified differences in prefrontal and subcortical affective structures between children and adults, which correspond with observed cognitive and behavioral maturations from relatively simplistic emotional experiences and expressions to more nuanced, complex ones. However, developmental changes in the neural representation of emotions have not yet been well explored. It stands to reason that adults and children may demonstrate observable differences in the representation of affect within key neurological structures implicated in affective cognition. Forty-five participants (25 children; 20 adults) passively viewed positive, negative, and neutral clips from popular films while undergoing functional magnetic resonance imaging (fMRI). Using representational similarity analysis (RSA) to measure variability in neural pattern similarity, we found developmental differences between children and adults in the amygdala, nucleus accumbens (NAcc), and ventromedial prefrontal cortex (vmPFC), such that children generated less pattern similarity within subcortical structures relative to the vmPFC; a phenomenon not replicated among their older counterparts. Furthermore, children generated valence-specific differences in representational patterns across regions; these valence-specific patterns were not found in adults. These results may suggest that affective representations grow increasingly dissimilar over development as individuals mature from visceral affective responses to more evaluative analyses

Pulsar Kicks and Spin Tilts in the Close Double Neutron Stars PSR J0737-3039, PSR B1534+12 and PSR B1913+16

In view of the recent measurement of the scintillation velocity for PSR J0737-3039, we examine the complete set of constraints imposed on the pulsar B natal kicks (magnitude and orientation) and predict the most favorable pulsar kick velocity and spin tilt for both isotropic and polar kicks. Our analysis takes into account both currently unknown parameters: the orientation of the orbital plane on the sky (Omega) and the radial component of the systemic velocity (V_r). Assuming that the system's peculiar velocity is entirely due to the second supernova explosion, we find that the system may have crossed the Galactic plane multiple times since the birth of the second neutron star and that the post-supernova peculiar velocity could have been as high as 1200km/s. We also confirm the absolute lower and upper limits on the physical parameters derived in our earlier study. For specific combinations of the two unknown parameters Omega and V_r, however, we find much tighter constraints on the pre-supernova binary configuration and natal kicks imparted to pulsar B, as well as on the age of system. Once Omega is measured in the coming year, it will be straightforward to use the results presented here to further constrain the natal kicks and the spin-tilt predictions. We complete our comprehensive study and derive similar constraints and spin-tilt predictions for PSR B1534+12, where the only free parameter is V_r. Lastly, for PSR B1913+16, we update the progenitor and kick constraints using the measured pulsar spin tilt and allowing for Roche-lobe overflow from the progenitor of the pulsar companion.Comment: Replaced Fig. 16 with corrected version. See ApJ 616, p. 414 for high-resolution figures and notes added in proo

Midwives\u27 knowledge, attitudes and learning needs regarding antenatal vaccination

Objective: To determine the knowledge, attitudes and learning needs of midwives regarding antenatal vaccination. Design & Setting: A cross-sectional, paper-based survey of midwives employed at the only public tertiary maternity hospital in the Australian state of XX between November 2015 and July 2016. Participants: 252 midwives providing care in antepartum, intrapartum, and/or postpartum settings. Measurements: Self-reported responses to a 41-item survey. Findings: The vast majority of midwives supported influenza and pertussis vaccination for pregnant women, with 90.0% and 71.7% reporting they would recommend pertussis and influenza vaccine, respectively, to a pregnant friend or family member, and almost all stating that midwives should administer vaccines to pregnant patients (94.8%). Seven out of ten midwives (68.1%) responded correctly to all knowledge items regarding vaccines recommended during pregnancy; 52.8% demonstrated correct knowledge regarding vaccine administration despite only 36.6% having attended an education session on antenatal vaccination in the previous two years. Nearly all midwives (97.3%) expressed a need for more education on vaccine administration. The most commonly reported barrier to administering influenza (61.3%) and pertussis (59.0%) vaccination was having staff available with the certification required to administer vaccines. Key Conclusions: Midwives view antenatal vaccination as their responsibility and are interested and receptive to education. Implications for Practice: There is an unmet need and demand among midwives for professional development that would enable them to recommend and administer vaccines to pregnant women in accordance with national immunisation guidelines and integrate vaccination into routine antenatal care

A case of crossed-doubled patellar tendon : an atavistic variant, simple mutation or pathologic finding?

Anatomical variants can be found throughout the whole body. Especially in the knee region, some variability has been reported concerning the osseous, tendinous, and muscular system. Beside a few cases of patellar tendon aplasia, no anatomical variations of this tendon are known. We present a rare case of a doubled patellar tendon as an anatomical variant, which to our knowledge, has not been described previously

A prospective cohort study comparing the reactogenicity of trivalent influenza vaccine in pregnant and non-pregnant women

Background: Influenza vaccination during pregnancy can prevent serious illness in expectant mothers and provide protection to newborns; however, historically uptake has been limited due to a number of factors, including safety concerns. Symptomatic complaints are common during pregnancy and may be mistakenly associated with reactions to trivalent influenza vaccine (TIV). To investigate this, we compared post-vaccination events self-reported by pregnant women to events reported by non-pregnant women receiving TIV. Methods: A prospective cohort of 1,086 pregnant women and 314 non-pregnant female healthcare workers (HCWs) who received TIV between March-May 2014 were followed-up seven days post-vaccination to assess local and systemic adverse events following immunisation (AEFIs). Women were surveyed by text message regarding perceived reactions to TIV. Those reporting an AEFI completed an interview by telephone or mobile phone to ascertain details. Logistic regression models adjusting for age and residence were used to compare reactions reported by pregnant women and non-pregnant HCWs. Results: Similar proportions of pregnant women and non-pregnant, female HCWs reported ≥1 reaction following vaccination with TIV (13.0% and 17.3%, respectively; OR = 1.2 [95% CI: 0.8-1.8]). Non-pregnant, female HCWs were more likely to report fever or headache compared to pregnant women (OR: 4.6 [95% CI 2.1-10.3] and OR: 2.2 [95% CI 1.0-4.6], respectively). No other significant differences in reported symptoms were observed. No serious vaccine-associated adverse events were reported, and less than 2% of each group sought medical advice for a reaction. Conclusions: We found no evidence suggesting pregnant women are more likely to report adverse events following influenza vaccination when compared to non-pregnant female HCWs of similar age, and in some cases, pregnant women reported significantly fewer adverse events. These results further support the safety of TIV administered in pregnant women