Meniscal ossicle

Meniscal ossicle, or bone within the substance of meniscus, is a rare entity and commonly confused with a loose body both clinically and radiologically. MRI is the modality that can definitely diagnose meniscal ossicle and avoid unnecessary diagnostic arthroscopy. Here we report one such case diagnosed using MRI; this patient is doing well without surgery one year after diagnosis

Adequacy and quality of abdominal echographies requested by primary care professionals

<p>Abstract</p> <p>Background</p> <p>The value of abdominal echography in primary care is great because it is innocuous, inexpensive, easy to perform and provides a great deal of information making this the first examination to be requested in cases of probable abdominal disease. <b>However, too many abdominal echographies are probably requested overcrowding the Departments of Radiodiagnosis with not always justified petitions or with repetition of tests based on little clinical criteria</b>.</p> <p>Methods/Design</p> <p><b>The aim of the study is </b>to evaluate the adequacy and quality of abdominal echographies requested by primary care physicians in the Maresme County (North of Barcelona), develop guidelines for indicating echographies and reevaluate this adequacy after implementing these guidelines.</p> <p>We will perform a two-phase study: the first descriptive, and retrospective evaluating the adequacy and quality of petitions for abdominal echographies, and in the second phase we will evaluate the impact of recommendations for indicating abdominal echographies for PC physicians on the adequacy and quality of echography petitions thereafter.</p> <p><b>This study will be carried out in 10 primary care centres </b>in the Maresme (Barcelona).</p> <p>1067 abdominal echographies requested by primary care physicians from the above mentioned centres from January 2007 to April 2010 and referred to the Department of Radiology and the same number of applications after the intervention.</p> <p>All the petitions for abdominal echographies requested will be analysed and the clinical histories will be obtained to determine demographic variables, the reason for the visit and for the echography petition and diagnostic orientation, clinical and echographic data, evaluation of the echographies according to the quality and variables characterising the professionals requesting the echographies including: age, sex, laboral situation, length of time in work post, formation, etc.</p> <p>To achieve a consensus of the adequacy of abdominal echography, a work group including gastroenterologists, radiologists and general practitioners will be created following the nominal group. This will allow the design of guidelines for the indication of abdominal echography and posterior evaluation of their impact among physicians by diffusion and posterior reevaluation of the adequacy of the petitions.</p

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

Life Cycle Analysis of Soil Remediation Technologies

Life cycle analysis (LCA) was applied to evaluate remediation technologies for soil and groundwater contaminated with organic components. The environmental impact, cost and risk of three techniques, namely (1) vacuum enhanced recovery, (2) a new in situ thermal treatment technique and (3) soil excavation have been evaluated by means of different tools. Several LCA-based software packages were screened, with special attention for their easiness to use, the amount of data necessary to perform the analysis, and the availability of information. Two contaminated sites were used as a case study for which the remediation technology with the overall best performance (taking into account environmental merit and cost) had to be selected. The results of the life cycle analysis were compared with the results of a BATNEEC (Best Available Technology Not Entailing Excessive Cost) analysis, a method that is currently applied in Flanders (Belgium) to evaluate the feasibility of remediation technologies for soil and groundwater. The outcome of the LCA analysis was highly dependent on the software package used, but in general, in situ techniques such as vacuum enhanced recovery and in situ thermal treatment performed better that soil excavation and off-site treatment. Although LCA is much more complex en requires much more data than a classical BATNEEC analysis, both evaluation tools could be used in a complementary way. A preliminary selection of remediation technologies could be based on a BATNEEC analysis, followed by a detailed analysis of the selected remediation options by means of LCA.status: publishe

Can thermal soil remediation be sustainable? A case study of the environmental merit of the remediation of a site contaminated by a light non-aqueous phase liquid (LNAPL)

When evaluating remediation technologies for contaminated soil and groundwater, the beneficial effects of the remediation, namely cleaner soil and groundwater, are mostly emphasized without consideration of the environmental impact of the remediation activities themselves. In the present study, the environmental impact of two soil remediation techniques was evaluated. Based on the detailed analysis of a case study, the results of a life cycle-based analysis (Risk Reduction, Environmental Merit and Costs (REC)) were compared with the results of a best available technology not entailing excessive costs (BATNEEC) analysis, a method that is currently applied in Flanders (Belgium) to evaluate the feasibility of remediation technologies for soil and groundwater. According to the REC analysis, in situ thermal treatment showed a lower global environmental impact than soil excavation and off-site treatment, mainly because there were fewer emissions from the transport of contaminated soil. Within the environmental aspects group of the BATNEEC method, soil excavation performed better than thermal soil remediation because it obtained a better score to meet the legal objectives for soil and groundwater quality. It also showed fewer environmental liabilities and obtained a better score for a decrease in the contaminants' content in soil and groundwater. The BATNEEC method does not take into account the emissions from the transport of the soil. Despite these differences between both methods, thermal remediation technology obtains the best overall score in terms of both assessment methods (taking into account the environmental, financial, and technical aspects). Although an life cycle analysis (LCA) based evaluation method is much more complex and requires much more data than a classical BATNEEC analysis, both evaluation tools could be used in a complementary way. A preliminary selection of remediation technologies could be based on a BATNEEC analysis, followed by a detailed analysis of the selected remediation options by means of LCA.status: publishe