The effect of routine radiological reporting of thyroid incidentalomas on rates of thyroid needle biopsy, thyroid surgery and detection of thyroid malignancy.

OBJECTIVE: This study looked at the effect of a changing radiology reporting policy to routinely review the thyroid gland where visible and report on any thyroid lesion, recommending further investigation as appropriate. CONTEXT: Incidentaloma is a term used to describe a lesion found on imaging unrelated to the clinical issue under investigation. There is variability in the radiological reporting of thyroid incidentalomas and conflicting recommendations as to how these lesions should be managed. DESIGN: Data were collected retrospectively during a two-year period, including 12 months before and 12 months after the change in reporting policy and categorized according to whether the lesion under investigation was a thyroid incidentaloma or a symptomatic thyroid lesion. PATIENTS: All patients undergoing ultrasound-guided fine-needle aspiration cytology or core biopsy were included. MEASUREMENTS: The effects of the change in policy were analysed including rates of needle biopsy, rates of malignancy and subsequent surgical intervention. RESULTS: There was a 122% increase in thyroid incidentalomas undergoing needle biopsy, the majority of these were detected on computed tomography. The number of malignancies increased from 1 to 4 from year 1 to year 2. All patients were >35 years old. One patient had a positron emission tomography (PET)-detected cancer, two of four of the non-PET-detected malignancies were <1.5 cm. CONCLUSION: This study posits that routine radiological reporting of thyroid incidentalomas, with further investigation when clinically appropriate, is warranted. The results suggest that lesion size and CT characteristics are not reliable criteria to triage patients for investigation/biopsy.

Dizziness, driving, and the Driver and Vehicle Licensing Agency: audit of advice given to patients, and design of a patient information leaflet.

BACKGROUND: Evidence from the literature shows that clinicians' knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness. METHODS: The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit. RESULTS AND CONCLUSION: The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients' notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.

Setting up a parathyroid multidisciplinary team meeting: one year's experience, outcomes and learning points.

OBJECTIVE: A parathyroid multidisciplinary team meeting was set up at East Sussex Healthcare Trust, from November 2014 to November 2015, in order to improve and streamline services for patients with parathyroid pathology. METHODS: Data were collected on all new referrals for hyperparathyroidism, and on the outcomes for each patient discussed at the meeting, including the number of operations and management outcomes. A survey was sent out to the members of the multidisciplinary team meeting to determine their perception of its effectiveness. RESULTS: Seventy-nine new referrals were discussed throughout the year; 43 per cent were recommended for surgery, 41 per cent had a trial of conservative or medical management before re-discussion, and 16 per cent required further imaging. Ninety-two per cent of patients underwent an ultrasound, single-photon emission computed tomography/computed tomography or nuclear medicine (sestamibi) scan prior to the meeting. All ultrasound scans were performed by a consultant radiologist. CONCLUSION: The multidisciplinary team meeting has been successful, with perceived benefits for patients, improved imaging evaluation and efficiency of referral pathways, leading to more appropriate patient management.

High-velocity facial gunshot wounds: multidisciplinary care from prehospital to discharge.

A case is presented in which a high velocity rifle (shotgun) was fired into the inferior part of a patient's face in an attempted suicide causing widespread trauma to the inferior and left side of the patient's face. He presented to his general practitioner where an ambulance was called. The patient is followed from prehospital care (air ambulance) to resuscitation in accident and emergency and through the first stages of reconstructive surgery. The article focuses on the multidisciplinary approach to the patient's prehospital care and initial resuscitation at a major trauma centre. CT reconstruction images of the patient's skull allow visualisation of the extent of bone damage at presentation. Medical photography allows visualisation of the extent of the initial damage and shows how reconstructive surgery was undertaken early and in progressive stages. A literature review was performed allowing discussion of the current evidence and best practice in the management of facial gunshot wounds.

Prospective/intentional and incidental everyday memory: effects of age and passage of time.

The effects of age and passage of time on incidental and prospective/intentional everyday memory were examined in this study. Seventy-nine volunteers, men and women between the ages of 23 and 93 years, were tested twice, and 33 of these volunteers were tested three times over an 18-month period. They were asked to recognize or to recall, either in writing or orally, experiences from a 3-day period in which they served as research subjects. Results demonstrated that incidental, but not prospective/intentional, memory appeared to be influenced by age and passage of time. Results imply that salience and context are important factors in aging memory performance, and that certain types of everyday retrospective reports may be reliable.

Comparison of aggression and incongruity as factors in children's judgments of humor.

It was hypothesized that both aggression and incongruity are variables that will positively influence preschool children's judgments of humorous incidents. Past research has shown the influence of incongruity on humor only for school-age children, and--with the exception of studies of children's television viewing--the allegedly "antisocial" variable of aggression has been ignored. Two hundred and thirty boys and girls from ages three to eight each made six paired comparison judgments as to which of two brief incidents was funnier. The incidents were produced by the E manipulating either one or two hand puppets with or without accompanying dialogue. At all ages children significantly preferred aggressive and incongruous incidents to neutral incidents. When aggressive and incongruous nonverbal incidents were paired, there was no significant preference. Two major conclusions were reached: (a) Though neglected in the developmental theory of humor, aggression is an early occurring and potent factor in children's humor; (b) The clear-cut results obtained from preschoolers argue for the usefulness of cognitive choice as against such observational measures as smiling and laughing.

Stress, health, and mental health symptoms of older women and men.

The objectives of this inquiry were to examine Langner mental health symptomatology screening scores in a community-dwelling sample of older adults, and to explore relations between Langner scores, health, and stress. Older adults (N = 364), who were participants in a study of sex roles, were interviewed in their homes concerning mental health symptoms, health, recent life stress, sex-role conflict, and demographic factors. Respondents reported relatively few symptoms. Symptoms were related to health and independent reports of nervousness and depression in both sexes, and to age in men, but not to stress and conflict in either sex. Mental health symptom screening devices may not mean the same thing for male and female older clients and should be used with caution until behavioral validation can be done.

Correlates of sex roles of older adults.

Current concepts of sex role development suggest that roles vary between sex-appropriate polar masculinity and femininity to complex androgyny at various points in life. Reviews of previous research suggest that certain roles may be more or less adaptive for an individual. In the exploratory study reported here 364 community-dwelling older adults described their own sex roles using the Bem Sex Role Inventory and were tested with additional measures of mental and physical health and current life situation. Most elderly persons described androgynous roles. Perceived sex roles related to several dimensions of life situation and well-being.

A psychometric study of the Bem Sex Role Inventory with an older adult sample.

The factor structure of the Bem Sex Role Inventory (BSRI) for an older adult sample was investigated. Confirmatory factor-analytic procedures failed to yield an adequate fit for the orthogonal two-factor model proposed by Bem for either men or women. Maximum-likelihood exploratory factor analyses were conducted separately for each sex. Eight- and nine-factor solutions for men and women, respectively, emerged as the most adequate models representing the observed variance/covariance matrices. Issues are raised regarding the usefulness of median-split-based procedures with the BSRI for purposes of sex role classifications and for assessing age-related changes in personality functioning among older adults. An alternative conceptual and methodological approach is proposed.

Performance of institutionalized and community-active old persons on concrete and formal Piagetian tasks.

This study investigates the effects of age, level of education, and institutionalization on the development of logical thinking. Seven Piagetian tasks, encompassing three levels of difficulty, were administered to thirty-four persons sixty-eight years of age or older. A significant positive relationship was found between success on task and educational level. With education controlled, Community-active elders performed significantly better than Institutionalized elders. Within the limitations of a cross-sectional design, results supported the hypothesis that cognitive abilities in old age retain an orderly structure.